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2.
PLoS Negl Trop Dis ; 17(3): e0011197, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36928657

RESUMO

Among the emerging and reemerging arboviral diseases, Zika, dengue and chikungunya deserve special attention due to their wide geographical distribution and clinical severity. The three arboviruses are transmitted by the same vector and can present similar clinical syndromes, bringing challenges to their identification and register. Demographic characteristics and individual and contextual social factors have been associated with the three arboviral diseases. However, little is known about such associations among adolescents, whose relationships with the social environment are different from those of adult populations, implying potentially different places, types, and degrees of exposure to the vector, particularly in the school context. This study aims to identify sociodemographic and environmental risk factors for the occurrence of Zika, dengue, and chikungunya in a cohort of adolescents from the Study of Cardiovascular Risks in Adolescents-ERICA-in the cities of Rio de Janeiro/RJ and Fortaleza/CE, from January 2015 to March 2019. Cases were defined as adolescents with laboratory or clinical-epidemiological diagnosis of Zika, dengue, or chikungunya, notified and registered in the Information System for Notifiable Diseases (SINAN). The cases were identified by linkage between the databases of the ERICA cohort and of SINAN. Multilevel Cox regression was employed to estimate hazard ratios (HR) as measures of association and respective 95% confidence intervals (95%CI). In comparison with adolescents living in lower socioeconomic conditions, the risk of becoming ill due to any of the three studied arboviral diseases was lower among those living in better socioeconomic conditions (HR = 0.43; 95%CI: 0.19-0.99; p = 0.047) and in the adolescents who attended school in the afternoon period (HR = 0.17; 95%CI: 0.06-0.47; p<0.001). When compared to areas whose Building Infestation Index (BII) for Aedes aegypti was considered satisfactory, a BII in the school region classified as "alert" and "risk" was associated with a higher risk of arboviral diseases (HR = 1.62, 95%CI: 0.98-2.70; p = 0.062; HR = 3.72, 95%CI: 1.27-10.9; p = 0.017, respectively). These findings indicate that living in less favored socioeconomic conditions, attending school in the morning, and having a high BII for Ae. aegypti in school's region can contribute to an increased risk of infection by Zika, dengue, or chikungunya in adolescents. The identification of residential or school areas based on those variables can contribute to the implementation of control measures in population groups and priority locations.


Assuntos
Aedes , Infecções por Arbovirus , Febre de Chikungunya , Dengue , Infecção por Zika virus , Zika virus , Adulto , Animais , Humanos , Adolescente , Febre de Chikungunya/epidemiologia , Brasil/epidemiologia , Dengue/epidemiologia , Mosquitos Vetores , Infecção por Zika virus/epidemiologia
3.
Int J Infect Dis ; 130: 8-16, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-36841502

RESUMO

OBJECTIVES: Evatuate if Bacillus Calmette-Guérin (BCG) vaccine could be used as a tool against SARS-CoV-2 based on the concept of trained immunity. METHODS: A multicenter, double-blinded, randomized clinical trial recruited health care workers (HCWs) in Brazil. The incidence rates of COVID-19, clinical manifestations, absenteeism, and adverse events among HCWs receiving BCG vaccine (Moreau or Moscow strains) or placebo were compared. BCG vaccine-mediated immune response before and after implementing specific vaccines for COVID-19 (CoronaVac or COVISHIELD) was analyzed. Cox proportional hazard and linear mixed effect modeling were used. RESULTS: A total of 264 volunteers were included for analysis (BCG = 134 and placebo = 130). The placebo group presented a COVID-19 cumulative incidence of 0.75% vs 0.52% of BCG. The Moreau strain also presented a higher incidence rate (1.60% × 0.22%). BCG did not show a protective hazard ratio against COVID-19. In addition, the log (immunoglobulin G) level against SARS-CoV-2 presented a higher increase in the BCG group, whether or not participants had COVID-19, but also without statistical significance. CONCLUSION: Our results suggest that BCG has a tendency of protection against SARS-CoV-2 and higher immunoglobulin G levels than placebo. The clinical trial was registered at https://clinicaltrials.gov/ (NCT04659941).


Assuntos
COVID-19 , Mycobacterium bovis , Humanos , SARS-CoV-2 , Vacinas contra COVID-19 , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacina BCG , Brasil/epidemiologia , ChAdOx1 nCoV-19 , Vacinação , Imunoglobulina G
4.
Epidemics ; 38: 100541, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35123281

RESUMO

Arboviruses are diseases of worldwide importance in the field of communicable diseases. In Brazil, the reemergence of dengue and the emergence of chikungunya and Zika since 2014 have led to epidemic waves of great magnitude and rapid spread. However, their diffusion patterns vary and change over time. This study analyzes the spatial diffusion of the simultaneous circulation of three arboviruses transmitted by the same vector in a large urban space over two epidemic waves in consecutive years. An ecological study of spatial and temporal aggregates on the occurrence of dengue, chikungunya, and Zika, from 2014 to 2019, in Feira de Santana, Bahia State, was carried out using data of cases reported to the national surveillance system. Four different methods were used to analyze the spatial diffusion: Kernel Estimation with sequential maps, cumulative nearest-neighbor ratios (NNI) over time, spatial correlograms and local autocorrelation changes (LISA) over time. From 2014-2019, there were 21,723 confirmed cases of arboviruses. The highest incidences were among women (496.9, 220.2, and 91.0 cases/100,000 women for dengue, chikungunya and Zika respectively). By age group, the highest incidences were from ages 10-19 years old (609.3 dengue cases/100,000), from 60 and more (306.7 chikungunya cases/100,000), and from 0-9 years old (124.1 Zika cases/100,000 inhabitants). The temporal distribution demonstrated two epidemic waves of simultaneous circulation in 2014 and 2015. Kernel maps indicate that arboviruses spread to neighboring areas near the first hotspots, suggesting an expansion diffusion pattern. The NNI, spatial correlograms and LISA changes results suggest expansion patterns for the three arboviruses in all periods. The spatial diffusion pattern of dengue, Zika, and chikungunya in the 2014-2015 epidemics in Feira de Santana was expansion. These findings are useful to guide prevention measures and reduce occurrence in other areas.


Assuntos
Arbovírus , Febre de Chikungunya , Dengue , Epidemias , Infecção por Zika virus , Zika virus , Adolescente , Adulto , Brasil/epidemiologia , Febre de Chikungunya/epidemiologia , Criança , Pré-Escolar , Dengue/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Adulto Jovem , Infecção por Zika virus/epidemiologia
5.
Vector Borne Zoonotic Dis ; 18(7): 335-342, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29672231

RESUMO

The domestic dog is considered the main reservoir of visceral leishmaniasis (VL) in urban areas, but the identification of cats infected by Leishmania suggests the possibility of these animals also acting as reservoirs. The incrimination of a species as reservoir requires the accumulation of epidemiological evidence on the co-occurrence between such species and the infection in question. This is a systematic review of epidemiological studies evaluating the association between exposure to cats and occurrence of VL in humans (HVL) or dogs (CVL). Among the six studies addressing CVL, one showed a higher chance of CVL in the presence of cats, one showed an inverse relationship between the presence of cats and CVL, and four were inconclusive. Among the four studies evaluating HVL, three were inconclusive, and one showed an association between the presence of cats and HVL among patients with renal transplantation. The inconsistency of the results, associated to the methodological weaknesses of the studies analyzed, does not allow a firm conclusion that there is co-occurrence between exposure to cats and VL. Methodologically robust studies should be performed to elucidate the role of cats in VL transmission.


Assuntos
Doenças do Gato/parasitologia , Doenças do Cão/transmissão , Leishmaniose Visceral/veterinária , Animais , Doenças do Gato/transmissão , Gatos , Cães , Humanos , Leishmaniose Visceral/transmissão , Fatores de Risco , Zoonoses
6.
PLoS One ; 12(6): e0179725, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28650987

RESUMO

BACKGROUND: Zika is a new disease in the American continent and its surveillance is of utmost importance, especially because of its ability to cause neurological manifestations as Guillain-Barré syndrome and serious congenital malformations through vertical transmission. The detection of suspected cases by the surveillance system depends on the case definition adopted. As the laboratory diagnosis of Zika infection still relies on the use of expensive and complex molecular techniques with low sensitivity due to a narrow window of detection, most suspected cases are not confirmed by laboratory tests, mainly reserved for pregnant women and newborns. In this context, an accurate definition of a suspected Zika case is crucial in order for the surveillance system to gauge the magnitude of an epidemic. METHODOLOGY: We evaluated the accuracy of various Zika case definitions in a scenario where Dengue and Chikungunya viruses co-circulate. Signs and symptoms that best discriminated PCR confirmed Zika from other laboratory confirmed febrile or exanthematic diseases were identified to propose and test predictive models for Zika infection based on these clinical features. RESULTS AND DISCUSSION: Our derived score prediction model had the best performance because it demonstrated the highest sensitivity and specificity, 86·6% and 78·3%, respectively. This Zika case definition also had the highest values for auROC (0·903) and R2 (0·417), and the lowest Brier score 0·096. CONCLUSIONS: In areas where multiple arboviruses circulate, the presence of rash with pruritus or conjunctival hyperemia, without any other general clinical manifestations such as fever, petechia or anorexia is the best Zika case definition.


Assuntos
Febre de Chikungunya/epidemiologia , Dengue/epidemiologia , Epidemias , Infecção por Zika virus/diagnóstico , Infecção por Zika virus/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Febre de Chikungunya/diagnóstico , Criança , Pré-Escolar , Estudos Transversais , Dengue/diagnóstico , Diagnóstico Diferencial , Monitoramento Epidemiológico , Feminino , Humanos , Lactente , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos , Valor Preditivo dos Testes , Gravidez , Adulto Jovem , Infecção por Zika virus/transmissão
7.
Rio de Janeiro; s.n; 2015. 123 f p. il.
Tese em Português | LILACS | ID: biblio-905044

RESUMO

Os animais de estimação podem ser fonte de infecções, principalmente para seres humanos imunocomprometidos, em especial, pacientes portadores do vírus HIV. Considerando que o contato com animais pode prover benefícios emocionais, profissionais da área da saúde, em particular médicos e médicos veterinários, devem estar conscientes do papel potencial destes animais na transmissão de doenças de forma a preconizar medidas profiláticas para que esta transmissão não ocorra. As circunstâncias que favorecem a transmissão de doenças a partir dos animais de estimação ainda não são totalmente conhecidas, principalmente na realidade brasileira. Faltam estudos com o objetivo de investigar o risco de doenças de origem zoonótica decorrentes do contato com estes animais, hoje também chamados de animais pet. Ademais, ressente-se da falta de um instrumento devidamente elaborado e validado com a finalidade de captar as informações necessárias para a realização de estudos deste tipo ou mesmo para servir como ferramenta de rastreio de situações de vulnerabilidade de pacientes imunodeprimidos com vistas ao aconselhamento sobre medidas de prevenção. Desta maneira, o objetivo deste estudo é elaborar um instrumento para averiguar a vulnerabilidade de pacientes imunodeprimidos a infecções zoonóticas a partir de animais de estimação. Inicialmente, foram mapeados os animais de estimação mais encontrados no ambiente doméstico e as principais infecções que podem ser transmitidas a partir deles. Selecionaram-se, então, os possíveis mecanismos de transmissão a serem abordados. Dentre as espécies de animais de estimação elencadas, os cães, gatos, aves, répteis e os pequenos roedores foram os selecionados para a confecção deste instrumento. As infecções selecionadas foram: Salmonelose; Criptosporidíase; Giardíase; Dermatofitoses, Esporotricose, Bartonelose; Ancilostomíase; Toxocaríase; Psitacose; Toxoplasmose; Escabiose; Campilobacteriose; Criptococose e Histoplasmose. Considerando as diferentes formas de transmissão de cada infecção foram identificados os possíveis atos e comportamentos no contato com animais de estimação, bem como características destes animais, que poderiam aumentar a probabilidade de transmissão. O instrumento desenvolvido foi composto de uma primeira parte abarcando os critérios de elegibilidade, e de outra envolvendo o escopo principal do instrumento. Como as características de contato e as infecções variam de acordo com a espécie de animal, o instrumento abordou cada um dos cinco grupos de animais separadamente. O instrumento aqui proposto concerne à etapa inicial de um processo de desenvolvimento formal para utilização em futuras pesquisas sobre o papel dos animais de estimação na transmissão de infecções para pacientes imunodeprimidos. Estudos que explorem a confiabilidade e validade do instrumento proposto, assim como sua aceitabilidade, são necessários antes que seu uso seja recomendado


Assuntos
Humanos , Animais , Gatos , Cães , Animais Domésticos , HIV , Pacientes , Zoonoses , Terapia de Imunossupressão , Infecções Oportunistas/prevenção & controle
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