Resumo Este estudo teve como objetivo analisar se as vítimas da epidemia da Zika têm acesso às políticas públicas essenciais à garantia dos direitos sociais. Métodos: Estudo transversal de uma coorte histórica de crianças com síndrome da Zika congênita (SZC) em um hospital de referência. Utilizou-se o protocolo do Ministério da Saúde para o diagnóstico de SZC. As variáveis analisadas foram características sociodemográficas e direitos sociais das crianças. Resultados: Das 161 crianças avaliadas de abril/2016 a julho/2018, 42 apresentavam SZC. Destas, 37 participaram do estudo, 75,7% com grave comprometimento neurológico. Anticonvulsivantes eram utilizados em 73% dos casos, 81% custeados pelas famílias. As famílias ainda custeavam fórmulas nutricionais (79%) e fraldas (100%). A terapia de reabilitação era realizada por 89% das crianças, embora 70% enfrentassem diversas barreiras para tal. Das 24 mães que trabalhavam, 83% não retornaram ao mercado de trabalho após o nascimento dos filhos. Conclusões: As famílias estavam situadas na interseção entre a atividade integral de cuidado de um filho com deficiências graves e a ineficiência e omissão do poder público, um contexto de desincentivo e desalento que, vencendo-as pelo cansaço, fazia com que muitas acabassem desistindo de tentar buscar seus direitos.

Abstract The objective of this study was to describe if the victims of the Zika have access to essential public policies to guarantee social rights. Methods: We used a cross-sectional study of a historical cohort of children with congenital Zika syndrome (CZS) in a reference hospital. CZS diagnosis was based on the Ministry of Health protocol. The variables analyzed were sociodemographic and social rights of children. Results: Of the 161 children seen from April 2016 to July 2018, 42 were diagnosed with CZS. Of these, 37 children participated in the study and 75.7% of them had severe neurological disorders. Anticonvulsants were used by 73% of the children, with 81% paid by families. The families were also responsible for purchasing nutritional formulas and diapers in, respectively, 79% and 100% of cases, and 89% of the children had access to rehabilitation therapy, although 70% of them faced several barriers to do it. Of the 24 working mothers, 83% did not return to the labor market after the birth of their children. Conclusions: The results showed that the families were at an intersection between the integral activity of caring for a child with severe disabilities and inefficient and omissive public authorities, a disincentive and discouraging context that made them give up in seeking their rights.

OBJECTIVE: To assess the performance of the rubella suspect case definition among patients with rash diseases seen at primary care units. METHODS: From January 1994 to December 2002, patients with acute rash, with or without fever, were seen at two large primary health care units and at a public general hospital in the municipality of Niterói, metropolitan area of Rio de Janeiro, Brazil. Data from clinical and serologic assessment were used to estimate the positive predictive values of the definition of rubella suspect case from the Brazilian Ministry of Health and other combination of signs/symptoms taking serologic status as the reference. Serum samples were tested for anti-rubella virus IgM using commercially available enzyme immunoassays. Positive predictive values and respective 95% confidence intervals were calculated. RESULTS: A total of 1,186 patients with an illness characterized by variable combinations of rash with fever, arthropathy and lymphadenopathy were studied. Patients with rash, regardless of other signs and symptoms, had 8.8% likelihood of being IgM-positive for rubella. The Brazilian suspect case definition (fever and lymphadenopathy in addition to rash) had low predictive value (13.5%). This case definition would correctly identify 42.3% of the IgM-positive cases, and misclassify 26.1% of the IgM-negative cases. CONCLUSIONS: These results support the recommendation to investigate and collect clinical specimens for laboratory diagnosis of all cases of rash, for surveillance purposes. Although this strategy may increase costs, the benefits of interrupting the circulation of rubella virus and preventing the occurrence of congenital rubella syndrome should pay off.

OBJETIVO: Avaliar a acurácia da definição de caso suspeito de rubéola entre pacientes com doenças exantemáticas atendidos em unidades de saúde pública. MÉTODOS: A população de estudo foi constituída de pacientes com doença exantemática, com ou sem febre, atendidos em serviços de saúde pública, de janeiro de 1994 a dezembro de 2002 no município de Niterói, RJ. Dados clínicos e sorológicos foram utilizados para estimar os valores preditivos positivos da definição de caso suspeito de rubéola do Ministério da Saúde do Brasil e outras combinações de sinais e sintomas, considerando o resultado da sorologia como referência. A detecção de IgM específica para rubéola em amostras sangüíneas foi realizada por ensaio imunoenzimático. Foram calculados os valores preditivos positivos e respectivos intervalos de confiança de 95%. RESULTADOS: Foram estudados 1.186 pacientes com uma doença caracterizada por uma variada combinação de rash com ou sem febre, artropatia e linfoadenopatia. Pacientes com exantema, independentemente da presença de outros sinais e sintomas, apresentaram uma probabilidade de 8,8% de serem IgM positivos para rubéola. A definição de caso suspeito de rubéola utilizada no Brasil apresentou baixo valor preditivo positivo (13,5%). Esta definição de caso identificou corretamente 42,3% dos casos IgM positivos, e classificou de forma incorreta 26,1% dos IgM negativos. CONCLUSÕES: Os resultados indicam que as doenças exantemáticas devem ser investigadas em conjunto para fins de vigilância epidemiológica e coleta de espécimens clínicos para o diagnóstico laboratorial. Esta estratégia aumenta os custos, mas gera benefícios na interrupção da circulação do vírus e na prevenção da síndrome da rubéola congênita.

OBJECTIVE: To assess the performance, in Brazil, of the definition of a suspected measles case among patients with rash diseases that has been adopted in Brazil and many other countries. METHODS: From January 1994 to December 2003, patients with acute rash were seen at two large primary health care units and a public general hospital in Niterói, a city in the metropolitan area of the city of Rio de Janeiro, Brazil. Data from clinical and serologic assessment were used to estimate sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the definition of a suspected measles case that has been adopted in Brazil, as well as other combinations of signs and symptoms; serologic status was taken as the reference. Using enzyme immunoassay, serum samples were tested for immunoglobulin M (IgM) antibodies against measles virus. RESULTS: A total of 1 221 patients with an illness characterized by different combinations of rash with other signs and symptoms were studied. The suspected case definition that has been adopted in Brazil (rash, fever, and at least one of the following: cough, coryza, or conjunctivitis) had an overall sensitivity of 100%, and a specificity of 58.7%. Confirmed measles cases were 2.4 times as likely as were other rash diseases to have that combination of signs/symptoms. The suspected case definition adopted in Brazil had a 6% PPV and 100% NPV. The combination of all five signs and symptoms had the highest specificity, PPV, and likelihood ratio, for both children (< 15 years old) and adults (> 15 years). That was achieved at the expense of sensitivity, which dropped to 89%, but the NPV was still very high. CONCLUSIONS: Our results show that the suspected measles case definition adopted in Brazil is extremely sensitive for measles surveillance among patients with rash diseases. However, the high false-positive rates that were found may result in a substantial number of other rash diseases being misclassified as measles, leading to the misdirection of control measures and increases in their cost.

OBJETIVO: Evaluar la utilidad, en el Brasil, de la definición de "caso sospechado de sarampión", aplicada en pacientes con enfermedades exantemáticas, que se ha adoptado en el Brasil y en muchos otros países. MÉTODOS: De enero de 1994 a diciembre de 2003, se examinó a pacientes con erupción cutánea aguda en dos grandes unidades de atención primaria y en un hospital general estatal en Niterói, en la zona metropolitana de la ciudad de Río de Janeiro, Brasil. Se usaron datos de la evaluación clínica y serológica para estimar la sensibilidad, especificidad, valor pronóstico de un resultado positivo (VPRP), y valor pronóstico de un resultado negativo (VPRN) aplicables a la definición de "caso sospechado de sarampión" adoptada en el Brasil, así como otras combinaciones de signos y síntomas; el resultado de pruebas serológicas se usó como parámetro de referencia. Usando la técnica de inmunoensayo enzimático, las muestras de suero se examinaron para detectar la presencia de anticuerpos de immunoglobulina M (IgM) contra el virus del sarampión. RESULTADOS: Se estudió a un total de 1 221 pacientes con una enfermedad caracterizada por exantema cutáneo más otros signos y síntomas en diversas combinaciones. La definición de "caso sospechado" adoptada en el Brasil (erupción, fiebre y por lo menos un síntoma más, que puede ser tos, congestión nasal o conjuntivitis), tuvo una sensibilidad general de 100% y una especificidad de 58.7%. La probabilidad de encontrar esa combinación de síntomas o signos fue 2,4 mayor entre los casos confirmados de sarampión que entre los casos de otras enfermedades exantemáticas. La definición de "caso sospechado" que se ha adoptado en el Brasil tuvo un VPRP de 6% y un VPRN de 100%. La presencia combinada de todos los cinco signos y síntomas tuvo la mayor especificidad, el mayor VPRP y la mayor razón de verosimilitud, tanto en niños (< 15 años de edad) como en adultos (> 15 años). Eso se logró a expensas de la sensibilidad, que se redujo a 89%, pero el VPRN siguió siendo muy alto. CONCLUSIONES: Nuestros resultados demuestran que la definición de "caso sospechado de sarampión" adoptada en el Brasil posee gran sensibilidad para la vigilancia de la enfermedad entre pacientes con enfermedades exantemáticas. No obstante, los elevados porcentajes de resultados positivos falsos que se detectaron podrían llevar a que se clasifiquen como sarampión, por error, muchas enfermedades exantemáticas de otra índole, lo que a su vez daría por resultado una mala orientación de las medidas de control y un aumento de su carestía.

Erythrovirus B19 infection is usually benign but may have serious consequences in patients with hemolytic anemia (transient aplastic crisis), immunodeficiency (in whom persistent infection can lead to chronic bone marrow failure with anemia), or who are in the first or second trimester of gestation (spontaneous abortion, hydrops fetalis, and fetal death). Being non-enveloped, B19 resists most inactivation methods and can be transmitted by transfusion. B19 is difficult to cultivate and native virus is usually obtained from viremic blood. As specific antibodies may be absent, and there is no reliable immunological method for antigen detection, hybridization or polymerase chain reaction are needed for detecting viremia. A rapid method, gel hemagglutination (Diamed ID-Parvovirus B19 Antigen Test), can disclose highly viremic donations, whose elimination lessens the viral burden in pooled blood products and may even render them non-infectious. In order to obtain native antigen and to determine the frequency of viremic donors, we applied this test to blood donors in a period of high viral activity in our community. Positive or indeterminate results were re-tested by dot-blot hybridization. We tested 472 donors in 1998 and 831 ones in 1999. One viremic donor was found in 1999. We suggest that in periods of high community viral activity the gel hemagglutination test may be useful in avoiding highly viremic blood being added to plasma pools or directly transfused to patients under risk.

OBJECTIVES: To estimate the proportion of individuals seronegative for measles antibody among blood donors from a blood bank in the city of Rio de Janeiro, Brazil, and to describe their social and demographic characteristics, with the goal of exploring the potential use of plasma banks to supplement serological surveillance with relevant data in order to support the program of measles elimination in the city of Rio de Janeiro and elsewhere. METHODS: Plasma samples from 1 101 consecutive blood donations made in November 2000 at HEMORIO, the largest blood bank in the state of Rio de Janeiro, were tested for measles immunoglobulin G, using a commercial enzyme immunoassay and a plaque reduction neutralization test. We calculated the proportion (and 95% confidence interval (CI)) of samples seronegative for measles antibody for the total sample of blood donors and also for subgroups categorized by age, sex, neighborhood of residence, education, and occupation. We used the chi-square test to assess the statistical significance of differences in proportions and linear trends in proportions. RESULTS: Of the total group of blood donors, 6.9% of them (95% CI: 5.4%8.4%) were seronegative for measles. Women had a higher proportion (10.1%; 95% CI: 6.8%13.4%) of seronegative results than did men (5.6%; 95% CI: 4.0%7.2%). In terms of age, 86.8% of seronegative individuals were born between 1971 and 1982. Seronegativity was inversely proportional to age (chi-square = 58.0; P < 0.0001). With regard to occupation, students had the highest proportion of seronegative individuals (17.8%). In terms of education, most of the susceptible persons were in the categories of "incomplete university degree" or "incomplete high school." For the various areas of residence the proportions ranged from 2.1% to 11.4%. CONCLUSIONS: Blood bank plasma may constitute a useful and convenient source of complementary data for serological surveillance in adults of measles and other infections for which immunization and surveillance activities are implemented. This approach could be beneficial to other areas in Brazil and other countries where plasma from blood donors is available for surveillance. The use of residual sera from patients and plasma from blood donors represents a tradeoff between representativeness and timeliness as well as economy of resources.

OBJETIVOS: Determinar la proporción de personas seronegativas a anticuerpos contra el sarampión entre los donantes de un banco de sangre de la ciudad de Río de Janeiro, Brasil, y describir sus características sociales y demográficas, con el fin de explorar el uso eventual de los bancos de plasma para complementar la vigilancia serológica con datos que permitan apoyar el programa de erradicación del sarampión en la ciudad de Río de Janeiro y en otras localidades. MÉTODOS: Se estudió la presencia de inmunoglobulinas G contra el sarampión en muestras de plasma de 1 101 donaciones de sangre consecutivas realizadas en noviembre de 2000 en HEMORIO, el mayor banco de sangre del estado de Río de Janeiro, mediante un ensayo inmunoenzimático comercial y una prueba de neutralización por reducción de placas. Se calculó la proporción (y el intervalo de confianza (IC) de 95%) de las muestras negativas a anticuerpos contra el sarampión en la totalidad de las donaciones y en subgrupos conformados según la edad, el sexo, el vecindario de residencia, la educación y la ocupación laboral. La significación estadística de las diferencias entre las proporciones y entre sus tendencias lineales se determinó mediante la prueba de ji al cuadrado. RESULTADOS: Del total de donantes de sangre, el 6,9% (IC95%: 5,4 a 8,4%) resultó seronegativo al sarampión. Las mujeres tuvieron una mayor proporción de resultados seronegativos (10,1%; IC95%: 6,8 a 13,4%) que los hombres (5,6%; IC95%: 4,0 a 7,2%). En relación con la edad, 86,8% de las personas seronegativas nacieron entre 1971 y 1982. La seronegatividad fue inversamente proporcional a la edad (ji al cuadrado = 58,0; P < 0,0001). En cuanto a la ocupación laboral, los estudiantes presentaron la mayor proporción de seronegativos (17,8%), mientras que en lo referente a la educación, la mayoría de las personas susceptibles a la enfermedad se encontraban en la categoría de "estudios universitarios incompletos" o "estudios secundarios incompletos". La proporción de seronegativos entre las diferentes áreas de residencia estuvo entre 2,1% y 11,4%. CONCLUSIONES: El plasma de los bancos de sangre puede ser una fuente útil y conveniente de datos complementarios para la vigilancia serológica en adultos, tanto de sarampión como de otras enfermedades infecciosas para las que se hayan implementado actividades de inmunización y vigilancia. Este enfoque puede ser beneficioso en otras regiones de Brasil y en otros países en los que se pueda contar para la vigilancia con el plasma de los donantes de sangre. El empleo del remanente de los sueros de los pacientes y del plasma de los donantes de sangre representa una solución de compromiso entre la representatividad y la oportunidad, y el buen uso de los recursos.

O parvovírus B19 replica-se em precursores eritróides. Não há geralmente manifestações hematológicas aparentes. Entretanto, nas altas taxas de reposição de eritrócitos, como as que ocorrem na anemia falciforme ou no feto, a infecção pode resultar, respectivamente, em aplasia transitória e hidropisia fetal. Em pacientes com AIDS, a infecção persistente pode resultar em anemia crônica. Já num paciente HIV-positivo sem AIDS, a infecção evolui como uma doença exantemática leve. Duas descrições exemplificam estas diferentes modalidades de apresentação clínica. Na primeira, um paciente com AIDS apresentou aplasia medular que respondeu a imunoglobulina. Na segunda, um paciente HIV-positivo sem AIDS apresentou um exantema morbiliforme, que cedeu sem tratamento. Diagnosticar a anemia crônica por B19 diminui as preocupações infundadas sobre anemia por drogas, evita que o paciente seja submetido a manobras diagnósticas invasivas, e impede que o paciente dissemine a infecção. Em pacientes com AIDS acometidos de aplasia eritrocítica pura, está indicada a pesquisa de DNA do parvovírus B19 no soro ou na medula óssea.

Human parvovirus B19 replicates in erythrocyte precursors. Usually, there are no apparent hematological manifestations. However, in individuals with high erythrocyte turnover, as in patients with sickle-cell disease and in the fetus, the infection may lead to severe transient aplasia and hydrops fetalis, respectively. In AIDS patients, persistent infection may result in chronic anemia. By contrast, in HIV-positive patients without AIDS the infection evolves as a mild exanthematous disease. Two clinical descriptions exemplify these forms of presentation. In the first, an AIDS patient presented with bone marrow failure that responded to immunoglobulin. In the second, an HIV-positive patient without AIDS had a morbilliform rash, and needed no treatment. Knowing that an AIDS patient has chronic B19 anemia lessens concern about drug anemia; protects the patient from invasive diagnostic maneuvers; and prevents the patient from disseminating the infection. In AIDS patients with pure red cell aplasia, a search for parvovirus B19 DNA in the serum or in the bone marrow is warranted.

This study was designed to analyse the clinical and epidemiological data from human parvovirus B19 cases in a six-year study of rash diseases conduct in an urban area in Brazil (Niterói city area, State of Rio de Janeiro). A total of 673 patients with acute rash diseases were seen at two primary health care units and at a general hospital. A clotted blood sample was collected from all subjects at the time of consultation. Forty-nine per cent (330 cases) of the patients were negative for dengue, rubella and measles IgM or for low avidity IgG to HHV-6. Of these 330, 105 (31.8%) were identified as IgM positive to parvovirus B19 by using an antibody capture EIA. During the study period, three distinct peaks of parvovirus infection were detected, suggesting that the disease appears to cycle in approximately 4-5 years. B19 infection was characterized by variable combinations of fever, flu-like symptoms, arthropathy, and gastrointestinal symptoms. Frequency of fever and arthropathy was substantially higher in adults, 75% [chi2 (1 D.F.) = 11.39, p = 0.0007] and 62.5% [chi2 (1 D.F.) = 29.89, p = 0.0000], respectively. "Slapped-cheek" appearance and reticular or lace-like rash were seen in only 30.1% of the children. No adult presented this typical rash. The lack of the typical rash pattern in a large proportion of parvovirus B19 and the similarity of clinical manifestations to other rash diseases, specially to rubella, highlight the difficulty of diagnosing B19 infection on clinical grounds alone.

Human parvovirus B19 infection can cause erythema infectiosum (EI) and several other clinical presentations. Central nervous system (CNS) involvement is rare, and only a few reports of encephalitis and aseptic meningitis have been published. Here, we describe 2 cases of B19 infection in a family presenting different clinical features. A 30 year old female with a 7-day history of headache, malaise, myalgias, joint pains, and rash was seen. Physical examination revealed a maculopapular rash on the patient's body, and arthritis of the hands. She completely recovered in 1 week. Two days before, her 6 year old son had been admitted to a clinic with a 1-day history of fever, headache, abdominal pain and vomiting. On admission, he was alert, and physical examination revealed neck stiffness, Kerning and Brudzinski signs, and a petechial rash on his trunk and extremities. Cerebrospinal fluid analysis was normal. He completely recovered in 5 days. Acute and convalescent sera of both patients were positive for specific IgM antibody to B19. Human parvovirus B19 should be considered in the differential diagnosis of aseptic meningitis, particularly during outbreaks of erythema infectiosum. The disease may mimic meningococcemia and bacterial meningitis.

Este estudo foi realizado para avaliar a validade da utilização da saliva no diagnóstico laboratorial da rubéola. Quarenta e cinco amostras pareadas de sangue e de saliva, coletadas de 1 a 29 dias após o início da doença, foram testadas para detecção de imunoglobulina (Ig) M específica por radioimunoensaio com captura (MACRIA). Anticorpos IgM específicos contra rubéola foram detectados em todas as amostras sangüíneas e em 38 (84,4%) das amostras de saliva. A especificidade do teste na saliva foi de 96%. Estes resultados indicam que a utilização da saliva pode ser uma alternativa válida para obtenção de espécimens clínicos na investigação de casos recentes de rubéola, especialmente nas atividades de vigilância epidemiológica e controle da virose.

This study was designed to investigate whether saliva could be a feasible alternative to serum for the diagnosis of recent rubella infection in a clinic setting. Forty-five paired blood and saliva samples collected 1 to 29 days after onset of illness were tested for specific immunoglobulin (Ig) M by antibody-capture radioimmunoassay (MACRIA). Rubella IgM was detected in all serum samples and in 38 (84.4%) saliva specimens. Forty-six serum and saliva samples from other patients with rash diseases were tested by MACRIA for control purposes and two saliva specimens were reactive. The saliva test had specificity of 96%. These results indicate that salivary IgM detection may be a convenient non-invasive alternative to serum for investigation of recent rubella cases, especially for disease surveillance and control programmes.

A freqüência de manifestações articulares foi avaliada em 251 pacientes com diagnóstico clínico e laboratorial (detecção de IgM por ensaio imunoenzimático) de virose exantemática. As artropatias (artralgia e/ou artrite) foram mais observadas nos casos de dengue (49%) e de rubéola (38,2%) do que naqueles com parvovirose humana (30%) e sarampo (28,1%). Com exceção do sarampo, as artropatias predominaram nos adultos (315 anos de idade), sendo tal diferença estatisticamente significativa. A ocorrência maior de artropatias em adultos foi mais evidente nos pacientes com parvovirose (75%), rubéola (65%) e dengue (57,7%) do que naqueles com sarampo (31%). As queixas articulares também predominaram nos pacientes do sexo feminino para todas as viroses avaliadas. Os resultados encontrados demonstram o freqüente acometimento articular nas doenças estudadas, e indicam a necessidade de comprovação laboratorial para o diagnóstico diferencial entre elas.

The frequency of arthropathy was evaluated in 251 patients with clinical and serological diagnosis (specific IgM detection by enzyme immunoassay) of exanthematic disease. Arthropathy (arthralgia and/or arthritis) was more frequent in dengue fever (49%) and rubella (38.2%) cases than in human parvovirus (30%) and measles (28.1%) cases. Except for measles cases, joint complaints prevailed in adults (315 years of age) and this difference was significant. The higher frequency of arthropathy in adults was more evident in human parvovirus (75%), rubella (65%) and dengue fever (57.7%) cases than in measles cases (31%). Arthropathy was also more frequent in females for all rash diseases studied. The results of this study showed the high occurrence of joint complaints in the diseases described here and the importance of laboratory confirmation for their differential diagnosis.

O perfil nosológico brasileiro tem passado por profundas modificações. Algumas devem-se às grandes campanhas de imunização e a tendências demográficas e socioeconômicas. Outras são puramente nosológicas, tal como o surgimento da Síndrome de Imunodeficiência Adquirida (SIDA). Este estudo de demanda descreve como estas alterações refletiram-se nas 8.630 admissões de uma Enfermaria de Doenças Infecciosas em Niterói, Brasil, durante trinta anos. As endemias rurais brasileiras foram infreqüentes (3,45%). Os homens predominaram (62%) todo o tempo, em todas as faixas etárias e em todas as doenças. Crianças menores de quinze anos predominaram até 1983. Houve, no caso do tétano, importante elevação das faixas etárias acometidas. A mortalidade institucional caiu de 31% em 1965 para 10% em 1984, voltando a subir para 15% em 1994. Entretanto, se os pacientes com SIDA não forem computados, a mortalidade mantém-se em declínio até o final do período de estudo (8%). A progressiva desimportância das doenças imunopreveníveis esteve em paralelo com a crescente proeminência da SIDA. Em menos de uma década, a SIDA atingiu o quinto lugar entre as doenças mais freqüentes durante todos os trinta anos do período estudado. Ao contrário das doenças imunopreveníveis, as meningoencefalites e as pneumonias mantiveram-se estáveis. A SIDA, pela sua incidência exponencial, pelo seu caráter crônico, e pelas incontáveis infecções oportunistas que determina, impõe-se como um desafio para os próximos anos.

Brazil's nosologic profile has been sustaining profound modifications. Some occurred because of massive immunization campaigns and socioeconomic and demographic trends. Some yet were pure nosologic transitions, such as the emergence of AIDS. In this demand study it is described how these changes reflected on the 8,630 admissions of an Infectious Diseases Department in Niterói, along a thirty year period. Brazilian rural endemic diseases were infrequent (3.45%). Men predominated (62%) all the time, in all age strata and in nearly all diseases. Children under fifteen predominated until 1983. There was, in the case of tetanus, a striking rise in age strata. Institutional mortality dropped from 31% in 1965 to 10% in 1984, but rose since then to 15% in 1994. However, if AIDS patients had not been computed, mortality would have kept descending till 8% at the end of the study period. The crescent unimportance of immunopreventable diseases paralleled with the growing prominence of AIDS. In less than a decade, AIDS ranked fifth among the most frequent diseases in the whole period of thirty years. As opposed to the immunopreventable diseases, neither meningitides nor pneumonia appear to be in decline. AIDS, by its exponential incidence, by its chronic character, and by the uncountable opportunistic infections it determines, imposes itself as a challenge for the coming years.