Rotavirus Genotypes Circulating in Brazil Before and After the National Rotavirus Vaccine Program: A Review.

We describe the rotavirus genotypes before and after rotavirus vaccine introduction in Brazil. 86 studies reported 6,884 (15.2%) rotavirus-episodes among 45,305 children. Rotavirus caused 22.4% and 11.6% of cases before and after vaccine introduction. G1P[8] and G9P[8], and G2P[4] and heterotypic-strains were most common before and after vaccine introduction. The vaccines may have selected heterotypic strains in this highly-vaccinated population

Pain and quality of life in leprosy patients in an endemic area of Northeast Brazil: a cross-sectional study

Background Pain emerges as a challenge in the treatment of leprosy patients. In this study, we describe the prevalence and type of pain in patients with leprosy, and its effect on patients’ quality of life in an endemic area of Northeast Brazil. Findings A cross-sectional survey of 260 patients attending leprosy reference centres in Sergipe, Northeast Brazil was conducted. Individuals were assessed for the presence and type of pain, skin sensory loss, peripheral nerve enlargement, touch and pinprick sensations, mechanical allodynia and nerve palpation. Participants completed the Douleur Neuropathique 4 questionnaire, and we also used the Brief Pain Inventory scale and the World Health Organization Quality of Life-BREF instrument to arrive at our results. One hundred and ninety-five (75 %) patients reported pain, mostly of the neuropathic type. Pain was moderate in 84 (43.1 %) and severe in 94 (48.2 %) participants. The presence of pain was associated with disability (p = 0.001), leprosy reactions (p = 0.004) and lower quality of life. Most patients with neuropathic pain were treated with steroids, despite their low efficacy for this type of pain. Conclusion Pain is highly prevalent among leprosy patients and is associated with low quality of life. Leprosy management should include a systematic assessment of the type of pain a patient experiences in order to provide adequate treatment

Agreement Between the Douleur Neuropathique in 4 Questions and Leeds Assessment of Neuropathic Symptoms and Signs Questionnaires to Classify Neuropathic Pain Among Patients with Leprosy.

Neuropathic pain (NP) often occurs during the course of leprosy, and screening tools to differentiate NP from non-NP are often used. However, their performance varies in different settings. The most frequently used scales are the Douleur Neuropathique in 4 questions (DN4) and the Leeds assessment of neuropathic symptoms and signs (LANSS) questionnaires. Thus, we conducted a study to evaluate the agreement between DN4 and LANSS questionnaires to classify NP in 195 leprosy patients attending two reference centers in Sergipe, Brazil. The DN4 and LANSS classified 166 and 110 patients, respectively, as having NP. One hundred and seven (54.8%) were classified as NP by both questionnaires; 59 (30.2%) solely by the DN4 questionnaire and three (1.5%) solely by the LANSS. The agreement of the questionnaires was 66.2% (weak agreement, Kappa = 0.30). Although both questionnaires identified a high proportion of NP, the development of more robust instruments is necessary to ensure the accuracy of diagnosis of leprosy patients classified as having NP

Risk factors for inadequate prenatal care use in the metropolitan area of Aracaju, Northeast Brazil

<p>Abstract</p> <p>Background</p> <p>The aim of prenatal care is to promote good maternal and foetal health and to identify risk factors for adverse pregnancy outcomes in an attempt to promptly manage and solve them. Although high prenatal care attendance is reported in most areas in Brazil, perinatal and neonatal mortalities are disproportionally high, raising doubts about the quality and performance of the care provided. The objective of the present study was to evaluate the adequacy of prenatal care use and the risk factors involved in inadequate prenatal care utilization in the metropolitan area of Aracaju, Northeast Brazil.</p> <p>Methods</p> <p>A survey was carried out with puerperal women who delivered singleton liveborns in all <b>four </b>maternity hospitals of Aracaju. A total of 4552 singleton liveborns were studied. The Adequacy of Prenatal Care Utilization Index, modified according to the guidelines of the Prenatal Care and Birth Humanization Programme, was applied. Socioeconomic, demographic, biological, life style and health service factors were evaluated by multiple logistic regression. Results: Prenatal care coverage in Aracaju was high (98.3%), with a mean number of 6.24 visits. Prenatal care was considered to be adequate or intensive in 66.1% of cases, while 33.9% were considered to have inadequate usage. Age < 18 to 34 years at delivery, low maternal schooling, low family income, two or more previous deliveries, maternal smoking during pregnancy, having no partner and prenatal care obtained outside Aracaju were associated with inadequate prenatal care use. In contrast, private service attendance protected from inadequate prenatal care use.</p> <p>Conclusion</p> <p>Prenatal care coverage was high. However, a significant number of women still had inadequate prenatal care use. Socioeconomic inequalities, demographic factors and behavioural risk factors are still important factors associated with inadequate prenatal care use.</p

Is adolescent pregnancy a risk factor for low birth weight?

OBJETIVO: Evaluar el embarazo en la adolescencia como factor de riesgo para bajo peso al nacer. MÉTODOS: Estudio transversal incluido en una cohorte de puérperas y sus respectivos recién nacidos, en las cuatro maternidades de Aracaju, SE (Brasil), de marzo a julio de 2005. Se estudiaron 4.646 pares de madres/recién nacidos. Los datos se colectaron consecutivamente durante cuatro meses. Variables sociales, biológicas y asistenciales se obtuvieron por medio de cuestionario estandarizado. Se realizó regresión logística múltiple, con control de factores de confusión y de modificación. RESULTADOS: Del total analizadas, 20,6% eran adolescentes (OBJECTIVE: The objective of this study was to evaluate whether adolescent pregnancy is a risk factor for low birth weight (LBW) babies. METHODS: This was a cross-sectional study of mothers and their newborns from a birth cohort in Aracaju, Northeastern Brazil. Data were collected consecutively from March to July 2005. Information collected included socioeconomic, biological and reproductive aspects of the mothers, using a standardized questionnaire. The impact of early pregnancy on birth weight was evaluated by multiple logistic regression. RESULTS: We studied 4,746 pairs of mothers and their babies. Of these, 20.6% were adolescents (< 20 years of age). Adolescent mothers had worse socioeconomic and reproductive conditions and perinatal outcomes when compared to other age groups. Having no prenatal care and smoking during pregnancy were the risk factors associated with low birth weight. Adolescent pregnancy, when linked to marital status "without partner", was associated with an increased proportion of low birth weight babies. CONCLUSIONS: Adolescence was a risk factor for LBW only for mothers without partners. Smoking during pregnancy and lack of prenatal care were considered to be independent risk factors for LBW.OBJETIVO: Avaliar a gravidez na adolescência como fator de risco para baixo peso ao nascer. MÉTODOS: Estudo transversal incluído numa coorte de puérperas e seus respectivos recém-nascidos, nas quatro maternidades de Aracaju, SE, de março a julho de 2005. Os dados foram coletados consecutivamente durante quatro meses. Variáveis sociais, biológicas e assistenciais foram obtidas por meio de questionário padronizado. Foi realizada regressão logística múltipla, com controle de fatores de confusão e de modificação. RESULTADOS: Foram estudados 4.746 pares de mães/recém-nascidos. Dessas, 20,6% eram adolescentes (< 20 anos). As mães adolescentes apresentaram piores condições socioeconômicas, reprodutivas e resultados perinatais mais adversos, quando comparadas com outros grupos etários. Foram identificados como fatores de risco associados ao baixo peso ao nascer a ausência de assistência no pré-natal e tabagismo na gestação. Identificou-se interação da idade materna com a situação conjugal: mães adolescentes sem companheiro tiveram maiores proporções de baixo peso ao nascer. CONCLUSÕES: A adolescência mostrou-se fator de risco para baixo peso ao nascer entre as mães sem companheiro. Tabagismo durante a gestação e ausência de assistência pré-natal associam-se ao baixo peso ao nascer

Acute norovirus gastroenteritis in children in a highly rotavirus-vaccinated population in Northeast Brazil.

Background: Gastroenteritis is one of the most important causes of morbidity and mortality in children and an important etiological agent is norovirus. Objective: We describe the occurrence and characteristics of norovirus diarrhoea in children from Sergipe, Northeast-Brazil, over two consecutive periods of three years following rotavirus vaccine introduction. Study design: A cross sectional hospital-based survey conducted from October-2006 to September-2009 and from July-2011 to January-2013. Acute diarrhoea cases had a stool sample collected and tested for norovirus by RT-PCR and positive samples were sequenced. Results: In total 280 (19.6%) of 1432 samples were norovirus positive, including 204 (18.3%) of 1,113 samples collected during the first period and 76 (23.9%) of 318 collected during the second period. The proportion of children with norovirus infection increased significantly through the second study period (χ2 for trend = 6.7; p = 0.009), was more frequent in rotavirus vaccinated and in younger children (p < 0.001). Of 280 norovirus-positive specimens, 188 (67.1%) were sequenced. Of these, 12 were genogroup I and 176 genogroup II. The main genotype was GII.4 (149/188, 79.3%), followed by GII.2 (6, 3.2%) and GII.6 (5, 2.6%). Conclusion: Norovirus annual detection rates increased over the study period. The detection of norovirus was higher among young children

Predominance of Rotavirus P[4]G2 in a Vaccinated Population, Brazil

We identified 21 rotaviruses in 129 patients with diarrhea in a Brazilian city with high rotavirus vaccine coverage. All rotaviruses were genotype P[4]G2 with 1 mixed infection with P[NT]G9. Although virus predominance could have occurred randomly, the vaccine may be less protective against P[4]G2. Prospective surveillance is urgently needed