Objetivo analisar a situação vacinal de pessoas com diabetes mellitus tipos 1 e 2 na Atenção Primária à Saúde. Método estudo transversal, analítico, realizado em 25 equipes de Saúde da Família com 274 pessoas com diabetes. Foram avaliadas as variáveis sociodemográficas e clínicas e esquema vacinal completo para cada vacina recomendada pelo Programa Nacional de Imunizações, por meio de análise bivariada e regressão logística. Resultados das pessoas com diabetes mellitus, 69,1% não tinham esquema vacinal completo contra hepatite B; 64,6%, contra difteria e tétano; 74,3%, contra febre amarela; 87,9%, contra pneumococo; 87,9%, contra varicela; 24,5%, contra influenza; e 0,7%, contra a covid-19. Entre os motivos referidos para o esquema incompleto, estão não conhecer a importância de vacinar e não ser informado por profissional de saúde. Houve associação estatística significativa entre o perfil sociodemográfico e clínico em relação ao esquema vacinal completo da vacina da influenza e a idade e renda; covid-19 e idade, tipo de diabetes e tempo convivendo com o diabetes. Conclusão pessoas com diabetes mellitus tipos 1 e 2 apresentaram baixa completude vacinal no contexto da Atenção Primária à Saúde, o que é preocupante devido à situação de maior vulnerabilidade a infecções imunopreveníveis e mortalidade nesse grupo.

Objective to analyze the vaccination status of individuals with type 1 and type 2 diabetes in Primary Healthcare. Method cross-sectional, analytical study conducted in 25 Family Health teams with 274 individuals with diabetes. Sociodemographic and clinical variables were evaluated, as well as the full vaccination schedule for each vaccine recommended by the National Immunization Program, through bivariate analysis and logistic regression. Results among individuals with diabetes mellitus, the following incomplete vaccination rates were found: 69.1% for hepatitis B; 64.6% for diphtheria and tetanus; 74.3% for yellow fever; 87.9% for pneumococcus; 87.9% for varicella; 24.5% for influenza; and 0.7% for COVID-19. The reported reasons for low vaccination rates included not knowing the importance of vaccination and not being informed by healthcare providers. A statistically significant association was found between sociodemographic and clinical profile regarding the full vaccination schedule between the influenza vaccine and age and income; COVID-19 and age, type of diabetes and duration of diabetes. Conclusion individuals with type 1 and type 2 diabetes treated in Primary Healthcare showed low vaccination rates, which is concerning due to increased vulnerability to vaccine-preventable infections and mortality within this group.

Objetivo analizar la situación vacunal de personas con diabetes mellitus tipos 1 y 2 en la atención primaria de salud. Método estudio transversal, analítico, realizado en 25 equipos de Salud de la Familia con 274 personas con diabetes. Se evaluaron las variables sociodemográficas, clínicas y el esquema vacunal completo para cada vacuna recomendada por el Programa Nacional de Inmunizaciones mediante un análisis bivariado y regresión logística. Resultados de las personas con diabetes mellitus, el 69,1% no contaba con el esquema vacunal completo contra la hepatitis B; el 64,6% contra la difteria y el tétanos; el 74,3% contra la fiebre amarilla; el 87,9% contra el neumococo; el 87,9% contra la varicela; el 24,5% contra influenza y el 0,7% contra la COVID-19. Entre los motivos aludidos para el esquema vacunal incompleto, figuran no conocer la importancia de vacunarse y no haber sido informado por el profesional de la salud. Hubo asociación estáticamente significante entre el perfil sociodemográfico y clínico con relación al esquema vacunal completo entre la vacuna contra la influenza y la edad y los ingresos; COVID-19 y edad, tipo de diabetes y tiempo viviendo con diabetes. Conclusión las personas con diabetes mellitus tipos 1 y 2 presentaron baja completitud de las vacunas en el contexto de la Atención Primaria de Salud, lo que es preocupante debido a la situación de mayor vulnerabilidad a infecciones inmunoprevenibles y mortalidad en este grupo.

Abstract Influenza viruses cause 3-5 million severe cases and 300,000-600,000 deaths worldwide. Most of the disease burden is in Low- and Middle-Income Countries (LMICs) owing to factors such as high population density, infrastructure challenges, poor quality healthcare, lack of consistent recommendations, less prioritization of all high-risk groups, and prevalent use of trivalent influenza vaccines. Although influenza vaccines are effective in reducing the annual influenza disease burden, existing vaccines have several limitations. In this narrative review, we address the unmet needs of existing influenza vaccines in LMICs in Africa, Asia Pacific, Latin America and the Middle East and discuss the characteristics of novel vaccines in clinical development. We also describe features of a successful vaccination program that LMICs could emulate to improve their current vaccination coverage and reduce the public health burden of influenza.

Resumen Introducción: Siendo la cuarta causa de muerte a nivel mundial, las infecciones respiratorias agudas representan una carga importante para los sistemas de salud. Después de la pandemia de SARS-CoV-2, era necesario estudiar su etiología. El objetivo es identificar los microorganismos asociados a las infecciones respiratorias agudas registradas en un hospital privado del país. Metodología: Estudio descriptivo de corte transversal utilizando los resultados del BioFire ® FilmArray ® Pneumonia panel en el periodo entre el 1 de enero 2022 al 30 de junio 2023, donde fueron seleccionadas 294 muestras positivas por muestreo no probabilístico por conveniencia. Resultados: El 58,5% de las muestras fue del sexo masculino, con un rango medio de 48,0 años. Los grupos etarios con mayor porcentaje fueron < 5 años 39,1% (n=115) y > 60 años 20,7%. La mayoría de las muestras fueron tomadas mediante hisopado nasofaríngeo 78,9%. Los agentes más frecuentemente identificados fueron el rinovirus/enterovirus humano 30,6%, seguido de parainfluenza 12,6%, adenovirus 12,3%, virus sincitial respiratorio 10,9%, SARS-CoV-2 10,5% e influenza A 10,2%. Conclusión: La mayoría de las infecciones se dieron en los extremos de edad, lo que sugiere que pueden ser grupos más vulnerables y necesitar de un hospital. Los hallazgos de este estudio enfatizan en la importancia de las medidas de prevención para reducir la transmisión de infecciones respiratorias.

Abstract Introduction: Acute respiratory infections represent a global burden for health systems, currently the fourth leading cause of death worldwide. After the SARS-CoV-2 pandemic, it was necessary to study its etiology. The objective is to identify microorganisms associated with acute respiratory infections registered in a private hospital in the country. Methodology: A descriptive cross-sectional study was conducted by gathering data between January 2022 and June 2023 from the BioFire ® FilmArray ® Pneumonia panel, where 294 positive samples were selected by non-probabilistic convenience sampling. Results: Among the samples analyzed, 58.5% were from male individuals, with a midrange of 48 years. The age groups with the highest frequency were < 5 years 39.1% and > 60 years 20.7%. Most samples were taken by nasopharyngeal swab 78.9%. The most identified microorganisms were human rhinovirus/enterovirus detected in 30.6%, followed by parainfluenza 12.6%, adenovirus 12.3%, respiratory syncytial virus 10.9%, SARS-CoV-2 10.5% and influenza A 10.2%. Conclusion: Most of the infections occurred at the extremes of age, which suggests the vulnerability of these groups and the need for hospital care. The study’s results emphasize the importance of preventive measures to reduce the transmission of respiratory infections.

Resumen La miositis benigna de la infancia es un cuadro in flamatorio, asociado a infecciones virales respiratorias, autolimitado que no deja secuelas. Afecta principal mente a varones en edad escolar, durante los meses de invierno. Puede asociarse a virus influenza A y B, VRS, Mycoplasma pneumoniae, entre otros. En el mes de septiembre de 2022 se generó una alerta epidemioló gica por el elevado número de casos reportados en el área metropolitana de Buenos Aires. Presentamos los casos de dos adolescentes mujeres de 10 y 14 años con este cuadro asociado a influenza B. El tratamiento y el seguimiento fueron diferentes en base a la clínica y el laboratorio. Hay que tener en cuenta esta entidad como un diagnóstico diferencial de mialgias de miembros infe riores, dificultad en la marcha e impotencia funcional. Es necesario establecer las pautas de manejo según clínica y laboratorio. La búsqueda de virus respiratorios, prin cipalmente influenza, debe hacerse teniendo en cuenta la epidemiología local.

Abstract Benign childhood myositis is a self-limiting in flammatory condition that primarily affects school-aged boys during the winter months. It is associated with respiratory viral infections, such as influenza A and B viruses, respiratory syncytial virus (RSV), and Mycoplasma pneumoniae, among others. In September 2022, an epidemiological alert was raised due to a high number of reported cases in the metropolitan area of Buenos Aires. We present two cases of female adolescents, aged 10 and 14 years, who developed this condition in association with influenza B virus infec tion. Their treatment and follow-up differed based on their clinical presentation and laboratory findings. This entity should be considered in the differential diagnosis of lower limb myalgia, difficulty walking, and functional impotence. It is necessary to establish management guidelines according to the clinic and laboratory. The search for respiratory viruses, mainly influenza, should be done taking into account the lo cal epidemiology.

Resumen Introducción: Las infecciones respiratorias son las enfermedades respiratorias con mayor mortalidad en el mundo. Las causadas por Streptococcus pneumoniae, virus de influenza, Bordetella pertussis, SARS-CoV-2 y el Virus Sincitial Respiratorio, cuentan hoy día con vacunas seguras y efectivas. Este documento representa una guía de práctica clínica (GPC) de la Asociación Latinoamericana de Tórax (ALAT), elaborada por iniciativa de los departamentos de enfermedades infecciosas y pediatría, con el objetivo de establecer recomendaciones sobre vacunas respiratorias, utilizando la evidencia disponible. Método: Se estableció un grupo de desarrollo de las guías conformado por cinco médicos responsables globales del proyecto, se crearon cinco subgrupos de trabajo, uno por cada vacuna, con expertos neumólogos de adulto, pediatras e infectólogos invitados, que generaron preguntas clínicas. Se trabajó con un grupo de expertos metodólogos que transformaron preguntas clínicas en preguntas PICO, seleccionándose nueve preguntas por método DELPHI. Luego, se utilizó el sistema GRADE (Grading of Recom-mendations Assessment, Development and Evaluation) para evaluar la evidencia disponible. Resultados: Se obtuvieron recomendaciones para población adulta y pediátrica de las vacunas de neumococo, influenza, tos ferina, COVID-19 y Virus Respiratorio Sincitial basadas en preguntas PICO. También se agregaron recomendaciones basadas en preguntas narrativas relacionadas al uso de vacunas respiratorias en población con enfermedades respiratorias crónicas como asma, EPOC y fibrosis pulmonar.

Abstract Introduction: Respiratory infections are the leading cause of respiratory disease-rela-ted mortality worldwide. Infections caused by Streptococcus pneumoníae, influenza virus, Bordetella pertussis, SARS-CoV-2 and Respiratory Syncytial Virus (RSV) now ha-ve safe and effective vaccines available. This document represents a Clinical Practice Guideline (CPG) by the Latin American Thoracic Association (ALAT), developed through the initiative of the departments of in-fectious diseases and pediatrics, with the goal of establishing recommendations on respiratory vaccines using the available evidence. Method: A guideline development group was established, composed of five lead physi-cians responsible for the overall project. Five working subgroups were created, one for each vaccine, involving invited experts in adult pulmonology, pediatrics, and infectious diseases, who formulated clinical questions. A group of expert methodologists then transformed these clinical questions into PICO questions, with nine questions selec-ted using the DELPHI method. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was then used to assess the available evidence. Results: Recommendations were obtained for the adult and pediatric populations for pneumococcal, influenza, pertussis, COVID-19 and Respiratory Syncytial Virus vaccines based on PICO questions. Additionally, recommendations based on narrative questions related to the use of respiratory vaccines in populations with chronic respiratory diseases such as asthma, COPD, and pulmonary fibrosis were included.

Resumen Este texto analiza, desde la perspectiva del framing, la forma en que los periódicos enmarcaron la “influenza española” que padecieron los habitantes de Chiapas en 1918. Se encontró que en un principio trataron de minimizar la letalidad de la enfermedad, pero cuando los fallecidos incrementaron y se comprobó la gravedad de la situación, destacaron las medidas dictadas por las autoridades políticas y sanitarias, la solidaridad generada y, de forma marginal, las consecuencias económicas. El frame que más se empleó fue de interés humano, seguido por el de soluciones/recomendaciones y de atribución de responsabilidad, en un contexto en el que Chiapas vivía enfrentamientos militares, aunque ya disminuidos, de la Revolución mexicana.

Abstract This text analyzes, from the perspective of framing, how newspapers framed the “Spanish influenza” suffered by the inhabitants of Chiapas in 1918. It was found that initially, they tried to minimize the lethality of the disease, but when the deceased increased and was verified the seriousness of the situation, they highlighted the measures dictated by political and health authorities, the generated solidarity, and marginally the economic consequences. The most frequently used frame was human interest, followed by solutions/recommendations and attribution of responsibility, in a context where Chiapas was experiencing military conflicts, eventho these had already decreased, from the Mexican Revolution.

RESUMEN Introducción: La Vigilancia Centinela de las Infecciones Respiratorias Agudas Graves (IRAG) incluye el monitoreo y caracterización de casos hospitalizados. Objetivo: Describir las características clínico-epidemiológicas y agentes etiológicos de los adultos con IRAG en un hospital centinela en Paraguay. Metodología: Estudio observacional, descriptivo, de corte transversal, con recolección de datos retrospectivos de los pacientes adultos con IRAG hospitalizados en el Hospital Nacional de Itauguá entre junio de 2022 a agosto de 2023. La información se tomó de la base de datos del Sistema Nacional de Vigilancia Epidemiológica. Resultados: Se analizaron los datos de 1598 pacientes con IRAG, 820 varones (51,3%), 875 (54,8%) con 60 o más años, 1054 (66,0%) del departamento Central. El 79.2% (n=1265) de los pacientes presentaba algún factor de riesgo de gravedad o comorbilidad, 764 (47,8%) con hipertensión arterial. El 38.5% (n=632) fue admitido a UCI y la mortalidad fue de 34,7% (n=554). En el 13,8% (n=353) se confirmó SARSCoV-2, rhinovirus (1,7%), influenza A (1,5%), influenza B (0,6%), parainfluenza 3 (0,6%), VSR (0,2%), bocavirus (0,4%) e influenza AH1N1 (0,6%). Hubo significativamente mayor frecuencia de fallecidos en los de 60 años y más (40,7%), con algún factor de riesgo de gravedad (35,5% vs 25,9%) y en los confirmados con COVID-19 (38,2% vs 30,5%). Discusión: SARSCoV-2 sigue siendo el agente etiológico principal de las IRAG. El conocimiento de la epidemiología y los agentes virales es crucial para desarrollar estrategias de prevención y terapéuticas efectivas.

ABSTRACT Introduction: Sentinel Surveillance of Severe Acute Respiratory Infections (SARI) includes the monitoring and characterization of hospitalized cases. Objective: To describe the clinical-epidemiological characteristics and etiological agents of adults with SARI in a sentinel hospital in Paraguay. Methodology: Observational, descriptive, cross-sectional study, with retrospective data collection, of adult patients with SARI hospitalized at the National Hospital of Itauguá between June 2022 and August 2023. The information was taken from the database of the National System of Epidemiological surveillance. Results: The data of 1598 patients with SARI were analyzed, 820 men (51.3%), 875 (54.8%) aged 60 or older, 1054 (66.0%) from the Central department. 79.2% (n=1265) of patients had some risk factor or comorbidity, 764 with hypertension (47.8%). 38.5% (n=632) were admitted to the ICU and mortality was 34.7% (n=554). SARSCoV-2 was confirmed in 13.8% (n=353), rhinovirus (1.7%), influenza A (1.5%), influenza B (0.6%), parainfluenza 3 (0.6%), RSV (0.2%), bocavirus (0.4%) and Influenza AH1N1 (0.6%). There was a significantly higher frequency of deaths in those aged 60 years and over (40.7%), with some risk factor (35.5% vs 25.9%), and in those confirmed with covid-19 (38.2% % vs 30.5%). Discussion: SARSCoV-2 continues to be the main etiological agent of SARI in a sentinel hospital in Paraguay. Continued knowledge of the epidemiology and viral agents involved is crucial to developing effective prevention and treatment strategies.

Abstract There is currently a sensitive epidemiological moment in the country. There have been cases of patients with influenza who have died from pneumonia caused by superinfection of the Streptococcus pyogenes bacterium. There has been talk in the different media about a "new bacterium" and a "killer bacterium" or "flesh eating bacterium". Documentary evidence is presented of the presence of pneumonic symptoms superinfected by S. pyogenes in 1873 in Chile. The suitability of such terms is discussed in some depth, specially, the concepts of bacterial species, clone and related.

Resumen Se cursa actualmente un momento epidemiológico sensible en el país. Han aparecido casos de pacientes con influenza que han fallecido por neumonía causada por la sobreinfección de la bacteria Streptococcus pyogenes. Se ha hablado en los diferentes medios de prensa de una "nueva bacteria" y de una "bacteria asesina" o "come carne". Se presenta evidencia documental de la presencia de cuadros neumónicos sobreinfectados por S. pyogenes en 1873 en Chile. Se discute además sobre la idoneidad de tales términos, profundizando en los conceptos de especie bacteriana, clon y otros relacionados.

ABSTRACT Introduction: Acute benign myositis of childhood (ABIM) is an inflammatory pathology of the musculoskeletal system, it usually manifests with pain in the lower limbs associated with elevation of creatine phosphokinase (CPK). It is a rare condition, but if it occurs, it appears after a flu case, frequently associated with influenza A and B viruses. Clinical Case: The case of a school-age girl with myalgia in lower limbs, fever and elevated CPK, diagnosed with MABI, with positive IgG to Bartonella henselae. Conclusions: It is considered important to report the case due to the little information available about this disease both in the country and in Latin America, in addition, to review the issue since there are no previous reports in Peru about Bartonella henselae as the etiological agent of MABI; Likewise, discuss management and how to reduce unnecessary hospitalizations.

RESUMEN Introducción: La miositis aguda benigna de la infancia (MABI) es una patología inflamatoria del sistema músculo esquelético, suele manifestarse con dolor en miembros inferiores asociado a elevación de creatina fosfoquinasa (CPK). Es una afección poco frecuente, pero de presentarse, aparece posterior a un cuadro gripal, asociado frecuentemente al virus influenza A y B. Caso Clínico: Se presenta el caso de una niña en edad escolar con mialgia en miembros inferiores, fiebre y elevación de CPK, diagnosticada con MABI, con IgG positiva para Bartonella henselae. Conclusiones: Se considera importante reportar el caso debido a la poca información que se tiene acerca de esta enfermedad tanto en el país como en Latinoamérica, además, revisar el tema ya que no hay reportes previos en Perú acerca de la Bartonella henselae como agente etiológico de MABI; asimismo, discutir acerca del manejo y cómo disminuir las hospitalizaciones innecesarias.

RESUMEN Objetivo: Determinar el comportamiento y evaluar las tendencias de atención médica de las enfermedades tipo influenza (ETI) dentro del sistema de salud peruano durante el periodo 2018-2022. Materiales y métodos: Estudio de tipo observacional, de diseño descriptivo y retrospectivo, el cual analizó el comportamiento de las atenciones por enfermedades tipo influenza en el Perú. Para ello se utilizó la base de datos abierta de la Superintendencia Nacional de Salud (Susalud). Las variables incluidas fueron diagnóstico CIE-10 compatible con ETI, grupos de edades, sexo, lugar y periodo de atención. El análisis estadístico se obtuvo mediante Microsoft Excel 365 y Stata v.18.0. Resultados: Durante el periodo 2018-2022, las ETI generaron, en los servicios ambulatorios, un promedio de 2 576 325 atenciones por año (rango: 1 790 821-3 710 299), las cuales representaron el 4,9 % del total de atenciones ambulatorias en el sistema de salud peruano. El 50 % de las atenciones ambulatorias por ETI se realizaron dentro de los servicios pertenecientes al Ministerio de Salud (Minsa); por su parte, el 51 % de las visitas a emergencias se realizaron en los servicios pertenecientes al Seguro Social de Salud (EsSalud). En los servicios de emergencias se registraron 1 077 584 visitas por año (rango: 312 306-1 644 758), que se codificaron según la Clasificación Internacional de Enfermedades, versión 10 (CIE-10), lo que equivalió al 15 % de todas las causas atendidas en estos servicios; mientras que en los servicios de hospitalización se reportaron 56 587 hospitalizaciones por año (rango: 46 338-67 233), las cuales representaron el 2,9 % de todas las causas de hospitalización dentro del sistema de salud del Perú. El 60,6 % de las hospitalizaciones de pacientes con ETI se realizaron en los servicios pertenecientes al Minsa. Conclusiones: En el sistema de salud peruano, cada año las ETI representan un problema frecuente que requiere de atención médica; los servicios de salud brindados por el Minsa y EsSalud son los más solicitados.

ABSTRACT Objective: To determine the behavior and healthcare trends of influenza-like illnesses (ILIs) in the Peruvian health system from 2018 to 2022. Materials and methods: An observational, descriptive, retrospective study which analyzed the behavior of healthcare visits for ILIs in Peru, using the open database of the Superintendencia Nacional de Salud (SUSALUD National Superintendency of Health). The variables included diagnoses compatible with ILIs according to the International Classification of Diseases, 10th Revision (ICD-10), age groups, sex, location and time of care. The statistical analysis was performed using Microsoft Excel 365 and Stata 18. Results: Between 2018 and 2022, ILIs generated an average of 2,576,325 outpatient visits per year (range: 1,790,821-3,710,299), which accounted for 4.9 % of all outpatient visits in the Peruvian health system. Fifty percent of outpatient visits for ILIs occurred at the Ministry of Health (MINSA) services; in contrast, 51 % of emergency visits for ILIs occurred at the Seguro Social de Salud (EsSalud Social Security Health Insurance) services. Emergency services recorded 1,077,584 visits annually (range: 312,306-1,644,758), coded according to ICD-10, which accounted for 15 % of all causes treated in these services. Meanwhile, hospitalization services reported 56,587 hospitalizations per year (range: 46,338-67,233), representing 2.9 % of all hospitalizations in the Peruvian health system, where 60.6 % of ILI-related hospitalizations were in MINSA’s services. Conclusions: In the Peruvian health system, ILIs pose a recurrent healthcare problem each year, with the health services of MINSA and EsSalud being the most in demand.

RESUMEN Introducción: La miositis aguda benigna de la infancia (MABI) es una patología inflamatoria del sistema músculo esquelético, suele manifestarse con dolor en miembros inferiores asociado a elevación de creatina fosfoquinasa (CPK). Es una afección poco frecuente, pero de presentarse, aparece posterior a un cuadro gripal, asociado frecuentemente al virus influenza A y B. Caso Clínico: Se presenta el caso de una niña en edad escolar con mialgia en miembros inferiores, fiebre y elevación de CPK, diagnosticada con MABI, con IgG positiva para Bartonella henselae. Conclusiones: Se considera importante reportar el caso debido a la poca información que se tiene acerca de esta enfermedad tanto en el país como en Latinoamérica, además, revisar el tema ya que no hay reportes previos en Perú acerca de la Bartonella henselae como agente etiológico de MABI; asimismo, discutir acerca del manejo y cómo disminuir las hospitalizaciones innecesarias.

ABSTRACT Introduction: Acute benign myositis of childhood (ABIM) is an inflammatory pathology of the musculoskeletal system, it usually manifests with pain in the lower limbs associated with elevation of creatine phosphokinase (CPK). It is a rare condition, but if it occurs, it appears after a flu case, frequently associated with influenza A and B viruses. Clinical Case: The case of a school-age girl with myalgia in lower limbs, fever and elevated CPK, diagnosed with MABI, with positive IgG to Bartonella henselae. Conclusions: It is considered important to report the case due to the little information available about this disease both in the country and in Latin America, in addition, to review the issue since there are no previous reports in Peru about Bartonella henselae as the etiological agent of MABI; Likewise, discuss management and how to reduce unnecessary hospitalizations.

RESUMO Introdução: A Gripe é uma ameaça global, com alto potencial epidémico e afeta anualmente entre 5 a 15% da população mundial. No ambiente hospitalar, a vacinação é crucial para proteger os Profissionais de Saúde. No entanto, apesar das recomendações internacionais, a adesão é baixa devido a preocupações de segurança e/ou desconfiança. Estudos mostram que os profissionais vacinados têm menores taxas de absentismo e, perante infeção pelo vírus, apresentam sintomatologia mais ligeira. Neste trabalho é realizado um estudo observacional transversal retrospetivo da taxa de vacinação contra esta doença numa população de trabalhadores de base hospitalar, no período de 2019 a 2023. Para compreender a importância da vacinação contra a Influenza nestes trabalhadores e quais os determinantes comportamentais que podem justificar esta evolução, realizou-se uma revisão dos desafios da vacinação entre Profissionais de Saúde, para identificar pontos chave e elaborar estratégias com o objetivo de promover a adesão às campanhas de vacinação. Metodologia: Para o estudo observacional da taxa de adesão à vacinação contra a Gripe num hospital periférico foram utilizados os dados de vacinação dos Profissionais de Saúde disponibilizados nos registos do Serviço de Saúde Ocupacional. A categoria profissional foi a única variável considerada. A análise dos dados foi realizada com o Microsoft® Excel®. Para a revisão recorreu-se às bases de dados Medline, Science Direct, Google Scholar; com as palavras-chave "Influenza vaccine”; “health professional” e “behaviour" e filtraram-se estudos de 2010 a 2024. Resultaram 1277 trabalhos e, após aplicar os critérios de exclusão, que incluíam vacinação para outras doenças e populações alvo que não os Profissionais de Saúde, foram selecionadas 22 fontes bibliográficas. Para espelhar a realidade nacional foram incluídos os artigos sobre o tema publicados pela Revista Portuguesa de Saúde Ocupacional Online, assim como estudos complementares e documentos de referência. Resultados: O estudo da adesão à vacinação contra a Gripe neste hospital periférico a Lisboa, entre 2019 e 2023, mostrou uma variação na adesão à vacinação, com uma média de 30%, valor abaixo dos valores reportados noutros países. As categorias com maior hesitação a esta vacina foram o Pessoal de Enfermagem e os Assistentes Técnicos. Na situação oposta estavam o Pessoal Médico e os Assistentes Técnicos. Durante a Pandemia COVID-19 existiu um número crescente de profissionais vacinados anualmente, tendo esta tendência invertido após o fim da emergência global desta doença. Da revisão da bibliografia sobre a hesitação vacinal destaca-se 8 dos 14 domínios comportamentais que representam as teorias de mudança comportamental que constituem fatores modificáveis que influenciam a atitude em relação à vacina. Abordou-se sobre esta perspetiva cada um deles, nomeadamente, o conhecimento; o contexto ambiental e recursos; influência social; crenças e conhecimento sobre consequências; bem como sobre a capacidade individual; identidade e papel social/profissional; reforço e emoção. Discussão: A hesitação vacinal contra a Gripe entre Profissionais de Saúde pode ser uma causa de morbilidade e mortalidade para os doentes. Compreender as barreiras e motivação para a adesão dos Profissionais de Saúde às campanhas de vacinação contra a Gripe é crucial. Profissionais portadores assintomáticos, tornam-se fontes de transmissão. A vacinação anual, embora segura e eficaz, enfrenta variabilidade devido à concordância antigénica. Em Portugal, estratégias educacionais e de comunicação são vitais, destacando o papel dos Profissionais de Saúde como modelos de comportamento preventivo. O acesso fácil a consultas médicas e tal ser recomendado pela Saúde Ocupacional é associado a maior adesão. Em tempos de pandemia, a propensão à vacinação aumentou, importando promover esta mudança. Estratégias adaptadas ao contexto cultural são essenciais para impulsionar a adesão à vacinação contra a Gripe entre Profissionais de Saúde. Conclusão: A abordagem para combater as barreiras e promover a vacinação nos Profissionais de Saúde deve envolver múltiplas áreas e vários níveis, com uma comunicação dirigida a grupos específicos, para aumentar a sua eficácia. Deve adaptar-se a mensagem aos diferentes grupos populacionais e aos diferentes níveis de literacia em saúde. Conhecer estes determinantes comportamentais pode ajudar a desenvolver campanhas de promoção da vacinação a partir de novas perspetivas e encontrar estratégias para aumentar a cobertura vacinal é crucial para os Serviços de Saúde Ocupacional. Pelas características éticas das profissões envolvidas na prestação de cuidados diretos aos doentes, existe a necessidade de reforçar a ideia de que a vacinação entre Profissionais de Saúde não é apenas para seu benefício mas, acima de tudo, para proteção dos seus doentes.

ABSTRACT Introduction: Influenza is a global threat, with high epidemic potential and affects between 5 and 15% of the world's population annually. In the hospital environment, vaccination is crucial to protect healthcare professionals. However, despite international recommendations, vaccination uptake is low due to safety concerns and/or distrust. Studies show that vaccinated professionals have lower rates of absenteeism, and when infected with the virus, they present milder symptoms. In this work, a retrospective cross-sectional observational study is carried out on the vaccination rate against this disease in a population of hospital-based workers, from 2019 to 2023. To understand the importance of vaccination against Influenza in these workers and which behavioral determinants may justify considering this evolution, we carried out a review of the challenges of vaccination among health professionals and identified key points to develop strategies with the aim of promoting adherence to vaccination campaigns. Methodology: For the observational study, vaccination data from hospital health professionals by the Occupational Health Service was used, recorded on a specific form at the time of administration. Professional category was the only variable considered. Data analysis was performed using Microsoft® Excel®. For the review, the databases Medline, Science Direct and Google Scholar were used, with the keywords "Influenza vaccine”, “health professional” and “behaviour”, selecting studies from 2010 to 2024. From the result of 1277 works, the exclusion criteria, which included vaccination for other diseases and target populations that did not include health professionals, 22 bibliographic sources were selected. To reflect the national reality, articles on the topic published by the Revista Portuguesa de Saúde Ocupacional Online were included, as well as complementary studies and reference documents. Results: The study of adherence to flu vaccination in this hospital peripheral to Lisbon, between 2019 and 2023, showed a variation in vaccination adherence, with an average of 30%, a value below the ones reported in other countries. The categories most hesitant about this vaccine were Nursing Staff and Technical Assistants; at the opposite extreme, there was greater adherence from Medical Personnel and Technical Assistants. During the COVID-19 Pandemic, an increasing number of professionals were vaccinated annually, with this trend reversing after the end of the global emergency of this disease. From the review of the literature on vaccine hesitancy, 8 of the 14 behavioral domains stand out that represent theories of behavioral change that constitute modifiable factors that influence behavior in relation to the vaccine. We approach each of them from this perspective, namely: knowledge, the environmental context and resources, social influence, beliefs and knowledge about consequences, beliefs about individual capacity, identity and social/professional role, reinforcement and emotion. Discussion: Flu vaccine hesitancy among healthcare professionals can be a cause of morbidity and mortality for patients. Understanding the barriers and motivation for healthcare professionals to adhere to flu vaccination campaigns is crucial. Professionals who are asymptomatic carriers become sources of transmission. Annual vaccination, although safe and effective, faces variability due to antigenic concordance. In Portugal, educational and communication strategies are vital, highlighting the role of health professionals as models of preventive behavior. Easy access to medical consultations and Occupational Health recommendations is associated with greater adherence. In times of pandemic, the propensity for vaccination has increased, and it is important to promote this change. Strategies adapted to the cultural context are essential to boost adherence to Influenza vaccination among healthcare professionals. Conclusion: The approach to combating barriers and promoting vaccination among healthcare professionals must involve multiple areas and multiple levels, with communication targeted at specific groups, to increase its effectiveness. The message must be adapted to different population groups and different levels of health literacy. Knowing these behavioral determinants can help develop vaccination promotion campaigns from new perspectives and finding strategies to increase vaccination coverage is crucial for Occupational Health Services. Due to the ethical characteristics of the professions involved in providing direct care to patients, there is a need to reinforce the idea that vaccination among healthcare professionals is not only for their benefit, but above all for the protection of their patients.

ABSTRACT Introduction: the need to have rapid, sensitive and specific laboratory techniques for the detection of pathogens that are difficult to diagnose led to the creation of the Molecular Biology Laboratory at the Provincial Center of Hygiene, Epidemiology and Microbiology of Villa Clara. Objective: to characterize the evolution and importance of Molecular Microbiology in the Laboratory of the Provincial Center of Hygiene, Epidemiology and Microbiology of Villa Clara from June 2018 to December 2023. Methods: cross-sectional descriptive study carried out at the Villa Clara Molecular Biology Laboratory in the period from June 2018 to December 2023 based on the total samples processed by polymerase chain reaction, several technological platforms and various kits were used. commercial. Results: In 2018, molecular diagnosis was implemented with two platforms, Rotor Gene-Q® and Gene Xpert® MTB/RIF, and in 2021, four were available, when the SLAN and the COBAS 4800® platform were introduced. The laboratory became relevant due to the arrival of the 2019 new coronavirus pandemic: 511,225 nasopharyngeal exudate samples and 14,568 determinations were processed for the diagnosis of human immunodeficiency viruses, hepatitis C and B, and human papilloma carried out on the COBAS 4800® platform. In 2023, the pathogen detection capacity was strengthened and the community cocirculation of influenza A and B, parainfluenza virus type 4, the OC 43 coronavirus, SARS-CoV-2 and dengue was identified. Conclusions: the progressive increase in the resolution capacity of the Molecular Biology Laboratory, together with the implementation of new diagnostic platforms, has allowed us to strengthen the detection of pathogens of clinical interest and improve virological sentinel surveillance.

RESUMEN Introducción: la necesidad de contar con técnicas de laboratorio rápidas, sensibles y específicas para la detección de patógenos de difícil diagnóstico llevó a la creación del Laboratorio de Biología molecular en el Centro Provincial de Higiene, Epidemiología y Microbiología de Villa Clara. Objetivo: caracterizar la evolución y la importancia de la Microbiología molecular en el Laboratorio del Centro Provincial de Higiene, Epidemiología y Microbiología de Villa Clara de junio de 2018 a diciembre de 2023. Métodos: estudio descriptivo transversal realizado en el Laboratorio de Biología Molecular de Villa Clara en el período comprendido de junio de 2018 a diciembre de 2023 a partir del total de muestras procesadas por reacción en cadena de la polimerasa, se emplearon varias plataformas tecnológicas y diversos estuches comerciales. Resultados: en 2018 se implementó el diagnóstico molecular con dos plataformas, Rotor Gene-Q® y Gene Xpert® MTB/RIF, y en 2021, se dispuso de cuatro, al introducir el SLAN y la plataforma COBAS 4800®. El laboratorio adquirió relevancia por la llegada de la pandemia por el nuevo coronavirus de 2019: se procesaron 511 225 muestras de exudado nasofaríngeo y 14 568 determinaciones para el diagnóstico de los virus de inmunodeficiencia humana, de hepatitis C y B y del papiloma humano que se realizaron en la plataforma COBAS 4800®. En el año 2023 se fortaleció la capacidad de detección de patógenos y se identificó la cocirculación comunitaria de influenza A y B, del virus parainfluenza tipo 4, el coronavirus OC 43, el SARS-CoV-2 y el dengue. Conclusiones: el aumento progresivo de la capacidad resolutiva del Laboratorio de Biología molecular, junto a la implementación de nuevas plataformas diagnósticas, ha permitido fortalecer la detección de patógenos de interés clínico y perfeccionar la vigilancia centinela virológica.

RESUMEN Introducción. Durante 2020 y 2021, la circulación de los virus influenza se mantuvo por debajo de lo esperado en todo el mundo. En Argentina, en el año 2022 observamos una circulación ininterrumpida de influenza todo el año. Nuestros objetivos fueron describir los patrones de circulación y las características clínicas de niños internados con influenza. Población y métodos. Estudio retrospectivo, analítico, observacional. Se incluyeron todos los niños internados en un centro pediátrico con detección del virus influenza durante los años 2019-2022. Resultados. Se internaron 138 pacientes en 4 años; en 2019 se observó una tasa del 4,5/1000 egresos hospitalarios mientras que en 2022, fue del 15,1/1000. En 2020 y 2021 no hubo casos. En el 2019 la mayoría de los casos ocurrieron en invierno, la causa de la internación fue la infeccción respiratoria aguda baja (IRAB) en el 79 % y se detectó influenza A en el 92 % de los casos. En el 2022, la mayoría de los casos ocurrieron en primavera, el 62 % presentó IRAB y en el 56 % se detectó influenza A. Ambos períodos tuvieron similares frecuencias de vacunación y de comorbilidades. Conclusiones. En el 2022 se registraron más internaciones por influenza, lo que podría corresponder a que se realizaron métodos diagnósticos moleculares, que son más sensibles, y se observó un cambio en la estacionalidad con más casos en primavera. En 2019 predominó influenza A en infecciones del tracto respiratorio inferior, mientras que en el 2022 influenza A y B fueron similares, y hubo más formas extrapulmonares.