Objective: To identify the proportion of unvaccinated elderly people and the reasons that interfere with influenza immunization in rural riverside locations and potential implications for vaccination against COVID-19. Method: Cross-sectional home-based survey carried out in 38 rural riverside locations on the left bank of the Negro river, Manaus, Amazonas. The selected elderly people answered a questionnaire that investigated living conditions, health status and access to health services. For this study, the outcomes related to influenza immunization in the last 12 months and the main reason given for non-vaccination were analyzed. Descriptive data analysis was performed, followed by logistic regression to identify the factors associated with non-vaccination. Results: Of the 102 elderly people included in the study, 28 (27.5%) reported no vaccination against influenza in the previous year. The main reasons were related to the lack of information on vaccination (60.71%) and barriers to accessing health services (28.58%). A greater chance of non-vaccination was identified among the elderly who did not consult the doctor in the last year (OR=4.18; 95%CI=1.57-11.11) and among those with the highest household income (OR=1.08; 95%CI=1.02-1.14). Conclusion: A high proportion of elderly people who have not been immunized against influenza have been identified. The reasons given for non-vaccination may persist and negatively interfere with the vaccination of this group against COVID-19. Thus, it is necessary to reorganize vaccination planning in rural riverside contexts, in order to achieve adequate coverage to one of the main risk groups for respiratory diseases.

Objetivo: Identificar a proporção de idosos não vacinados e os motivos que interferem na imunização contra a influenza em localidades rurais ribeirinhas e potenciais implicações na vacinação contra COVID-19. Método: Inquérito transversal de base domiciliar realizado em 38 localidades rurais ribeirinhas da margem esquerda do rio Negro, Manaus, Amazonas. Os idosos selecionados responderam a um questionário que investigou as condições de vida, saúde e acesso aos serviços de saúde. Para este estudo foram selecionados os desfechos relacionados à imunização contra a Influenza nos últimos 12 meses e o principal motivo alegado pelos que não tomaram a vacina. Foi realizada análise descritiva dos dados, seguida de análise de regressão logística para identificar os fatores associados à não vacinação. Resultados: Dos 102 idosos incluídos no estudo, 28 (27,5%) referiram não vacinação contra a influenza no ano anterior. Os principais motivos foram relacionados à falta de informação sobre a vacinação (60,71%) e às barreiras de acesso aos serviços de saúde (28,58%). Foi identificada maior chance de não vacinação entre os idosos que não consultaram o médico no último ano (RC=4,18; IC95%=1,57-11,11) e entre aqueles com maior renda domiciliar (RC=1,08; IC95%=1,02-1,14). Conclusão: Foi identificada uma elevada proporção de idosos não imunizados contra a influenza. Os motivos referidos para a não vacinação podem persistir e interferir negativamente na vacinação deste grupo contra a COVID-19. Dessa forma, faz-se necessário reordenar o planejamento da vacinação em contextos rurais ribeirinhos, de forma a oferecer uma cobertura adequada à um dos principais grupos de risco para doenças respiratórias.

Resumo Objetivo Avaliar a proporção de pessoas idosas não vacinadas e os motivos que interferem na imunização contra influenza em localidades rurais ribeirinhas, discutindo as potenciais implicações na vacinação contra a infecção por SARS-CoV-2. Método Inquérito epidemiológico de base domiciliar realizado em 38 localidades rurais ribeirinhas de Manaus (AM), Brasil, assistidas por uma Unidade Básica de Saúde Fluvial. Os participantes responderam a um questionário que investigou condições de vida, saúde e acesso aos serviços de saúde. Para este estudo foram avaliados os desfechos relacionados à imunização contra a Influenza nos últimos 12 meses e o principal motivo alegado para a não vacinação. Foi realizada análise descritiva dos dados, seguida por análise de regressão logística para identificar fatores associados à não vacinação. Resultados Das 102 pessoas idosas incluídas no estudo, 28 (27,5%) referiram não vacinação contra a Influenza no ano anterior. Os principais motivos foram a falta de informação sobre a vacinação (60,7%) e barreiras de acesso aos serviços de saúde (28,6%). Foi identificada maior chance de não vacinação entre aqueles que não consultaram o médico no último ano (RC=4,18; IC95%=1,57-11,11) e com maior renda domiciliar (RC=1,08; IC95%=1,02-1,14). Conclusão Verificou-se elevada proporção de pessoas idosas autorreferindo não imunização contra Influenza. Os motivos identificados para a não vacinação podem também representar barreiras à vacinação desse grupo populacional contra a covid-19. Dessa forma, faz-se necessário adequar o planejamento da vacinação em contextos rurais ribeirinhos, desenvolvendo estratégias mais contextualizadas para garantia de cobertura a essa população com maior vulnerabilidade aos efeitos de doenças respiratórias.

Abstract Objective To evaluate the proportion of unvaccinated older adults and the reasons that interfere with immunization against Influenza in rural riverside locations, discussing the potential implications on vaccination against SARS-CoV-2 infection. Method Household-based survey conducted in 38 rural riverside locations in Manaus, Amazonas, Brazil, covered by a primary care Fluvial Health Unit. Participants answered a questionnaire that investigated living conditions, health status and access to health services. In this study, the outcomes related to immunization against Influenza in the last 12 months and the main reported reason for non-vaccination were evaluated. Descriptive data analysis was performed, followed by logistic regression to identify factors associated with non-vaccination. Results Of the 102 older adults included in the study, 28 (27.5%) reported not vaccinating against Influenza in the previous year. The main reasons were lack of information about vaccination (60.7%) and barriers to accessing health services (28.6%). An increased chance of non-vaccination was identified among those who did not see a doctor in the last year (OR=4.18; 95%CI=1.57-11.11) and those with higher household income (OR=1.08; 95%CI= 1.02-1.14). Conclusion A high proportion of older adults reporting no immunization against Influenza was identified. The reasons for non-vaccination may also represent barriers to the vaccination of this population group against COVID-19. Thus, it is necessary to improve the vaccination planning in rural riverside contexts, developing more contextualized strategies to assure coverage for this population, more vulnerable to the effects of respiratory diseases.

In Brazil, more than 99% of malaria cases are reported in the Amazon, and the State of Amazonas accounts for 40% of this total. However, the accumulated experience and challenges in controlling malaria in this region in recent decades have not been reported. Throughout the first economic cycle during the rubber boom (1879 to 1912), malaria was recorded in the entire state, with the highest incidence in the villages near the Madeira River in the Southern part of the State of Amazonas. In the 1970s, during the second economic development cycle, the economy turned to the industrial sector and demanded a large labor force, resulting in a large migratory influx to the capital Manaus. Over time, a gradual increase in malaria transmission was observed in peri-urban areas. In the 1990s, the stimulation of agroforestry, particularly fish farming, led to the formation of permanent Anopheline breeding sites and increased malaria in settlements. The estimation of environmental impacts and the planning of measures to mitigate them, as seen in the construction of the Coari-Manaus gas pipeline, proved effective. Considering the changes occurred since the Amsterdam Conference in 1992, disease control has been based on early diagnosis and treatment, but the development of parasites that are resistant to major antimalarial drugs in Brazilian Amazon has posed a new challenge. Despite the decreased lethality and the gradual decrease in the number of malaria cases, disease elimination, which should be associated with government programs for economic development in the region, continues to be a challenge.

INTRODUCTION: In the State of Amazonas, particularly in the capital Manaus, meningitis has affected populations of different cultures and social strata over the years. Bacterial meningitis is caused by several different species and represents a major issue of public health importance. The present study reports the meningitis case numbers with different etiologies in Amazonas from January 1976 to December 2012. METHODS: Since the 1970s, the (currently named) Tropical Medicine Foundation of Doutor Heitor Vieira Dourado [Fundação de Medicina Tropical Doutor Heitor Vieira Dourado (FMT-HVD)] has remained a reference center in Amazonas for the treatment of meningitis through the diagnosis and notification of cases and the confirmation of such cases using specific laboratory tests. RESULTS: The foundation has achieved coverage of over 90% of the state medical records for many years. Between 1990 and 2012, meningitis cases caused by Haemophilus influenzae decreased with the introduction of the H. influenzae vaccine. Meningococcal disease previously had a higher frequency of serogroup B disease, but starting in 2008, the detection of serogroup C increased gradually and has outpaced the detection of serogroup B. Recently, surveillance has improved the etiological definition of viral meningitis at FMT-HVD, with enteroviruses, Epstein-Barr virus (EBV) and varicella zoster virus (VZV) prevailing in this group of pathogens. With the advent of acquired immunodeficiency syndrome (AIDS), cryptococcal meningitis has become an important disease in Amazonas. Additionally, infectious meningitis is an important burden in the State of Amazonas. CONCLUSIONS: Changes in the epidemiological profile for the different etiology-defined cases are the result of continuous epidemiological surveillance and laboratory capacity improvements and control measures, such as Haemophilus influenzae vaccination.

Introduction Chagas disease is considered as emerging in the Brazilian Amazon, usually occurring in acute outbreaks. Methods We describe 17 cases of acute Chagas disease in Rio Negro, Amazonas. Results There were 15 males (average age, 31.3 years), all positive for Trypanosoma cruzi in fresh blood smear examination, and 14 positive by xenodiagnosis and PCR. The top clinical manifestations were fever, asthenia, abdominal pain, and palpitations. Electrocardiograms featured low-voltage QRS, anterosuperior divisional block, and right bundle branch block associated with anterosuperior divisional block. Conclusions All patients had consumed açaí products from Monte Alegre in the rural area around Santa Izabel do Rio Negro, Brazil.

Dengue fever is the world's most important viral hemorrhagic fever disease, the most geographically wide-spread of the arthropod-born viruses, and it causes a wide clinical spectrum of disease. We report a case of dengue hemorrhagic fever complicated by acute hepatitis. The initial picture of classical dengue fever was followed by painful liver enlargement, vomiting, hematemesis, epistaxis and diarrhea. Severe liver injury was detected by laboratory investigation, according to a syndromic surveillance protocol, expressed in a self-limiting pattern and the patient had a complete recovery. The serological tests for hepatitis and yellow fever viruses were negative. MAC-ELISA for dengue was positive.

Dois casos de lactentes atendidos na Fundação de Medicina Tropical do Amazonas, com síndrome febril exantemática aguda, extravasamento capilar e manifestações hemorrágicas de pequena magnitude, caracterizando quadro de febre hemorrágica do dengue. O diagnóstico etiológico foi confirmado pelo MAC-ELISA e pelo ELISA de inibição para IgG, realizados nos lactentes e nas respectivas mães.

Two cases of infants assisted at the Tropical Medicine Foundation of Amazonas with febrile exanthematic syndrome and mild hemorrhagic manifestations, defining a picture of dengue hemorrhagic fever. The etiologic diagnose was confirmed by the MAC-ELISA and the Inhibition - ELISA, performed in both infants and respective mothers.