This study focuses the profile of the adverse events after-vaccine occurrences in Teresina in 2006. The data had been collected by means of the form application with 73 participants in 18 Basic Units of Health. The results show that the vaccines that had more produced events adverse had been tetravalente, BCG and DPT The events most frequent had been: fever, hiporresponsivo hipotonic episode, moderate irritability and local manifestations. Amongst the behaviors adopted for the health professionals, 80% had been approximately adjusted. The year minors had been accomitted by the events. All the events had evolved for the cure. It was concluded that the action of vaccination still continues requiring constant qualification of the professionals of the area. It is suggested to deepen the knowledge with relation to the handling, diagnosis, inquiry and treatment.

ObjectivesTo assess HIV-1 diversity, transmission dynamics and prevalence of transmitted drug resistance (TDR) in Angola, five years after ART scale-up.MethodsPopulation sequencing of the pol gene was performed on 139 plasma samples collected in 2009 from drug-naive HIV-1 infected individuals living in Luanda. HIV-1 subtypes were determined using phylogenetic analysis. Drug resistance mutations were identified using the Calibrated Population Resistance Tool (CPR). Transmission networks were determined using phylogenetic analysis of all Angolan sequences present in the databases. Evolutionary trends were determined by comparison with a similar survey performed in 2001.Results47.1% of the viruses were pure subtypes (all except B), 47.1% were recombinants and 5.8% were untypable. The prevalence of subtype A decreased significantly from 2001 to 2009 (40.0% to 10.8%, P = 0.0019) while the prevalence of unique recombinant forms (URFs) increased>2-fold (40.0% to 83.1%, P<0.0001). The most frequent URFs comprised untypable sequences with subtypes H (U/H, n = 7, 10.8%), A (U/A, n = 6, 9.2%) and G (G/U, n = 4, 6.2%). Newly identified U/H recombinants formed a highly supported monophyletic cluster suggesting a local and common origin. TDR mutation K103N was found in one (0.7%) patient (1.6% in 2001). Out of the 364 sequences sampled for transmission network analysis, 130 (35.7%) were part of a transmission network. Forty eight transmission clusters were identified; the majority (56.3%) comprised sequences sampled in 2008–2010 in Luanda which is consistent with a locally fuelled epidemic. Very low genetic distance was found in 27 transmission pairs sampled in the same year, suggesting recent transmission events.ConclusionsTransmission of drug resistant strains was still negligible in Luanda in 2009, five years after the scale-up of ART. The dominance of small and recent transmission clusters and the emergence of new URFs are consistent with a rising HIV-1 epidemics mainly driven by heterosexual transmission.

In Mozambique, the evaluation of retention in HIV care and ART programmes is limited. To assess rate and predictors of attrition (no retention in care) and HAART effectiveness in HIV-1 infected patients who pay for medication and laboratory testing in Mozambique, we conducted a multicenter survey of HIV-1-infected patients who started HAART during 2002–2006. Cox proportional hazard models were used to assess risk of attrition and of therapy failure. Overall, 142 patients from 16 healthcare centers located in the capital city Maputo were followed-up for 22.2 months (12.1–46.7). The retention rate was 75%, 48% and 37% after one, two and three years, respectively. Risk of attrition was lower in patients with higher baseline CD4 count (P = 0.022) and attending healthcare center 1 (HCC1) (P = 0.013). The proportion of individuals with CD4 count ≤200 cells/µL was 55% (78/142) at baseline and decreased to 6% (3/52) at 36 months. Among the patients with available VL, 86% (64/74) achieved undetectable VL levels. The rate of immunologic failure was 17.2% (95% CI: 12.6–22.9) per 100 person-years. Risk of failure was associated to higher baseline CD4 count (P = 0.002), likely reflecting low adherence levels, and decreased with baseline VL ≥10,000 copies/mL (P = 0.033). These results suggest that HAART can be effective in HIV-1 infected patients from Mozambique that pay for their medication and laboratory testing. Further studies are required to identify the causes for low retention rates in patients with low CD4 counts and to better understand the association between healthcare setting and attrition rate.

CONTEXT AND OBJECTIVE: The number of acquired immunodeficiency syndrome (AIDS)-related deaths covers different segments of the population differently, making monitoring of this mortality essential. The aim of this study was to describe the epidemiological situation of AIDS-related mortality in a municipality in the northeastern region of Brazil. DESIGN AND SETTING: Retrospective cross-sectional study based on data from death certificates in the mortality information system of the Health Information Center, Municipal Health Foundation, Brazil. METHODS: Between 2003 and 2013, we investigated death certificates on which AIDS-related mortality was reported. Sociodemographic data, year, place, type of establishment where death occurred and underlying and associated causes that led to AIDS-related death were described. The Mann-Kendall test was used to verify the growth trend of the standardized mortality rate over the period studied. RESULTS: Among the 1,066 AIDS-related deaths, 69.7% were among men; 47.2% of the individuals were 28-41 years of age, 32.7% had had 4-7 years of schooling, 66.9% were pardos (mixed race), 55.7% were unmarried and 15.3% were housekeepers. Hospitals were the site of 97% of the deaths, and 91% occurred at public hospitals. Respiratory failure was the main cause of death. The prevalence of infectious and parasitic diseases was 99.0%. AIDS-related mortality increased by 160% over the period studied, from 5.5/100,000 inhabitants in 2003 to 14.3/100,000 in 2013. CONCLUSION: In the Brazilian municipality studied here, AIDS-related mortality was most prevalent among men and young adults of lower socioeconomic level. Over the period studied, the mortality rate increased.

The investigation of an outbreak of cryptosporidiosis in a hospital day-care centre is reported. Twenty-eight (27%) children and one member of the staff were infected. Most of the cases were symptomatic and the major presenting symptom was watery diarrhoea. Shedding of oocysts continued for a mean of 12 days after diarrhoea had subsided and most of the cases were still excreting oocysts when the first follow-up sample was examined. Intermittent shedding or a carrier state were not seen in any of the cases. Giardia intestinalis cysts were detected in 19 children, 7 of whom showing mixed infection with Cryptosporidium sp., but this association was not statistically significant. All cases recovered without specific therapy. No definite proof could be found to demonstrate the source of the outbreak or the route of transmission but some observations suggesting person-to-person transmission are discussed.

931Nóbrega BSM, Oliveira JL, Almeida RO, Abdalla FTM, Nichiata LYI, Carvalho PMG. Prevention of sexually transmitted diseases by homosexual and bisexual women: a descriptive study. Online braz j nurs [Internet]. RESUMOObjetivos: identificar a percepção das mulheres homossexuais e bissexuais sobre a assistência nos serviços de saúde e as formas de prevenir as Doenças Sexualmente Transmissíveis (DST). Método: estudo exploratório, descritivo e qualitativo, realizado com nove mulheres homossexuais e bissexuais. Os dados foram coletados por meio de entrevista semiestruturada e tratados por análise temática. Resultados: Estas mulheres reconhecem a busca por assistência e cuidados com a saúde como fundamental. Tem conhecimento sobre as DST, desconhecem doenças relacionadas às relações homossexuais e utilizam métodos inadequados e improvisados de prevenção das DST. Discussão: mulheres homossexuais e bissexuais apresentam-se vulneráveis às DST e a outros agravos preveníveis. Conclusão: Os profissionais de saúde têm dificuldade em escutar e acolher de forma adequada estas mulheres. Propõe-se um diálogo entre os serviços de saúde e esta população para identificar necessidades de saúde e promover ações para prevenção de doenças e promoção da saúde.

A qualitative study aiming at understanding the socio-political aspects that mediate the implantation of the Transplant Center of Piauí, identify the social topics involved in this implantation and analyze the participation of the organized civil society. Ten people directly related to the implantation of the transplant center were involved in the study, selected through the "snowball" technique. A loosely structured interview, taped, transcribed and submitted for thematic analysis was used. It was concluded that the implantation of the transplant center in Piauí was the fruit of a complex series of negotiations and interests among the State and organized civil society, as there was no political project for action in the area of transplants. This distancing from the responsibility of the public sector characterizes the importance that was given to this implantation.

OBJETIVO: Analisar o comportamento sexual e a ocorrência de sífilis em estudantes da área da saúde de uma universidade pública do estado do Piauí. MÉTODO: Estudo epidemiológico, transversal, realizado no período de outubro de 2017 a fevereiro de 2018, com 357 estudantes universitários da área da saúde. Os dados foram coletados por meio de questionário, com perguntas fechadas e semiabertas, e teste rápido para Sífilis. Foram realizadas análises univariadas e bivariadas por meio da distribuição de frequências e teste exato de Fisher. Os dados foram analisados com o uso do Statistical Package for the Social Sciences. RESULTADOS: Verificou-se que 135 (37,8%) estudantes afirmaram não utilizar o preservativo em todas as relações sexuais; 200 (56,0%) foram classificados com comportamento sexual de risco; a frequência do uso de bebida alcoólica apresentou associação significativa com comportamento sexual de risco (p=0,001). Foram detectados 2 (0,6%) resultados reagentes para sífilis, ambos discentes do curso de Odontologia. CONCLUSÃO: Embora a ocorrência de sífilis nos estudantes tenha sido abaixo da esperada, a utilização de álcool previamente às relações sexuais pode comprometer práticas sexuais seguras.