Respiratory Syncytial Virus Seasonality In Brazil: Implications For The Immunisation Policy For At-risk Populations

Respiratory syncytial virus (RSV) infection is the leading cause of hospitalisation for respiratory diseases among children under 5 years old. The aim of this study was to analyse RSV seasonality in the five distinct regions of Brazil using time series analysis (wavelet and Fourier series) of the following indicators: monthly positivity of the immunofluorescence reaction for RSV identified by virologic surveillance system, and rate of hospitalisations per bronchiolitis and pneumonia due to RSV in children under 5 years old (codes CID-10 J12.1, J20.5, J21.0 and J21.9). A total of 12,501 samples with 11.6% positivity for RSV (95% confidence interval 11 - 12.2), varying between 7.1 and 21.4% in the five Brazilian regions, was analysed. A strong trend for annual cycles with a stable stationary pattern in the five regions was identified through wavelet analysis of the indicators. The timing of RSV activity by Fourier analysis was similar between the two indicators analysed and showed regional differences. This study reinforces the importance of adjusting the immunisation period for high risk population with the monoclonal antibody palivizumab taking into account regional differences in seasonality of RSV.111529430

Introduction And Transmission Of Zika Virus In Brazil: New Challenges For The Americas

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A emergência da nova variante P.1 do SARS-CoV-2 no Amazonas (Brasil) foi temporalmente associada a uma mudança no perfil da mortalidade devido a COVID-19, segundo sexo e idade

Background Since the end of 2020, there has been a great deal of international concern about the variants of SARS-COV-2 B.1.1.7, identified in the United Kingdom; B.1.351 discovered in South Africa and P.1, originating from the Brazilian state of Amazonas. The three variants were associated with an increase in transmissibility and worsening of the epidemiological situation in the places where they expanded. The lineage B.1.1.7 was associated with the increase in case fatality rate in the United Kingdom. There are still no studies on the case fatality rate of the other two variants. The aim of this study was to analyze the mortality profile before and after the emergence of the P.1 strain in the Amazonas state. Methods We analyzed data from the Influenza Epidemiological Surveillance Information System, SIVEP-Gripe (Sistema de Informação de Vigilância Epidemiológica da Gripe), comparing two distinct epidemiological periods: during the peak of the first wave, between April and May 2020, and in January 2021 (the second wave), the month in which the new variant came to predominate. We calculated mortality rates, overall case fatality rate and case fatality rate among hospitalized patients; all rates were calculated by age and gender and 95% confidence intervals (95% CI) were determined. Findings We observed that in the second wave there were a higher incidence and an increase in the proportion of cases of COVID-19 in the younger age groups. There was also an increase in the proportion of women among Severe Acute Respiratory Infection (SARI) cases from 40% (2,709) in the first wave to 47% (2,898) in the second wave and in the proportion of deaths due to COVID-19 between the two periods varying from 34% (1,051) to 47% (1,724), respectively. In addition, the proportion of deaths among people between 20 and 59 years old has increased in both sexes. The case fatality rate among those hospitalized in the population between 20 and 39 years old during the second wave was 2.7 times the rate observed in the first wave (female rate ratio = 2.71; 95% CI: 1.9-3.9], p <0.0001; male rate ratio = 2.70, 95%CI:2.0-3.7), and in the general population the rate ratios were 1.15 (95% CI: 1.1-1.2) in females and 0.78 (95% CI: 0.7-0.8) in males]. Interpretation Based on this prompt analysis of the epidemiological scenario in the Amazonas state, the observed changes in the pattern of mortality due to COVID-19 between age groups and gender simultaneously with the emergence of the P.1 strain suggest changes in the pathogenicity and virulence profile of this new variant. Further studies are needed to better understanding of SARS-CoV-2 variants profile and their impact for the health population.Introdução Desde o final de 2020 tem havido grande preocupação internacional com as variantes do SARS-COV-2: B.1.1.7, identificada no Reino Unido; B.1.351, descoberta na África do Sul e P.1, que emergiu inicialmente estado brasileiro do Amazonas. As três variantes foram associadas a aumento na transmissibilidade e piora da situação epidemiológica nos locais onde se expandiram. A linhagem B.1.1.7 foi associada ao aumento da taxa de letalidade no Reino Unido. Ainda não existem estudos conclusivos sobre letalidade das outras duas variantes. O objetivo deste estudo foi analisar o perfil de mortalidade antes e depois da emergência da linhagem P.1 no Amazonas. Métodos Analisamos os dados do sistema nacional de vigilância epidemiológica, comparando dois momentos epidemiológicos distintos: durante o pico da primeira onda, entre abril e maio de 2020, e em janeiro de 2021, mês em que a nova variante passou a predominar. Calculamos as taxas de mortalidade, letalidade e letalidade entre pacientes internados, todas as taxas foram calculadas por idade e por sexo e determinados os intervalos de confiança de 95%. Achados Observamos que na segunda onda houve maior incidência e aumento na proporção de casos de COVID-19 nas faixas etárias mais jovens. Observou-se, também, um aumento na proporção de mulheres entre os casos de SARI de 40% (2.709) na primeira onda para 47% (2.898) na segunda onda e entre mortes por COVID-19 de 34% (1,051) para 47% (1.724), respectivamente. Além disso, a proporção de mortes entre 20 e 59 anos aumentou em ambos os sexos. A letalidade entre os hospitalizados na população entre 20 e 39 anos durante a segunda onda foi 2.7 vezes a primeira onda [razão de taxas sexo feminino=2,71; CI(95%)=1,9-3,9], p<0.0001; razão de taxas sexo masculino=2.70(2.0-3.7)), na população geral as razões de taxa foram 1,15(1,1-1,2) no sexo feminino e 0,78(0,7-0,8) no sexo masculino. Interpretação Observamos mudanças no padrão de mortalidade por COVID-19 entre as faixas etárias e sexo simultaneamente à emergência da linhagem P.1, sugerindo mudanças nos perfis de patogenicidade e virulência, novos estudos são necessários para melhor compreensão das variantes do SARS-CoV-2 e suas consequências na saúde da população

Uso do excesso de mortalidade associado à epidemia de COVID-19 como estratégia de vigilância epidemiológica – resultados preliminares da avaliação de seis capitais brasileiras

In early 2020, the World Health Organization (WHO) recognized the pandemic situation of the new coronavirus (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2), which causes Coronavirus Disease-2019 (COVID-19). In Brazil by the end of April 2020, another 110 thousand cases and 5,000 deaths had been confirmed. The scarcity of laboratory resources and overload of the care network, added to the broad clinical spectrum of the disease, can make it difficult to capture all mortality from this disease through epidemiological surveillance based on individual notification of cases. The aim of this study was to evaluate the excess of deaths in Brazilian capitals with the highest incidence of COVID-19, as a way of validating the method, we also evaluated a capital with low incidence. We assessed weekly mortality from all causes during the year 2020, up to the epidemiological week 17, compared with the previous year. The data were obtained through the National Civil Registry Information Center (CNIRC, acronym in Portuguese). We estimate the expected mortality and the 95% confidence interval by projecting the observed mortality in 2019 for the population of 2020. In the five capitals with the highest incidences it was possible to identify excess deaths in the pandemic period, the age group most affected were those over 60 years old, 31% of the excess deaths occurred in the population between 20 and 59 years old. There was a strong correlation (r = 0.94) between the excess of deaths in each city and the number of deaths confirmed by epidemiological surveillance. There was no excess of deaths in the capital with the lowest incidence, nor among the population under 20 years old. We estimate that epidemiological surveillance managed to capture only 52% of all mortality associated with the COVID-19 pandemic in the cities studied. Considering the simplicity of the method, its low cost and reliability for assessing the real burden of the disease, we believe that the assessment of excess mortality associated with the COVID-19 pandemic should be widely used as a complementary tool to regular epidemiological surveillance and its use should be encouraged by WHO.No início de 2020 a Organização Mundial da Saúde (OMS) reconheceu a situação de pandemia do novo coronavírus (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2), causador da Coronavirus Disease-2019 (COVID-19). No Brasil até o final de abril de 2020 já tinham sido confirmados mais 110 mil casos e de 5 mil óbitos. A escassez de recursos laboratoriais e sobrecarga da rede assistencial, somados ao amplo espectro clínico da doença, pode dificultar a captação de toda a mortalidade por esta doença pela vigilância epidemiológica baseada na notificação individual dos casos. O objetivo deste estudo foi avaliar o excesso de mortes nas capitais brasileiras com maiores incidências de COVID-19, como forma de validação do método avaliamos, também, uma capital com baixa incidência. Nós avaliamos a mortalidade semanal por todas as causas durante o ano de 2020, até a semana epidemiológica 17, comparando com o ano anterior. Os dados foram obtidos através da Central Nacional de Informações do Registro Civil (CNIRC). Nós estimamos a mortalidade esperada e o intervalo de confiança de 95% projetando a mortalidade observada em 2019 para a população de 2020. Nas cinco capitais com maiores incidências foi possível identificar excesso de mortes no período da pandemia, a faixa etária mais afetada foram aqueles com mais de 60 anos, 31% do excesso de mortes ocorreu na população entre 20 e 59 anos. Houve uma forte correlação (r=0.94) entre o excesso de mortes em cada cidade e o número de mortes confirmados pela vigilância epidemiológica. Não houve excesso de mortes na capital com mais baixa incidência, nem entre a população com menos de 20 anos. Estimamos que a vigilância epidemiológica conseguiu captar apenas 52% de toda a mortalidade associada à pandemia de COVID-19 nas cidades estudadas. Considerando a simplicidade do método, seu baixo custo e confiabilidade para avaliação da carga real da doença, acreditamos que a avaliação do excesso de mortalidade associado à pandemia de COVID-19 deveria ser amplamente utilizada como ferramenta complementar à vigilância epidemiológica regular e ter seu uso incentivado pela OMS

Study on the occurence of spinal cord neuroschistosomiasis mansoni in a low prevalence area (Campinas, SP, Brazil)

Orientador: Luiz Jacintho SilvaDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: Os programas de controle da esquistossomose têm obtido relativo sucesso ao controlar a morbidade relacionada a altas cargas parasitárias desta doença, sem, no entanto, diminuir a área de transmissão no Brasil. Como a neuroesquistossomose medular á uma forma grave de esquistossomose não relacionada a altas cargas parasitárias existe risco teórico de ocorrer em áreas de baixa endemicidade. O objetivo deste estudo foi estudar a ocorrência da NE (neuroesquistossomose) medular em uma região de baixa endemicidade, região de Campinas, estado de São Paulo. Foi feito um estudo retrospectivo, descritivo de base hospitalar com busca ativa em múltiplas fontes de informação. Utilizou-se como base os dois maiores hospitais públicos da região de Campinas. Os pacientes com diagnóstico de NE medular tiveram seus diagnósticos ratificados por critérios padronizados e baseados em quadro clínico típico, comprovação da infecção por Schistosoma mansoni e exclusão de outras causas de mielopatia. Os pacientes foram classificados como autóctones, importados, sem informação e indeterminado. Após esta classificação os dados clínicos e epidemiológicos foram analisados. Foram identificados 27 pacientes com NE medular dos quais 19 (85,2%) homens e 4 (14,8%) mulheres, as idades no momento do diagnóstico foram de 13 a 57 anos (média=31,2; desvio padrão=12,8 e mediana=29). Os pacientes foram classificados quanto ao local provável de infecção da seguinte forma: 14(51,9%) autóctones, 11(40,7%) importados e 2(7,4%) sem informações, não houve paciente classificado como indeterminado. Todos os pacientes importados se infectaram em municípios de áreas de alta endemicidade. A clínica deste grupo de pacientes não foi diferente do encontrado na literatura, nem foi diferente quando comparados os pacientes autóctones com os importados. Houve uma demora média de 70,6 dias (mediana=19; dp=166,9) entre a primeira consulta e o diagnóstico. A demora foi em média 88,1 dias maior entre os pacientes autóctones (média=112 dias; mediana=26; dp=224,3) do que entre os importados (média=23,9 dias; mediana=9; dp=42,7) e esta diferença foi estatisticamente significativa p=0,0247. A sensibilidade da sorologia foi de 87,5%, da imunologia de LCR 93,8% e dos exames parasitológicos foi de 40,0%. Apenas 4 (14,8%) tiveram evolução com melhora completa, 6 (22,2%) apresentaram melhora sem limitações, 13 (48,1%) apresentaram melhora com limitações e 4 (14,8%) não apresentaram melhora alguma. Apenas 11 pacientes (41%) com NE medular incluídos neste estudo estavam notificados à vigilância epidemiológica e a informação de que estes pacientes tinham quadros neurológicos não constavam no banco de informações do SINAN. Concluiu-se que a NE medular ocorre mesmo em áreas de baixa endemicidade e nestas áreas existe uma demora muito grande no diagnóstico, principalmente entre os pacientes autóctones. O exame de fezes não se mostrou sensível para diagnóstico e rastreamento de pacientes vulneráveis a NE medular por se tratarem de pacientes com baixas cargas parasitárias. Portanto métodos diagnósticos mais sensíveis deveriam ser utilizados pelos programas de controle de esquistossomoseAbstract: Programs for schistosomiasis control have enjoyed relative success in controlling death associated to high parasitary loads for this illness, without, however, decreasing the area of transmission in Brazil. Since spinal neuroschistosomiasis is a grave form of neuroschistosomiasis unrelated to high parasitary loads, there is a theoretical risk of its occurrence even when not in a particularly endemic area. The goal of this study was to study the occurrence of spinal NE (neuroschistosomiasis) in a non-endemic area, the region of Campinas, in the Sate of São Paulo. A retrospective, descriptive, hospital-based study was carried, with information actively sought after from various sources of information. The two largest public hospitals in the region of Campinas were used as bases. The patients diagnosed with spinal NE had their diagnoses ratified according to standard criteria and based on typical clinical status, proof of infection by Schistosoma mansoni and the exclusion of other causes for myelopathy. Patients were classified as autochthonous, imported, without information and undetermined. After this classification, the clinical and epidemiological data were analyzed. A total of 27 patients with spinal NE were identified, of which 19 (85.2%) were men and 4 (14.8%) women. The ages on diagnosis ranged from 13 to 57 (average=31.2; standard deviation=12.8 and median=29). The patients were classified as to their probable location of infection the following way: 14(51.9%) autochthonous, 11(40.7%) imported and 2(7.4%) without information. No patients were deemed undetermined. All imported patients were infected in municipalities located in highly endemic areas. Clinical evaluation of this group of patients was no different from that found in the literature, nor was it different when autochthonous patients were compared to imported patients. There was an average period of 70.6 days (median=19; sd=166.9) between the first consultation and diagnosis. The period was on average 88.1 days longer for autochthonous patients (average=112 days; median=26; sd=224.3) than for imported patients (average=23.9 days; median=9; sd=42.7) and this difference was statistically significant p=0.0247. Sensitivity of the serology was 87.5%, LCR immunology 93.8% and for parasitological exams it was 40.0%. Only 4 (14.8%) had evolution with complete recovery, 6 (22.2%) presented improvement without limitations, 13 (48.1%) presented improvement with limitations and 4 (14.8%) did not present improvement. Only 11 patients (41%) with spinal NE included in the study had been notified to epidemiological surveillance and the information that these patients had neurological patterns of symptoms was not present in the SINAN data base. It can be concluded that spinal NE occurs even in non-endemic areas and that diagnosis in such locations can take excessively long, especially for autochthonous patients. Feces exams were not shown to be sensitive for diagnosis and tracing of patients vulnerable to spinal NE since such patients presented low parasitary loads. Therefore more sensitive means of diagnosis should be utilized by schistosomiasis control programsMestradoCiencias BiomedicasMestre em Clinica Medic

Respiratory syncytial virus seasonality in Brazil: implications for the immunisation policy for at-risk populations

Respiratory syncytial virus (RSV) infection is the leading cause of hospitalisation for respiratory diseases among children under 5 years old. The aim of this study was to analyse RSV seasonality in the five distinct regions of Brazil using time series analysis (wavelet and Fourier series) of the following indicators: monthly positivity of the immunofluorescence reaction for RSV identified by virologic surveillance system, and rate of hospitalisations per bronchiolitis and pneumonia due to RSV in children under 5 years old (codes CID-10 J12.1, J20.5, J21.0 and J21.9). A total of 12,501 samples with 11.6% positivity for RSV (95% confidence interval 11 - 12.2), varying between 7.1 and 21.4% in the five Brazilian regions, was analysed. A strong trend for annual cycles with a stable stationary pattern in the five regions was identified through wavelet analysis of the indicators. The timing of RSV activity by Fourier analysis was similar between the two indicators analysed and showed regional differences. This study reinforces the importance of adjusting the immunisation period for high risk population with the monoclonal antibody palivizumab taking into account regional differences in seasonality of RSV1115294301sem informaçã

Could Clinical Symptoms Be A Predictor Of Complications In Zika Virus Infection?

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Could clinical symptoms be a predictor of complications in Zika virus infection?

sem informação38810042338339sem informaçã

ZIKV-specific NS1 epitopes as serological markers of acute zika virus infection

Differentiate ZIKV from other cocirculating flaviviruses for accurate diagnosis remains a challenge. We investigated antibody responses in 51 acute ZIKV-infected adult patients from Campinas, Brazil, including 7 pregnant women who later delivered during the study. Using enzyme-linked immunosorbent assays, levels of antibody response were measured and specific epitopes identified. Several antibody-binding hot spots were identified in ZIKV immunogenic antigens, including membrane, envelope (E) and nonstructural protein 1 (NS1). Interestingly, specific epitopes (2 from E and 2 from NS1) strongly recognized by ZIKV-infected patients' antibodies were identified and were not cross-recognized by dengue virus (DENV)-infected patients' antibodies. Corresponding DENV peptides were not strongly recognized by ZIKV-infected patients' antibodies. Notably, ZIKV-infected pregnant women had specific epitope recognition for ZIKV NS1 (amino acid residues 17-34), which could be a potential serological marker for early ZIKV detection.This study identified 6 linear ZIKV-specific epitopes for early detection of ZIKV infections. We observed differential epitope recognition between ZIKV-infected and DENV-infected patients. This information will be useful for developing diagnostic methods that differentiate between closely related flaviviruses2202203212CONSELHO NACIONAL DE DESENVOLVIMENTO CIENTÍFICO E TECNOLÓGICO - CNPQFUNDAÇÃO DE AMPARO À PESQUISA DO ESTADO DE SÃO PAULO - FAPESPnão tem2016/00194-8; 2013/25807-4This work is supported by the Biomedical Research Council (BMRC) core research grants to the Singapore Immunology Network and the Zika Virus Consortium Fund, led by BMRC A*Star (project number 15/1/82/27/001); Agency for Science, Technology and Research, Singapore; Fundação de Amparo à Pesquisa do Estado de São Paulo (grant numbers 2016/00194-8 and 2013/25807-4 fellowship to J. A. L.); and the Conselho Nacional de Desenvolvimento Científico e Tecnológico (research fellowships to G. P. M. and F. T. M. C.