ABSTRACT The article describes a strategy to facilitate access to pneumococcal conjugate vaccine 13 (PCV-13) for people living with HIV/AIDS (PLHIV) during the COVID-19 pandemic. Method: report on the experience regarding the organization of a care service for PLHIV in the city of São Paulo to facilitate access to PCV-13 in the framework of the 2020 influenza vaccination campaign during the COVID-19 pandemic. Results: through the integration between a PLHIV care service and an Immunization Center (CRIE in Portuguese), it was possible to offer PCV-13 to PLHIV at the point of care, reducing physical barriers to access to immunization. Thus, of the 1,906 PLHIV who passed through the service during the period March 23-July 31, 2020, 84.4% (1,609) received the influenza vaccine, PCV-13 or both. Of the 1609 vaccinated, 50.6% (814) were eligible and received PCV-13. Conclusion: offering the vaccine at the point of care and orienting PLHIV on the importance of vaccination as a disease prevention strategy, identifying those eligible to receive it, was an important action carried out by the institution together with the nursing team, as a strategy to facilitate access to vaccination.

RESUMEN El artículo describe una estrategia para facilitar el acceso a la vacuna neumocócica conjugada 13 (PCV-13) a las personas que viven con VIH/SIDA (PVVS) durante la pandemia de COVID-19. Método: relato de experiencia sobre la organización de un servicio de atención a las PVVS en la ciudad de São Paulo, para facilitar el acceso a la PCV-13 en el marco de la campaña de vacunación contra la gripe de 2020, durante la pandemia de COVID-19. Resultados: a través de la integración entre un servicio de atención a las PVVS y un Centro de Inmunización (CRIE), fue posible ofrecer la PCV-13 a las PVVS en su punto de atención, reduciendo las barreras físicas para el acceso a la inmunización. Así, de las 1.906 PVVS que pasaron por el servicio durante el periodo comprendido entre el 23 de marzo y el 31 de julio de 2020, el 84,4% (1.609) recibieron la vacuna de la gripe, la PCV-13 o ambas. De los 1609 vacunados, el 50,6% (814) eran elegibles y recibieron la PCV-13. Conclusión: ofrecer la vacuna en el lugar de atención y orientar a las PVVS sobre la importancia de la vacunación como estrategia de prevención de enfermedades, identificando a las personas elegibles para recibirlas, fue una acción importante realizada por la institución junto con el equipo de enfermería, como estrategia para facilitar el acceso a la vacunación.

RESUMO Descrever uma estratégia para facilitar o acesso à vacina conjugada pneumocócica 13-valente (PCV-13) para pessoas vivendo com HIV (PVHIV), durante a pandemia de COVID-19. Método: relato de experiência sobre a organização de um serviço de atendimento para PVHIV na cidade de São Paulo, para facilitar o acesso à PCV-13 no decorrer da campanha de vacinação de influenza de 2020, durante a pandemia de COVID-19. Resultados: por meio da integração entre um serviço de atendimento para PVHIV e um Centro de Imunizações (CRIE) foi possível oferecer a PCV-13 para as PVHIV em seu local de atendimento, diminuindo barreiras físicas de acesso à imunização. Dessa forma, das 1906 PVHIV que passaram pelo serviço durante o período de 23 de março a 31 de julho de 2020, 84,4% (1609) receberam a vacina influenza, PCV-13 ou ambas. Dos 1609 vacinados, 50,6% (814) foram elegíveis e receberam a PCV-13. Conclusão: oferecer a vacina em seu local de tratamento e orientar as PVHIV sobre a importância da vacinação como estratégia de prevenção de doenças, identificando os elegíveis a recebê-las, foi uma importante ação realizada pela instituição em conjunto com a equipe de enfermagem, como estratégia de facilitar o acesso à vacinação.

ABSTRACT This observational retrospective study conducted during an yellow fever (YF) outbreak in Sao Paulo, Brazil, in 2017-2018, describes adverse events (AE) following YF vaccination of immunocompromised persons. Risks and benefits of vaccination were individually evaluated by physicians. AE were assessed by phone call or electronic mail, 14 to 90 days after vaccination. Three hundred and eighty one immunocompromised persons received a full-dose of YF vaccine. Their age ranged from 1.4 to 89.3 years (median 50.8 years); 53% were women; 178 (46.7%) had chronic kidney disease, 78 (20.5%) had immune-mediated inflammatory diseases; 94 (24.7%) were using or had recently used immunosuppressive/ immunomodulatory drugs. All of them denied previous YF vaccination. We were able to contact 341 (89.5%) vaccinees: 233 (68.3%) of them received the YF vaccine from BioManguinhos and 108 (31.7%) received the vaccine from Sanofi-Pasteur; 130 (38.1%) vaccinees received other vaccines (up to 4) simultaneously with the the YF vaccine, mostly hepatitis B (59 vaccinees), pneumococcal polysaccharide 23-valent (46), influenza (43) and diphtheria-tetanus (dT, 41). One hundred and eleven vaccinees (32.6%) reported at least one AE: 79 (23.2%) presented systemic AE, 44 (12.9%) had local AE and 12 had both, local and systemic AE. The most common AE was pain at the injection site (41 persons, 12%), myalgia (34; 10%), fever (25; 7.3%) and headache (16; 4.7%). There was no statistically significant difference on the AE frequency according to the vaccine producer. There were four severe AE: one hospitalization and three deaths, considered not related to the YF vaccine.

Abstract Introduction: Vaccination with tetanus-diphtheria-acellular pertussis (Tdap) has been recommended for healthcare workers (HCWs) by Brazilian Ministry of Health since November 2014. Objective: To describe the strategies implemented to improve Tdap uptake, cumulative vaccine coverage after each intervention, variables associated to Tdap vaccination, and reasons for non-vaccination among HCWs of the main building of a quaternary hospital attached to the Sao Paulo University Medical School. Methods: A list of HCWs eligible for pertussis vaccination was generated. From April to December 2015, the following interventions were implemented: note on intern journal reminding the importance of pertussis vaccination; email to the head nurses strengthening vaccine recommendations; lectures on pertussis and Tdap for physicians of Obstetrics and Neonatology Clinics; on-site vaccination by mobile teams at the Obstetrics, Neonatology, and Anesthesiology Clinics. Vaccine coverage was accessed at the end of each month. Multivariate Poisson regression model with a robust error variance was used to evaluate variables associated with Tdap vaccination. Reasons for non-vaccination were evaluated from January to May 2017 through phone calls for HCWs who had not received Tdap. Results: The study included 456 HCWs. After the interventions, Tdap coverage raised from 2.8% to 41.2%. In the multivariate analysis, occupation (physician), working place (obstetrics or anesthesiology) and influenza vaccination in 2015 were independently associated to Tdap vaccination. The main reason for non-vaccination was unawareness of Tdap recommendations. Conclusions: Tdap uptake among HCWs was low in our hospital. Providing vaccination at convenient places/times for HCW seems to be the most efficient strategy to increase vaccine uptake.

OBJECTIVES: The purpose of this study was to evaluate the incidence of urinary tract infection (UTI) in patients with cystitis symptoms who underwent pelvic radiation therapy and identify correlated predictive factors. METHODS: A prospective cohort study was conducted of patients who met the following: primary pelvic cancer treated with curative intent, older than 18 years old, and good performance status. The exclusion criteria were patients being treated for a UTI, using a urinary catheter, in dialysis or with cystostomy or nephrostomy, and using antibiotics during treatment. Urinalysis and urine culture were collected before the beginning of radiation therapy. Weekly evaluations of urinary symptoms were subsequently performed. In cases of new or worsening symptoms, a questionnaire was applied, and new urine exams were collected. The UTI diagnosis was defined by uroculture as bacterial growth greater than 104 CFU/mL. RESULTS: From September 2014 to November 2015, 112 patients were sequentially recruited, and 72 (64%) fulfilled the inclusion criteria. During follow-up, 24 (33%) patients had new urinary symptoms or worse preexisting symptoms. A UTI was confirmed in the second urinary culture in only one (1.4%) patient. CONCLUSIONS: The incidence of UTI was much lower than expected, suggesting that asymptomatic bacteriuria develops symptoms due to radiotherapy. Due to the low rate of UTI, no predictive factor was identified.

OBJECTIVES: The impact of Chagas disease (CD) in HIV-infected patients is relevant throughout the world. In fact, the characterization of the adaptive immune response in the context of co-infection is important for predicting the need for interventions in areas in which HIV and Chagas disease co-exist. METHODS: We described and compared the frequency of cytokine-producing T cells stimulated with soluble antigen of Trypanosoma cruzi (T. cruzi) using a cytometric assay for the following groups: individuals with chronic Chagas disease (CHR, n=10), those with Chagas disease and HIV infection (CO, n=11), those with only HIV (HIV, n=14) and healthy individuals (C, n=15). RESULTS: We found 1) a constitutively lower frequency of IL-2+ and IFN-γ+ T cells in the CHR group compared with the HIV, CO and healthy groups; 2) a suppressive activity of soluble T. cruzi antigen, which down-regulated IL-2+CD4+ and IFN-γ+CD4+ phenotypes, notably in the healthy group; 3) a down-regulation of inflammatory cytokines on CD8+ T cells in the indeterminate form of Chagas disease; and 4) a significant increase in IL-10+CD8+ cells distinguishing the indeterminate form from the cardiac/digestive form of Chagas disease, even in the presence of HIV infection. CONCLUSIONS: Taken together, our data suggest the presence of an immunoregulatory response in chronic Chagas disease, which seems to be driven by T. cruzi antigens. Our findings provide new insights into immunotherapeutic strategies for people living with HIV/AIDS and Chagas disease.

RESUMOOBJETIVO Estimar prevalência de infecção pelo vírus da hepatite C entre a população carcerária no Brasil.MÉTODOS Revisão sistemática sobre infecção pelo vírus da hepatite C em populações carcerárias. Foram avaliados estudos brasileiros publicados a partir de 1 de janeiro de 1989 até 20 de fevereiro de 2014. A qualidade metodológica dos estudos foi avaliada utilizando-se escala de zero a oito pontos.RESULTADOS Onze estudos elegíveis foram analisados, os quais forneceram dados sobre a infecção pelo vírus da hepatite C de 4.375 detentos de sete estados do Brasil, com classificação em média de qualidade de 7,4. A prevalência de infecção pelo vírus da hepatite C na população carcerária brasileira foi 13,6%, (variando de 1,0% a 41,0%, dependendo do estudo). As chances de os indivíduos serem soropositivos para o vírus da hepatite C nos estados de Minas Gerais, Sergipe, Mato Grosso do Sul, Rio Grande do Sul, Goiás e Espírito Santo foram 84,0% (IC95% 0,06;0,45), 92,0% (IC95% 0,04;0,13), 88,0% (IC95% 0,09;0,18), 74% (IC95% 0,16;0,42), 84,0% (IC95% 0,08;0,31) e 89,0% (IC95% 0,01;0,05), respectivamente, inferiores àquela observada no estado de São Paulo (soroprevalência de 29,3%). Os quatro estudos realizados na cidade de São Paulo mostraram menor prevalência em estudos mais recentes em comparação aos mais antigos.CONCLUSÕES A maior prevalência de infecção pelo vírus da hepatite C em população carcerária do Brasil foi encontrada em São Paulo, o que pode refletir a diversidade urbana do País. Apesar de os estudos brasileiros apresentarem boa qualidade metodológica para avaliação da prevalência do vírus da hepatite C, são escassos e faltam dados sobre fatores de risco associados a esta infecção, dados esses que poderiam auxiliar nas decisões de prevenção e implementação de políticas em saúde pública para as prisões brasileiras.

OBJECTIVE To estimate the prevalence of hepatitis C virus infection in Brazil’s inmate population.METHODS Systematic review on hepatitis C virus infection in the inmate population. Brazilian studies published from January 1, 1989 to February 20, 2014 were evaluated. The methodological quality of the studies was assessed using a scale of 0 to 8 points.RESULTS Eleven eligible studies were analyzed and provided data on hepatitis C virus infection among 4,375 inmates from seven states of Brazil, with a mean quality classification of 7.4. The overall hepatitis C virus prevalence among Brazilian inmates was 13.6% (ranging from 1.0% to 41.0%, depending on the study). The chances of inmates being seropositive for hepatitis C virus in the states of Minas Gerais (MG), Sergipe (SE), Mato Grosso do Sul (MS), Rio Grande do Sul (RS), Goiás (GO) and Espirito Santo (ES) were 84.0% (95%CI 0.06;0.45), 92.0% (95%CI 0.04;0.13), 88.0% (95%CI 0.09;0.18), 74.0% (95%CI 0.16;0.42), 84.0% (95%CI 0.08;0.31) and 89.0% (95%CI 0.01;0.05) respectively, lower than that observed in the Sao Paulo state (seroprevalence of 29.3%). The four studies conducted in the city of Sao Paulo revealed a lower prevalence in more recent studies compared to older ones.CONCLUSIONS The highest prevalence of hepatitis C virus infection in Brazil’s inmate population was found in Sao Paulo, which may reflect the urban diversity of the country. Despite Brazilian studies having good methodological quality to evaluate the prevalence of the hepatitis C virus, they are scarce and lack data on risk factors associated with this infection, which could support decisions on prevention and implementation of public health policies for Brazilian prisons.

RESUMOOBJETIVO Estimar prevalência de infecção pelo vírus da hepatite C entre a população carcerária no Brasil.MÉTODOS Revisão sistemática sobre infecção pelo vírus da hepatite C em populações carcerárias. Foram avaliados estudos brasileiros publicados a partir de 1 de janeiro de 1989 até 20 de fevereiro de 2014. A qualidade metodológica dos estudos foi avaliada utilizando-se escala de zero a oito pontos.RESULTADOS Onze estudos elegíveis foram analisados, os quais forneceram dados sobre a infecção pelo vírus da hepatite C de 4.375 detentos de sete estados do Brasil, com classificação em média de qualidade de 7,4. A prevalência de infecção pelo vírus da hepatite C na população carcerária brasileira foi 13,6%, (variando de 1,0% a 41,0%, dependendo do estudo). As chances de os indivíduos serem soropositivos para o vírus da hepatite C nos estados de Minas Gerais, Sergipe, Mato Grosso do Sul, Rio Grande do Sul, Goiás e Espírito Santo foram 84,0% (IC95% 0,06;0,45), 92,0% (IC95% 0,04;0,13), 88,0% (IC95% 0,09;0,18), 74% (IC95% 0,16;0,42), 84,0% (IC95% 0,08;0,31) e 89,0% (IC95% 0,01;0,05), respectivamente, inferiores àquela observada no estado de São Paulo (soroprevalência de 29,3%). Os quatro estudos realizados na cidade de São Paulo mostraram menor prevalência em estudos mais recentes em comparação aos mais antigos.CONCLUSÕES A maior prevalência de infecção pelo vírus da hepatite C em população carcerária do Brasil foi encontrada em São Paulo, o que pode refletir a diversidade urbana do País. Apesar de os estudos brasileiros apresentarem boa qualidade metodológica para avaliação da prevalência do vírus da hepatite C, são escassos e faltam dados sobre fatores de risco associados a esta infecção, dados esses que poderiam auxiliar nas decisões de prevenção e implementação de políticas em saúde pública para as prisões brasileiras.

OBJECTIVE To estimate the prevalence of hepatitis C virus infection in Brazil’s inmate population.METHODS Systematic review on hepatitis C virus infection in the inmate population. Brazilian studies published from January 1, 1989 to February 20, 2014 were evaluated. The methodological quality of the studies was assessed using a scale of 0 to 8 points.RESULTS Eleven eligible studies were analyzed and provided data on hepatitis C virus infection among 4,375 inmates from seven states of Brazil, with a mean quality classification of 7.4. The overall hepatitis C virus prevalence among Brazilian inmates was 13.6% (ranging from 1.0% to 41.0%, depending on the study). The chances of inmates being seropositive for hepatitis C virus in the states of Minas Gerais (MG), Sergipe (SE), Mato Grosso do Sul (MS), Rio Grande do Sul (RS), Goiás (GO) and Espirito Santo (ES) were 84.0% (95%CI 0.06;0.45), 92.0% (95%CI 0.04;0.13), 88.0% (95%CI 0.09;0.18), 74.0% (95%CI 0.16;0.42), 84.0% (95%CI 0.08;0.31) and 89.0% (95%CI 0.01;0.05) respectively, lower than that observed in the Sao Paulo state (seroprevalence of 29.3%). The four studies conducted in the city of Sao Paulo revealed a lower prevalence in more recent studies compared to older ones.CONCLUSIONS The highest prevalence of hepatitis C virus infection in Brazil’s inmate population was found in Sao Paulo, which may reflect the urban diversity of the country. Despite Brazilian studies having good methodological quality to evaluate the prevalence of the hepatitis C virus, they are scarce and lack data on risk factors associated with this infection, which could support decisions on prevention and implementation of public health policies for Brazilian prisons.

Paciente de 16 anos do sexo masculino apresentou-se ao serviço de emergência com quadro de erupção cutânea súbita, artrite e meningite por Neisseria meningitidis, uma semana após apresentar sintomas de infecção de vias aéreas superiores. No décimo dia de tratamento, seguido da melhora clínica neurológica e da artrite, ele volta a apresentar derrame articular moderado com limitação importante da amplitude dos movimentos passivo e ativo secundária à dor. Em seguida, foi submetido à drenagem cirúrgica e a análise do líquido sinovial mostra características inflamatórias. Foi iniciado tratamento com antiinflamatório não esteroidal por cinco dias com melhora completa dos sintomas. Esse caso tem como característica peculiar o fato do indivíduo apresentar tanto as características de artrite séptica pelo meningococo quanto de artrite imunomediada, o que tem sido pouco usual no mesmo paciente.

We present a case of a 16-year-old male patient with sudden-onset, rash, arthritis and meningitis by Neisseria meningitidis one week after an acute upper respiratory infection. On the 10th day of treatment followed by neurological and arthritis clinical improvement, he presented once again a tender and swollen left knee with a moderate effusion, and active and passive range of motion was severely limited secondary to pain, and when he was submitted to surgical drainage and synovial fluid analysis he showed inflammatory characteristics. A non-steroidal anti-inflammatory drug was taken for five days with complete improvement of symptoms. The case is notable for its combination of features of septic and immune-mediated arthritis, which has rarely been reported in the same patient.