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ObjectivesTo assess natural history and 12-month change of a series of scales and functional outcome measures in a cohort of 117 patients with primary mitochondrial myopathy (PMM).MethodsTwelve months follow-up data of 117 patients with PMM were collected. We analysed the 6-min walk test (6MWT), timed up-and-go test (× 3) (3TUG), five-times sit-to-stand test (5XSST), timed water swallow test (TWST), and test of masticating and swallowing solids (TOMASS) as functional outcome measures; the Fatigue Severity Scale and West Haven-Yale Multidimensional pain inventory as patient-reported outcome measures. PMM patients were divided into three phenotypic categories: mitochondrial myopathy (MiMy) without extraocular muscles involvement, pure chronic progressive external ophthalmoplegia (PEO) and PEO&MiMy. As 6MWT is recognized to have significant test–retest variability, we calculated MCID (minimal clinically important difference) as one third of baseline 6 min walking distance (6MWD) standard deviation.ResultsAt 12-month follow-up, 3TUG, 5XSST and FSS were stable, while TWST and the perceived pain severity (WHYMPI) worsened. 6MWD significantly increased in the entire cohort, especially in the higher percentiles and in PEO patients, while was substantially stable in the lower percentile (< 408 m) and MiMy patients. This increase in 6MWD was considered not significant, as inferior to MCID (33.3 m). NMDAS total score showed a slight but significant decline at 12 months (0.9 point). The perceived pain severity significantly worsened. Patients with PEO performed better in functional measures than patients with PEO&MiMy or MiMy, and had lower values of NMDAS.ConclusionsPMM patients showed a slow global decline valued by NMDAS at 12 months; 6MWT was a more reliable measurement below 408 m, substantially stable at 12 months. PEO patients had better motor performance and lower NMDAS than PEO&MiMy and MiMy also at 12 months of follow-up.

The aim of this case-control study was to evaluate the ability of digital health technology (DHT) to detect and quantify mobility alterations in late-onset Pompe Disease. The study enrolled eight subjects with Pompe Disease, including three young mildly affected/asymptomatic subjects, who underwent an extensive DHT mobility assessment and were contrasted to 52 matched controls. DHT enabled the detection of subtle mobility alterations, indicating a lower speed in walking, and worse performances in postural transition and turning in patients compared to controls. Interestingly, in the three mildly affected/asymptomatic cases, step time variability and step length showed detectable alterations compared to controls, despite scores within the normal range on clinical scales and timed tests.

Organization of national immunization days (NIDs) in all countries in Latin America in which polio was endemic has been one of the key elements that led to the interruption of the circulation of the wild poliovirus in 1991 from the Americas. National initiatives for control or elimination of measles using similar strategies have emerged from the successful organization of NIDs for polio eradication and lead the way to the eventual global eradication of this major killer of children. The major reasons for the success of polio eradication in the Americas were the commitment of national authorities, well-defined strategies, sustainable effort, and the participation of all sectors of society.

To assess factors that may influence the immunogenicity of oral poliovirus vaccine (OPV), neutralizing antibody responses were measured in 1409 infants in Brazil and the Gambia who were randomized to receive one offfour different formulations of OPV at ∼birth and at 6,10, and 14 weeks. Overall seroconversion rates at the end of the trial were 85% for poliovirus type 1 (PI), 94% for type 2 (P2), and 68% for type 3 (P3). Factors associated with vaccine failure included high levels of maternal antibody (PI, P2, and P3), vaccination during the rainy season (PI, P2, and P3), diarrhea at the time of vaccination (P2 and P3), household exposure to other OPV recipients (PI), and breast-feeding (P3) (P < .05 for each factor, logistic regression analysis). OPV containing twice the standard potency of Sabin type 1 virus increased seroconversion rates to PI by 8% in Brazil (P < .05) and 15% in the Gambia (P < .001). Suboptimal responses to OPV in developing countries are determined by a complex array of factors related to the vaccine, host, and environment.

Measles is regarded as a major public health problem in Brazil, accounting for much of the morbidity and mortality among children younger than five years of age. Rates of immunization have risen steadily since the National Immunization Program (NIP) was set up in 1973, reaching a maximum of 72.1% in 1981. However, the impact of the program cannot yet be demonstrated because of variations in reporting and of operational problems involved in the maintenance of efficient routine vaccination in most states. Changes in NIP field strategies after 1980 included the organization of campaigns in areas where the rates of vaccination are lowest, particularly in northern and northeastern Brazil.

Minocycline, rifampin, sulfadiazine, and a combination of minocycline and rifampin were studied for efficacy in eradication of meningococcal infection in families of patients with meningococcal disease in São Paulo, Brazil. The rate of meningococcal infection two weeks after treatment of carriers with sulfadiazine (49%) was greater than the rates after treatment with minocycline (17%), rifampin (9%), or the combination of minocycline and rifampin (0%). While persistence of carriage was not statistically different in the groups receiving minocycline or rifampin, seven of 69 persons (10%) receiving rifampin alone were subsequently found to carry rifampin-resistant meningococci. No minocyclineresistant meningococci were found. The most effective regimen tested for eradicating meningococcal carriage was the combination of minocycline and rifampin, but unpleasant side effects were experienced by 33% of the persons who received this combination.

A large urban epidemic of meningococcal disease is occurring in Saõ Paulo, Brazil. Cases were first reported to the Saõ Paulo Health Department at an epidemic rate in June 1971, and the reported incidence of meningococcal disease has remained above the endemic level ever since, with peaks in late 1971 and from July 1972 through the time of our investigation (December 1972). Infants are at greatest risk, although the greatest relative increases in attack rates have occurred in groups older than 15 years. Age-specific attack rates for males and females are the same, except that 20–25-year-old males have had a significantly higher rate. The entire metropolitan area was involved by the second year of the epidemic. The epidemic strain was identified as a sulfonamide-resistant serogroup C Neisseria meningitidis.