[Rotavirus infection in Brazil: epidemiology and challenges for its control]

The effects of health spending on the propagation of infectious diseases

We explore the discontinuity in the allocation of the main federal grant to Brazilian municipalities to identify the local effects of health spending and the spillovers into the bordering jurisdictions. Fiscal reactions are asymmetric: small neighbors reduce health spending, while we do not find a significant budgetary response in the largest neighbor. Our results suggest a reduction in the spread of infectious diseases in the neighbors, with fewer residents hospitalized with gastrointestinal infections. In addition, the elderly demand less hospitalization in the largest bordering jurisdictions due to respiratory infectious diseases. Finally, we find a direct and significant reduction in infant mortality, consistent with the observed pediatricians' increase, while the spillover effects on neighbors' mortality rates are not conclusive.

Rotavirus vaccination in Brazil: effectiveness and health impact seven years post-introduction

Before vaccine introduction in Brazil, rotavirus caused approximately 650,000 outpatient visits, 92,000 hospitalizations and 850 deaths annually among children aged <5 years. Brazil was one of the first countries to introduce rotavirus vaccination into the National Immunisation Program (NIP), in 2006, but estimated coverage (87.1%) for 2011 remained lower if compared with other routine immunizations (95%). Case-control studies reached effectiveness rates as high as 85%. Observational studies showed a significant reduction in gastroenteritis-related hospitalizations and deaths among children aged <1 year, at rates as high as 48 and 54%, respectively. There was a significant increase in the relative prevalence of G2P[4] genotype after vaccine introduction, reaching 100% of strains in some settings. A small increase in intussusception incidence was seen within 1 week following the second vaccine dose, but benefits far outweigh any potential risk. This article provides an in-depth review of postlicensure studies conducted in Brazil 7-year postintroduction.

Molecular characterization of rotavirus genotypes in immunosuppressed and non-immunosuppressed pediatric patients

OBJECTIVE

To describe the genotypic variability of group A rotavirus (RVA) found in immunosuppressed and non-immunosuppressed pediatric patients treated at the Hospital de Clínicas da Universidade Federal do Paraná (HC-UFPR), Curitiba, Paraná.

METHODS

A cross-sectional study was conducted with 1,140 stool samples collected from April, 2001 to December, 2008 in outpatients and hospitalized patients with acute gastroenteritis referred to the hospital. RVA diagnosis was performed through the latex agglutination method and enzyme immunoassay. Reverse transcription followed by multiplex hemi-nested polymerase chain reaction (PCR) and nucleotide sequencing were used for genotype characterization. Genotype combinations, clinical, epidemiological, laboratory data, and presence of hospital-acquired infections were reported.

RESULTS

A total of 80 rotavirus-positive stool samples were analyzed. The most frequent associations between genotypes G and P were: G4 P[8] (38.9%), G1 P[8] (30.5%), G9 P[8] (13.9%), G2 P[4] (6.9%), and G3 P[8] (1.4%). G2 P[4] was the most prevalent genotype after the vaccine implementation in the years 2006 and 2008. A total of 62,5% of infected children were aged less than 12 months. Of these, 55.6% had severe dehydration and 26.7% needed intensive care. A frequency of 12.5% of nosocomial infections was found. No correlation was observed between genotype and severity of infection in the study patients.

CONCLUSION

RVA infections can be associated with severe clinical manifestations, and the surveillance of genotypic variability of this virus is crucial to monitor the emergence of new strains and the impact of the immunization in these patients.

Genotyping of human rotaviruses circulating among children with diarrhea in Valencia, Venezuela

Rotavirus infection is the most common cause of severe gastroenteritis during childhood worldwide, especially in developing countries. Two rotavirus vaccines are available for childhood immunization programs. Evaluation of the vaccine performance will benefit from knowledge of the epidemiological features of rotavirus infection in regional settings. Limited information on the molecular characteristics of the rotavirus types circulating in Venezuela is available. Eighty seven (89.7%) of the 97 ELISA rotavirus positive stool samples collected from children with diarrhea aged <5 years during 2003 in Valencia (Carabobo State), were G-, P- and NSP4-genotyped by RT-PCR and/or automated sequencing. Four common combinations, G3P[8]/NSP4-E1, G2P[4]/NSP4-E2, G9P[8]/NSP4-E1, and G1P[8]/NSP4-E1 were responsible for 50.6%, 35.6%, 5.7%, and 1.1%, respectively of cases of rotavirus diarrhea, most of them (66%) in children ≤12 months. One uncommon G8P[14]/NSP4-E2 strain was also detected. Temporal fluctuation of genotype distribution occurred, but no differences by age, diarrhea severity score, sex, treatment type or patient medical attention were observed, except for the G3P[8]/NSP4-E1, associated with a more severe dehydration than any other type (P < 0.01). The results confirm the broad diversity among rotavirus strains circulating in Venezuela prior to vaccine implementation, showing the predominance of G3, significant proportion of G2 and moderate circulation of G9 strains. Epidemiological surveillance is needed to detect the emergence of new genotypes that could escape protection induced by vaccination.

Monitoring of group C rotavirus in children with acute gastroenteritis in Brazil: an emergent epidemiological issue after rotavirus vaccine?

Group C rotavirus (GpCRV) has a worldwide distribution; however, its epidemiology and ecology are still unclear. Evidence for a possible zoonotic role has been postulated recently for Brazilian children strains. The aim of this study was to monitor GpCRV in children ≤15 years with acute gastroenteritis during the 2007-2010 national Brazilian rotavirus surveillance, and to undertake the molecular characterization of the major VP6 capsid protein. A total of 3,019 fecal samples were first screened for Group A rotavirus (GpARV). A total of 2,205 GpARV ELISA negative samples were tested further for the presence of GpCRV by SDS-PAGE, electronic microscopy, and RT-PCR for the VP6 gene. The genetic diversity of GpCRV was carried out by sequencing the VP6 gene. GpARV and GpCRV infections were detected in 24.6% (742/3,019) and 0.3% (8/3,019), respectively. The GpCRV detection rate increased from 0.2% (1/422) in 2007 to 1% (7/708) in 2008, and GpCRV cases were not detected in 2009 and 2010. The phylogenetic analysis indicated that the strains belonged to the human lineage, and showed a genetic relationship with the GpCRV strain from Japan isolated in 2009. None of the study sequences was related closely to animal GpCRV strains. This study provides further evidence that GpCRV is a minor cause of acute childhood gastroenteritis in Brazil, and does not suggest that GpCRV may assume epidemiological importance in the future, even after the introduction of a GpARV vaccine. In addition, the molecular analyses of the GpCRV samples in this study do not support the zoonotic hypothesis.

Rotavirus infection in a tertiary hospital: laboratory diagnosis and impact of immunization on pediatric hospitalization

BACKGROUND AND OBJECTIVES

Rotavirus (RV) is the main etiological agent of diarrhea in childhood; its laboratory diagnosis is crucial to guide the clinical management and prevention of its spread. RV immunization was introduced in Brazilian 6-month-old children in 2006. The present study was aimed to evaluate three methodologies used for human RV detection in stool samples obtained from patients hospitalized due to gastroenteritis in a teaching hospital and report the impact of RV immunization in hospitalization by diarrhea.

METHODS

293 stool samples collected in the 2001-2008 period were analyzed by enzyme immunoassay (EIA), latex agglutination (LA) and polyacrylamide gel electrophoresis (PAGE).

RESULTS

Rotavirus was detected in 34.8% of samples by LA assay, 28.3% of samples by EIA assay and in 25.6% of samples by PAGE assay. Considering the PAGE method as gold standard, the sensitivity, specificity and accuracy of EIA were 94.6%, 94.4% and 94.5%, and to LA were 82.6%, 81.6% and 81.9%, respectively.

CONCLUSION

These results indicate that antigen detection by EIA is a rapid, sensitive and specific method, and could be used in large-scale applications for screening stool samples suspected of RV infection. This study showed decreased incidence of RV infection in hospitalized children prior to the implementation of the national immunization program against RV.

[The rotavirus disease and the oral human rotavirus vaccination in the Brazilian scenario: an integrative literature review]

Due to the epidemiological relevance of rotavirus disease on the worldwide panorama as an important cause of morbid-mortality in the infantile public and to the still incipient production of studies concerning the problematic in the nationwide scenario, not to mention the unique necessity of encouraging the promotion of care and education as inseparable factors in the health spaces, it was delimited as study object of the present article the rotavirus disease in the Brazilian scenario, emphasizing the vaccination as preventive measure against this ill. Thus it is aimed to analyze the publications about rotavirus disease in our country's contexture, stressing the vaccination against the Rotavirus (VORH) as the strategy mentioned. It is a bibliographic research performed on the BDENF, Lilacs, SciELO and Medline databases, in February 2010. During the study the following thematic pillars were discussed: rotavirus characteristics; the rotavirus disease as a public health issue; and the vaccination against rotavirus as primordial action of health care. The study evidenced the epidemiological importance of rotavirus disease in the worldwide scenario and the relevance of vaccination as preventive measure against such problematics.

Rotavirus infection: a perspective on epidemiology, genomic diversity and vaccine strategies

For centuries, acute diarrhea has been a major cause of death in young children worldwide, and until 1973, before rotavirus was discovered; no infectious agents could be identified in about 80% of patients admitted to hospital with severe dehydrating diarrhea. Rotaviruses have now been shown to cause 40-50% of severe acute diarrhea in young children worldwide in both developing and developed countries. More than 600,000 young children die and approximately 2.4 million hospitalize annually from rotavirus disease, especially in South-East Asia and sub-Saharan Africa. Two safe and effective vaccines are now licensed in 100 countries but used in 17 countries. Rotarix (GSK) vaccine is derived from single attenuated human rotavirus G1P[8], representative of the most common serotype identified worldwide. RotaTeq (Merck) is a pentavalent mixture of naturally attenuated bovine/human rotavirus reassortants representing G1, G2, G3, G4, and P[8] serotypes. Though these vaccines have already dramatically decreased the morbidity associated with rotavirus in countries where they are widely used, the third generation of vaccines, based on inactivated viruses or recombinant virus like particle are already in pipeline. Continuous surveillance and the genetic and antigenic analysis of the various strains of rotavirus circulating worldwide will aid significantly in assessing the effectiveness of these vaccines and monitor emergence of new strains. Introduction of rotavirus vaccines in national vaccine policy along with other childhood vaccines may result in significant reduction in mortality in children in poor socioeconomic countries.

[Rotavirus prevalence in infants and children in the public healthcare system of the state of Pernambuco]

INTRODUCTION

Rotaviruses are considered important etiological agents of acute gastroenteritis and a common cause of the hospitalization of children aged zero to four years-old. In Brazil, the incidence of rotavirus gastroenteritis in children is 12 to 42% and the distribution of infection is related to seasonality, which apparently occurs in different periods and intensity according to each region. The study investigated group A rotavirus in fecal samples of suspected children attended by the public health system of the State of Pernambuco.

METHODS

Diagnosis was achieved by ELISA and the Latex agglutination test.

RESULTS

Of the 171 samples studied, 33 (19.3%) presented positivity for Rotavirus A. Among positive samples, 72.7% belonged to male patients and 27.3% to female. Among the positive casuistic, 15.2% were vaccinated. When comparing the results obtained for the ELISA and Latex agglutination tests, 100% agreement between positivity by Latex agglutination and ELISA was verified.

CONCLUSIONS

The high incidence of this infection reinforces the need to monitor this virus and define health policies concerning its diagnosis, prophylaxis, improvement in socioeconomic conditions and the refinement of the vaccine.

Human rotavirus genotypes circulating in Brazil before and after a nationwide rotavirus vaccination program established in 2006

Accounting for an estimated 600,000 deaths worldwide each year, rotaviruses are recognized as the most important etiologic agents causing severe acute gastroenteritis among children under the age of five years. In Brazil, until rotavirus vaccination was established in the public health system in 2006, acute gastroenteritis striking children under five years and caused by these viruses was clearly associated with 3.5 million episodes of diarrhea, 650,000 visits to outpatient health care facilities, 92,000 hospitalizations, and 850 deaths each year. After the introduction of the rotavirus vaccine in Brazil in March 2006, studies all over the country have been comparing rotavirus genotypes circulating in the recent pre- and postvaccination era. Most of these studies have reported a high prevalence of the G2P[4] genotype and also a decrease in rotavirus detection all over Brazil after the introduction of the vaccine. So far, these are preliminary studies, as a longer period of time is necessary to establish if this high prevalence of G2P[4] is due to selective pressure by the vaccine on the circulating viruses or to a normal genotype fluctuation, and if it will have any impact on vaccine efficacy in the future. This review describes results from the most recent studies addressing this issue and on rotavirus genotypic variability in Brazil.

Outbreak of acute gastroenteritis in young children with death due to rotavirus genotype G9 in Rio Branco, Brazilian Amazon region, 2005

BACKGROUND

An epidemic of acute gastroenteritis occurred in Rio Branco City, Acre State, in Brazil's Amazon region in 2005. An investigation was conducted to confirm the etiology and identify possible risk factors for death.

METHODS

Rio Branco municipality surveillance data for the period May to October 2005 were reviewed. In a case-control study, children who died following acute gastroenteritis were compared to age-matched controls with acute gastroenteritis who survived. Rotavirus A (RV-A) was investigated in 799 stool samples and genotyped by reverse transcription polymerase chain reaction (RT-PCR).

RESULTS

The cumulative incidence of diarrhea in children aged <5 years was 21%. A fatal outcome was significantly associated with uncovered household water storage containers. RV-A was identified in 88% of samples and G9 was the prevalent genotype (71%).

CONCLUSIONS

Oral rehydration solution and boiling or chlorinating drinking water likely limited mortality. This epidemic was caused by RV-A genotype G9. After the outbreak, a rotavirus vaccine was introduced into the official childhood immunization schedule in Brazil.

Surto de diarréia por rotavírus no município de Bom Jesus (PI)

O presente estudo trata de um surto de diarréia, por rotavírus, em um município piauiense, objetivando identificar a etiologia, protocolo para atendimento aos casos. Realizou-se um estudo do tipo série de casos, com 22 crianças atendidas com diarréia aguda em 2006, nas Unidades de Saúde do município de Bom Jesus. Os dados foram coletados mediante realização de entrevistas com formulário aplicado aos responsáveis pelas crianças e observações das fichas de atendimento. A maioria das famílias (59,1%) tinha renda inferior a um salário mínimo, 59,1% utilizavam fossa séptica, 77,3% consumiam água da rede de abastecimento pública e 54,5% não bebiam água filtrada. Com relação à idade, 54,5%, tinham entre um a quatro anos e maioria apresentava estado nutricional adequado. Dentre as 22 amostras de swab retal coletadas para coprocultura, isolaram-se E. coli (69,6%), Klebsiella sp. (95,6%), Proteus Mirabilis (47,8%). Em relação às dezesseis amostras de fezes in natura para pesquisa de rotavírus, 100% foram positivas para o genótipo G2; 93,7%, para o sorotipo P4 e 7,2% não foram tipadas. Conclui-se que o monitoramento contínuo dos genótipos circulantes na população é fundamental, o que implica a necessidade de capacitação dos profissionais da área da saúde para o enfrentamento das diarréias.

Efficacy and safety of an oral live attenuated human rotavirus vaccine against rotavirus gastroenteritis during the first 2 years of life in Latin American infants: a randomised, double-blind, placebo-controlled phase III study

BACKGROUND

Peak incidence of rotavirus gastroenteritis is seen in infants between 6 and 24 months of age. We therefore aimed to assess the 2-year efficacy and safety of an oral live attenuated human rotavirus vaccine for prevention of severe gastroenteritis in infants.

METHODS

15 183 healthy infants aged 6-13 weeks from ten Latin American countries randomly assigned in a 1 to 1 ratio to receive two oral doses of RIX4414 or placebo at about 2 and 4 months of age in a double-blind, placebo-controlled phase III study were followed up until about 2 years of age. Primary endpoint was vaccine efficacy from 2 weeks after dose two until 1 year of age. Treatment allocation was concealed from investigators and parents of participating infants. Efficacy follow-up for gastroenteritis episodes was undertaken from 2 weeks after dose two until about 2 years of age. Analysis was according to protocol. This study is registered with ClinicalTrials.gov, number NCT00140673 (eTrack444563-023).

FINDINGS

897 infants were excluded from the according-to-protocol analysis. Fewer cases (p<0.0001) of severe rotavirus gastroenteritis were recorded for the combined 2-year period in the RIX4414 group (32 [0.4%] of 7205; 95% CI 0.3-0.6) than in the placebo group (161 [2.3%] of 7081; 1.9-2.6), resulting in a vaccine efficacy of 80.5% (71.3-87.1) to 82.1% (64.6-91.9) against wild-type G1, 77.5% (64.7-86.2) against pooled non-G1 strains, and 80.5% (67.9-88.8) against pooled non-G1 P[8] strains. Vaccine efficacy for hospital admission for rotavirus gastroenteritis was 83.0% (73.1-89.7) and for admission for diarrhoea of any cause was 39.3% (29.1-48.1). No cases of intussusception were reported during the second year of follow-up.

INTERPRETATION

Two doses of RIX4414 were effective against severe rotavirus gastroenteritis during the first 2 years of life in a Latin American setting. Inclusion of RIX4414 in routine paediatric immunisations should reduce the burden of rotavirus gastroenteritis worldwide.

Human rotavirus serotype G9, São Paulo, Brazil, 1996-2003

Diverse rotavirus strains are present, and frequency of G9 is high.

A total of 3,101 fecal specimens were collected during an 8-year survey for rotavirus infection in São Paulo, Brazil. Group A rotavirus was detected in 774 (25.0%) specimens. Of these, 431 strains (55.7%) were analyzed for G and P types by reverse transcription–polymerase chain reaction; G1 was the predominant serotype (68.2%), followed by G9 (17.2%), G4 (6.3%), G2 (1.2%), G3 (0.7%), mixed infection (1.8%), and untypeable (4.6%). Both rotavirus G and P types could be established in 332 strains (77.0%). We identified the 4 most common strains worldwide: P[8]G1 (66.6%), P[4]G2 (1.0%), P[8]G3 (0.6%), and P[8]G4 (7.2%). Among the single G9 strains detected, VP4 genotyping showed that P[8]G9 was the most prevalent, followed by P[4]G9 and P[6]G9. The emergence and high frequency of rotavirus G9 in São Paulo, Brazil, and other parts of the world will affect the development and evaluation of future vaccines.

Diarréia por rotavírus em crianças desnutridas hospitalizadas no Instituto Materno Infantil Prof. Fernando Figueira, IMIP

OBJETIVOS: verificar a freqüência do rotavírus em crianças de zero a cinco anos com doença diarréica e desnutrição moderada e grave, hospitalizadas no Instituto Materno Infantil Prof. Fernando Figueira (IMIP). MÉTODOS: foi realizado um estudo série de casos durante o período de agosto de 2004 e junho de 2005. No total fizeram parte do estudo 50 crianças. Utilizou-se um questionário pré-codificado e foi montado um banco de dados no software Epi-info 6.0. As amostras de fezes foram analisadas quanto à presença do rotavírus, através de técnicas de imunoensaio enzimático. RESULTADOS: verificou-se que a freqüência do rotavírus na doença diarréica do grupo estudado foi de 24,0%. Em geral as famílias eram pobres, 96,0% delas com renda familiar per capita inferior a R$150,00. Com relação às crianças dois terços (60,4%) receberam leite materno por um período inferior a três meses e 10% delas nunca haviam sido vascinadas. CONCLUSÕES: o estudo traz contribuição para o conhecimento da etiologia da diarréia na criança com desnutrição, no entanto, se faz necessária a realização de estudos com um maior número de crianças para que os resultados possam ser mais conclusivos.

Rotavirus serotypes and electropherotypes identified among hospitalised children in São Luís, Maranhão, Brazil

During June 1997-June 1999 rotavirus infection was screened in infants aged up to 2 years and hospitalised with acute diarrhoea in São Luís, Northeastern Brazil. Altogether, 128 stool samples were collected from diarrhoeic patients and additional 122 faecal specimens from age- and- temporal matched inpatients without diarrhoea were obtained; rotavirus positivity rates for these groups were 32.0% (41/128) and 9.8% (12/122), respectively (p < 0.001). Both electropherotyping and serotyping could be performed in 42 (79.2%) of the 53 rotavirus-positive stool samples. Long and short electropherotypes were detected at similar rates - 38.1% and 40.5% of specimens, respectively. Overall, a G serotype could be assigned for 35 (83.3%) of specimens, the majority of them (66.7%) bearing G1-serotype specificity. Taking both electropherotypes and serotypes together, G1 rotavirus strains displaying long and short RNA patterns accounted for 30.9% and 19.0% of tested specimens, respectively; all G2 strains had short electropherotype. Rotavirus gastroenteritis was detected year-round and, in 1998, the incidence rates tended to be higher during the second semester than in the first semester: 45.2% and 26.1% (p = 0.13), respectively. Rotavirus infections peaked at the second semester of life with frequencies of 30.1% and 13.5% for diarrhoeic children and controls, respectively. While the six rotavirus strains bearing G2-type specificity were circulating throughout the whole study period, G1 serotypes (n = 27) emerged as from June 1998 onwards, 20 (74.1%) of which clustering in 1998. These data underscore the importance of rotaviruses in the aetiology of severe infantile gastroenteritis in Northeastern Brazil and sustain the concept that a future vaccine should confer protection against more than one serotype.

Modeling diarrhea disease in children less than 5 years old

PURPOSE

Identification of the temporal pattern of diarrhea disease in children less than 5 years of age in Rio de Janeiro City (1995-1998) to provide support for decisions about prevention and control of the disease.

METHODS

The weekly counts of hospitalizations and deaths due to diarrhea disease were analyzed separately. An initial generalized linear model (GLM) was derived using variables related to weather and month. Displays of fitted generalized additive models (GAM) including a spline smoothed function of time suggested additional predictors that were used to obtain new models.

RESULTS

The initial models did not properly account for the observed cyclical pattern of the data. Graphical displays of the GAM model show a nonhomogeneous decline and annual cycles. Stepwise fitting of GLMs with two factors (cycle and season), and a time trend, showed that the full three-way interaction model was required. Plots of the residuals from the death model suggested a mixture of distributions while the residuals from the hospitalization model were approximately normal.

CONCLUSIONS

The same general pattern for both time series was found by graphical inspection and fitting of appropriate GLMs. This study provides some additional evidence that severe cases of diarrhea disease may be attributed to rotavirus.

Characterization of rotavirus strains from hospitalized and outpatient children with acute diarrhoea in São Paulo, Brazil

From August 1994 to July 1995, 234 faecal samples from children with or without acute diarrhoea were collected and tested. The group of children with acute diarrhoea (A) was subdivided into two subgroups: subgroup A(1) was made up of children with severe diarrhoea, dehydrated and who needed hospitalization and subgroup A(2) was composed of children who only needed outpatient care. Group B was composed of children without acute diarrhoea (controls). Rotavirus was detected in 36.7% (18/49), 22.0% (15/68) and 1.7% (2/117) patients in groups A(1), A(2) and B, respectively. Of the 35 positive samples in which rotaviruses were detected the VP7 genotypes G1, G2, G3, G5 and the mixture (G2 + G5) were found in 40.0, 11.4, 11.4, 22.9 and 2.9% of the samples, respectively. Also, the VP4 genotypes P[8], P[4] and P[6] were detected in 57.1, 31.4 and 5.7%, respectively. Rotavirus VP6 subgroups I and II were detected at a frequency of 22.4 and 54.3%, respectively. Rotavirus RNA segments had short and long electrophoresis profiles in 20.0 and 51.4% of the cases, respectively. The severity of the disease was not related to a specific G and P types, subgroup or electropherotype.

Padrão temporal das internações e óbitos por diarréia em crianças, 1995 a 1998, Rio de Janeiro

OBJETIVO: Analisar o padrão temporal dos óbitos e internações, no período de 1995 a 1998, associadas à diarréia em crianças menores de cinco anos de idade para subsidiar ações específicas de prevenção e controle dessa doença. MÉTODOS: Os dados foram obtidos do Sistema de Informações sobre Mortalidade (SIM) e Sistema de Internações Hospitalares (SIH) do Ministério da Saúde. As séries mensais de internações e de óbitos por diarréia foram decompostas em componentes de tendência linear estocástica, sazonalidade determinística e irregularidades mediante a aplicação dos modelos estruturais para análise de séries temporais. RESULTADOS: Os níveis de ambas as séries apresentaram mudanças ao longo do tempo, com declínio mais perceptível na série de internações. A variação das taxas de inclinação foi constante para cada uma das séries, em média, a menos 5,3 internações por mês (p-valor <0,001) e menos um óbito por mês (p-valor <0,1), respectivamente. Na análise dos resíduos do modelo de internações, observou-se mudança no nível da tendência em janeiro de 1996. O componente sazonal de ambos os modelos foi estatisticamente significante (p-valor <0,0001), sendo maio e junho os meses com maior excesso de internações e óbitos. Os pressupostos de normalidade e de independência temporal dos resíduos não puderam ser rejeitados ao nível de 0,05. CONCLUSÕES: Os resultados sugerem a predominância da etiologia viral das diarréias moderadas e graves. Neste caso, a vacinação específica é a medida mais eficaz na prevenção e controle, sendo necessários estudos de eficácia de novas candidatas à vacina contra o rotavírus no Brasil.

[Enteropathogens associated with diarrheal disease in infants (< 5 years old) in a population sample in Greater Metropolitan Criciúma, Santa Catarina State, Brazil]

Enteropathogens were investigated in 94 children with diarrhea and 45 age-matched controls, 0 to 5 years old, attending an outpatient unit in Criciúma, Santa Catarina State, Brazil. Cryptosporidium (85.1%) topped the list of parasite isolates, followed by Entamoeba histolytica (56.4%) and Giardia lamblia (4.3%). Four samples contained enteropathogenic Escherichia coli (4.3%). Samonella and Shiguella were not detected. Only one sample contained rotavirus (1.1%).