RESUMO
SETTING: Metropolitan region of Recife, Brazil. OBJECTIVE: To estimate the additional protection against tuberculosis (TB) provided by a second dose of bacille Calmette-Guérin (BCG) vaccine. DESIGN: Case-control study. Cases were cases of TB newly diagnosed by the TB control programme, independent of clinical form. Three matched neighbourhood controls were selected using a systematic routine, starting from the case's address. The matching was within the age groups 7-9, 10-14 and 15-19 years. RESULTS: Analysis was conducted among 169 cases and 477 controls. For the efficacy of BCG revaccination against TB overall, matched (crude) vaccine effectiveness (VE) was -3 (95% CI -50-29) and matched (adjusted) VE was 8 (95% CI -77-52). CONCLUSIONS: This study suggests that a second dose of BCG does not offer additional protection. Revaccination should not be offered. As large numbers of subjects are already vaccinated and vaccine appears to offer some protection in older subjects, further studies with larger sample sizes could investigate the potential efficacy of revaccination with BCG in the age group > or = 15 years.
Assuntos
Vacina BCG/administração & dosagem , Tuberculose/prevenção & controle , Adolescente , Adulto , Brasil/epidemiologia , Estudos de Casos e Controles , Criança , Feminino , Humanos , Modelos Logísticos , Masculino , Fatores Socioeconômicos , Tuberculose/epidemiologia , População UrbanaRESUMO
This study aimed to compare the radiographic characteristics of patients with pulmonary tuberculosis (TB) and human immunodeficiency virus (HIV) infection with those of HIV-negative patients. In all, 275 TB patients attending the outpatients clinics at the University Hospital/UFPE, were studied from January 1997 to March 1999. Thirty nine (14.2%) of them were HIV(+), with a higher frequency of males in this group (p=0.044). Seventy-five percent of the HIV(+) patients and 19% of the HIV(-) had a negative tuberculin test (PPD) (p < 0.001). The proportion of positive sputum smears in the two groups was similar. The radiological finding most strongly associated with co-infection was absence of cavitation (p < 0.001). It may therefore be concluded that the lack of cavitation in patients with pulmonary TB may be considered a useful indicator of the need to investigate HIV infection. This approach could contribute to increasing the effectiveness of local health services, by offering appropriate treatment to co-infected patients.
Assuntos
Infecções por HIV/complicações , Tuberculose Pulmonar/complicações , Tuberculose Pulmonar/diagnóstico por imagem , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , RadiografiaRESUMO
A decreasing trend in the prevalence rate of leprosy was reached in Brazil only after the introduction of the World Health Organization multidrug therapy (WHO/MDT) program in 1990. This paper analyzes leprosy morbidity indicators and the prevalence rate, and their utilization in monitoring the progress of leprosy elimination in Brazil. Since these indicators are modified by changes in health service procedures, comparing prevalence rates from different endemic countries or current prevalence rates with old ones from the same endemic region needs careful attention. The current official prevalence rate of 6.72/10,000 inhabitants in Brazil could be considered high when compared with rates from other countries, but it is important to remember that defaulters and patients being treated with old regimens are kept on the active registers in Brazil, while in most other endemic countries they are not.
Assuntos
Hanseníase/epidemiologia , Hanseníase/prevenção & controle , Brasil/epidemiologia , Quimioterapia Combinada , Humanos , Morbidade , Prevalência , Organização Mundial da SaúdeRESUMO
Bancroftian filariasis is spreading in towns of endemic areas in Recife, northeastern Brazil, where it is a major public health problem. This paper deals with the prevalence of microfilaraemia and filarial disease in two urban areas of Recife, studying their association with individual characteristics and variables related to the exposure to the vectors. The parasitologic survey was performed through a "door-to-door" census and microfilaraemia was examined by the thick-drop technique using 45 microliters of peripheral blood collected between 20:00 and 24:00 o'clock. 2,863 individuals aged between 5 and 65 years were interviewed and submitted to clinical examination. Males aged between 15 and 44 years old presented the greatest risk of being microfilaraemic. Microfilaraemia was also significantly associated with no use of bednet to sleep. The risk of being microfilaraemic was greater among those who had lived in the studied areas for more than 5 years. The overall disease prevalence was 6.3%. Males presented the greatest risk of developing acute disease. The risk of developing chronic manifestations was also greater among males and increased with age. We found no association between time of residence, bednet use, microfilaraemia and acute and chronic disease. We may conclude that in endemic areas there are subgroups of individuals who has a higher risk of being microfilariae carriers due to different behaviours in relation to vector contact.