RESUMO
OBJECTIVES: A combination vaccine against hepatitis A and B provides the opportunity for simultaneous protection against both diseases with a single vaccine. This clinical study investigated the reactogenicity and immunogenicity of a combined hepatitis A and B vaccine (Twinrix, GlaxoSmithKline Biologicals, Rixensart, Belgium) in healthy Chilean adults between 18 and 40 years of age. METHODS: In total, 345 healthy, seronegative health care workers were enrolled and randomized to three groups who received one of three lots of Twinrix on a 0-, 1- and 6-month schedules. Blood samples were screened 1 month after each dose for anti-HAV and anti-HBs antibodies. Reactogenicity after each dose was assessed using diary cards. RESULTS: The nature and incidence of symptoms were similar to those reported for other Twinrix studies. Very few symptoms were scored as severe. Upon completion of the vaccination, all subjects had anti-HAV antibodies with titers $6000 mIU/mL, and all but one were protected against hepatitis B, with titers $4000 mIU/mL. CONCLUSIONS: We have demonstrated the high immunogenicity and tolerance of the combined hepatitis A and B vaccine. Combined vaccination has the advantage of offering dual protection with a reduction in the number of injections needed, lower associated costs, and a positive impact on compliance.
Assuntos
Vacinas contra Hepatite A/efeitos adversos , Vacinas contra Hepatite A/imunologia , Vírus da Hepatite A/imunologia , Vacinas contra Hepatite B/efeitos adversos , Vacinas contra Hepatite B/imunologia , Vírus da Hepatite B/imunologia , Vacinas Combinadas/efeitos adversos , Vacinas Combinadas/imunologia , Adolescente , Adulto , Chile , Método Duplo-Cego , Feminino , Saúde , Anticorpos Anti-Hepatite A , Vacinas contra Hepatite A/economia , Anticorpos Anti-Hepatite/sangue , Anticorpos Anti-Hepatite B/sangue , Vacinas contra Hepatite B/economia , Humanos , Esquemas de Imunização , Masculino , Pessoa de Meia-Idade , Vacinas Combinadas/economiaRESUMO
BACKGROUND: Current hepatitis A vaccines are either licensed for children >2 years of age, as in the U.S. or Chile, or >1 year of age, as in Europe and other parts of the world. Recent recommendations for immunization against hepatitis A have included routine vaccination of children in areas or regions of higher endemicity. However, data on hepatitis A vaccination in toddlers aged between 1 and 2 years are scarce. METHODS: This open clinical study investigated the reactogenicity and immunogenicity of two doses (0, 6-month schedule) of an inactivated hepatitis A vaccine (Havrix pediatric, Glaxco SmithKline Biologicals, Rixensart, Belgium) in 120 seronegative children aged 12-24 months. RESULTS: Pain at the injection site and irritability were the most frequently reported local and general symptoms, respectively. No serious adverse events related to the study vaccine were reported. One month after the first dose, all but one subject had antibodies against hepatitis A with a GMT of 159 mIU/mL. After the booster dose, all had antibodies with a GMT of 2,939 mIU/mL. CONCLUSIONS: Our data show that the inactivated hepatitis A vaccine was well tolerated by these toddlers and that the vaccine elicits a good immune response.
Assuntos
Vacinas contra Hepatite A/imunologia , Hepatite A/prevenção & controle , Anticorpos Anti-Hepatite/biossíntese , Pré-Escolar , Eritema/etiologia , Feminino , Febre/etiologia , Anticorpos Anti-Hepatite A , Vacinas contra Hepatite A/efeitos adversos , Anticorpos Anti-Hepatite/sangue , Humanos , Imunização Secundária , Lactente , Masculino , Dor/etiologia , Vacinas de Produtos Inativados/efeitos adversos , Vacinas de Produtos Inativados/imunologiaRESUMO
BACKGROUND: The knowledge of varicella complications and their associated cost may help for a better evaluation of varicella immunization benefits. AIM: To determine frequency, type, outcome and affected population of varicella complications in children requiring hospitalization, and to estimate their direct costs. MATERIAL AND METHODS: Retrospective analysis of medical records of children admitted to four hospitals in Santiago, Chile, due to varicella complications between January 1997 and February 1999. Calculation of direct costs of hospitalizations in a sample of 30 patients. RESULTS: One hundred fifty four patients were identified, 74% were younger than 5 years old, only one was immunocompromised. Complications identified were skin and soft tissue infections in 63%, invasive infections in 25.3%, neurological in 7.1% and miscellaneous in 4.5%. Staphylococcus aureus and Group A beta-haemolytic Streptococcus (GABS) were predominantly isolated. S. aureus was the main agent identified in superficial infections and GABS in invasive infections (sterile sites). Two patients died due to invasive infections (streptococcal toxic shock and S. aureus septicaemia) and 11 required surgical procedures. The average cost per hospitalization was US$ 600 in public hospitals and US$ 1,800 in the private hospital. CONCLUSIONS: Varicella complications requiring hospitalization are due mainly to bacterial infections and they affect immunocompetent toddlers. These complications can be severe and even fatal.
Assuntos
Varicela/complicações , Custos Diretos de Serviços , Hospitalização/economia , Adolescente , Infecções Bacterianas/economia , Infecções Bacterianas/etiologia , Varicela/economia , Criança , Pré-Escolar , Chile , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos RetrospectivosRESUMO
In a multicenter study, hepatitis A virus (HAV) seroprevalence was surveyed in six countries in Latin America in which in 12,000 subjects were stratified for age. The highest rates of seroprevalence were recorded in the Dominican Republic (89.0%) and Mexico (81.0%), with lower rates in Brazil (64.7%), Chile (58.1%), Venezuela (55.7%), and Argentina (55.0%). The seroprevalence of HAV in children between 1 and 5 years of age was less than 50%, except in the Dominican Republic. In the 5-10-year-old age group, seroprevalence rates have also decreased compared with previous reports. This suggests that the epidemiology is shifting from high to intermediate endemicity, with the population susceptible to HAV infection shifting from children to adolescents and adults. Furthermore, data from Brazil, Argentina, and Mexico show that HAV seroprevalence is significantly lower in people living in medium and high socioeconomic conditions. This study suggests the need for appropriate vaccination programs to be implemented targeting children, adolescents, and adults, particularly in higher socioeconomic groups.
Assuntos
Hepatite A/epidemiologia , Hepatovirus/imunologia , Adolescente , Adulto , Distribuição por Idade , Criança , Pré-Escolar , Estudos Transversais , Feminino , Anticorpos Anti-Hepatite A , Anticorpos Anti-Hepatite/sangue , Humanos , Técnicas Imunoenzimáticas , Lactente , América Latina/epidemiologia , Masculino , Estudos Soroepidemiológicos , Distribuição por Sexo , Classe SocialRESUMO
BACKGROUND: The epidemiology of hepatitis A virus (HAV) infection is closely associated to the level of hygiene and sanitation of the population. Newly industrialising areas experience a transition from high to intermediate endemicity, which is characterized by a shift in the exposure age to HAV, from early childhood to school ages or adolescence. AIM: To measure the prevalence of HAV antibodies in subjects living in urban Santiago. SUBJECTS AND METHODS: A HAV antibody survey in five medium and low socioeconomic level urban districts of northern Santiago, was conducted in 1996. Healthy subjects aged 1 to 39 years old were recruited from randomly selected households. RESULTS: Five hundred three subjects were studied. Anti HAV antibodies were found in 13.2, 29.5, 59.6, 78.1, 95.6 and 98.2% of individuals aged 1 to 4, 5 to 9, 10 to 14, 15 to 19, 20 to 29 and 30 to 39 years old, respectively. CONCLUSIONS: The profile of positive antibodies is compatible with an intermediate pattern of transmission of HAV. The current data supports the idea that infection is shifting towards older ages. A progressive increase in the number of susceptible school age children and teenagers is propitious for the occurrence of common source hepatitis A outbreaks.
Assuntos
Distribuição por Idade , Hepatite A/imunologia , Anticorpos Anti-Hepatite/sangue , Hepatovirus/imunologia , Adolescente , Adulto , Criança , Pré-Escolar , Chile/epidemiologia , Feminino , Hepatite A/sangue , Hepatite A/etiologia , Humanos , Lactente , Masculino , Fatores Socioeconômicos , População UrbanaRESUMO
BACKGROUND: As sanitary and economic conditions improve, the prevalence of antibodies to hepatitis A is now significantly lower. AIM: To evaluate the prevalence of hepatitis A virus antibodies in healthy Chilean adults. MATERIAL AND METHODS: Antibodies to hepatitis A virus were measured, using a commercial ELISA assay, in 215 voluntary blood donors (163 male, aged 19 to 30 years old) and 295 medical students and health personnel (156 male, aged 19 to 39 years old), residing in Valdivia, Chile. RESULTS: Antibodies against hepatitis A virus were found in 68.2% of the total sample (351/510). Ninety percent of flood donors and 54% of health personnel and students were positive (p < 0.01). Age specific prevalence in blood donors 19 to 22, 23 to 29 and 27 to 30 years old was 81.0%, 95.2% and 95.6% respectively. Among the same age groups in medical students, the prevalence was 47.9%, 53.2% and 61.9% respectively (p < 0.01). CONCLUSIONS: This study indicates a reduction in the prevalence of hepatitis A virus antibodies among adults in Valdivia (Chile). Differences detected between individuals are probably related to different socioeconomic levels. Medical students have an increased risk for hepatitis A infections than the general population.
Assuntos
Hepatite A/imunologia , Anticorpos Anti-Hepatite/sangue , Hepatovirus/imunologia , Adulto , Fatores Etários , Chile , Feminino , Hepatite A/sangue , Anticorpos Anti-Hepatite A , Humanos , Masculino , PrevalênciaRESUMO
We evaluated the efficacy of a vancomycin solution in the prevention of bacteremia caused by vancomycin-sensitive organisms (VSO) in cancer patients with a tunneled central venous catheter (CVC). Eighty-three patients who had a single lumen CVC were randomized to use a heparin solution (25 U/ml) for daily catheter flush with (HepVan) or without (Hep) vancomycin, 25 mcg/ml. Febrile episodes were recorded, and central and peripheral blood cultures were drawn before beginning antibiotic therapy. Patients participated in follow-up to 16,677 catheter days (8,666 Hep and 8,011 HepVan), and 143 febrile episodes were recorded (82 Hep and 61 HepVan). Forty-four episodes of bacteremia occurred, 23 of them due to VSO (16 occurred in the Hep group and 7 in the HepVan group (P = 0.19). VSO bacteremia occurred in 14 neutropenic (absolute neutrophil count < 500 x 10(9)/l) episodes (7 Hep vs. 7 HepVan) and in 9 non-neutropenic episodes (9 Hep vs. O HepVan; P = 0.013). Vancomycin effectively prevented bacteremia by VSO in non-neutropenic patients, supporting the idea that intraluminal colonization of indwelling CVCs contributes to bacteremia only in these patients.
Assuntos
Antibacterianos/administração & dosagem , Bacteriemia/prevenção & controle , Cateterismo Venoso Central/efeitos adversos , Cateteres de Demora/efeitos adversos , Neoplasias/sangue , Neutropenia/complicações , Vancomicina/administração & dosagem , Adolescente , Adulto , Anticoagulantes/administração & dosagem , Bacteriemia/etiologia , Bacteriemia/microbiologia , Criança , Pré-Escolar , Método Duplo-Cego , Feminino , Heparina/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/terapia , Estudos ProspectivosRESUMO
Se enfatizam las repercusiones de la desnutricion, sea calorica-proteica (marasmo o caquexia) sea proteica pura (kwashiorkor), sobre la capacidad de defensa y recuperacion de los pacientes y, por ende, de su pronostico. La desnutricion, en sus diversos grados, existe en el 30 a 50% de los adultos que se hospitalizan. Por ello cada paciente debe ser objeto de una evaluacion y de un plan nutricional que puede o no implicar asistencia nutricional. Esta puede ser no intensiva o intensiva (enteral o parenteral, parcial o total). Se enumeran las ventajas relativas de la alimentacion enteral. Se establecen y describen los principales parametros antropometricos, bioquimicos, inmunologicos y citologicos en los que se fundamenta la evaluacion del estado nutricional: reserva calorica (depositos grasos); reverva proteica (muscular y visceral); grado de catabolismo. Esta evaluacion debe complementarse, en todos los casos con el estudio de la suficiencia respiratoria, hepatica y renal
Assuntos
Humanos , Necessidades Nutricionais , Desnutrição Proteico-CalóricaRESUMO
Se destallan las indicaciones y las principales contraindicaciones de la alimentacion enteral, asi como los niveles de soporte nutricional requeridos en diversas circunstancias clinicas.Se senalan las bases que permiten calcular los aportes caloricos, proteico, glucidico, lipidicos y de vitaminas y minerales. Con respecto al aporte calorico, este se determina precisando el gasto energetico basal. Para ello se utiliza la formula propuesta por Harris y Benedict. Los valores ostentan diferencias atribuibles al sexo y deben corregirse segun el grado de actividad fisica; la patologia existente y al estado del metabolismo. Se describe la tecnica de intubacion con o sin control fluoroscopico y el tipo de sondas disponibles.Se analisan las caracteristicas de las mezclas nutritivas disponibles y la forma de administrarlas.Finalmente se destacan las posibles complicaciones del procedimiento, mencionando las mecanicas; gastrointestinales y metabolicas