This case-control study aimed to assess the risk factors for death from influenza A(H1N1)pdm09 in patients with laboratory confirmation, who had severe acute respiratory illness-SARI and were hospitalized between June 28th and August 29th 2009, in the metropolitan regions of São Paulo and Campinas, Brazil. Medical charts of all the 193 patients who died (cases) and the 386 randomly selected patients who recovered (controls) were investigated in 177 hospitals. Household interviews were conducted with those who had survived and the closest relative of those who had died. 73.6% of cases and 38.1% of controls were at risk of developing influenza-related complications. The 18-to-59-year age group (OR = 2.31, 95%CI: 1.31–4.10 (reference up to 18 years of age)), presence of risk conditions for severity of influenza (OR = 1.99, 95%CI: 1.11–3.57, if one or OR = 6.05, 95%CI: 2.76–13.28, if more than one), obesity (OR = 2.73, 95%CI: 1.28–5.83), immunosuppression (OR = 3.43, 95%CI: 1.28–9.19), and search for previous care associated with the hospitalization (OR = 3.35, 95%CI: 1.75–6.40) were risk factors for death. Antiviral treatment performed within 72 hours of the onset of symptoms (OR = 0.17, 95%CI: 0.08–0.37, if within 48hours, and OR = 0.30, 95%CI: 0.11–0.81, if between 48 and 72 hours) was protective against death. The identification of high-risk patients and early treatment are important factors for reducing morbi-mortality from influenza.

To investigate the factors associated with death and describe the gestational outcomes in pregnant women with influenza A(H1N1)pdm09, we conducted a case-control study (deaths and recovered) in hospitalized pregnant women with laboratory-confirmed influenza A(H1N1)pdm09 with severe acute respiratory illness (SARI) in the state of São Paulo from June 9 to December 1, 2009. All cases were evaluated, and four controls that were matched by the epidemiological week of hospitalization of the case were randomly selected for each case. Cases and controls were selected from the National Disease Notification System-SINAN Influenza-web. The hospital records from 126 hospitals were evaluated, and home interviews were conducted using standardized forms. A total of 48 cases and 185 controls were investigated. Having had a previous health visit to a healthcare provider for an influenza episode before hospital admission was a risk factor for death (adjusted OR (ORadj) of 7.93, 95% CI 2.19–28.69). Although not significant in the multiple analysis (ORadj of 2.13, 95% CI 0.91–5.00), the 3rd trimester deserves attention, with an OR = 2.22, 95% CI 1.13–4.37 in the univariate analysis. Antiviral treatment was a protective factor when administered within 48 hours of symptom onset (ORadj = 0.16, 95% CI 0.05–0.50) and from 48 to 72 hours (ORadj = 0.09, 95% CI 0.01–0.87). There was a higher proportion of fetal deaths and preterm births among cases (p = 0.001) and live births with low weight (p = 0.019), compared to control subjects who gave birth during hospitalization. After discharge, control subjects had a favorable neonatal outcome. Early antiviral treatment during the presence of a flu-like illness is an important factor in reducing mortality from influenza in pregnant women and unfavorable neonatal outcomes. It is important to monitor pregnant women, particularly in the 3rd trimester of gestation, with influenza illness for diagnosis and early treatment.

Background: Visceral Leishmaniasis and Human Immunodeficiency Virus co-infection (VL-HIV) occurs mainly in risk groups for HIV/AIDS (youth adult males). These co-infected individuals have greater mortality and relapses rates compared to VL as they share similar immune pathogenic mechanisms. Interest in co-infection VL/HIV and the lack of data in the literature led the authors to a survey on the subject comparing outcomes in VL-HIV co-infected treated with different drugs anti-Leishmania used in Brazil, such that Pentavalent Antimoniate (MA), Amphotericin B deoxicolate (AmBd), and liposomal Amphotericin B (LAmB).Methods: A retrospective descriptive study using routine program data was performed comparing drugs used for treatment of co-infected patients in Sao Paulo state, Brazil, among 1999-2010, observing their outcomes (cure, failure, relapse or death), and analyzing them by each drug used.Results: In the period of twelve years were reported 1,614 VL cases in Sao Paulo state from whom 1 070 (66.30%) were HIV-negative, 117 (7.25%) were HIV-positive and in 427 patients (26.45%) HIV status was unknown. To compare treatment response according to drugs used, we included only the 117 VL/HIV co-infected patients. Related to demographic data we found 72.65% (85/117) of males and 80.34% (94/117) of young adults (21-50 years old). From 117 co-infected patients, 95 had complete data of the treatment performed and these were included in the analysis. The lethality of VL-HIV co-infected patients was 24.2% (23/95) and general relapse rate was 10.5% (10/95). Deaths in co-infected were more prevalent among 31-50 years. According to drug used, 35.64% (36/101) were treated with pentavalent antimoniate (20 mg/kg/day per 28 days), 12 (11%) received Amphotericin B deoxicolate (AmBd) (total dose: 20 to 24 mg/kg) and 47 were treated with Liposomal amphotericin B (LAmB) (total dose: 20 to 24 mg/kg). Patients treated with PA presented similar cure rates compared to LAmB. Patients treated with AmBd had higher lethality and patients treated with LAmB had no failures. Conclusion:High lethality and relapses rates occur in VL-HIV co-infected patients. Poor outcome leading to death was observed in AmBd group. There is an urgent necessity to perform prospective clinical trials to evaluate the safety and efficacy of different schemes for treatment of co-infected patients, especially in New World.

Brazil has not had endemic circulation of the measles virus since 2000. Between May and June 2011, the Metropolitan Region of Campinas, State of Sao Paulo, Southeastern Brazil, reported three cases of measles. This report presents a descriptive study of the cases, control measures, and the search for a possible source and secondary cases. The genotypic characterization of the virus identified genotype D4, circulating in Europe. Secondary cases or index case were not found. The control measures and adequate vaccination coverage in Metropolitan Region of Campinas contributed to the interruption of disease transmission.

Brazil has not had endemic circulation of the measles virus since 2000. Between May and June 2011, the Metropolitan Region of Campinas, State of Sao Paulo, Southeastern Brazil, reported three cases of measles. This report presents a descriptive study of the cases, control measures, and the search for a possible source and secondary cases. The genotypic characterization of the virus identified genotype D4, circulating in Europe. Secondary cases or index case were not found. The control measures and adequate vaccination coverage in Metropolitan Region of Campinas contributed to the interruption of disease transmission.