Is Brazil prepared for the new era of infectious disease epidemics?

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Phylogenetic, epidemiological and clinical studies on dengue and dengue virus in Vitória, Espírito Santo state, Brazil

Background: Vitória is an endemic area in Brazil for dengue. This thesis presents the phylogeny of dengue virus serotype 4, the evaluation of dengue dispersion and the influence of serotypes and demographics to severe dengue outcomes in Vitória. Methods: Sequences of envelope (n = 8) and NS1 (n = 4) gene of dengue virus serotype 4 were used to construct phylogenetic trees (2013). Spatial variation in temporal trends was analyzed (2012-2013). Cross-sectional studies were performed to assess associations of serotypes (2009-2013) and demographics (2007-2013) with severe outcomes. Results: Dengue virus serotype 4 genotype I (n = 2) related to a strain from Bahia, and genotype II (n = 8) related to strains from Roraima, Mato Grosso and São Paulo were detected. Five space-time clusters with lower Time Trend Increase presented higher risk for dengue transmission and lower income than the six space-time clusters with higher Time Trend Increase. In 6,703 dengue cases, 11.3% presented severe dengue, which was significantly higher among males (13.0%) than females (10.0%), and among elderlies (15.5%) than children (8.8%), adolescents (12.5%), and adults (10.5%). Children with severe dengue presented hemorrhage (68.8%-86.4%) and plasma leakage (52.4%-62.5%) in a higher proportion than other age groups. Serotype was determined for 485 cases and severe dengue affected 6.6% of them. Severe dengue occurred at a significantly higher frequency in infections caused by dengue virus serotype 2 (32.3%) than in those caused by dengue virus serotype 4 (6.4%) or by dengue virus serotype 1 (4.5%). Conclusion: Apparently, Vitória is not an international route for dengue introduction in Brazil. Living in low-income areas increased the chance of dengue infection. Dengue virus serotype 2 was associated with an elevated occurrence of severe dengue, which also affected more males and elderlies. Manifestations of severe dengue were worse in children than in other age group

Phylogenetic, epidemiological and clinical studies on dengue and dengue virus in Vitória, Espírito Santo state, Brazil

Background: Vitória is an endemic area in Brazil for dengue. This thesis presents the phylogeny of dengue virus serotype 4, the evaluation of dengue dispersion and the influence of serotypes and demographics to severe dengue outcomes in Vitória. Methods: Sequences of envelope (n = 8) and NS1 (n = 4) gene of dengue virus serotype 4 were used to construct phylogenetic trees (2013). Spatial variation in temporal trends was analyzed (2012-2013). Cross-sectional studies were performed to assess associations of serotypes (2009-2013) and demographics (2007-2013) with severe outcomes. Results: Dengue virus serotype 4 genotype I (n = 2) related to a strain from Bahia, and genotype II (n = 8) related to strains from Roraima, Mato Grosso and São Paulo were detected. Five space-time clusters with lower Time Trend Increase presented higher risk for dengue transmission and lower income than the six space-time clusters with higher Time Trend Increase. In 6,703 dengue cases, 11.3% presented severe dengue, which was significantly higher among males (13.0%) than females (10.0%), and among elderlies (15.5%) than children (8.8%), adolescents (12.5%), and adults (10.5%). Children with severe dengue presented hemorrhage (68.8%-86.4%) and plasma leakage (52.4%-62.5%) in a higher proportion than other age groups. Serotype was determined for 485 cases and severe dengue affected 6.6% of them. Severe dengue occurred at a significantly higher frequency in infections caused by dengue virus serotype 2 (32.3%) than in those caused by dengue virus serotype 4 (6.4%) or by dengue virus serotype 1 (4.5%). Conclusion: Apparently, Vitória is not an international route for dengue introduction in Brazil. Living in low-income areas increased the chance of dengue infection. Dengue virus serotype 2 was associated with an elevated occurrence of severe dengue, which also affected more males and elderlies. Manifestations of severe dengue were worse in children than in other age group

Parental alcoholism and associated risk factors

El uso indebido de alcohol de forma precoz actúa como un factor predisponente para problemas de salud, sociales y económicos: delante de eso, la finalidad de esta investigación fue identificar condiciones de riesgo relacionadas a los niños y adolescentes expuestos al alcoholismo parental. Fue llevada a cabo una revisión sistemática, mediante los descriptores "alcoholismo, factores de riesgo y hijos", de artículos publicados entre 2005 y 2009, en las bases de datos Lilacs, Medline, Scielo y Adolec. Fueron verificados problemas respecto al uso de alcohol por los hijos; respecto al comportamiento y/o respecto a los factores emocionales de los hijos, implicando la necesidad de discusión del tema, con vistas a contribuir a la formulación de políticas públicas destinadas a esta población.The abusive use of alcohol at an early age becomes a predisposing factor for health, social and economic problems; thus, this research sought to identify risk conditions related to children and adolescents exposed to parental alcoholism. A systematic review was conducted, using the descriptors "alcoholism, risk factors and children", of papers published between 2005 and 2009 in Lilacs, Medline, Scielo and Adolec databases. Problems were found related to alcohol use by children; in relation to behavior and/or in relation to children's emotional factors, implying the need to discuss the issue in order to contribute to the formulation of public policies aimed at this population.O uso indevido de álcool, de forma precoce torna-se um fator predisponente para problemas de saúde, sociais e econômicos. Face a isso, esta pesquisa buscou identificar condições de risco relacionadas às crianças e adolescentes expostos ao alcoolismo parental. Foi realizada revisão sistemática, por meio dos descritores alcoolismo, fatores de risco e filhos, de artigos publicados nos anos de 2005 a 2009, nas bases de dados LILACS, MEDLINE, SciELO e Adolec. Constataram-se problemas em relação ao uso de álcool pelos filhos, em relação ao comportamento e/ou em relação aos fatores emocionais dos filhos, implicando na necessidade de discussão do tema, a fim de contribuir para a formulação de políticas públicas destinadas a essa população

Determination of clusters and factors associated with dengue dispersion during the first epidemic related to Dengue virus serotype 4 in Vitoria, Brazil

Dengue occurrence is partially influenced by the immune status of the population. Consequently, the introduction of a new Dengue virus serotype can trigger explosive epidemics in susceptible populations. The determination of clusters in this scenario can help to identify hotspots and understand the disease dispersion regardless of the influence of the population herd immunity. The present study evaluated the pattern and factors associated with dengue dispersion during the first epidemic related to Dengue virus serotype 4 in Vitoria, Espirito Santo state, Brazil. Data on 18,861 dengue cases reported in Vitoria from September 2012 to June 2013 were included in the study. The analysis of spatial variation in temporal trend was performed to detect clusters that were compared by their respective relative risk, house index, population density, and income in an ecological study. Overall, 11 clusters were detected. The time trend increase of dengue incidence in the overall study population was 636%. The five clusters that showed a lower time trend increase than the overall population presented a higher incidence in the beginning of the epidemic and, compared to the six clusters with higher time trend increase, they presented higher relative risk for their inhabitants to acquire dengue infection (P-value = 0.02) and a lower income (P-value < 0.01). House index and population density did not differ between the clusters. Early increase of dengue incidence and higher relative risk for acquiring dengue infection were favored in low-income areas. Preventive actions and improvement of infrastructure in low-income areas should be prioritized in order to diminish the magnitude of dengue dispersion after the introduction of a new serotype

From the Approach to the Concept: One Health in Latin America-Experiences and Perspectives in Brazil, Chile, and Colombia

Professionals throughout the world have been working to assess the interdisciplinary interaction and interdependence between health and wellbeing in a constantly changing environment. The One Health concept was developed to encourage sustainable collaborative partnerships and to promote optimal health for people, animals, plants, the environment, and the whole planet. The dissemination of scientific discoveries and policies, by working directly with diverse communities, has been one of the main goals for Global One Health. The One Health concept has also been referred or related to as "One Medicine, One Medicine-One Health, One World-One Health, EcoHealth," and Planetary Health," depending on each fundamental view and approach. In Latin America, despite the concept still being discussed among health professionals and educators, several One Health initiatives have been used daily for more than decades. One Health action has been applied especially in rural and underserved urban areas where low socioeconomic status, lack of health professionals, and scarcity of medical resources may require professionals to work together. Local communities from diverse social and economic statuses, including indigenous populations have been working with institutions and social organizations for many years, accomplishing results through grassroots movements. These "bottom-up" socio-community approaches have also been tools for the prevention and control of diseases, such practice has preceded the One Health concepts in Latin American countries. It is strongly believed that collaborative, multidisciplinary, political, and economic initiatives with prosocial focus may become investments toward obtaining significant results in the face of global, economic and health challenges; working for a healthier world with inclusivity, equity, and equality. In this study, it is briefly presented how the One Health approach has been initiated and developed in Latin America, highlighting the events and actions taken in Brazil, Chile, and Colombia

Serotype influences on dengue severity: a cross-sectional study on 485 confirmed dengue cases in Vitória, Brazil

Abstract Background Dengue is caused by a RNA virus of the family Flaviviridae, which presents four serotypes (DENV-1 to DENV-4) capable of inducing hemorrhage. The purpose of this study was to evaluate the influence of serotype on the outcome of dengue. Methods This cross-sectional study included data from dengue cases with serotyping results that occurred between 2009 and 2013 in Vitória, Espírito Santo, Brazil. Data were accessed through the Information System for Notifiable Diseases. Chi-square test, Fisher exact test, Mann–Whitney U test, and logistic regression were performed to assess associations between different serotypes and dengue severity, while considering gender and age. Results The sample consisted of 485 laboratory confirmed dengue cases, of which 46.4 % were females, with median age of 26 years. Regarding overall samples, 77.3 % were caused by DENV-1, 16.1 % by DENV-4, 6.4 % by DENV-2, and 0.2 % by DENV-3. Severe dengue affected 6.6 % of all cases, of which 32.3 % of the cases caused by DENV-2, 6.4 % of those caused by DENV-4, 4.5 % of those caused by DENV-1, and none of those caused by DENV-3. Severe dengue was found to be seven times more frequent among cases of DENV-2 than among those of the other serotypes. Conclusions The present study found that cases of DENV-2 had a higher proportion of severe dengue than among those of DENV-1 and DENV-4. Consequently, early detection of serotypes circulating in the territory could be an important approach to prevent increasing numbers of severe outcomes during dengue outbreaks by predicting the health support needed for early diagnoses and treatment of dengue cases

Características sociodemográficas e fatores relacionados à assistência dos casos de dengue ocorridos em Vitória no ano de 2011

Introdução: A ocorrência da dengue sofre influência do comportamento, estrutura social e distribuição da população e sua transmissão pode variar de acordo com as áreas do município. Seu prognóstico depende do diagnóstico precoce e da imediata instituição do tratamento. Este estudo avalia fatores associados à ocorrência da dengue, enfatizando a distribuição territorial e os relacionados à dengue grave. Métodos: Foram realizados dois estudos, sendo um transversal e outro retrospectivo, sobre a totalidade dos casos de dengue que ocorreram em Vitória no ano de 2011, com base nos dados do Sistema de Informações de Agravos de Notificação. Resultados: Entre os casos confirmados, 53,4% ocorreram em mulheres, 74,7% em maiores de 15 anos e 6,3% evoluíram para gravidade. Os territórios de saúde de Jardim Camburi, Maruípe, Ilha das Caieiras, Santa Martha e Santo André responderam por 41,6% das notificações. Quase metade dos casos foram concluídos por critério laboratorial e, destes, 80% realizaram sorologia. Em todos os territórios, mais de 20% dos notificados realizaram sorologia e, na maioria, mais de 51% tiveram resultado positivo. Nas regiões de São Pedro, Maruípe e Santo Antônio, os afetados eram principalmente jovens, enquanto nas regiões Continental e Forte São João, eram pessoas mais velhas. Dos 371 casos de dengue grave, 78,7% foram de dengue com complicações e 21,3% de febre hemorrágica da dengue. Sessenta e sete por cento dos casos ocorreram em pessoas com idade superior a 15 anos. As Regiões de Saúde de Maruípe e São Pedro foram responsáveis por mais da metade dos casos de dengue grave (56,35%). Houve associação estatisticamente significante entre ocorrência de febre hemorrágica da dengue com idades mais jovens (menores de 15 anos) e maior tempo decorrido na procura por atendimento. Também houve associação estatisticamente significante entre maior tempo decorrido na procura pelo atendimento e idade menor que 15 anos. Os casos de dengue grave estavam concentrados em faixas etárias mais jovens na região de São Pedro. Conclusão: A distribuição territorial não foi uniforme, e pode ser determinada pela alta densidade populacional e pelas condições socioeconômicas. As diferenças de idade entre as regiões podem estar relacionadas à incidência da doença nestes locais. A grande proporção de sorologias positivas e o número de exames realizados possibilitaram uma boa detecção e acompanhamento dos casos de dengue. Os resultados corroboram os de outras pesquisas que apontam uma mudança no perfil da febre hemorrágica da dengue nas Américas e no Brasil, com crescente acometimento de jovens, e apontam a demora no tempo de procura por atendimento, baixa qualidade urbana e alta endemicidade como possíveis fatores de risco.Introduction: The incidence of dengue, influenced by human behavior, social structure and population distribution, may vary with respect to the geographical areas of a given city. Its prognosis depends on early diagnosis and prompt initiation of treatment. This study evaluates factors related to the occurrence of dengue, emphasizing the territorial distribution and risk factors for severe dengue. Methods: A cross-sectional and a retrospective study on all cases were conducted with dengue cases of Vitória in 2011, based on data from the Information System of Notifiable Diseases (SINAN). Results: 53.4% of confirmed cases occurred in women, 74.7% were 15 years old or older, and 6.3% were severe forms. The health territories of Jardim Camburi, Maruípe, Ilha das Caieiras, Santa Martha and Santo André accounted for 41.6% of reported cases. Almost half of the cases had final classification based on laboratory tests, and of these, 80% were submitted to serological tests. Of all territories, more than 20% of those reported cases had been submitted to serological tests, and more than 51% of them had a positive result. In the regions of São Pedro, Santo Antônio e Maruípe, the affected individuals were younger, while in Continental Region and Forte São João Region, they were older. Of the 371 cases of severe dengue, 78.7% were classified as dengue with complications and 21.3% were classified as dengue hemorrhagic fever, whose age distribution disclosed a frequency of 67.1% in individuals 15 years old or older. Regions of Maruípe and São Pedro were responsible for over half of cases of severe dengue (56.3%). There was a statistically significant association between the occurrence of dengue hemorrhagic fever and younger ages (under 15 years) and longer time interval between the beginning of symptoms and seeking for care. People younger than 15 years old take longer to seek for care. The frequencies of cases of severe dengue were concentrated in younger age groups in the region of São Pedro. Conclusion: The geographical distribution was not uniform, and can be influenced by the high population density and socioeconomic conditions. The age differences between regions may be related to disease incidence in these locations. A large proportion of positive tests and a great number of tests performed allowed a good detection and monitoring of dengue cases. The results corroborate those of other studies that indicate a change in the profile of dengue hemorrhagic fever in the Americas and Brazil, with growing involvement of young people, and indicate the time delay in seeking treatment, urban poor quality and high endemic scenario as possible risk factors

Differentiation of mucosal lesions in mucocutaneous leishmaniasis and paracoccidioidomycosis.

Mucocutaneous leishmaniasis and paracoccidioidomycosis are infectious diseases with similar epidemiological and clinical aspects. Cases of both diseases may manifest similar lesions in the mucosa. Therefore, the determination of distinguishing characteristics for the purpose of differential diagnosis is critical for better management of the diseases. The present study evaluated factors that assist in the differentiation of mucosal lesions between these diseases. This cross-sectional study included data from medical records of 122 cases of mucocutaneous leishmaniasis and 83 cases of paracoccidioidomycosis attended at the university hospital Cassiano Antonio Moraes, located in Vitória, Espírito Santo State, Brazil. Comparison between the diseases included the following variables: sex, age, time of disease evolution, location of the lesion and symptoms. Adults and males were affected by both diseases at higher rates. Lesions in the nasal region (95.1%; p-value = 0.000) and the pharynx (20.5%; p-value = 0.009) and nasal obstruction (34.4%; p-value = 0.000) were associated with leishmaniasis. Paracoccidioidomycosis was associated with lesions in the oral region (90.4%; p-value = 0.000), oral pain (16.9%; p-value = 0.000), and hoarseness (14.5%; p-value = 0.008). In leishmaniasis, lesions in oral regions were not associated with oral pain and were frequently located close to the nasal area. The manifestations cited above could improve the differential diagnosis of leishmaniasis and paracoccidioidomycosis, and thereby potentially aid in the choice of appropriate confirmatory diagnostic testing