Seroprevalence and factors associated with SARS-CoV-2 infection among education workers after the first wave: the first cross-sectional study in Brazil

ABSTRACT Background: The school community was heavily impacted by the Covid-19 pandemic, especially with the long time of school closures. This study aimed to analyze the seroprevalence of SARS-CoV-2 antibodies and possible factors associated with seropositivity for COVID-19 in teachers and other school staff, and to estimate the fraction of asymptomatic individuals by sex and age group. Methods: We conducted a serological survey of SARS-CoV-2 infections. An analytical cross-sectional study was conducted in Fortaleza, Brazil. Teachers and other staff members from pre-schools to universities of higher education to were investigated. Results: A total of 1,901 professionals participated in the study, of which 1,021 were staff and 880 were teachers. The seroprevalence of SARS-CoV-2 was 8.0% (152/1901). In the seropositive group, 48.3% were asymptomatic. There was a predominance of women (68.4%); and, 47.1% of the participants were between 31 and 45 years old. There was an increase in prevalence with increasing age. An inverse relationship was found for education level: more professionals with less education tested positive for COVID-19. The presence of an infected person living in the same household was significantly associated with positive results for COVID-19 among the professionals. Conclusions: This is the first study to report the seroprevalence of IgG against SARS-CoV-2 in Brazilian educational staff after the first wave of the disease. In this study, the seroprevalence was much lower than that in the general population. During school reopening, a small fraction of school workers showed serologically detectable signs of SARS-CoV-2 exposure.

A major chikungunya epidemic with high mortality in northeastern Brazil

Abstract INTRODUCTION Chikungunya causes fever and severe and persistent joint pain. METHODS We reported a chikungunya outbreak that occurred in Ceará State, Brazil between 2016 and 2017 with emphasis on epidemiological characterization of cases, high number of deaths, mortality-associated factors, and spatial and temporal spread of the epidemic among municipalities. RESULTS: In November 2015, the first autochthonous cases of chikungunya were confirmed in Ceará, Brazil. In 2016-2017, 195,993 cases were reported, with an incidence of 2,186.5/100,000 inhabitants and 244 confirmed deaths. CONCLUSIONS: Rapid transmission and high mortality rate are serious problems, especially in regions with co-circulating arboviruses.

Trinta anos de dengue no Ceará: história, contribuições para ciência e desafios no cenário atual com tripla circulação de arbovírus / Thirty years of dengue in Ceará: history, contributions to science and challenges in the current scenario with triple arbovirus circulation

Introdução: Embora os primeiros casos de dengue no estado do Ceará tenham ocorrido em 1986, há registros da presença do mosquito Aedes aegypti desde os anos de 1851/1852. Mesmo após 30 anos, a dengue permanece como um problema grave de saúde pública com epidemias cada vez mais frequentes. Objetivo: Resgatar, reunir e sintetizar a evidência científica produzida nos primeiros 30 anos de dengue no Ceará, contribuindo para melhorar sua compreensão e as intervenções de vigilância e controle. Métodos: Realizou-se uma revisão de literatura com busca de artigos (inglês, português e espanhol) nas bases de dados Pubmed, Scielo, Clinicalkey, Lilacs, Google Acadêmico e banco virtual de teses e dissertações da CAPES, além de livros. O período de 1986 a 2016 foi usado como limite de busca e a mesma foi realizada entre os meses de agosto a novembro de 2016. Utilizaram-se os descritores controlados: dengue, Ceará, Fortaleza e Aedes; com interposição do operador boleano "AND". Resultados: Foram identificadas 574 publicações potencialmente elegíveis, sendo 461 artigos e 113 dissertações ou teses. Foram retirados 272 artigos duplicados ou que não atenderam aos critérios de inclusão. Foram lidos 114 artigos publicados em 60 revistas diferentes, sendo 72,8% artigos completos, 75,2% em inglês, 42,2% experimentais e 81,5% com abordagem quantitativa. Foi publicado apenas um artigo na década de 1980, já na década seguinte foram sete, número que cresceu bastante nos anos 2000, com 38 artigos. No entanto, já há 69 artigos publicados apenas na primeira metade da década de 2010. No período, o Ceará confirmou quase um milhão de casos de dengue, com a circulação dos quatro sorotipos (DENV1 - 1986, DENV2 - 1994, DENV3 - 2002 e DENV4 - 2011) e registrou pelo menos 14 epidemias. A partir de 2015, o Ceará passou a apresentar um cenário diferenciado de tripla epidemia, com a cocirculação autóctone de dois outros arbovírus: Chikungunya e Zika. Conclusão: Nesse período de 30 anos (1986-2016), o Ceará vivenciou várias epidemias de dengue, e, de certa forma, isto vem impulsionando a busca por respostas para o controle desta doença. Há claramente um crescimento em número de artigos publicados a cada ano, revelando a pujança dos grupos locais, que contribuiu de forma importante para a produção científica em diversos fatores relacionados à compreensão da epidemiologia e controle da dengue. (AU)

Introduction: Although the first cases of dengue in the state of Ceará occurred in 1986, there are records of the presence of the Aedes aegypti mosquito since the years 1851/1852. Even after 30 years, dengue remains a serious public health problem with frequent epidemics. Objective: To rescue, gather and synthesize scientific evidence in the first 30 years of dengue in Ceará, contributing to improve its understanding, surveillance and control interventions. Methods: An integrative review was carried out with the search of articles (English, Portuguese and Spanish) in the databases Pubmed, Scielo, Clinicalkey, Lilacs, Google Scholar and virtual bank of thesis and dissertations of CAPES, as well as books. The period from 1986 to 2016 was used as a search limit and it was carried out between August and November 2016. The following descriptors were used: dengue, Ceará, Fortaleza and Aedes; with interposition of the Boolean operator "AND". Results: 574 potentially eligible publications were identified, 461 articles and 113 dissertations or thesis. 272 duplicate articles were removed or did not meet the inclusion criteria. We have read 114 articles published in 60 different journals, 72.8% were full articles, 75.2% were in English, 42.2% were experimental and 81.5% were quantitative. Only one article was published in the 1980s, and in the next decade there were seven, this number grew up considerably in the 2000s with 38 articles. However, there are already 69 articles published only in the first half of the decade of 2010. In this period, Ceará confirmed almost 1 million cases of dengue with the circulation of the four serotypes (DENV1 - 1986, DENV2 - 1994, DENV3 - 2002 and DENV4 - 2011) and recorded at least 14 epidemics. From 2015 on, Ceará started to present a differentiated scenario of a triple epidemic, with the autochthonous co-circulation of two other arboviruses: chikungunya and Zika. Conclusion: In this period of 30 years (1986-2016), Ceará experienced. (AU)

Aspectos entomológicos e epidemiológicos das epidemias de dengue em Fortaleza, Ceará, 2001-2012 / Aspectos entomológicos y epidemiológicos de las epidemias de dengue en Fortaleza, Ceará, Brasil, 2001-2012 / Entomological and epidemiological aspects of dengue epidemics in Fortaleza, Ceará, Brazil, 2001-2012

Objetivo: descrever os aspectos entomológicos e epidemiológicos das epidemias de dengue ocorridas em Fortaleza, Ceará, Brasil, de 2001 a 2012. Métodos: estudo descritivo com dados dos Sistemas de Informação de Agravos de Notificação (Sinan), de Informações Hospitalares (SIH), do Programa de Febre Amarela e Dengue (2001-2009), do Programa Nacional de Controle da Dengue (2010-2012) e Levantamento Rápido do Índice de Infestação de Aedes aegypti, referentes aos anos quando a incidência da doença superou o percentil 75%. Resultados: De 2001 a 2012 foram notificados 194.446 casos suspeitos de dengue. Os anos epidêmicos foram: 2001, 2006, 2008, 2011 e 2012. Houve aumento progressivo da incidência (587,0/100 mil hab. [2001] e 1.561,1/100 mil hab [2012]), com cocirculação de até três sorotipos e elevada infestação vetorial, principalmente em depósitos para armazenar água. Conclusão: após longo período de circulação do vírus em Fortaleza, a dengue permanece como importante problema de saúde, com casos graves e alta letalidade.

Objetivo: caracterizar los aspectos entomoepidemiológicos de epidemias de dengue ocurridas en Fortaleza, Ceará, Brasil, entre 2001 y 2012. Métodos: estudio descriptivo con datos del Sistema de Información de Agravios de Notificación (Sinan), de Hospitalizaciones, del Sistema de Información de Fiebre Amarilla y Dengue (2001-2009), SisPNCD (2010-2012) y del Levantamiento Rápido del Índice de Infestación de Aedes aegypti, referentes a los años cuando la incidencia de dengue fue superior al percentil 75%. Resultados: en 2001-2012, se notificaron 194.446 casos sospechosos de dengue; los años epidémicos fueron 2001, 2006, 2008, 2011 y 2012; hubo un aumento progresivo de incidencia de dengue (587,0/100 mil hab. en 2001 y 1.561,1/100 hab. en 2012), con co-circulación de hasta tres serotipos y elevada infestación vectorial, principalmente en depósitos utilizados para almacenar agua. Conclusión: tras un largo período de circulación del virus en Fortaleza, el dengue permanece como un importante problema de salud, con casos más graves y alta letalidad.

Objective: to characterize the entomological and epidemiological aspects of dengue epidemics occurred in Fortaleza, Ceará, Brazil, from 2001 to 2012. Methods: descriptive study with data from the Information System for Notifiable Diseases (Sinan), Information System of Hospitalizations due to Yellow Fever and Dengue (2001-2009), National Program for Dengue Control (2010-2012), and Rapid Survey of Aedes aegypti Infestation Index, referring to the years in which the incidence of dengue was above 75%. Results: from 2001 to 2012, 194,446 cases of suspected dengue were notified; the epidemic years were 2001, 2006, 2008, 2011 and 2012; there was a progressive increase in the incidence of the disease (587.0/100 thousand inhabitants in 2001 and 1,561.1/100 inhabitants in 2012); there was co-circulation of up to three serotypes and high vector infestation, especially in water tanks. Conclusion: after a long period of virus circulation in Fortaleza, dengue remains as an important health issue, with severe cases and high fatality rate.

Dengue 4 in Ceará, Brazil: characterisation of epidemiological and laboratorial aspects and causes of death during the first epidemic in the state

BACKGROUND The first dengue cases in Brazil with laboratory confirmation occurred in the northern region of the country, with the isolation of two serotypes, dengue virus 1 (DENV-1) and DENV-4. In Ceará, the introduction of DENV-4 was reported during a DENV-1 epidemic in 2011, with only two isolations. OBJECTIVES The aim of this study was to characterise the first DENV-4 epidemic in the state of Ceará, Brazil. METHODS The study population was composed of patients with suspected dengue that were reported to health care units from January to December 2012. The laboratory confirmation of infection was made by viral isolation, reverse transcription polymerase chain reaction (RT-PCR), AgNS1, immunohistochemistry and IgM enzyme-linked immunosorbent assay (ELISA). MAIN CONCLUSIONS In the study year, 72,211 suspected dengue cases were reported and 51,865 of these cases (71.8%) were confirmed to be positive. Co-circulation of three serotypes, DENV-1, DENV-3 and DENV-4, was detected with a predominance of DENV-4 (95.3%). Most cases were not severe, but there were 44 fatal outcomes. DENV-4 Genotype II was identified for the first time in Ceará.

Evaluation of the World Health Organization 2009 classification of dengue severity in autopsied individuals, during the epidemics of 2011 and 2012 in Brazil

Abstract: INTRODUCTION: The dengue classification proposed by the World Health Organization (WHO) in 2009 is considered more sensitive than the classification proposed by the WHO in 1997. However, no study has assessed the ability of the WHO 2009 classification to identify dengue deaths among autopsied individuals suspected of having dengue. In the present study, we evaluated the ability of the WHO 2009 classification to identify dengue deaths among autopsied individuals suspected of having dengue in Northeast Brazil, where the disease is endemic. METHODS: This retrospective study included 121 autopsied individuals suspected of having dengue in Northeast Brazil during the epidemics of 2011 and 2012. All the autopsied individuals included in this study were confirmed to have dengue based on the findings of laboratory examinations. RESULTS: The median age of the autopsied individuals was 34 years (range, 1 month to 93 years), and 54.5% of the individuals were males. According to the WHO 1997 classification, 9.1% (11/121) of the cases were classified as dengue hemorrhagic fever (DHF) and 3.3% (4/121) as dengue shock syndrome. The remaining 87.6% (106/121) of the cases were classified as dengue with complications. According to the 2009 classification, 100% (121/121) of the cases were classified as severe dengue. The absence of plasma leakage (58.5%) and platelet counts <100,000/mm3 (47.2%) were the most frequent reasons for the inability to classify cases as DHF. CONCLUSIONS: The WHO 2009 classification is more sensitive than the WHO 1997 classification for identifying dengue deaths among autopsied individuals suspected of having dengue.

Severe coinfection of melioidosis and dengue fever in northeastern Brazil: first case report / Coinfecção grave de melioidose e dengue no nordeste do Brasil: primeiro caso

This report focuses on a fatality involving severe dengue fever and melioidosis in a 28-year-old truck driver residing in Pacoti in northeastern Brazil. He exhibited long-term respiratory symptoms (48 days) and went through a wide-ranging clinical investigation at three hospitals, after initial clinical diagnoses of pneumonia, visceral leishmaniasis, tuberculosis, and fungal sepsis. After death, Burkholderia pseudomallei was isolated in a culture of ascitic fluid. Dengue virus type 1 was detected by polymerase chain reaction in cerebrospinal fluid (CSF); this infection was the cause of death. This description reinforces the need to consider melioidosis among the reported differential diagnoses of community-acquired infections where both melioidosis and dengue fever are endemic.

Estudo de caso fatal de coinfecção de melioidose e dengue grave em um motorista de 28 anos, residente no município de Pacoti, nordeste do Brasil. O paciente apresentou inicialmente sintomas respiratórios com evolução por 48 dias. Foi internado em três diferentes unidades de saúde com suspeitas de pneumonia, leishmaniose visceral, tuberculose e sepse fúngica. Após o óbito, a cultura de líquido ascítico identificou a bactéria Burkholderia pseudomallei. O vírus da dengue tipo 1 foi detectado por PCR no líquor do paciente. Esta descrição reforça a necessidade de considerar a melioidose entre os diagnósticos diferenciais de infecções comunitárias onde as duas doenças são endêmicas.

Concurrent infection with dengue virus type-2 and DENV-3 in a patient from Ceará, Brazil

Dengue outbreaks have occurred in several regions in Brazil and cocirculating dengue virus type 1 (DENV-1), DENV-2, and DENV-3 have been frequently observed. Dual infection by DENV-2 and DENV-3 was identified by type-specific indirect immunofluorescence assay and confirmed by reverse transcription polymerase chain reaction in a patient in Ceará with a mild disease. This is the first documented case of simultaneous infection with DENV-2 and DENV-3 in Brazil. Sequencing confirmed DENV-2 and DENV-3 (South-East/American) genotype III and (SriLanka/India), genotype III respectively.