The pandemic novel influenza A (H1N1) infection was considered widespread in Brazil on July, 2009. Since then, 9.249 cases were confirmed in Brazil, most of them concentrated in São Paulo. The Hospital das Clínicas of the University of São Paulo is a reference center for H1N1 cases in São Paulo. The purpose of this review is to analyze the evidence concerning diagnosis, prevention, and treatment of novel influenza A (H1N1) infection. In addition, we propose guidelines for the management of this pandemic emphasizing Hospital das Clínicas "bundles" for the control of the pandemic novel influenza A (H1N1).

The pandemic novel influenza A (H1N1) infection was considered widespread in Brazil on July 16, 2009. Since then, 46,810 cases of acute respiratory syndrome have been reported in Brazil, most of them concentrated in São Paulo. Through September 16, we have confirmed 9,249 cases of novel influenza A H1N1in Brazil, including 699 deaths. The mortality rate observed in Brazil is 0.47/100,000 inhabitants and varies according to region. In this period, São Paulo registered 3733 cases (40.3% of the total) of novel influenza A (H1N1) infection and 327 deaths, reflecting a mortality rate of 0.79/100,000 inhabitants. The Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC) is a reference center for H1N1 cases in São Paulo. During the winter of 2009, 472 patients in this hospital were diagnosed with H1N1 infection; of these, 210 were admitted, and 16 died. To control this pandemic and to provide adequate care for these patients, the Hospital das Clínicas implemented "bundles" including prevention strategies, an epidemiologic surveillance service, availability of fast diagnosis, antiviral treatment and training of staff. The purpose of this manuscript is to describe the epidemiologic features of novel human influenza A (H1N1) infection in the Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo during the winter period of the 2009 pandemic.

INTRODUÇÃO: Em 1996-1997 ocorreu no Estado de São Paulo uma epidemia de sarampo. Uma das estratégias de controle da Secretaria do Estado da Saúde foi a vacinação dos profissionais da saúde. Nesse sentido objetivou-se avaliar a soroprevalência de sarampo entre os pediatras. MÉTODOS: Foram colhidas 150 amostras de sangue de médicos pediatras voluntários, as quais foram submetidas ao teste de ELISA. Um questionário sobre história de sarampo e situação vacinal foi respondido pelos pediatras estudados. RESULTADOS: A maioria dos pediatras 147/150 tinha títulos protetores; sendo 80,3% sem e 19,7% com história pregressa de sarampo. Em 2% dos pediatras as sorologias foram negativas. Nos sem história de doença, 67% afirmavam terem sido vacinados e 33% apesar de apresentarem títulos protetores ignoravam sua situação vacinal. Dos 79 médicos vacinados, 81% tinham recebido a vacina há pelo menos 25 anos e mantido títulos protetores. Dos 3 com sorologias negativas, um referia vacinação anterior. CONCLUSÕES: Apesar da elevada soroprevalência para sarampo, 2% de pessoas susceptíveis podem constituir grupo de risco para aquisição e disseminação da doença em situação epidêmica.

OBJECTIVE: A measles outbreak occurred in S. Paulo state, during 1996 and 1997, resulting in 20,921 cases. Forty seven percent of the cases occurred in people between 20 and 29 years of age, and one of the control strategies of the Department of Health was the vaccination of health care workers. The prevalence of antibodies against measles among the hospital pediatricians was investigated. METHODS: One hundred and fifty samples were taken from voluntee pediatricians to test for measles antibodies using ELISA. A questionnaire about their having had measles and the vaccine was filled out. RESULTS: Of the 150 doctors, 122 (81.4%) were female and 28 (18.6%) male, of between 23 and 46 years of age (mean and median 27 years). The majority (98%-147/150) had protective levels of antibodies against measles (>100 UI/ml); 118 (80.3%-118/147) without and 29 (19.7%-29/147) with a history of measles. Only 3 pediatricians (2%-3/150), had negative serology, 2 without and 1 with a history of measles. Out of the 118 without history of measles, 79 (67%-39/118) in spite of the protective level of antibodies against measles, did not know if they, had been vaccinated. Out of the 79 vaccinated pediatricians, 64 (81%-64/79), had been vaccinated 25 years before, and still maintained protective levels of antibodies. Of the 3 doctors with negative sorologies only one declared that he had been vaccinated. CONCLUSIONS: Measles seroprevalence among pediatricians of this hospital is high, especially due to preceeding vaccination. On the other hand, the 2% of pediatricians with negative sorology, in an epidemic situation could constitute a significant population for the acquisition and dissemination of the disease.

INTRODUÇÃO: Em 1996-1997 ocorreu no Estado de São Paulo uma epidemia de sarampo. Uma das estratégias de controle da Secretaria do Estado da Saúde foi a vacinação dos profissionais da saúde. Nesse sentido objetivou-se avaliar a soroprevalência de sarampo entre os pediatras. MÉTODOS: Foram colhidas 150 amostras de sangue de médicos pediatras voluntários, as quais foram submetidas ao teste de ELISA. Um questionário sobre história de sarampo e situação vacinal foi respondido pelos pediatras estudados. RESULTADOS: A maioria dos pediatras 147/150 tinha títulos protetores; sendo 80,3% sem e 19,7% com história pregressa de sarampo. Em 2% dos pediatras as sorologias foram negativas. Nos sem história de doença, 67% afirmavam terem sido vacinados e 33% apesar de apresentarem títulos protetores ignoravam sua situação vacinal. Dos 79 médicos vacinados, 81% tinham recebido a vacina há pelo menos 25 anos e mantido títulos protetores. Dos 3 com sorologias negativas, um referia vacinação anterior. CONCLUSÕES: Apesar da elevada soroprevalência para sarampo, 2% de pessoas susceptíveis podem constituir grupo de risco para aquisição e disseminação da doença em situação epidêmica.

OBJECTIVE: A measles outbreak occurred in S. Paulo state, during 1996 and 1997, resulting in 20,921 cases. Forty seven percent of the cases occurred in people between 20 and 29 years of age, and one of the control strategies of the Department of Health was the vaccination of health care workers. The prevalence of antibodies against measles among the hospital pediatricians was investigated. METHODS: One hundred and fifty samples were taken from voluntee pediatricians to test for measles antibodies using ELISA. A questionnaire about their having had measles and the vaccine was filled out. RESULTS: Of the 150 doctors, 122 (81.4%) were female and 28 (18.6%) male, of between 23 and 46 years of age (mean and median 27 years). The majority (98%-147/150) had protective levels of antibodies against measles (>100 UI/ml); 118 (80.3%-118/147) without and 29 (19.7%-29/147) with a history of measles. Only 3 pediatricians (2%-3/150), had negative serology, 2 without and 1 with a history of measles. Out of the 118 without history of measles, 79 (67%-39/118) in spite of the protective level of antibodies against measles, did not know if they, had been vaccinated. Out of the 79 vaccinated pediatricians, 64 (81%-64/79), had been vaccinated 25 years before, and still maintained protective levels of antibodies. Of the 3 doctors with negative sorologies only one declared that he had been vaccinated. CONCLUSIONS: Measles seroprevalence among pediatricians of this hospital is high, especially due to preceeding vaccination. On the other hand, the 2% of pediatricians with negative sorology, in an epidemic situation could constitute a significant population for the acquisition and dissemination of the disease.