Perfil epidemiológico dos nascidos vivos em Tangaráda Serra-MT durante osurto do vírus Zika em 2016

Introdução: Em 2015, o vírus Zika (ZIKV) ocasionou surto de infecção em grandes proporções no Brasil, iniciando no nordeste e espalhando-se para 18 estados brasileiros até o final do mesmo ano. Apesar de descrita como uma doença aguda com sintomatologia leve, em março de 2016 foi comprovada como a causa de danos cerebrais e microcefalia em recém-nascidos de mães expostas ao vírus durante a gestação. No inicio de 2016 foi descrita a Síndrome Congênita por Vírus Zika. Mas muitas questões ainda permanecem abertas, por exemplo, se existem diferenças geográficas no risco de desenvolvimento de microcefalia em mulheres expostas bem como fatores sociais e genéticos envolvidos. O Centro-Oeste brasileiro, apesar de atingido fortemente pelo surto pelo ZIKV foi menos estudado comparativamente ao Nordeste e até o momento poucos estudos com populações definidas e inteiramente cobertas foram realizados. Objetivo: Descrever o perfil epidemiológico das crianças expostas ao ZIKV no período gestacional materno em Tangará da Serra, MT. Métodos: Estudo transversal, observacional, com base nos dados do SINASC (Sistema de informação sobre nascidos vivos), SINAN (Sistema de Informação de Agravos de Notificação) e do RESP (Registro de Eventos em Saúde Pública). Realizado no município de Tangará da Serra, localizado a cerca de 240 km da capital do estado, Cuiabá. Foram avaliados todos os nascidos vivos residentes em Tangará da Serra, entre 01 de janeiro e 31 de dezembro de 2016. Estes nascidos foram categorizados em dois grupos: grupo exposto e grupo sem história de exposição. Foram extraídos do SINASC os dados de condições sócio demográficas, do parto e do nascimento. A microcefalia foi investigada inicialmente ao nascimento e após 48 horas de vida a partir da medida do perímetro cefálico (PC), de acordo com os critérios do Ministério da Saúde. Os exames laboratoriais de RT-PCR para ZIKV foram realizados a partir de coleta de sangue periférico nas gestantes sintomáticas no dia da suspeita da doença. Os locais de moradia das mães durante a gravidez foram georreferenciadas a partir de coordenadas geográficas de latitude e longitude. Resultados: No ano de 2016, em que dentre os 1.441 nascidos vivos de residentes de Tangará da Serra, 106 (7,3%) foram de mães com exposição ao ZIKV. Cinco nascidos vivos apresentaram microcefalia devido à exposição ao ZIKV, assim, a prevalência de microcefalia atribuível à infecção congênita foi de 34,7/10.000. Comparativamente, no grupo não exposto, houve dois casos de 9 microcefalia (1,5/10.000). A macrocefalia também foi mais prevalente nas pessoas expostas ao ZIKV, assim como a morte neonatal. As variáveis sociodemográficas e geográficas, com exceção da cor da pele autorreferida, não diferiram entre crianças expostas e presumivelmente não expostas. A maior ocorrência dos nascimentos de crianças em que as mães foram expostas ao ZIKV ocorreu entre março e julho de 2016, o que coincide com o período de maior circulação do vírus no município. A observação geográfica e a análise de Hot Spot relacionando nascidos vivos, nascidos vivos expostos ao ZIKV, e microcefálicos, não indicam regiões de maior risco para nascimentos com a SCZ em Tangará da Serra (p = 0,6). Conclusão: Este é o primeiro estudo de base populacional realizado em um espaço geográfico definido que investiga a prevalência de microcefalia congênita decorrente do ZIKV após um surto desta infecção.Introduction: In 2015, the Zika virus (ZIKV) caused a major outbreak of infection in Brazil, starting in the northeast and spreading to 18 Brazilian states by the end of the same year. Although described as an acute disease with mild symptomatology, in March 2016 it was proven to cause microcephaly in newborns of mothers exposed to the virus during pregnancy and Congenital Zika Virus Syndrome was soon described. But many questions remain open, for example, whether there are geographical differences in the risk of developing microcephaly in exposed women as well as the social and genetic factors involved. The Brazilian Midwest, despite being hit hard by the Zika virus outbreak, has been less studied compared to the Northeast and so far few studies with defined and fully covered populations have been conducted. Objective: To describe the epidemiological profile of children exposed to the ZIKV in the maternal gestational period in Tangará da Serra, MT. Methods: Cross-sectional, observational study, based on data from SINASC (Information System on live births), SINAN (Information System for Notifiable Diseases) and RESP (Public Health Events Register). Held in the municipality of Tangará da Serra, located about 240 km from the state capital, Cuiabá. All live births residing in Tangará da Serra, between January 1 and December 31, 2016, were evaluated. These births were categorized into two groups: exposed group and group with no history of exposure. Data on socio-demographic conditions, childbirth and birth were extracted from SINASC. Microcephaly was initially investigated at birth and after 48 hours of life from the measurement of the head circumference (CP), according to the criteria of the Ministry of Health. Laboratory tests of RT-PCR for ZIKV were performed based on peripheral blood in symptomatic pregnant women on the day of suspected disease. The mothers' places of residence during pregnancy were georeferenced from geographic coordinates of latit The mothers' places of residence during pregnancy were georeferenced from geographic coordinates of latitude and longitude. Results: In 2016, among the 1,441 live births of residents of Tangará da Serra, 106 (7.3%) were mothers with exposure to ZIKV. Five live births showed microcephaly due to exposure to ZIKV, thus the prevalence of microcephaly attributable to congenital infection was 34.7 / 10,000. Comparatively, in the unexposed group, there were two cases of microcephaly (1.5 / 10,000). Macrocephaly was also more prevalent in people exposed to ZIKV, as well as neonatal death. Sociodemographic and geographic variables, with the exception of self-reported skin color, did not differ between exposed and presumably unexposed children. The highest occurrence of childbirths in which mothers were exposed to ZIKV occurred between March and July 2016, which coincides with the period of greatest virus circulation in the municipality. Geographic observation and Hot Spot analysis relating live births, live births exposed to ZIKV, and microcephalics, do not indicate regions of higher risk for births with SCZ in Tangará da Serra (p = 0.6). Conclusion: This is the first population-based study carried out in a defined geographical space that investigates the prevalence of congenital microcephaly due to ZIKV after an outbreak of this infection

Knowledge and actions for the control of the vector Aedes aegypti in a municipality in the Legal Amazon

Infections caused by arboviruses that have mostly impacted the Brazilian morbidity and mortality are caused by the same vector, Aedes aegypti. Preventive actions related to the vector are the most effective strategies in the prevention and control of these diseases. This study aimed to associate the knowledge on the vector that transmits dengue, Zika and chikungunya with the sociodemographic and behavioral preventive practices towards Aedes aegypti in the municipality of Tangara da Serra, Mato Grosso State, in the Brazilian Legal Amazon. A probabilistic urban population sampling was obtained by clusters: census sectors and households. The sample size calculation considered 10% of loss and a 1.5 design effect. This is a cross-sectional research carried out through a household survey in February and March 2018. There were 583 participants. The study variables were knowledge on the vector, sociodemographic characteristics and preventive practices related to the vector. The statistical analysis was based on a bivariate analysis and Poisson multiple regressions. Inadequate or insufficient knowledge on the vector Aedes aegypti remained associated with education in the categories illiterate (p<0.001) and 8 years of study or less (p<0.001), in addition to not adopting practices of capping and cleaning the water tank (p=0.002) and not using insecticides at home (p=0.007). It is concluded that there is a need for health communication actions that consider characteristics the population, especially the level of education and previous knowledge on the vector, allowing a dialogical approach and enabling the community participation in preventive practices and control of the vector Aedes aegypti

Perfil das anomalias congênitas em nascidos vivos de Tangará da Serra, Mato Grosso, 2006-2016

Objective: to describe congenital anomalies (CA) among live births of mothers resident in Tangará da Serra, MT, Brazil, during the period 2006-2016. Methods: this was a descriptive study, using Brazilian Live Birth Information System (SINASC) data. Results: out of 15,689 births, 77 were registered with CA (prevalence of 4.9/1,000); there was an 80.7% increase of recorded CA in 2016, accounting for 10.3/1,000 live births, including five cases of microcephaly; CA prevalence was higher among children born to women aged over 35 years (prevalence ratio [PR] =1.91; confidence interval [95%CI] 1.01;3.60), preterm (PR=2.22; 95%CI 1.26;3.92) and low birth weight infants (PR=3.21; 95%CI 1.86;5.54). Conclusion: low CA prevalence was found, possibly related to under-recording at birth; the increase observed in 2016 may be related to the Zika epidemic causing microcephaly, as well as greater attention by health professionals in relation to CA during this public health emergency.Objetivo: descrever as anomalias congênitas (ACs) entre nascidos vivos de mães residentes em Tangará da Serra, MT, Brasil, durante o período 2006-2016. Métodos: estudo descritivo, com dados do Sistema de Informações sobre Nascidos Vivos (Sinasc). Resultados: de 15.689 nascimentos, 77 foram registrados com ACs (4,9/1.000); houve incremento de 80,7% no registro de AC em 2016, representando 10,3/1.000 nascidos vivos, incluídos cinco casos de microcefalia; a prevalência de AC foi maior entre crianças de mulheres maiores de 35 anos de idade (razão de prevalência [RP] =1,91; intervalo de confiança [IC95%] 1,01;3,60), prematuros (RP=2,22; IC95% 1,26;3,92) e com baixo peso ao nascer (RP=3,21; IC95% 1,86;5,54). Conclusão: observou-se baixa prevalência de AC, possivelmente relacionada ao sub-registro no nascimento; o aumento observado em 2016 pode estar relacionado à epidemia de Zika como causa de microcefalia, e à maior atenção dos profissionais de saúde às ACs durante a emergência em Saúde Pública

Recent dengue virus infection: epidemiological survey on risk factors associated with infection in a medium-sized city in Mato Grosso

BACKGROUND: Dengue is considered to be the most important arbovirus worldwide, with important complications that increase its lethality. In Brazil, an endemic country, the disease reaches significant incidence levels, with occurrences of serious cases and high costs of hospitalizations for its treatment. OBJECTIVE: To analyze risk factors among individuals with recent histories of dengue infection in a medium-sized city in Mato Grosso. DESIGN AND SETTING: Descriptive cross-sectional study, of epidemiological-survey type, conducted among the urban population of a city located in mid-northern Mato Grosso. METHODS: A seroepidemiological survey using questionnaires and collection of biological material was conducted among 596 adults aged ≥ 18 years who had been selected through a cluster sampling process. Positive dengue cases were those with positive results from anti-dengue immunoassays (ELISA). Statistical analyses with descriptive and inferential techniques were used, with 95% confidence intervals and a 5% significance level.RESULTS: The seroepidemiological profile of the study participants was predominantly female, with ages between 18 and 39 years, self-declared non-white race/color, not more than eight years of education and not living with a companion. Among the sanitary factors analyzed, the following were risk factors for dengue virus infection: no running water at home; no water supply from the public piped network; no waste from drains or toilets sent to the sewage network; endemic disease combat agents visiting the home; and presence of mosquito breeding sites at home. CONCLUSION: Low schooling levels and previous dengue virus infection were associated with current dengue virus infection

Hantavirus and criminality: disease and family

Background and objectives: Hantavirus is a pathogen that causes a viral disease with an acute and severe presentation, and a high mortality rate. In face of a sudden loss, some families may not conceive the complete absence of the deceased relative. Thus, we sought to understand the changes that took place in a family after the death of the provider by Hantavirus Pulmonary Syndrome (HPS). Methods: A descriptive exploratory study with a qualitative approach of the type case report. Data collection took place between October and December 2016 through recorded individual interviews and using questions about family dynamics after family provider’s death of HPS, which were assessed by content analysis in the light of Roy's theory. Results: It was observed that the illness and death of the family patriarch weakened the family's strengths and resources, leading to a period of mourning and despair. In addition, unemployment among other family members worsened socioeconomic conditions, seeing drugs as an alternative for support as it became a commercial activity, and the rise of a command in the region that culminated in the arrest of the wife, two daughters and a son of the deceased. Conclusions: In this case, it was evidenced that the family was weakened due to the illness and death of their loved one by HPS, and because of the lack of support and welcome from the reference social services, they chose to act in criminality and it ended up with the arrest of four members

Epidemiological and prison profile of the detention of a municipality of the north of Mato Grosso

The objective of this study was to present the profile of women deprived of their liberty in a public chain in the middle region of Mato Grosso. This was a cross-sectional survey with a quantitative approach carried out in 2017. A semi-structured questionnaire containing open and closed questions was applied to 57 women with individual interviews, later the data systematized in electronic spreadsheets and analyzed by the SPSS version 20.0. The predominant profile self-reported by the participants was brown (73.7%), aged between 18 and 31 (56.2%), incomplete elementary school (56.2%), housewives (38.6%), (47.4%), with up to 4 children (82.5%), arrested for the crime of drug trafficking (54.4%) and with imprisonment for up to two years (82.5%). The profile described reflects the relationship between the population with greater socioeconomic fragility, insertion in crime through the partner and drug trafficking as a search for income. In this sense is necessary the elaboration of intersectional public policies that allow the reduction of social and gender inequalities and the insertion of women since their childhood in environments that enhance the quality of life

Association between Genetic Variants in NOS2 and TNF Genes with Congenital Zika Syndrome and Severe Microcephaly

Zika virus (ZIKV) causes Congenital Zika Syndrome (CZS) in individuals exposed prenatally. Here, we investigated polymorphisms in VEGFA, PTGS2, NOS3, TNF, and NOS2 genes as risk factors to CZS. Forty children with CZS and forty-eight children who were in utero exposed to ZIKV infection, but born without congenital anomalies, were evaluated. Children with CZS were predominantly infected by ZIKV in the first trimester (p < 0.001) and had mothers with lower educational level (p < 0.001) and family income (p < 0.001). We found higher risk of CZS due the allele rs2297518[A] of NOS2 (OR = 2.28, CI 95% 1.17–4.50, p = 0.015). T allele and TT/CT genotypes of the TNF rs1799724 and haplotypes associated with higher expression of TNF were more prevalent in children with CZS and severe microcephaly (p = 0.029, p = 0.041 and p = 0.030, respectively). Our findings showed higher risk of CZS due ZIKV infection in the first trimester and suggested that polymorphisms in NOS2 and TNF genes affect the risk of CZS and severe microcephaly

Aspectos clínico-epidemiológico dos pacientes convalescentes após infecção por hantavírus em Mato grosso

Justificativa e objetivo: As hantaviroses são zoonoses causadas pelos orthohantavirus. Nas américas são caracterizadas pela Síndrome Pulmonar por Hantavírus (SPH), com alta letalidade e existem poucos estudos sobre os pacientes que evoluem para cura após a infecção. Dessa forma, objetiva-se, identificar o perfil dos pacientes em convalescência após a infecção por hantavírus. Métodos: Foi realizado um estudo epidemiológico descritivo de uma série de dados secundários, referente aos casos confirmados de SPH em Mato Grosso, registrados entre os anos de 1999 a 2016. Resultados: Utilizou-se 160 fichas de notificação de pacientes convalescentes. Nessa população predominou o sexo masculino (75,6%), faixa etária de 25 anos a 34 anos, raça/cor branca, ensino fundamental incompleto e atividade profissional voltadas à área agrícola (26,2%), as situações de risco envolveram desmatamento, aragem de terra, plantio ou colheita agrícola (44,8%). Os principais sinais e sintomas descritos foram febre (86,9%), cefaleia (74,4%) e dispneia (72,5%). Do total de pacientes, 77,5% realizaram exames laboratoriais e exame de imagem por raios X 79,4%, maioria dos achados com infiltrado pulmonar difuso (66,9%). Foram hospitalizados (87,5%) com utilização de assistência respiratória mecânica (46,5%), uso de antibioticoterapia (50,5%) e drogas vasoativas (35,5%). Conclusão: A doença está presente em duas regiões distintas do estado, com registro de casos em todos os meses do ano. Conhecer o perfil dos pacientes que evoluem para cura possibilita instrumentalizar os profissionais para a adoção de medidas adequadas tanto no diagnóstico precoce, como na terapêutica eficaz que possam contribuir com a redução da letalidade

Functional polymorphisms in the p53 pathway genes on the genetic susceptibility to zika virus teratogenesis

Congenital Zika Syndrome (CZS) occurs in up to 42% of individuals exposed to ZIKV prenatally. Deregulation in gene expression and protein levels of components of the p53 signaling pathway, such as p53 and MDM2, due to ZIKV infection has been reported. Here, we evaluate functional polymorphisms in genes of the p53 signaling pathway as risk factors to CZS. Forty children born with CZS and forty-eight children exposed to ZIKV, but born without congenital anomalies were included in this study. Gestational and sociodemographic information as well as the genotypic and allelic frequencies of functional polymorphisms in TP53, MDM2, MIR605 and LIF genes were compared between the two groups. We found children with CZS exposed predominantly in the first trimester and controls in the third trimester (p<0.001). Moreover, children with CZS were predominantly from families with a lower socioeconomic level (p=0.008). We did not find a statistically significant association between the investigated polymorphisms and development of CZS; however, by comparing individuals with CZS and lissencephaly or without lissencephaly, we found a significative difference in the allelic frequencies of the TP53 rs1042522, which is associated with a more potent p53-induced apoptosis (p=0.007). Our findings suggest that the TP53 rs1042522 polymorphism should be better investigate as a genetic risk factor for the development of lissencephaly in children with CZS

Microcephaly prevalence after the 2015 to 2016 Zika outbreak in Tangará da Serra, Brazil: a population-based study

Objective: Prenatal infection with the Zika virus (ZIKV) can lead to congenital Zika syndrome (CZS), characterized by microcephaly and brain injury. However, there are questions regarding the prevalence of microcephaly/CZS after the ZIKV outbreak in defined geographic areas. This study aimed to identify adverse outcomes in live births of fetuses exposed in utero to the ZIKV, compared to unexposed births, as well as maternal sociodemographic, delivery, and birth characteristics. Methods: Here, we conducted a cross-sectional observational study to investigate the characteristics of all live births in the city of Tangará da Serra, Mato Grosso, Brazil, in 2016, after the outbreak of ZIKV infection in late 2015. All live births of children to women residing in the municipality of Tangará da Serra between January 1 and December 31, 2016, were evaluated, and head circumference was measured at birth and after 24 hours. Children born with microcephaly or a maternal history of confirmed or suspected prenatal ZIKV infection were evaluated by a multidisciplinary team. The outcomes of the exposed and non-exposed children were compared. Prevalence ratios and their respective 95% confidence intervals were calculated for sociodemographic, delivery, and live birth characteristics. Results: Of 1,441 live births, 106 (7.3%) were from mothers with confirmed or highly probable exposure to ZIKV. The prevalence of severe congenital microcephaly (41.7/10,000) in Tangará da Serra in 2016 was ten-fold higher than that in Latin America before 2015. Conclusion: This study may serve as a model to investigate possible outbreaks of infections in a defined geographical space in the future