RESUMO

The objective of this study was to analize data of pertussis morbidity and mortality in Argentina and vaccination coverage with combined pertussis vaccine (DwPT), which was available from 1969 until 2000 inclusive, and to investigate their interrelation. A retrospective study was performed based on National Registers. Notification and mortality annual mean variation rates and geometric mean rates, by periods, were analyzed, and correlation coefficients between each one of them and with vaccination coverage were calculated. Notification annual mean variation rates for 1969-2000 were -14.34 and for 1980-2000 -17.26; mortality annual mean variation rates for 1980-2000 was -10.41. Vaccination coverage in infants up to one year of age (3 doses) was 44.4% in 1980; less than 60% until 1982 and higher than 80% after 1990. A highly significant inverse correlation was observed, between (a) vaccine implementation, increase in its coverage, introduction of a fifth vaccine dose, and (b) notification and mortality rates. It was observed during the study, that in our country there is a relatively little knowledge about disease occurrence in adults, and an apparent absence of population-based studies performed on the efficacy of erythromycin chemo prophylaxis in epidemics outbreaks. Based on these data, strategies for a better surveillance and control of pertussis, are exposed.

Se analizaron los datos de morbilidad y mortalidad por coqueluche y su relación con la cobertura de vacunación con vacuna triple bacteriana (DPT), entre los años 1969 y 2000 inclusive, con base en la información disponible en los registros nacionales. Se calcularon el porcentaje de variación anual promedioy las medias geométricas de las tasas de notificación y mortalidad, por períodos, y los coeficientes de correlaciónentre las mismas y entre cada una de ellas y la cobertura de vacunación. La variación anual promedio, de la tasa de notificación para el período 1969-2000 fue –14.34 y para 1980-2000 –17.26 y la correspondiente a la tasa de mortalidad para 1980-2000 fue –10.41. Las coberturas de vacunación del niño menor de un año (3 dosis), fueron del 44.4% en 1980; inferiores al 60% hasta 1982 y mayores al 80% a partir de 1990. Se observó una correlación inversa altamente significativa entre (a) la implementación de la vacunación, el aumento de su cobertura, la introducción de la quinta dosis a los 6 años de edad, y (b) las tasas de incidencia y mortalidad. Se observó además que en nuestro país existe poco conocimiento sobre la ocurrencia de la enfermedad enel adulto y que no se cuenta con estudios poblacionales sobre la eficacia de la quimioprofilaxis con eritromicina,durante brotes epidémicos. Se proponen estrategias para la mejor vigilancia y control de esta enfermedad.

Assuntos

RESUMO

The objective of this study was to analize data of pertussis morbidity and mortality in Argentina and vaccination coverage with combined pertussis vaccine (DwPT), which was available from 1969 until 2000 inclusive, and to investigate their interrelation. A retrospective study was performed based on National Registers. Notification and mortality annual mean variation rates and geometric mean rates, by periods, were analyzed, and correlation coefficients between each one of them and with vaccination coverage were calculated. Notification annual mean variation rates for 1969-2000 were -14.34 and for 1980-2000 -17.26; mortality annual mean variation rates for 1980-2000 was -10.41. Vaccination coverage in infants up to one year of age (3 doses) was 44.4% in 1980; less than 60% until 1982 and higher than 80% after 1990. A highly significant inverse correlation was observed, between (a) vaccine implementation, increase in its coverage, introduction of a fifth vaccine dose, and (b) notification and mortality rates. It was observed during the study, that in our country there is a relatively little knowledge about disease occurrence in adults, and an apparent absence of population-based studies performed on the efficacy of erythromycin chemo prophylaxis in epidemics outbreaks. Based on these data, strategies for a better surveillance and control of pertussis, are exposed.(AU)

Se analizaron los datos de morbilidad y mortalidad por coqueluche y su relación con la cobertura de vacunación con vacuna triple bacteriana (DPT), entre los años 1969 y 2000 inclusive, con base en la información disponible en los registros nacionales. Se calcularon el porcentaje de variación anual promedioy las medias geométricas de las tasas de notificación y mortalidad, por períodos, y los coeficientes de correlaciónentre las mismas y entre cada una de ellas y la cobertura de vacunación. La variación anual promedio, de la tasa de notificación para el período 1969-2000 fue ¹14.34 y para 1980-2000 ¹17.26 y la correspondiente a la tasa de mortalidad para 1980-2000 fue ¹10.41. Las coberturas de vacunación del niño menor de un año (3 dosis), fueron del 44.4% en 1980; inferiores al 60% hasta 1982 y mayores al 80% a partir de 1990. Se observó una correlación inversa altamente significativa entre (a) la implementación de la vacunación, el aumento de su cobertura, la introducción de la quinta dosis a los 6 años de edad, y (b) las tasas de incidencia y mortalidad. Se observó además que en nuestro país existe poco conocimiento sobre la ocurrencia de la enfermedad enel adulto y que no se cuenta con estudios poblacionales sobre la eficacia de la quimioprofilaxis con eritromicina,durante brotes epidémicos. Se proponen estrategias para la mejor vigilancia y control de esta enfermedad.(AU)

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UNLABELLED: The objective was to determine annual mortality rate for asthma and chronic obstructive pulmonary disease (COPD) from 1980 to 1998, in Argentina. Data base on death certificates from the National Ministry of Health were evaluated. They were individualized for COPD: ICD-9: 490 to 496 and ICD-10: J-40 to J47; for asthma: ICD-9: 493 and ICD-10: J44, J45-J46. Global mortality rate was calculated from each code and for 24 provinces. For asthma, the adjusted mortality rate for 5-34 year-old patients was calculated. Population data were provided by National Institute of Statistics and Census. Global mortality rate for asthma increased from 3.37 in 1980 to 3.96/100,000 in 1985 and decreased from 3.16 in 1991 to 1.74 in 1997 (-30.8%, p < 0.0001) and increased to 2.18 in 1998. Asthma's 5-34 year old mortality rate increased from 0.72 in 1980 to 1.12/100,000 in 1986, and decreased to 0.35 in 1998 (-70%, p < 0.0001). Global mortality rate for COPD increased from 12.76/100,000 in 1980 to 27.16/100,000 in 1998 (+113%, p < 0.0001). There were marked inter-provinces differences for asthma and COPD. IN CONCLUSION: as in developed countries, Argentine mortality rate for asthma has decreased, probably related to dissemination of international and national guides. On the other hand, COPD has increased significantly.

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RESUMO

The objective was to determine annual mortality rate for asthma and chronic obstructive pulmonary disease (COPD) from 1980 to 1998, in Argentina. Data base on death certificates from the National Ministry of Health were evaluated. They were individualized for COPD: ICD-9: 490 to 496 and ICD-10: J-40 to J47; for asthma: ICD-9: 493 and ICD-10: J44, J45-J46. Global mortality rate was calculated from each code and for 24 provinces. For asthma, the adjusted mortality rate for 5-34 year-old patients was calculated. Population data were provided by National Institute of Statistics and Census. Global mortality rate for asthma increased from 3.37 in 1980 to 3.96/100,000 in 1985 and decreased from 3.16 in 1991 to 1.74 in 1997 (-30.8

, p < 0.0001) and increased to 2.18 in 1998. Asthmas 5-34 year old mortality rate increased from 0.72 in 1980 to 1.12/100,000 in 1986, and decreased to 0.35 in 1998 (-70

, p < 0.0001). Global mortality rate for COPD increased from 12.76/100,000 in 1980 to 27.16/100,000 in 1998 (+113

, p < 0.0001). There were marked inter-provinces differences for asthma and COPD. In conclusion: as in developed countries, Argentine mortality rate for asthma has decreased, probably related to dissemination of international and national guides. On the other hand, COPD has increased significantly.

RESUMO

CONTEXT: Botulism is an important public health problem in Argentina, but obtaining antitoxin rapidly has been difficult because global supplies are limited. In January 1998, a botulism outbreak occurred in Buenos Aires. OBJECTIVES: To determine the source of the outbreak, improve botulism surveillance, and establish an antitoxin supply and release system in Argentina. DESIGN, SETTING, AND PARTICIPANTS: Cohort study in January 1998 of 21 drivers of a specific bus route in urban Buenos Aires. MAIN OUTCOME MEASURE: Occurrence of botulism and implication of a particular food as the vehicle causing this outbreak. RESULTS: Nine (43%) of 21 bus drivers developed botulism, presenting with gastroenteritis, symptoms of acute cranial nerve dysfunction including ptosis, dysphagia, blurred vision, and motor weakness. One driver experienced respiratory failure. Type A toxin was detected from 3 of 9 patients' serum samples. All drivers received botulism antitoxin; there were no fatalities. Consumption of matambre (Argentine meat roll) was significantly associated with illness. Among 11 persons who ate matambre, 9 developed illness, compared with none of those who did not eat it (P<.001). The matambre had been cooked in water at 78 degrees C to 80 degrees C for 4 hours, sealed in heat-shrinked plastic wrap, and stored in refrigerators that did not cool adequately. Subsequently, a botulism surveillance and antitoxin release system was established. CONCLUSIONS: Insufficient cooking time and temperatures, storage in heat-shrinked plastic wrap, and inadequate refrigeration likely contributed to Clostridium botulinum spore survival, germination, and toxin production. A rapid-response botulism surveillance and antitoxin release system in Argentina should provide more timely distribution of antitoxin to patients and may serve as a model for other nations.

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