Factors associated with deaths among pulmonary tuberculosis patients: a case-control study with secondary data.

BACKGROUND: Tuberculosis remains an important public health problem in Brazil where over 100 000 new cases and 6000 deaths are reported every year. Current drug efficacy and wide availability should have curbed this toll. The goal was to study the factors associated with death in incident cases of pulmonary tuberculosis (PT) during treatment. METHODS: This is a case-control study including all new cases of PT reported between 2000 and 2004; cases were patients who died of any cause and controls were those cured after initial PT treatment. Data analyses included unconditional multiple hierarchical logistic regression. RESULTS: A total of 313 502 new cases of tuberculosis were reported between 2000 and 2004; 224 355 (71.6%) were cured after initial treatment and 20 721 (6.6%) died during the surveillance follow-up. Over 82% of all cases were diagnosed with PT. After controlling for significant variables, the factors associated with a higher risk of death included gender (males: odds ratio (OR) 1.4; 95% confidence interval (CI) 1.33 to 1.47), age (<5 years of age: OR 1.90; 95% CI 1.51 to 2.38; 30-59 years: OR 2.78; 95% CI 2.61 to 2.97; over 60 years: OR 10.92; 95% CI 10.09 to 11.81), positive HIV serology (OR 10.59; 95% CI 9.76 to 11.48), alcoholism (OR 1.49; 95% CI 1.36 to 1.65), mental disorder (OR 1.80; 95% CI 1.43 to 2.27) and presence of additional lung pathology on chest x ray (OR 2.22; 95% CI 1.83 to 2.70). Protective variables included education (highest level: OR 0.67; 95% CI 0.63 to 0.70). CONCLUSIONS: Preventive interventions should target the most vulnerable patients, in particular the very young and the elderly, those infected with HIV and those presenting with a mental disorder or additional lung pathology.

[Urbanization and dengue ecology]. / Urbanização e ecologia do dengue.

Demographic changes occurring in underdeveloped countries due to intense rural-urban migration since the 1960s have resulted in overcrowded cities with multiple deficiencies, particularly in housing and basic sanitation. Some 20% of the population in large and medium-sized cities live in slums or under similar conditions. Lack of regular water supply and public garbage collection foster the proliferation of potential breeding sites for Aedes aegypti (the main mosquito vector for dengue), including precarious reservoirs for potable water and disposable recipients which accumulate water, like used cans and plastic and glass bottles. Modern industries also produce large volumes of disposable materials. Propagation of the dengue virus and the spread of dengue vectors are favored by the high intensity, frequency, and speed of private and public transportation. Such factors can help explain the re-emergence of dengue, the most important arbovirus in the world today, affecting thousands of people each year.

Prevalence of celiac disease among blood donors in Brazil.

OBJECTIVE: There are no studies on the prevalence of celiac disease (CD) in either Brazil or, as far as we know, South America. The aim of this study was to determine the prevalence of CD in healthy blood donors in the city of Brasilia, Brazil. METHODS: Sera were obtained, independently of age and gender, from an unselected group of 2045 blood donors attending the Hematological Center of Brasilia. An IgG antigliadin antibody (AGA) test was used as a first-level screening step, followed by IgA-AGA test, serum IgA antiendomysium (EMA), and total serum IgA determination performed in all sera showing abnormally high IgG-AGA results. Jejunal biopsy was suggested for all subjects showing at least one of the following: IgA-EMA positivity; IgG-AGA and IgA-AGA positivity; IgG-AGA positivity and selective IgA deficiency. AGA was determined by an enzyme-linked immunosorbent assay (ELISA) technique and IgA-EMA was ascertained by indirect immunofluorescence on cryostat sections of monkey esophagus. Jejunal mucosa samples were obtained with a Watson capsule. RESULTS: Sixty-two (3.03%) blood donors had IgG-AGA above the cut-off values. Fifty-eight individuals showed isolated high values of IgG-AGA, whereas four had simultaneously increased IgG and IgA-AGA. Three patients had positive IgA-EMA test (one with both IgG- and IgA-AGA and two with only IgG-AGA) and underwent jejunal biopsies that disclosed complete villous atrophy associated with an increased number of intraepithelial lymphocytes and hypertrophic criptae. In this study group, the prevalence of biopsy-proven celiac disease was 1.47 +/- 1.66 in 1000 subjects. CONCLUSIONS: We found a prevalence of undiagnosed CD of 1:681 among apparently healthy blood donors. These preliminary results support the view that CD is not a rare disease in Brazil.

Evaluation of SPf66 malaria vaccine efficacy in Brazil.

This paper reports the efficacy results of the randomized, placebo-controlled, field trial of SPf66 malaria vaccine in Costa Marques, Rondonia, Brazil. This region is characterized by the seasonal distribution of Plasmodium falciparum and P. vivax infections, and the recent occupation by migrants from nonendemic areas. A total of 800 individuals of both sexes, ranging in age from seven to 60 years, were included in the study. Of the initial cohort, 572 participants completed the vaccination schedule. Clinical and parasitologic evaluations were obtained by active and passive searches on a periodic basis. The overall protective efficacy against P. falciparum infections was -1.6% (-32.9% to 22.4%), and 14.1% (-17.0% to 36.9%) for the first episode. The overall protective efficacy for P. vivax infections was -19.7% (-44.8% to 1.03%), and -10.8% (-41.1% to 12.8%) for the first episode. No statistical evidence of an overall significant protective effect of SPf66 malaria vaccine against P. falciparum and P. vivax malaria was obtained in this trial.

PIP: The efficacy of the SPf66 malaria vaccine was evaluated in a randomized, placebo-controlled, field trial in Costa Marques, Rondonia, Brazil; a region characterized by seasonal Plasmodium falciparum and P. vivax infections and a recent influx of migrants from nonendemic areas. This vaccine is composed of sequences of 3 peptides from P. falciparum merozoite, erythrocytic stages, and a peptide from the circumsporozoite protein. Enrolled were 800 predominantly migrant men and women, 7-60 years of age, 572 of whom completed the vaccination schedule. Clinical and parasitologic evaluations were obtained by periodic active and passive searches up to Day 720. After the third dose, 5684 blood samples were collected and 967 (520 in the vaccine group and 447 in the placebo group) were positive. 212 P. falciparum infections (107 episodes in 76 participants in the vaccine group and 105 in 85 members of the placebo group) were confirmed after exclusion of relapses and treatment failures. A total of 427 P. vivax infections were detected (233 in 138 participants in the vaccine group and 194 in 127 participants in the placebo group). The overall protective efficacy against P. falciparum infections was -1.6% (95% confidence interval (CI), -32.9-22.4%) and 14.1% (95% CI, -17.0-36.9%) for the first episode. The overall protective efficacy for P. vivax infections was -19.7% (95% CI, -44.8-1.03%) and -10.8% (95% CI, -41.1-12.8%) for the first episode. These findings fail to provide evidence of an overall significant protective effect of the SPf66 malaria vaccine in this population.

Safety evaluation of SPf66 malaria vaccine in Brazil

The frequency and description of side effects secondary to the subcutaneous application of SPf66 malaria vaccine and placebo are reported for each dose of application in the participants of the vaccine efficacy trial in Brazil. Side effects evaluated two hours after each application were detected in 8.0 per cent, 30.2 per cent and 8.8 per cent, for the 1st, 2nd and 3rd dose, respectively, in the SPf66 group, and in 7.0 per cent, 8.5 per cent and 2.9 per cent in the placebo group. Local reactions such as mild inflammation, nodule and pain or erythema frequently accompanied by pruritus were the most common reactions detected in both groups (3.8 per cent, 29.1 per cent and 8.5 per cent in the SPf66 group and 4.0 per cent, 7.6 per cent and 2.5 per cent in the placebo group). Among vaccinees, local side effects after the 2nd dose were more frequent in females. Systemic side effects were expressed mainly through general symptoms referred by the participants and were most frequent after the 1st dose in both groups (4.3 per cent in the SPf66 group and 3.0 per cent in the placebo group). Muscle aches and fever were referred by few participants. No severe adverse reactions were detected for either dose of application or group.

Safety evaluation of SPf66 malaria vaccine in Brazil.

The frequency and description of side effects secondary to the subcutaneous application of SPf66 malaria vaccine and placebo are reported for each dose of application in the participants of the vaccine efficacy trial in Brazil. Side effects evaluated two hours after each application were detected in 8.0%, 30.2% and 8.8%, for the 1st, 2nd and 3rd dose, respectively, in the SPf66 group, and in 7.0%, 8.5% and 2.9% in the placebo group. Local reactions such as mild inflammation, nodule and pain or erythema frequently accompanied by pruritus were the most common reactions detected in both groups (3.8%, 29.1% and 8.5% in the SPf66 group and 4.0%, 7.6% and 2.5% in the placebo group). Among vaccinees, local side effects after the 2nd dose were more frequent in females. Systemic side effects were expressed mainly through general symptoms referred by the participants and were most frequent after the 1st dose in both groups (4.3% in the SPf66 group and 3.0% in the placebo group). Muscle aches and fever were referred by few participants. No severe adverse reactions were detected for either dose of application or group.

SPf66 vaccine trial in Brazil: conceptual framework study design and analytical approach

This paper describes the study population and the study design of the phase III field trial of the SPf66 vaccine in Brazil. Assessment of validity and precision principles necessary for the appropriate evaluation of the protective effect of the vaccine are discussed, as well as the results of the preliminary analyses of the gathered data. The analytical approach for the estimation of the protective effect of the vaccine is presented. This paper provides the conceptual framework for future publications.

SPf66 vaccine trial in Brazil: conceptual framework study design and analytical approach.

This paper describes the study population and the study design of the phase III field trail of the SPf66 vaccine in Brazil. Assessment of validity and precision principles necessary for the appropriate evaluation of the protective effect of the vaccine are discussed, as well as the results of the preliminary analyses of the gathered data. The analytical approach for the estimation of the protective effect of the vaccine is presented. This paper provides the conceptual framework for future publications.

Surto de dengue em Boa Vista, Roraima Nota previa. / Dengue outbreak in Boa Vista, Roraima. Preliminary report

Os autores descrevem a ocorrencia de um surto de dengue em Boa Vista, Territorio Federal de Roraima em final de 1981 e inicio de 1982. O numero estimado de casos elevou-se a 7000, tendo sido identificados virus dos tipos 1 e 4 em uma amostra populacional. Essa e a primeira descricao de ocorrencia de um surto de dengue no Brasil