INTRODUÇÃO: O objetivo deste estudo foi identificar e analisar fatores relacionados à meningite neonatal. MÉTODO: Em estudo de caso-controle, foram examinados neonatos com meningite no período de agosto/2002 a dezembro/2003 na Unidade de Tratamento Intensivo Neonatal (UTIN) e alocados recém-nascidos hígidos como grupo controle (GC). Foram relatados dados referentes à gestação, ao parto e ao neonato. Os resultados foram considerados significativos quando p (alfa)< 0,05. RESULTADOS: Foram examinados 42 neonatos com meningite e 42 controles. A média numérica de consultas durante o pré-natal foi menor no grupo meningite (GM). As intercorrências mais comuns detectadas nas gestações, em ambos os grupos, foram o uso de substâncias de abuso, infecções, pré-eclâmpsia, diabetes melitus gestacional e infecções do trato urinário. O sofrimento fetal e a utilização de cuidados respiratórios foram associados à meningite. O GM apresentou médias menores de peso e de índice de APGAR em relação ao GC. A prevalência de prematuridade e de neonatos pequenos para a idade gestacional foi significativamente maior no GM. O exame neurológico foi alterado em apenas 35,7% dos casos de meningite. CONCLUSÃO: Em nosso meio, a associação de fatores de risco relacionados à gestação, ao parto e próprios do neonato com o desfecho de meningite neonatal não diferiu da literatura.

OBJECTIVE: The goal of this study was to identify and to analyze the features related to the occurrence of neonatal meningitis. METHOD: In a case-control study we examined all newborns presenting meningitis between August/2002 and December/2003 in the neonatal Intensive Care Unit. Healthy newborns were enrolled as a Control Group (CG). Data related to pregnancy, labor and the neonate itself were collected. The results with p<0,05 were considered significant. RESULTS: 42 newborns with meningitis were compared to 42 controls. The meningitis group (MG) presented a lower number of medical visits during the prenatal care. The most common abnormalities detected in both groups were: drug addiction, congenital infections, preeclampsia, eclampsia, gestational diabetes mellitus and urinary tract infections. Fetal respiratory distress and the use of respiratory support were related to the occurrence of meningitis. The average weight and the APGAR scores were lower in the MG. The prevalence of premature and small for the gestational age infants was significantly higher in the MG. The neurological examination detected abnormalities in 35.7% of the meningitis cases. CONCLUSION: The association of risk factors related to pregnancy, labor and the newborn itself to the neonatal meningitis outcome in our setting is similar to the described in the literature.

Objective. To compare the incidence of adverse events following the administration of three commercially available measles-mumps-rubella (MMR) combination vaccines. Methods. A randomized double-blind clinical trial was performed in 1996 that involved a total of 10 142 students 6-12 years of age in the state of Rio Grande do Sul, in Brazil. An MMR vaccine containing the Edmonston-Zagreb, Leningrad-Zagreb, and RA 27/3 strains ("vaccine A") was administered to 2 226 students (21.9% of the total); an MMR vaccine with the Moraten, Jeryl Lynn, and Wistar 27/3 strains ("vaccine B") was administered to 2 216 children (21.8%); and an MMR vaccine containing the Schwartz, Urabe AM-9, and Wistar 27/3 strains ("vaccine C") was given to 2 179 students (21.5%). A control group of 3 521 students (34.7%) was not vaccinated. Both the vaccinated subjects and the control subjects were followed daily for 30 days to detect any clinical manifestations. Results. Adverse events were more frequent in the vaccinated children than in the control group (P < 0.01). In terms of causing parotitis, vaccine A had a relative risk (RR) of 5.72 (95% confidence interval (CI) = 3.11-10.54) when compared with vaccine B, and an RR of 2.33 (95% CI = 1.52-3.58) when compared with vaccine C. Vaccine A was also associated with an increased risk of lymphadenopathy when compared with vaccine B (RR = 3.11; 95% CI = 1.78-5.45) and with vaccine C (RR = 2.22; 95% CI = 1.35-3.66). Vaccine C was associated with an increased risk of parotitis when compared with vaccine B (RR = 2.46; 95% CI = 1.26-4.80). Three cases of aseptic meningitis were detected among the children in the study group, but only one case of vaccine-related aseptic meningitis was identified, among the children receiving vaccine A. Conclusions. The three MMR vaccines that we studied are associated with different risks of adverse events. We found vaccine A to cause more reactions than the two other vaccines, especially vaccine B. In addition, vaccine A presented both a temporal and a cause-and-effect association with one case of aseptic meningitis. We hope that this study will contribute information that can be used in choosing MMR vaccines with safe and effective strains, especially for mass vaccination strategies.

Objetivos. Comparar la incidencia de acontecimientos adversos tras la administración de tres vacunas combinadas contra el sarampión, la parotiditis y la rubéola que ya están en el mercado. Métodos. En 1996 se realizó un ensayo clínico aleatorizado, doblemente enmascarado, en el que participaron 10 142 estudiantes de 6 a 12 años del estado de Rio Grande do Sul, Brasil. Las vacunas utilizadas contenían: A) las cepas Edmonston-Zagreb, Leningrado-Zagreb y RA 27/3A; B) las cepas Moraten, Jeryl Lynn y Wistar 27/3, y C) las cepas Schwartz, Urabe AM-9 y Wistar 27/3. La vacuna A se administró a 2 226 niños (21,9%), la B a 2 216 (21,8%), y la C a 2 179 (21,5%). El grupo de control lo formaron 3 521 niños (34,7%) no vacunados. Todos los participantes fueron observados diariamente durante 30 días para detectar posibles manifestaciones clínicas. Resultados. Los acontecimientos adversos fueron más frecuentes en los niños vacunados que en el grupo de control (P < 0,01). El riesgo relativo (RR) de tumefacción parotídea con la vacuna A fue de 5,72 (intervalo de confianza del 95% [IC95]: 3,11 a 10,54) en comparación con la vacuna B, y de 2,33 (IC95: 1,52 a 3,58) en comparación con la vacuna C. La vacuna A también se asoció a un mayor riesgo de linfadenopatía que las vacunas B (RR = 3,11; IC95: 1,78 a 5,45) y C (RR = 2,22; IC95: 1,35 a 3,66). La vacuna C se asoció a un mayor riesgo de tumefacción parotídea que la vacuna B (RR = 2,46; IC95: 1,26 a 4,80). En los niños vacunados se detectaron tres casos de meningitis aséptica, pero solo uno, que recibió la vacuna A, se relacionó con la vacuna. Conclusiones. Las tres vacunas estudiadas se asociaron a diferentes riesgos de acontecimientos adversos. La vacuna A causó más reacciones que las otras dos, en particular más que la vacuna B. Además, la vacuna A presentó una asociación temporal y causal con un caso de meningitis aséptica. Este estudio aporta información que puede ser utilizada para elegir vacunas contra el sarampión, la parotiditis y la rubéola a base de cepas eficaces y seguras, especialmente para la vacunación en masa.