RESUMO
Diarrheal diseases are a leading cause of childhood morbidity and mortality in Latin America. Most studies have focused on infants but not on older children. We enrolled 505 children (age, 12-59 months) with diarrhea and age-matched controls in a case-control study in Sao Paulo, Brazil. Independent risk factors for diarrhea included another household member with diarrhea (matched odds ratio [mOR], 8.1; attributable fraction [AF], 0.17; P<.001) and consumption of homemade juice (mOR, 1.8; AF, 0.10; P=.01); protective factors included boiling of the baby bottle or nipple (mOR, 0.60; AF, 0.19; P=.026), childcare at home (mOR, 0.58; AF, 0.12; P=.004), and piped sewage (mOR, 0.58; AF, 0.05; P=.047). Hand washing by the caretaker after helping the child defecate protected against Shigella infection (mOR, 0.35; P<.05). Preparation of rice, beans, or soup in the morning and serving it to children after noon were associated with enterotoxigenic Escherichia coli infection (mOR, 8.0; P<.05). In these poor households, 28% of cases of diarrhea in 1-4-year-old children was attributable to easily modifiable exposures.
Assuntos
Diarreia Infantil/epidemiologia , Diarreia/epidemiologia , Infecções por Adenovirus Humanos/epidemiologia , Infecções por Adenovirus Humanos/prevenção & controle , Idoso , Brasil/epidemiologia , Infecções por Campylobacter/epidemiologia , Infecções por Campylobacter/prevenção & controle , Estudos de Casos e Controles , Pré-Escolar , Diarreia/microbiologia , Diarreia/prevenção & controle , Diarreia/virologia , Diarreia Infantil/microbiologia , Diarreia Infantil/prevenção & controle , Diarreia Infantil/virologia , Disenteria Bacilar/epidemiologia , Disenteria Bacilar/prevenção & controle , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/prevenção & controle , Fezes/microbiologia , Fezes/virologia , Feminino , Humanos , Lactente , Masculino , Seleção de Pacientes , Valor Preditivo dos Testes , Fatores de Risco , Infecções por Rotavirus/epidemiologia , Infecções por Rotavirus/prevenção & controle , Distribuição por Sexo , Shigella/isolamento & purificação , Shigella/patogenicidade , Especificidade da EspécieRESUMO
Fresh produce increasingly is recognized as an important source of salmonellosis in the United States. In December 1999, the Centers for Disease Control and Prevention detected a nationwide increase in Salmonella serotype Newport (SN) infections that had occurred during the previous month. SN isolates recovered from patients in this cluster had indistinguishable pulsed-field gel electrophoresis (PFGE) patterns (which identified the outbreak strain), suggesting a common source. Seventy-eight patients from 13 states were infected with the outbreak strain. Fifteen patients were hospitalized; 2 died. Among 28 patients enrolled in the matched case-control study, 14 (50%) reported they ate mangoes in the 5 days before illness onset, compared with 4 (10%) of the control subjects during the same period (matched odds ratio, 21.6; 95% confidence interval, 3.53- infinity; P=.0001). Traceback of the implicated mangoes led to a single Brazilian farm, where we identified hot water treatment as a possible point of contamination; this is a relatively new process to prevent importation of an agricultural pest, the Mediterranean fruit fly. This is the first reported outbreak of salmonellosis implicating mangoes. PFGE was critical to the timely recognition of this nationwide outbreak. This outbreak highlights the potential global health impact of foodborne diseases and newly implemented food processes.