The 10-valent pneumococcal conjugate vaccine (PCV10) became available in Portugal in mid-2009 and the 13-valent vaccine (PCV13) in early 2010. The incidence of invasive pneumococcal disease (IPD) in patients aged under 18 years decreased from 8.19 cases per 100,000 in 2008-09 to 4.52/100,000 in 2011-12. However, IPD incidence due to the serotypes included in the 7-valent conjugate vaccine (PCV7) in children aged under two years remained constant. This fall resulted from significant decreases in the number of cases due to: (i) the additional serotypes included in PCV10 and PCV13 (1, 5, 7F; from 37.6% to 20.6%), particularly serotype 1 in older children; and (ii) the additional serotypes included in PCV13 (3, 6A, 19A; from 31.6% to 16.2%), particularly serotype 19A in younger children. The decrease in serotype 19A before vaccination indicates that it was not triggered by PCV13 administration. The decrease of serotype 1 in all groups, concomitant with the introduction of PCV10, is also unlikely to have been triggered by vaccination, although PCVs may have intensified and supported these trends. PCV13 serotypes remain major causes of IPD, accounting for 63.2% of isolates recovered in Portugal in 2011-12, highlighting the potential role of enhanced vaccination in reducing paediatric IPD in Portugal.

We report the case of a 9-year-old girl admitted with fever, headache, and a cerebrospinal fluid lymphocytic pleocytosis. Polymerase chain reaction was positive for human herpes virus 6. She subsequently developed ataxia and bilateral loss of vision. Magnetic resonance imaging (MRI) showed bilateral optic nerve lesions with extension to optic chiasm and a short-segment myelitis. Serologic studies were positive for Borrelia burgdorferi IgM. Anti-aquaporin 4 antibody was negative and anti-myelin oligodendrocyte glycoprotein antibody (MOG) positive. After intravenous methylprednisolone, ceftriaxone, and intravenous immunoglobulin, her vision slowly recovered. The patient was discharged with only mild visual acuity loss, 1 month after admission. Brain MRI was repeated later and was normal and MOG assay became negative. In our view, this patient suffered from a postinfectious, anti-MOG-mediated, spinal cord and optic nerve demyelination. Borrelia burgdorferi infection is associated with neurologic manifestations in up to 15% of cases.1 Optic neuritis related with Lyme borreliosis has been reported infrequently and there is uncertainty about the validity of the diagnosis in many cases.2 Neurologic manifestations associated with human herpes virus 6 (HHV6) infection are usually febrile seizures in infants and encephalitis in immunosuppressed patients. 3Optic neuritis may have multiple causes, including infection and several autoimmune diseases, such as multiple sclerosis, acute disseminated encephalomyelitis, or neuromyelitis optica spectrum disorders.We describe a case of one female adolescent with antimyelin oligodendrocyte glycoprotein (MOG)-positive optic neuritis and myelitis. She had a positive polymerase chain reaction for HHV6 in cerebrospinal fluid and positive enzyme-linked immunosorbent assay and Western blot for Borrelia burgdorferi in serum. We propose that our case expands the spectrum of the association between infection and immunemediated MOG demyelination. Case ReportA previously healthy 9-year-old girl of African descent living in the Azores Islands was admitted to her local hospital with a 6-day history of a febrile illness, headache, and somnolence, previously treated with amoxicillin-clavulanic acid without resolution of symptoms. She had no history of recent travel. Her white blood cell count was 16340/mL (80% neutrophils) and c-reactive protein 0.88 mg/dL. Cerebrospinal fluid examination revealed a cell count of 95 cells/mL, with lymphocytic predominance and elevated protein (66 mg/dL). Polymerase chain reaction in the cerebrospinal fluid was positive for HHV6 and negative for Borrelia burgdorferi, and no serologic tests were performed regarding HHV6. Four days later, she presented with gait imbalance, abdominal pain, and dysuria. Neurologic examination was positive for gait ataxia with a positive Romberg sign. She underwent treatment with a 21-day course of ganciclovir (10 mg/kg/d) and was discharged on the 26th day after admission with a normal physical examination. Brain

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Purpose: Since the beginning of the 2000s, several countries around the world saw the resurgence of mumps outbreaks. In São Paulo State the MMR vaccine was introduced in 1992 and the coverage for the second dose varied between 75 and 95% in recent years. But, since 2007 several outbreaks were notified in the State usually affecting young adults. Objective: to describe an outbreak of mumps in the Campinas University (UNICAMP) occurring between August 27,2015 and January 6,2017.Methods & Materials: All cases notified to the Health State Department Center of Disease Control were analyzed and the data were complemented by medical records information, local surveillance register and phone call for missing data. Time-space distribution and epidemiological characteristics were studied.Results: The epidemic curve shows the typical pattern of person to person transmission, preserving the seasonal variation normally see in the distribution of mumps cases, with high number of cases in autumn and spring time. The duration of the outbreak draws attention by showing the ineffectiveness of the control measures. The first case occurred in the Chemical Institute and disseminated the disease for other 11 institutes at the campus. In 2016, new cases were identified in the same institutes and other 5 were affected. The incidence was 2,77 cases by 1,000 students; 2,14 cases by 1,000 professors and 2,38 by 1,000 staff. The outbreak affected mostly male individuals, 16 to 24 years old. Only 8,3% presented orchitis. 64% of the cases were confirmed by PCR-RT or IgM seropositivity. 40% referred prior contact with a suspected or confirmed case. There was information on the vaccination status for 57.5% of cases and of these 48.3% had received one dose of vaccine and 10.3% two doses. 58.7% of the vaccinees received the last dose less than 10 years ago.Conclusion: The epidemiological characteristics of this outbreak was very similar to others that occurred in similar sets but several fragilities presented by epidemiological surveillance were identified, such a wrong strategy of post-exposure prophylaxis during a single day after the emergence of cases on certain unities, absence of a social communication plan and minimum community involvement.