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An update on vaccination in preterm infants
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Sadeck, Lilian dos Santos Rodrigues

; Kfouri, Renato de Ávila

Jornal de Pediatria

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Abr 2023, Volume 99 Supl. 1 Páginas S81 - S86

Resumo: En | Texto: En | PDF: En

Abstract Objective: The objective of this article is to review the most current literature on vaccines, focusing on their safety, immunogenicity, and efficacy in preterm newborns, aiming to improve vaccine coverage in this population. Data source: Most recent scientific publications addressing the immunization of preterm newborns. Data synthesis: Despite its immunological immaturity, vaccination is well tolerated by preterm infants, and protective immune responses are observed, but some studies have shown that preterm infants undergo unjustified delays in their vaccination schedule. Conclusions: Despite being widely recommended, the routine immunization of preterm infants is often delayed, putting this vulnerable population at risk for several diseases, many of which are preventable by immunization. Every effort should be made to develop universal guidelines that define the immunization of preterm infants. Objective vaccines safety immunogenicity newborns source synthesis immaturity observed schedule Conclusions recommended delayed diseases

https://doi.org/10.1016/j.jped.2022.12.004

Chronic medical conditions associated with invasive pneumococcal diseases in inpatients in teaching hospitals in São Paulo city: Estimating antimicrobial susceptibility and serotype-coverage of pneumococcal vaccines
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Kfouri, Renato A.

; Brandileone, Maria-Cristina C.

; Sáfadi, Marco Aurélio P.

; Richtmann, Rosana

; Gilio, Alfredo E.

; Rossi, Flavia

; Guimarães, Thais

; Bierrenbach, Ana Luiza

; Moraes, José C.

Brazilian Journal of Infectious Diseases

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2023, Volume 27 Nº 2 elocation 102746

Resumo: En | Texto: En | PDF: En

ABSTRACT Background: Chronic conditions increase the risk of invasive pneumococcal diseases (IPD). Pneumococcal vaccination remarkably reduced IPD morbimortality in vulnerable populations. In Brazil, pneumococcal vaccines are included in the National Immunization Program (PNI): PCV10 for < 2 years-old, and PPV23 for high risk-patients aged ≥ 2 years and institutionalized ≥ 60 years. PCV13 is available in private clinics and recommended in the PNI for individuals with certain underlying conditions. Methods: A retrospective study was performed using clinical data from all inpatients from five hospitals with IPD from 2016 to 2018 and the corresponding data on serotype and antimicrobial-non-susceptibility of pneumococcus. Vaccine-serotype-coverage was estimated. Patients were classified according to presence of comorbidities: healthy, without comorbidities; at-risk, included immunocompetent persons with specific medical conditions; high-risk, with immunocompromising conditions and others Results: 406 IPD cases were evaluated. Among 324 cases with information on medical conditions, children < 5 years were mostly healthy (55.9%), while presence of comorbidity prevailed in adults ≥ 18 years old (> 82.0%). Presence of ≥1 risk condition was reported in ≥ 34.8% of adults. High-risk conditions were more frequent than at-risk in all age groups. Among high-risk comorbidity (n = 211), cancer (28%), HIV/AIDS (25.7%) and hematological diseases (24.5%) were the most frequent. Among at-risk conditions (n = 89), asthma (16.5%) and diabetes (8.1%) were the most frequent. Among 404 isolates, 42.9% belonged to five serotypes: 19A (14.1%), 3 (8.7%), 6C (7.7%), 4 and 8 (6.2% each); 19A and 6C expressed antimicrobial-non-susceptibility. The vaccine-serotype-coverage was: PCV10, 19.1%, PCV13, 43.8%; PCV15, 47.8%; PCV20, 62.9%; PCV21, 65.8%, and PPV23, 67.3%. Information on hospital outcome was available for 283 patients, of which 28.6% died. Mortality was 54.2% for those with meningitis. Conclusion: Vaccine with expanded valence of serotypes is necessary to offer broad prevention to IPD. The present data contribute to pneumococcal vaccination public health policies for vulnerable patients, mainly those with comorbidity and the elderly.

https://doi.org/10.1016/j.bjid.2023.102746

Vaccination for meningococcal disease: Number 9 – September 2022
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Roteli-Martins, Cecilia Maria

; Neves, Nilma Antas

; Magno, Valentino Antonio

; Kfouri, Renato

Revista Brasileira de Ginecologia e Obstetrícia

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Set 2022, Volume 44 Nº 9 Páginas 901 - 905

Resumo: En | Texto: En | PDF: En

https://doi.org/10.1055/s-0042-1757755

Vaccines for COVID-19 - state of the art
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Lima, Eduardo Jorge da Fonseca

; Almeida, Amalia Mapurunga

; Kfouri, Renato de Ávila

Revista Brasileira de Saúde Materno Infantil

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Fev 2021, Volume 21 Supl. 1 Páginas 13 - 19

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

Resumo As vacinas candidatas contra COVID-19 têm diversas composições, desde vacinas de vírus inativados a várias de nova geração. Atualmente, cerca de 175 equipes de pesquisa em todo o mundo estão estudando diversas possibilidades, visto que a necessidade de vacinar toda a população contra o vírus SARS-CoV-2 é urgente. Embora o desenvolvimento de uma vacina COVID-19 segura e eficaz não seja fácil, a fabricação, distribuição e administração também podem enfrentar desafios extraordinários. Nesta revisão, destacamos alguns dos conhecimentos atuais sobre as fases dos ensaios clínicos de diferentes vacinas candidatas COVID-19, seus potenciais pontos fortes e desvantagens, e discutimos os aspectos éticos e suas chances de sucesso em aplicações em grande escala.

Abstract Vaccine candidates against COVID-19 have diverse compositions, from traditional inac-tivated virus vaccines to various new-generation vaccines. Currently, approximately 175 research teams worldwide are studying various vaccine possibilities as the necessityto vacci-nate the entire population against the SARS-CoV-2 virus is urgent. Although, the development of a safe and effective COVID-19 vaccine is not easy, the manufacturing, distribution, and administration of the vaccine can also face extraordinary challenges. In this review, we enhance some of the current knowledge regarding the clinical trial phases on different COVID-19 vaccine candidates, its potential strengths and disadvantages, and to discuss ethical aspects and their chances of success in large-scale applications.

https://doi.org/10.1590/1806-9304202100s100002 22728 downloads

Reflexões sobre o uso das vacinas para COVID-19 em crianças e adolescentes
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Lima, Eduardo Jorge da Fonseca

; Faria, Sônia Maria de

; Kfouri, Renato de Ávila

Epidemiologia e Serviços de Saúde

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2021, Volume 30 Nº 4 elocation e2021957

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

https://doi.org/10.1590/s1679-49742021000400028

Reflexões sobre o uso das vacinas para COVID-19 em crianças e adolescentes
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Lima, Eduardo Jorge da Fonseca

; Faria, Sônia Maria de

; Kfouri, Renato de Ávila

Epidemiologia e Serviços de Saúde

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2021, Volume 30 Nº 4 elocation e2021957

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

https://doi.org/10.1590/s1679-49742021000400028 1 downloads

Capsular genotype distribution of Group B Streptococcus colonization among at-risk pregnant women in Sao Paulo, Brazil.
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Kfouri, Renato de Ávila

; Pignatari, Antônio Carlos Campos

; Kusano, Elisa Junko Ura

; Rocchetti, Talita Trevizani

; Fonseca, Clara Lopes

; Weckx, Lily Yin

Brazilian Journal of Infectious Diseases

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2021, Volume 25 Nº 3 elocation 101586

Resumo: En | Texto: En | PDF: En

ABSTRACT Background: Vaccines in development against Group B Streptococcus (GBS) should contain the most prevalent capsular genotypes screened in the target population. In low- and middle-income countries epidemiological data on GBS carriage among pregnant women, a prerequisite condition for GBS neonatal sepsis, is needed to inform vaccine strategies. Objective: To investigate the prevalence of different GBS capsular genotypes that colonizes at-risk pregnant women in a private maternity hospital in São Paulo, Brazil. Methods: GBS strains isolated in routine maternity procedures from at-risk pregnant women from 2014 to 2018 were confirmed by mass spectrometry (MALDI-TOF) with subsequent DNA extraction for identification of capsular genotype through polymerase chain reaction (PCR). Demographic and gestational data were analyzed. Results: A total of 820 Todd-Hewitt broths positive for GBS were selected for streptococcal growth. Recovery and confirmation of GBS by MALDI-TOF were possible in 352. Strains were processed for determination of capsular genotype by PCR. From the total of 352 GBS isolates, 125 strains (35.5%) were genotyped as Ia; 23 (6.5%) as Ib; 41 (11.6%) as II; 36 (10.2%) as III; 4 (1.1%) as IV; 120 (34.1%) as V and 1 strain (0.3%) as VIII. Two isolates (0.7%) were not genotyped by used methodology. No statistically significant correlation between gestational risk factors, demographic data and distribution of capsular genotypes were found. Conclusions: GBS capsular genotypes Ia, Ib, II, III, and V were the most prevalent isolates colonizing at risk pregnant women in the present study. The inclusion of capsular genotypes Ia and V in the composition of future vaccines would cover 69.6% of capsular genotypes in the studied population. No statistically significant differences were observed between capsular genotype and gestational and demographic data and risk factors.

https://doi.org/10.1016/j.bjid.2021.101586 42 downloads

Vaccination in pregnant and postpartum women
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Lajos, Giuliane Jesus

; Fialho, Susana Cristina Aidé Viviani

; Kfouri, Renato de Ávila

; Robial, Renata

; Roteli-Martins, Cecília Maria

Revista Brasileira de Ginecologia e Obstetrícia

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Dez 2020, Volume 42 Nº 12 Páginas 851 - 855

Resumo: En | Texto: En | PDF: En

https://doi.org/10.1055/s-0040-1722522 313 downloads

Brazilian recommendations on the safety and effectiveness of the yellow fever vaccination in patients with chronic immune-mediated inflammatory diseases
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Pileggi, Gecilmara Salviato

; Mota, Licia Maria Henrique Da

; Kakehasi, Adriana Maria

; Souza, Alexandre Wagner De

; Rocha, Aline

; Melo, Ana Karla Guedes de

; Fonte, Caroline Araujo M. da

; Bortoletto, Cecilia

; Brenol, Claiton Viegas

; Marques, Claudia Diniz Lopes

; Zaltman, Cyrla

; Borba, Eduardo Ferreira

; Reis, Enio Ribeiro

; Freire, Eutilia Andrade Medeiros

; Klumb, Evandro Mendes

; Christopoulos, Georges Basile

; Laurindo, Ieda Maria M.

; Ballalai, Isabella

; Costa, Izaias Pereira Da

; Michelin, Lessandra

; Valadares, Lilian David de Azevêdo

; Chebli, Liliana Andrade

; Lacerda, Marcus

; Toscano, Maria Amazile Ferreira

; Yazbek, Michel Alexandre

; Vieira, Rejane Maria R. De Abreu

; Magalhães, Renata

; Kfouri, Renato

; Richtmann, Rosana

; Merenlender, Selma Da Costa Silva

; Valim, Valeria

; Assis, Marcos Renato De

; Kowalski, Sergio Candido

; Trevisani, Virginia Fernandes Moça

Advances in Rheumatology

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2019, Volume 59 elocation 17

Resumo: En | Texto: En | PDF: En

Abstract Background: In Brazil, we are facing an alarming epidemic scenario of Yellow fever (YF), which is reaching the most populous areas of the country in unvaccinated people. Vaccination is the only effective tool to prevent YF. In special situations, such as patients with chronic immune-mediated inflammatory diseases (CIMID), undergoing immunosuppressive therapy, as a higher risk of severe adverse events may occur, assessment of the risk-benefit ratio of the yellow fever vaccine (YFV) should be performed on an individual level. Main body of the abstract: Faced with the scarcity of specific orientation on YFV for this special group of patients, the Brazilian Rheumatology Society (BRS) endorsed a project aiming the development of individualized YFV recommendations for patients with CIMID, guided by questions addressed by both medical professionals and patients, followed an internationally validated methodology (GIN-McMaster Guideline Development). Firstly, a systematic review was carried out and an expert panel formed to take part of the decision process, comprising BRS clinical practitioners, as well as individuals from the Brazilian Dermatology Society (BDS), Brazilian Inflammatory Bowel Diseases Study Group (GEDIIB), and specialists on infectious diseases and vaccination (from Tropical Medicine, Infectious Diseases and Immunizations National Societies); in addition, two representatives of patient groups were included as members of the panel. When the quality of the evidence was low or there was a lack of evidence to determine the recommendations, the decisions were based on the expert opinion panel and a Delphi approach was performed. A recommendation was accepted upon achieving ≥80% agreement among the panel, including the patient representatives. As a result, eight recommendations were developed regarding the safety of YFV in patients with CIMID, considering the immunosuppression degree conferred by the treatment used. It was not possible to establish recommendations on the effectiveness of YFV in these patients as there is no consistent evidence to support these recommendations. Conclusion: This paper approaches a real need, assessed by clinicians and patient care groups, to address specific questions on the management of YFV in patients with CIMID living or traveling to YF endemic areas, involving specialists from many areas together with patients, and might have global applicability, contributing to and supporting vaccination practices. We recommended a shared decision-making approach on taking or not the YFV.

https://doi.org/10.1186/s42358-019-0056-x 1111 downloads

10.

Vacinação contra o vírus influenza em gestantes: cobertura da vacinação e fatores associados
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Kfouri, Renato de Ávila

; Richtmann, Rosana

einstein (São Paulo)

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Mar 2013, Volume 11 Nº 1 Páginas 53 - 57

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

OBJETIVO: Descrever a cobertura vacinal de gestantes para influenza e fatores associados à recusa ou à aceitação da vacina. MÉTODOS: Estudo descritivo, prospectivo, que incluiu 300 puérperas atendidas no Hospital e Maternidade Santa Joana (SP). Os dados foram coletados em outubro de 2010, por meio de questionário pré-testado, aplicado por profissional treinado. RESULTADOS: A média de idade das mães foi 30,5 anos; 231 (77%) eram casadas; 164 (54,7%) primigestas; 192 (64%) tinham nível superior de escolaridade; e 240 (80%) estavam empregadas. Durante o pré-natal, 234 (78%) receberam informação sobre a vacina contra influenza e 287 (95,7%) foram imunizadas; 210 (73,2%) mulheres tinham conhecimento sobre a proteção neonatal pela vacinação materna. Fatores associados à aceitação foram: campanha do governo (133; 44,3%) e recomendação médica durante o pré-natal (163; 54,3%). Entre as 13 grávidas que recusaram a vacinação, as razões foram: negligência (4), falta de tempo (4), falta de indicação médica (3) ou contraindicação pelo médico (2), mas 69,2% teriam sido vacinadas se tivessem sido informadas sobre a proteção neonatal. CONCLUSÃO: O receio da pandemia e a campanha pública tiveram importante impacto na elevada cobertura vacinal para influenza em gestantes. Recomendação médica e campanha do governo foram os principais motivos de aceitação da vacina.

OBJECTIVES: To describe the immunization coverage of the influenza vaccine for pregnant women, and factors associated to vaccination compliance. METHODS: This is a prospective, descriptive study including 300 women who had just given birth at Hospital and Maternity Santa Joana in Sao Paulo, Brazil. Data were collected through a pre-tested questionnaire applied by a trained evaluator during October 2010. RESULTS: The mean age of mothers was 30.5 years; 231 (77%) were married; 164 (54.7%) were primigravidas; 192 (64%) had higher education; and 240 (80%) were employed. During the prenatal period, 234 (78%) received information about the influenza vaccine and 287 (95.7%) were immunized; 210 (73.2%) women knew about neonatal protection achieved through maternal vaccination. The factors associated with maternal acceptance of the vaccine were government campaign (133; 44.3%), and medical recommendation during prenatal visits (163; 54.3%). A total of 13 pregnant women refused vaccination for the following reasons: neglect (4), lack of time (4), lack of recommendation from their physician (3) or contraindication by physician (2), but 69.2% of them would have accepted immunization had they been informed about neonatal protection. CONCLUSIONS: The fear of a pandemic and the public vaccination campaign had an important impact on the high immunization coverage for influenza on pregnant women. Medical recommendation and the government campaign were the main reasons for vaccine compliance.

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