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1.
PLoS Negl Trop Dis ; 16(4): e0007507, 2022 04.
Article in English | MEDLINE | ID: mdl-35404948

ABSTRACT

BACKGROUND: Leptospirosis is an important public health problem affecting vulnerable urban slum populations in developing country settings. However, the complex interaction of meteorological factors driving the temporal trends of leptospirosis remain incompletely understood. METHODS AND FINDINGS: From March 1996-March 2010, we investigated the association between the weekly incidence of leptospirosis and meteorological anomalies in the city of Salvador, Brazil by using a dynamic generalized linear model that accounted for time lags, overall trend, and seasonal variation. Our model showed an increase of leptospirosis cases associated with higher than expected rainfall, lower than expected temperature and higher than expected humidity. There was a lag of one-to-two weeks between weekly values for significant meteorological variables and leptospirosis incidence. Independent of the season, a weekly cumulative rainfall anomaly of 20 mm increased the risk of leptospirosis by 12% compared to a week following the expected seasonal pattern. Finally, over the 14-year study period, the annual incidence of leptospirosis decreased significantly by a factor of 2.7 (8.3 versus 3.0 per 100,000 people), independently of variations in climate. CONCLUSIONS: Strategies to control leptospirosis should focus on avoiding contact with contaminated sources of Leptospira as well as on increasing awareness in the population and health professionals within the short time window after low-level or extreme high-level rainfall events. Increased leptospirosis incidence was restricted to one-to-two weeks after those events suggesting that infectious Leptospira survival may be limited to short time intervals.


Subject(s)
Leptospira , Leptospirosis , Climate , Humans , Humidity , Incidence , Leptospirosis/epidemiology , Meteorological Concepts
2.
BMC Infect Dis ; 11: 323, 2011 Nov 21.
Article in English | MEDLINE | ID: mdl-22103652

ABSTRACT

BACKGROUND: Prior to the availability of generic third-generation cephalosporins, penicillins were widely used for treatment of pneumococcal meningitis in developing countries despite concerns about rising levels of penicillin resistance among pneumococcal isolates. We examined the impact of penicillin resistance on outcomes of pneumococcal meningitis over a ten year period in an infectious diseases hospital in Brazil. METHODS: Clinical presentation, antimicrobial therapy and outcomes were reviewed for 548 patients with culture-confirmed pneumococcal meningitis from December, 1995, to November, 2005. Pneumococcal isolates from meningitis patients were defined as penicillin-resistant if Minimum Inhibitory Concentrations for penicillin were greater than 0.06 µg/ml. Proportional hazards regression was used to identify risk factors for fatal outcomes. RESULTS: During the ten-year period, ceftriaxone replaced ampicillin as first-line therapy for suspected bacterial meningitis. In hospital case-fatality for pneumococcal meningitis was 37%. Of 548 pneumococcal isolates from meningitis cases, 92 (17%) were resistant to penicillin. After controlling for age and severity of disease at admission, penicillin resistance was associated with higher case-fatality (Hazard Ratio [HR], 1.62; 95% Confidence Interval [CI], 1.08-2.43). Penicillin-resistance remained associated with higher case-fatality when initial therapy included ceftriaxone (HR, 1.68; 95% CI 1.02-2.76). CONCLUSIONS: Findings support the use of third generation cephalosporin antibiotics for treatment of suspected pneumococcal meningitis even at low prevalence of pneumococcal resistance to penicillins.


Subject(s)
Anti-Bacterial Agents/administration & dosage , Meningitis, Pneumococcal/drug therapy , Meningitis, Pneumococcal/microbiology , Penicillin Resistance , Streptococcus pneumoniae/drug effects , beta-Lactams/administration & dosage , Adolescent , Adult , Aged , Aged, 80 and over , Brazil , Child , Child, Preschool , Female , Hospitals , Humans , Infant , Infant, Newborn , Male , Meningitis, Pneumococcal/mortality , Microbial Sensitivity Tests , Middle Aged , Treatment Outcome , Young Adult
3.
J Infect Dis ; 202(10): 1577-84, 2010 Nov 15.
Article in English | MEDLINE | ID: mdl-20932170

ABSTRACT

Since the introduction of Haemophilus influenzae type b (Hib) conjugate vaccines, meningitis caused by serotypes other than Hib has gained in importance. We conducted active hospital-based surveillance for meningitis over an 11-year period in Salvador, Brazil. H. influenzae isolates were serotyped and analyzed by polymerase chain reaction, pulsed-field gel electrophoresis, and DNA sequencing to identify strains with a specific deletion (IS1016) in the bexA gene (IS1016-bexA). We identified 43 meningitis cases caused by non-type b H. influenzae: 28 (65%) were caused by type a (Hia), 9 (21%) were caused by noncapsulated strains, and 3 (7%) each were caused by types e and f. Hia isolates clustered in 2 clonal groups; clonal group A strains (n = 9) had the IS1016-bexA deletion. Among children <5 years of age, meningitis caused by Hia from clonal group A had higher case-fatality than meningitis caused by clonal group B. Despite small numbers, these results indicate that the presence of the IS1016-bexA deletion is associated with enhanced virulence in non-type b H. influenzae.


Subject(s)
ATP-Binding Cassette Transporters/genetics , Bacterial Proteins/genetics , Haemophilus/genetics , Meningitis, Haemophilus/microbiology , Base Sequence , Brazil/epidemiology , Child, Preschool , Female , Gene Deletion , Haemophilus/classification , Haemophilus/pathogenicity , Hospitals, Municipal , Humans , Incidence , Infant , Male , Meningitis, Haemophilus/epidemiology , Molecular Sequence Data , Phylogeny , Sentinel Surveillance , Sequence Alignment , Virulence/genetics
4.
PLoS Negl Trop Dis ; 2(1): e154, 2008 Jan 30.
Article in English | MEDLINE | ID: mdl-18357340

ABSTRACT

BACKGROUND: Leptospirosis, a spirochaetal zoonotic disease, is the cause of epidemics associated with high mortality in urban slum communities. Infection with pathogenic Leptospira occurs during environmental exposures and is traditionally associated with occupational risk activities. However, slum inhabitants reside in close proximity to environmental sources of contamination, suggesting that transmission during urban epidemics occurs in the household environment. METHODS AND FINDINGS: A survey was performed to determine whether Leptospira infection clustered within households located in slum communities in the city of Salvador, Brazil. Hospital-based surveillance identified 89 confirmed cases of leptospirosis during an outbreak. Serum samples were obtained from members of 22 households with index cases of leptospirosis and 52 control households located in the same slum communities. The presence of anti-Leptospira agglutinating antibodies was used as a marker for previous infection. In households with index cases, 22 (30%) of 74 members had anti-Leptospira antibodies, whereas 16 (8%) of 195 members from control households had anti-Leptospira antibodies. Highest titres were directed against L. interrogans serovars of the Icterohaemorrhagiae serogroup in 95% and 100% of the subjects with agglutinating antibodies from case and control households, respectively. Residence in a household with an index case of leptospirosis was associated with increased risk (OR 5.29, 95% CI 2.13-13.12) of having had a Leptospira infection. Increased infection risk was found for all age groups who resided in a household with an index case, including children <15 years of age (P = 0.008). CONCLUSIONS: This study identified significant household clustering of Leptospira infection in slum communities where recurrent epidemics of leptospirosis occur. The findings support the hypothesis that the household environment is an important transmission determinant in the urban slum setting. Prevention therefore needs to target sources of contamination and risk activities which occur in the places where slum inhabitants reside.


Subject(s)
Leptospira/physiology , Leptospirosis/transmission , Poverty Areas , Adolescent , Adult , Age Distribution , Antibodies, Bacterial/blood , Brazil/epidemiology , Child , Child, Preschool , Female , Humans , Leptospira/isolation & purification , Leptospirosis/epidemiology , Leptospirosis/microbiology , Male , Middle Aged , Residence Characteristics , Young Adult
5.
Emerg Infect Dis ; 14(3): 505-8, 2008 Mar.
Article in English | MEDLINE | ID: mdl-18325275

ABSTRACT

We report the emergence of leptospirosis-associated severe pulmonary hemorrhagic syndrome (SPHS) in slum communities in Salvador, Brazil. Although active surveillance did not identify SPHS before 2003, 47 cases were identified from 2003 through 2005; the case-fatality rate was 74%. By 2005, SPHS caused 55% of the deaths due to leptospirosis.


Subject(s)
Hemorrhage/complications , Leptospirosis/complications , Leptospirosis/epidemiology , Lung Diseases/complications , Lung Diseases/epidemiology , Adult , Brazil/epidemiology , Communicable Diseases, Emerging , Female , Humans , Leptospirosis/mortality , Lung Diseases/mortality , Male , Population Surveillance , Time Factors
6.
Trans R Soc Trop Med Hyg ; 101(11): 1147-53, 2007 Nov.
Article in English | MEDLINE | ID: mdl-17681359

ABSTRACT

This study aimed to describe the clinical, epidemiological and microbiological features of meningococcal meningitis in Salvador, Brazil. Between February 1996 and January 2001, a hospital-based surveillance prospectively identified cases of culture-positive meningococcal meningitis. Demographic and clinical data were collected through interview and medical chart review. Antisera and monoclonal antibodies were used to determine the serogroup and serotype:serosubtype of the isolates, respectively. Surveillance identified a total of 408 cases of meningococcal meningitis, with a case fatality rate of 8% (32/397). The mean annual incidence for the 304 culture-positive cases residing in metropolitan Salvador was 1.71 cases per 100,000 population. Infants <1 year old presented the highest incidence (14.7 cases per 100,000 population). Of the 377 serogrouped isolates, 82%, 16%, 2% and 0.3% were serogroups B, C, W135 and Y, respectively. A single serotype:serosubtype (4,7:P1.19,15) accounted for 64% of all cases. Continued surveillance is necessary to characterise strains and to define future prevention and control strategies.


Subject(s)
Meningitis, Meningococcal/diagnosis , Neisseria meningitidis/isolation & purification , Serotyping , Adolescent , Adult , Age Distribution , Brazil/epidemiology , Child , Child, Preschool , Female , Humans , Infant , Male , Meningitis, Meningococcal/drug therapy , Meningitis, Meningococcal/epidemiology , Middle Aged , Prevalence , Treatment Outcome
7.
Vaccine ; 25(22): 4420-8, 2007 May 30.
Article in English | MEDLINE | ID: mdl-17449150

ABSTRACT

The long-term impact of Haemophilus influenzae type b (Hib) conjugate vaccine, introduced throughout Latin America in the late 1990s, has not been evaluated. Active surveillance for H. influenzae meningitis was performed from August 9, 1996 to August 8, 2004 in Metropolitan Salvador, Brazil. Five years after the introduction of Hib conjugate vaccine, Hib meningitis incidence decreased from 2.39 to 0.06 cases per 100,000 population (98%) overall, and from 60.9 to 3.1 cases per 100,000 population (95%) in children <1 year of age. A transient serotype replacement phenomenon was observed associated with a small increase of meningitis due to two H. influenzae type a clonal groups. These findings indicate that Hib immunization campaign has led to the virtual elimination of Hib disease in this region.


Subject(s)
Haemophilus Vaccines , Haemophilus influenzae type b/immunology , Immunization Programs , Meningitis, Haemophilus/epidemiology , Population Surveillance , Tetanus Toxoid , Vaccines, Conjugate , Brazil/epidemiology , Child , Child, Preschool , Haemophilus Vaccines/administration & dosage , Haemophilus Vaccines/immunology , Haemophilus influenzae type b/classification , Haemophilus influenzae type b/isolation & purification , Humans , Incidence , Infant , Infant, Newborn , Meningitis, Haemophilus/microbiology , Meningitis, Haemophilus/mortality , Meningitis, Haemophilus/prevention & control , Program Evaluation , Serotyping , Tetanus Toxoid/administration & dosage , Tetanus Toxoid/immunology , Vaccines, Conjugate/administration & dosage , Vaccines, Conjugate/immunology
8.
J Infect Dis ; 187(1): 109-16, 2003 Jan 01.
Article in English | MEDLINE | ID: mdl-12508153

ABSTRACT

Surveillance for Haemophilus influenzae meningitis cases was performed in Salvador, Brazil, before and after introduction of H. influenzae type b (Hib) immunization. The incidence of Hib meningitis decreased 69% during the 1-year period after initiation of Hib immunization (from 2.62 to 0.81 cases/100,000 person-years; P<.001). In contrast, the incidence for H. influenzae type a meningitis increased 8-fold (from 0.02 to 0.16 cases/100,000 person-years; P=.008). Pulsed-field gel electrophoretic analysis demonstrated that H. influenzae type a isolates belonged to 2 clonally related groups, both of which were found before Hib immunization commenced. Therefore, Hib immunization contributed to an increased risk for H. influenzae type a meningitis through selection of circulating H. influenzae type a clones. The risk attributable to serotype replacement is small in comparison to the large reduction in Hib meningitis due to immunization. However, these findings highlight the need to maintain surveillance as the use of conjugate vaccines expands worldwide.


Subject(s)
Haemophilus Vaccines/immunology , Haemophilus influenzae type b/classification , Haemophilus influenzae/classification , Meningitis, Haemophilus/prevention & control , Polysaccharides, Bacterial/immunology , Bacterial Capsules , Brazil , Child , Child, Preschool , Female , Haemophilus influenzae/pathogenicity , Humans , Immunization , Infant , Male , Meningitis, Haemophilus/microbiology , Serotyping , Virulence
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