Epidemiology of HIV in pregnant women and its relationship with the period of the COVID-19 pandemic / Epidemiología del VIH en mujeres embarazadas y su relación con el período de la pandemia de COVID-19 / Epidemiologia do HIV em gestantes e sua relação com o período da pandemia de COVID-19

ABSTRACT Objective: To analyze, in the light of the Social Ecological Theory, the progression of reported cases of HIV during pregnancy in a Brazilian state and their relationship with the onset of the COVID-19 pandemic. Method: Retrospective study, with a sample consisting of all reports of gestational HIV in the state of Ceará - Brazil from 2017 to 2021, on the IntegraSUS platform. Data collection was carried out in January 2022. The analyzed variables were organized according to the theoretical levels: macrosystem, exosystem, mesosystem, and microsystem. Results: A total of 1,173 cases of HIV in pregnant women were recorded. When comparing the pre- and post-pandemic period, a reduction in the disease detection rate (from 231 to 122.67 pregnant women) was observed, as well as 1.82 times more chances of women not using antiretrovirals during childbirth after the start of the pandemic. There was a 55% reduction in vaginal births and 39% in cesarean sections among women diagnosed with HIV after the start of the pandemic. Conclusion: The COVID-19 pandemic had an epidemiological and care impact, leading to a reduction in the number of notifications and in the detection rate of pregnant women living with HIV in the state of Ceará. Therefore, the need to ensure health care coverage is emphasized, with early diagnosis actions, guaranteed treatment, and quality prenatal care.

RESUMEN Objetivo: Analizar, a la luz de la Teoría Ecológica Social, la evolución de los casos notificados de VIH durante el embarazo en un estado brasileño y su relación con el inicio de la pandemia de COVID-19. Método: Estudio retrospectivo, con una muestra compuesta por todos los informes de VIH gestacional en el estado de Ceará - Brasil de 2017 a 2021, en la plataforma IntegraSUS. La recolección de datos se realizó en enero de 2022. Las variables analizadas se organizaron según los niveles teóricos: macrosistema, exosistema, mesosistema y microsistema. Resultados: Se registraron 1.173 casos de VIH en gestantes. Al comparar el período pre y pospandemia, hubo una reducción en la tasa de detección de la enfermedad (de 231 a 122,67 mujeres embarazadas) y 1,82 veces más posibilidades de que las mujeres no usaran antirretrovirales durante el parto después del inicio de la pandemia. Hubo una reducción del 55% en los partos vaginales y del 39% en las cesáreas entre las mujeres diagnosticadas con VIH después del inicio de la pandemia. Conclusión: La pandemia de COVID-19 tuvo un impacto epidemiológico y asistencial, lo que provocó una reducción en el número de notificaciones y en la tasa de detección de mujeres embarazadas que viven con el VIH en el estado de Ceará. Por lo tanto, se refuerza la necesidad de asegurar la cobertura de salud, con acciones de diagnóstico temprano, tratamiento garantizado y atención prenatal de calidad.

RESUMO Objetivo: Analisar, à luz da Teoria Social Ecológica, a evolução dos casos notificados de HIV na gestação em um estado brasileiro e sua relação com o início da pandemia de COVID-19. Método: Estudo retrospectivo, com amostra composta por todas as notificações de HIV gestacional do estado do Ceará - Brasil no período de 2017 a 2021, na plataforma IntegraSUS. A coleta de dados foi realizada em janeiro de 2022. As variáveis analisadas foram organizadas de acordo com os níveis teóricos: macrossistema, exossistema, mesossistema e microssistema. Resultados: Foram registrados 1.173 casos de HIV em gestantes. Ao comparar o período pré e pós-pandemia, observou-se redução da taxa de detecção da doença (de 231 para 122,67 gestantes) e 1,82 vezes mais chances de as mulheres não usarem antirretrovirais no parto após o início da pandemia. Houve redução de 55% de partos vaginais e de 39% de cesarianas das mulheres com diagnóstico de HIV após o início da pandemia. Conclusão A pandemia de COVID-19 causou impacto epidemiológico e assistencial, levando a uma redução do número de notificações e taxa de detecção de gestantes que vivem com HIV no estado do Ceará. Logo, reforça-se a necessidade de assegurar a cobertura de atenção à saúde, com ações de diagnóstico precoce, garantia de tratamento e uma assistência pré-natal de qualidade.

COVID-19 in the municipalities of Botucatu and Serrana, São Paulo, Brazil, the effects of lethality and mortality / COVID-19 nos municípios de Botucatu e Serrana, São Paulo, Brasil, os efeitos da letalidade e mortalidade

Introduction: In 2019, the proliferation of a virus identified as SARS-CoV-2 emerged in the city of Wuhan, a district in China, quickly spread throughout the world, gaining pandemic status and less than 1 year, its repercussions and magnitude caused scientists, governments and society to adopt severe measures to combat this disease. Objective: To analyze mortality, incidence and mortality from COVID-19 in the municipalities of Botucatu and Serrana, São Paulo, Brazil. Methods: This is an ecological study with a time series design with secondary data. All registered cases and deaths registered by COVID-19 from April 2020 to August 2021 in the municipalities of Botucatu and Serrana, São Paulo, Brazil were considered. The incidence, mortality and lethality rate were used. The monthly and/or weekly percentage variation and their respective 95% confidence intervals were estimated.Results: It identified that 12.88% of the residents of the city of Botucatu were infected with COVID-19 and 8.61% of the population of the municipality of Serrana was infected. There was a stationary trend of mortality and incidence in the period between April 2020 and May 2021 and decreasing in both sexes in the mortality rate in the municipality of Serrana, in the city of Botucatu there was a trend of increasing mortality and incidence in the same period observed. Conclusion: The mass vaccination strategy of citizens in the cities of Botucatu and Serrana present robust data to consider that immunization has a decreasing effect on the number of cases and deaths from COVID-19, which effectively contributes to fighting the pandemic and reduces the contamination and progression of the disease to more severe cases.

Introdução: em 2019, surgiu na cidade de Wuhan, um distrito na região da China a proliferação com a infecção de um vírus identificado como SARS-CoV-2, rapidamente espalhou-se pelo mundo ganhando status de pandemia em menos de 1 ano, suas repercussões e magnitude fizeram que os cientistas, governos e sociedade adotarem medidas severas para o combate a esta enfermidade. Objetivo: analisar a mortalidade, incidência e letalidade por COVID-19 nos municípios de Botucatu e Serrana, São Paulo, Brasil. Método: trata-se de um estudo ecológico com delineamento de série temporal com dados secundários. Foram consideradas todos os casos registrados e óbitos registrados por COVID-19 no período de abril de 2020 a agosto de 2021, nos municípios de Botucatu e Serrana, São Paulo, Brasil. Foi utilizado a taxa de incidência, mortalidade e letalidade. Estimou-se a variação percentual mensal e/ou semanal e seus respectivos intervalos de 95% de confiança. Resultados: identificou que e 12,88% dos munícipes da cidade de Botucatu foram infectados com COVID-19 e 8,61% da população do município de Serrana foi infectada. Observou-se uma tendência estacionária de mortalidade e incidência no período entre abril 2020 a maio 2021 e decrescente em ambos os sexos na taxa de letalidade no município de Serrana, na cidade de Botucatu houve tendência de mortalidade e incidência crescentes no mesmo período observado. Conclusão: a estratégia de vacinação em massa dos munícipes das cidades de Botucatu e Serrana apresentam dados robustos para considerar que a imunização tem efeito de queda no número de casos e óbitos por COVID-19, o que contribui efetivamente no combate a pandemia e reduz a contaminação e evolução da doença para casos mais graves.

Glycoprotein B Genotyping in Congenital/perinatal Cytomegalovirus Infection in Symptomatic Infants.

Background: Molecular epidemiological studies on circulating strains of CMV in cogenital/perinatal infections have not been done earlier in this region. Objective: To study the glycoprotein B genotypes in babies with symptomatic congenital/perinatal CMV infection and to assess the possible influence of genotype on the outcome of the infection. Methods: Clinical samples (blood and urine) of symptomatic babies are sent to the Virology Department of NCDC, Delhi for the diagnosis of congenital infections. 375 clinical samples of infants (newborn - 6 months old) were included for the study. Serum samples were subjected to ELISA for detection of IgM antibodies against CMV. DNA isolation and amplification of CMV genomic DNA targeting gB gene fragment by nested PCR, was carried out in the samples. The amplified fragment including the cleavage site was subjected to RFLP using restriction enzymes Rsal and Hinf1. They were also verified by sequencing using Big Dye Terminator chemistry. Results: 75 samples out of 375 tested were confirmed positive for CMV infection by serology and PCR. Both RFLP and sequencing of gB gene fragment showed that gB 1, 2 and 3 genotypes were in circulation. gB 3 was the most prevalent genotype in symptomatic infants. Hepatosplenomegaly was the most common feature in gB-3 genotype of CMV. gB2 congenital CMV infection was more commonly associated with long term sequelae.

Study on the molecular-epidemiological characteristics of HIV-1 in Shenzhen, 1992- 2008 / 中华流行病学杂志

Objective To investigate the epidemiological characteristics of HW-1 subtype in Shenzhen from 1992 to 2008.Methods 489 HIV-1 positive plasma samples were collected from 1992 to 2008 in Shenzhen.HIV-1 env genes were amplified by nested-PCR from RNA.Phylogenetic analysis was performed on data regarding the nucleotide sequence.Results A total of 464 sequences were amplified and genotyped.Data from this study revealed that CRF01_AE was a predominant HIV-1 subtype in Shenzhen (64.4％,299/464),followed by subtypes CRF_BC( 17.5％,81/464),B'( 14.7％,68/464) and B (2.4％,11/464).Subtype C (0.4％,2/464),A1 (0.2％,1/464),CRF02_AG(0.2％,1/464) and CRF06_cpx (0.2％,1/464) were also prevalent in Shenzhen.CRF01_AE and CRF_BC were predominant among heterosexuals,homosexuals and injection drug users,while B'was predominant among blood donors.Results from phylogenetic tree analysis showed that some of the HIV-1 clusters had been defined in CRF01_AE strains at different time or groups with different transmission routes.Cross-infections were also seen.Conclusion CRF01_AE was the predominant HIV-1 subtype in Shenzhen while CRF_BC,B,B',C,A1,CRF02_AG and a small amount of CRF06_cpx or recombinant subtypes were prevalent in this city.Different subtypes showed great variation in the process of epidemics.

Enfoque de los sistemas complejos en la epidemiología: [revisión] / Approach of the complex systems in epidemiology: [review]

Para confeccionar la presente revisión se utilizaron bases de datos disponibles en INFOMED, (PUDMED e HINARI;) utilizando los descriptores “epidemics models”, “epidemics contact patterns” y “epidemics spatio-temporal”. Se realizaron observaciones, entrevistas individuales y grupales con el personal de Epidemiología de la provincia de Camagüey y Ciudad Habana. Se destaca el hecho de que existe abundante bibliografía actualizada en las bases de datos de INFOMED, la cual muestra tendencia internacional al uso de herramientas matemáticas propias del enfoque de la complejidad. En el caso específico de la Epidemiología se aprecia en el mundo el uso de modelos matemáticos de avanzada, análisis cartográficos dinámicos y el establecimiento de patrones de contacto de las poblaciones, lo que pone en evidencia que la toma de decisiones se vale de métodos científicos de avanzada propios del enfoque de los sistemas complejos. Se concluye que urge el reconocimiento de la no linealidad de los procesos epidemiológicos, para que la calidad de la vigilancia epidemiológica se enriquezca con este tipo de análisis.

To make the present review, available databases were used such as: INFOMED, (PUDMED and HINARI;) using "epidemics models", "epidemics contact patterns" and "epidemics spatio-temporal" as describers. Observations, individual and group interviews with the Epidemiology staff of Camagüey province and Havana City were performed. It stands out the fact that abundant updated bibliography in INFOMED databases exists, which shows international tendency to the use of mathematical tools typical of the complexity approach. In the specific case of Epidemiology it is appreciated all over the world the use of advanced mathematical models, dynamic cartographic analysis and the establishment of patterns of the populations' contact, what puts in evidence that taking decisions uses scientific methods of advanced characteristic to the complex systems approach. It is concluded that urges the recognition of the nonlinearity of the epidemic processes, so that the quality of the epidemic surveillance gets rich with this kind of analysis.

Epidemiological analysis and thinking on infections in the 533 trauma patients following Chinese Wenchuan earthquake / 中华创伤杂志

Objective To provide better emergency and patient services in well-equipped comprehensive hospitals, the organization and wisdom therapeutic strategy are of great importance for the recovery of injured patients from the earthquake zone. Method From 12 May 2008, following the 8.0 Magnitude earthquake in Wenchuan county of Sichuan Province, six Chongqing hospitals with third class in grade A were involved in the rescue of the injured patients with great effort. A total of 533 patients were retreated and followed up from quake zone. All the patients were scored with ISS and AIS system. The profiles of the patients examined, operated and clinical infection investigation were documented. Results Of 533 patients, the number of the patients whose ISS is below 16 is 456 (83.6%), the number between 16 and 25 is 65 (12.2%), and the humor above 25 is 12 (2.3%). The patients were classfled based on their fracture parts as follows: head and neck (n = 42), face (n = 7), chest (n = 114), abdominal and cavitas pelvis (n =81), limb and pelvis (n =314), body surface (n =205), with 180 single fracture site, 139 of them being two combined fracture sites, and 114 of them being above three combined fracture sites. Thirty-two of the patients were suffered from amputation. The number of patients suffered from crushing syndrome reached 21, with 281 surgical operations in hospitals. Seventy-nine patients were suffered from infections including 87.3% of pre-hespital infections. The results from bacteria culture and antibiotic susceptibility showed that the infected bacteria mainly involved in Escherichia coli, Staphylococcus anreus, Staphylococcus haemolyticns, Klebsiella pneumoniae, Baumanii, Aerobacter cloacae, Pseudomonas aeruginosa, C type chain coccus, Bacillus aerogenes capsulatus. The antibiotic susceptibility to diverse bacteria has no obvious changes and exists partial overlapping, and infected patients should be given the treatment of cephalosporin, macrolide antibiotic and so on. Conclusions For the emergency conditions after the catastrophe, the comprehensive hospitals must be prepared to meet large quantities of severe trauma and infection therapy. The scientific selection of antibiotics in the combinative therapy is of great importance to the enhancement of early specific treatment, prevention of severe trauma complications and rehabilitation of patients.

Situação atual da hepatite B e D na região de Cotriguaçu, Amazônia Mato-grossense, 2001. (Nota Prévia) / Current situation of hepatitis B and D in the Amazon Region of Cotriguaçu, Mato Grosso State, 2001: (Previous Note)

DELINEAMENTO DO PROBLEMA: Em 1995, foi identificada epidemia comunitária de hepatite B entre colonos então recentemente assentados em Cotriguaçu, no noroeste mato-grossense. Houve campanha de vacinação nos municípios da região. Nos anos seguintes, manteve-se a estratégia de vacinar os migrantes que continuaram chegando. Para avaliar a atual situação da infecção pelo VHB na região rural de Cotriguaçu, foi planejado inquérito sobre a prevalência dos marcadores do vírus da hepatite B (VHB) e do vírus de hepatite D (VHD) em 2001. MATERIAL E MÉTODOS: Este estudo, tipo corte-transversal, foi desenhado para rastrear todos os habitantes das vilas. Aos moradores, foi solicitado consentimento por escrito. Foi realizada entrevista e coleta de sangue para testar presença de marcadores de hepatite B e D. Considerou-se como expostos à infecção pelo VHB os indivíduos com anti-HBc positivo, independente de serem positivos ou não para o HBsAg ou anti-HBs. Foram considerados como respondedores à vacina aqueles vacinados contra o VHB, com títulos de anti-HBs acima de 10U/L, e com HBsAg e anti-HBc negativos. Os portadores do VHB foram submetidos à pesquisa de anticorpos contra o VHD. Foram feitas análises univariada e multivariada, com regressões linear e logística. RESULTADOS: De 838 participantes, 335 (40%; IC95%: 36,7-43,4) foram infectados pelo VHB e 18 (2,1%; IC95%: 1,3-3,4) eram portadores do HBsAg. Foram considerados respondedores à vacina contra o VHB, 342 (40,8%; IC95%: 37,5-44,2). Os outros 161 (19,2%; IC95%: 16,6-22,1) eram ainda suscetíveis ao VHB. De 802 indivíduos que responderam à pergunta, 72,3% informaram vacinação prévia contra o VHB e 40,2% afirmaram ter tomado as três doses. Após análise multivariada, mantiveram associação independente com os marcadores do VHB: atividade sexual (p<0,01), uso regular de álcool (p<0,01), contato domiciliar com hepatite (p<0,02) e ter vivido em garimpo (p<0,02), assim como pertencer à faixa etária mais elevada (p<0,05). A avaliação de determinantes dos títulos de anti-HBs nos imunes, controlados por idade e fatores de risco, demonstrou que o fato de ter tomado ao menos uma dose da vacina (p<0,001) esteve associado independentemente a maiores títulos de anti-HBs, assim como ter tido a infecção natural pelo VHB (p<0,001). Cinco (28%) dos 18 portadores do HBsAg tiveram infecção também pelo VHD. CONCLUSÕES: Este inquérito demonstra mudança do padrão epidemiológico de hepatite B de alta para moderada prevalência (40% expostos e 2% de portadores). Análise dos índices de cobertura vacinal mostram que o pool de suscetíveis atualmente é pequeno na região e dificilmente sustentará novos surtos de hepatite B como vistos anteriormente. O crescimento dos casos de VHD pode tornar a região hiperendêmica para essa infecção.

BACKGROUND: A community outbreak of hepatitis B among recently settled farmers in Cotriguaçu County in the northwestern area of Mato Grosso State, Brazil, occurred in 1995. There was a vaccination campaign in the counties of the region. In the following years, efforts were made to maintain the vaccination of new immigrants. To assess the current status of HBV and HDV infection in the countryside of Cotriguaçu a cross-sectional survey was designed and carried out in 2001. MATERIAL AND METHODS:The cross-sectional survey was designed to include the entire population of the villages. The settlers who agreed to participate in the study were asked for written consent. Participants were interviewed and bled to test for HBV and HDV markers. Anti-HBc-positive subjects were considered as HBV exposed, independently if positive for HbsAg or anti-HBs. Participants were considered to be responders to vaccination if they were vaccinated, had anti-HBs titers higher than 10U/L and were negative for HbsAg and anti-HBc. HBsAg carriers were tested for HBD antibodies. Univariate and multivariate analyses, including linear and logistic regression models were performed. RESULTS: A total of 335 of 838 study participants (40%; 95% CI:36.7-43.4) had been exposed to HBV. Eighteen (2.1%; 95% CI:1.3-3.4) were HBV carriers; 342 (40.8%; 95% CI:37.5-44.2) were considered as vaccine responders, and 161 (19.2%; 95% CI:16.6-22.1) were susceptible to HBV infection. Previous vaccination was reported by 580/802 (72.3%) subjects, and 40.2% had received the complete schedule. After adjustment with multivariate analyses, the following variables were independently associated with HBV markers: sexual activity (p<0.01), regular use of alcohol (p<0.01), household contact with hepatitis cases (p<0.02), having lived in mining camps (p<0.02) and older age (p<0.05). Anti-HBs titers among immune subjects were assessed. Having received vaccination, at least one dose, and to have been naturally exposed to HBV were associated with higher anti-HBs titers (p<0.001). Five of 18 HBV carriers (28%) were coinfected with HDV. CONCLUSIONS: This survey showed a change in the HBV epidemiological pattern from high to moderate prevalence (40% exposed and 2% of HBV carriers). Vaccine coverage analysis shows that the pool of susceptibles is small. New HBV outbreaks will not likely take place again in this region. The increasing number of HDV infection can result in this area becoming hyperendemic.

Filariasis Elimination in Zoucheng City of Shandong Province: Measures and Effect / 中国寄生虫学与寄生虫病杂志

Zoucheng was a high endemic area of bancrotian filariasis with Culex pipiens pallens as the principal transmitting vector. Transmissiom of the disease was interrupted in 1981. Epidemiological surveillance has been then carried out. After 1989, parasitological and immunological examinations were conducted for those cases previously with and without microfilaremia, entomological surveillance was also carried out. Results showed that the antibody level in inhabitants has been at normal level, and no infection has been found in mosquitoes.