Forecasting temporal dynamics of cutaneous leishmaniasis in Northeast Brazil.

IntroductionCutaneous leishmaniasis (CL) is a vector-borne disease of increasing importance in northeastern Brazil. It is known that sandflies, which spread the causative parasites, have weather-dependent population dynamics. Routinely-gathered weather data may be useful for anticipating disease risk and planning interventions.Methodology/principal findingsWe fit time series models using meteorological covariates to predict CL cases in a rural region of Bahía, Brazil from 1994 to 2004. We used the models to forecast CL cases for the period 2005 to 2008. Models accounting for meteorological predictors reduced mean squared error in one, two, and three month-ahead forecasts by up to 16% relative to forecasts from a null model accounting only for temporal autocorrelation.SignificanceThese outcomes suggest CL risk in northeastern Brazil might be partially dependent on weather. Responses to forecasted CL epidemics may include bolstering clinical capacity and disease surveillance in at-risk areas. Ecological mechanisms by which weather influences CL risk merit future research attention as public health intervention targets

Forecasting temporal dynamics of cutaneous leishmaniasis in Northeast Brazil.

IntroductionCutaneous leishmaniasis (CL) is a vector-borne disease of increasing importance in northeastern Brazil. It is known that sandflies, which spread the causative parasites, have weather-dependent population dynamics. Routinely-gathered weather data may be useful for anticipating disease risk and planning interventions.Methodology/principal findingsWe fit time series models using meteorological covariates to predict CL cases in a rural region of Bahía, Brazil from 1994 to 2004. We used the models to forecast CL cases for the period 2005 to 2008. Models accounting for meteorological predictors reduced mean squared error in one, two, and three month-ahead forecasts by up to 16% relative to forecasts from a null model accounting only for temporal autocorrelation.SignificanceThese outcomes suggest CL risk in northeastern Brazil might be partially dependent on weather. Responses to forecasted CL epidemics may include bolstering clinical capacity and disease surveillance in at-risk areas. Ecological mechanisms by which weather influences CL risk merit future research attention as public health intervention targets

Seizures as a Complication of Congenital Zika Syndrome in Early Infancy

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2018-08-07T14:08:53Z No. of bitstreams: 1 Oliveira-Filho J Seizures as a Complication of Congenital Zika.pdf: 82677 bytes, checksum: e67ebd92b967354def5e0e51f9e225c4 (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2018-08-07T15:44:32Z (GMT) No. of bitstreams: 1 Oliveira-Filho J Seizures as a Complication of Congenital Zika.pdf: 82677 bytes, checksum: e67ebd92b967354def5e0e51f9e225c4 (MD5)Made available in DSpace on 2018-08-07T15:44:32Z (GMT). No. of bitstreams: 1 Oliveira-Filho J Seizures as a Complication of Congenital Zika.pdf: 82677 bytes, checksum: e67ebd92b967354def5e0e51f9e225c4 (MD5) Previous issue date: 2018NIH Grants RO1 NS064905, NIH R01 AI052473, U01 AI088752, and R25 TW009338, and the Oswaldo Cruz FoundationUniversidade Federal da Bahia. Faculdade de Medicina da Bahia. Postgraduate Program in Health Sciences. Salvador, BA, BrasilUniversidade Federal da Bahia. Faculdade de Medicina da Bahia. Instituto de Saúde Coletiva. Escola de Enfermagem. Salvador, BA, BrasilUniversidade Federal da Bahia. Faculdade de Medicina da Bahia. Instituto de Saúde Coletiva. Escola de Enfermagem. Salvador, BA, BrasilFundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, BrasilHospital Geral Roberto Santos. Secretaria Estadual da Saúde da Bahia. Salvador, BA, BrasilInstituto Evandro Chagas. Belem, PA, BrasilFundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, Brasil / Yale School of Public Health. Department of Epidemiology of Microbial Diseases. New Haven, ConnecticutFor The Salvador Zika Response TeamZika virus transmission in Brazil was linked to a large outbreak of microcephaly but less is known about longer term anthropometric and neurological outcomes. We studied a cohort of infants born between October 31, 2015, and January 9, 2016, in a state maternity hospital, followed up for 101 ± 28 days by home visits. Microcephaly (< 2 standard deviations, Intergrowth standard) occurred in 62 of 412 (15%) births. Congenital Zika syndrome (CZS) was diagnosed in 29 patients. Among CZS patients, we observed a significant gain in anthropometric measures (P < 0.001) but no significant gain in percentile for these measures. The main neurological outcome was epilepsy, occurring in 48% of infants at a rate of 15.6 cases per 100 patient-months, frequently requiring multiple anti-seizure medications. The cumulative fatality rate was 7.4% (95% confidence interval: 2.1-23.4%). Health-care professionals should be alerted on the high risk of epilepsy and death associated with CZS in early infancy and the need to actively screen for seizures and initiate timely treatment

Measures of prediction error.

<p>Mean squared error (MSE) in predictions is presented for each model at each forecast horizon (1, 2, and 3 months ahead). Percent change in MSE relative to the null model (∂MSE₀) is presented to measure improvement in prediction accuracy. Improvements greater than 5% relative to the null model are indicated with <b>bold</b> text.</p><p>Measures of prediction error.</p

Covariate lag selections and model parameter estimates.

<p>The values of the cross correlation function (CCF) between the pre-whitened series are presented alongside parameter estimates in the best-fitting and averaged models according to each information criterion. Significance at the 95% confidence level is indicated with <b>bold</b> text.</p><p>Covariate lag selections and model parameter estimates.</p

Meteorological and climatic predictors, 1994–2008.

<p>Panels for each variable include (right) the interpolated time series for meteorological and climate conditions in the study region, and (left) the cross-correlation with the square root-transformed case series during the training period, in which the dotted line indicates the 95% significance cut-off. The X-axis gives the time separating the meteorological observation from the month of case notification; negative X values indicate lags (weather precedes cases), while positive values indicate leads.</p

One month-ahead forecasts.

<p>(A) Null model; (B) Best-fitting model according to BIC; (C) Averaged model according to BIC. Black lines plot the square root-transformed cases; orange lines plot model fit to data during the training period; red lines plot model forecasts, with the grey area representing the 95% confidence region.</p

Cutaneous leishmaniasis cases in the study region, 1994–2008.

<p>(A) Cases presenting to the Corte de Pedra health post, aggregated by month; (B) Autocorrelation function computed from the square root-transformed case series during the training period; (C) Partial autocorrelation function computed from the square root-transformed case series during the training period. For (B) and (C): the dotted line indicates the 95% significance cut-off.</p

Adverse birth outcomes associated with Zika virus exposure during pregnancy in São José do Rio Preto, Brazil

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2017-11-17T12:41:59Z No. of bitstreams: 1 Nogueira ML (PREPRINT) Adverse birth outcomes associated with Zika virus exposure during pregnancy in São....pdf: 2093267 bytes, checksum: 6543c2d2fad9c94caa4b20a635a1eab9 (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2017-11-17T12:43:36Z (GMT) No. of bitstreams: 1 Nogueira ML (PREPRINT) Adverse birth outcomes associated with Zika virus exposure during pregnancy in São....pdf: 2093267 bytes, checksum: 6543c2d2fad9c94caa4b20a635a1eab9 (MD5)Made available in DSpace on 2017-11-17T12:43:36Z (GMT). No. of bitstreams: 1 Nogueira ML (PREPRINT) Adverse birth outcomes associated with Zika virus exposure during pregnancy in São....pdf: 2093267 bytes, checksum: 6543c2d2fad9c94caa4b20a635a1eab9 (MD5) Previous issue date: 2017The São Paulo Research Foundation (FAPESP) via Grant 262 No. 2013/21719-3 and 2016/15021-1for M.L.N, Grant No. 2015/12295-0 for A.C.B.T., and Grant 263 No. 2016/05115-9 for L.C.M. P.F.C.V. was supported by the Zika Virus Fast Track program pro264 vided by the Association for the Improvement of Higher Education Personnel (CAPES) and the 265 Brazilian National Council for Scientific and Technological Development (CNPq) via Grant Nos. 266 303999/2016-0, 440405/2016-5, and 457664/2013-4. MLM is a CNPq Research Fellow.São José do Rio Preto School of Medicine. São José do Rio Preto, SP, Brazil.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil.São José do Rio Preto School of Medicine. São José do Rio Preto, SP, Brazil.São José do Rio Preto School of Medicine. São José do Rio Preto, SP, Brazil.São José do Rio Preto School of Medicine. São José do Rio Preto, SP, Brazil.São José do Rio Preto School of Medicine. São José do Rio Preto, SP, Brazil.São José do Rio Preto School of Medicine. São José do Rio Preto, SP, Brazil.São José do Rio Preto School of Medicine. São José do Rio Preto, SP, Brazil.São José do Rio Preto School of Medicine. São José do Rio Preto, SP, Brazil.São Paulo State University. São José do Rio Preto, SP, Brazil.São Paulo State University. São José do Rio Preto, SP, Brazil.São Paulo State University. São José do Rio Preto, SP, Brazil.Evandro Chagas Institute. Ananindeua, PA, Brazil.Evandro Chagas Institute. Ananindeua, PA, Brazil.Health Secretariat. São José do Rio Preto, SP, Brazil.Health Secretariat. São José do Rio Preto, SP, Brazil.Health Secretariat. São José do Rio Preto, SP, Brazil.Health Secretariat. São José do Rio Preto, SP, Brazil.Health Secretariat. São José do Rio Preto, SP, Brazil.Health Secretariat. São José do Rio Preto, SP, Brazil.Health Secretariat. São José do Rio Preto, SP, Brazil.Health Secretariat. São José do Rio Preto, SP, Brazil.Health Secretariat. São José do Rio Preto, SP, Brazil.Health Secretariat. São José do Rio Preto, SP, Brazil.Health Secretariat. São José do Rio Preto, SP, Brazil.Fundação Oswaldo Cruz. Instituto Gonçalo Moniz. Salvador, BA, Brasil / Federal University of Bahia. Salvador, BA, Brazil / Yale School of Public Health. New Haven, Connecticut, USA.Fundacao Oswaldo Cruz. Rio de Janeiro, RJ, Brazil.São José do Rio Preto School of Medicine. São José do Rio Preto, SP, Brazil.São José do Rio Preto School of Medicine. São José do Rio Preto, SP, Brazil.São José do Rio Preto School of Medicine. São José do Rio Preto, SP, Brazil.University of Texas Medical Branch. Galveston, Texas, USA.São José do Rio Preto School of Medicine. São José do Rio Preto, SP, Brazil.São José do Rio Preto School of Medicine. São José do Rio Preto, SP, Brazil.Yale School of Public Health. New Haven, Connecticut, USA.Objective: We aimed to report the first 54 cases of pregnant women infected by Zika vírus (ZIKV) and their virological and clinical outcomes, as well as the newborns’ outcomes in 2016, after the emergence of ZIKV in dengue endemic areas of São Paulo, Brazil. Methods: This is a descriptive study performed from February to October 2016 on 54 qPCR ZIKV50 positive pregnant women identified by the Public Health Authority of São Jose do Rio Preto, São Paulo, Brazil. The women were followed and had clinical and epidemiological data collected before and after birth. Adverse outcomes in newborns were analyzed and reported. Urine or blood samples from newborns were collected to identify ZIKV infection by RT-PCR. Results: 216 acute Zika-suspected pregnant women were identified, and 54 had the diagnosis con55 firmed by RT-PCR. None of the 54 women miscarried. Among the 54 newborns, 15 exhibited ad56 verse outcomes at birth. The highest number of ZIKV infections occurred during the second and third trimesters. No cases of microcephaly were reported, though the broad clinical spectrum of outcomes, as lenticulostriate vasculopathy, subependymal cysts, auditive and ophtalmological dis59 orders, were identified. ZIKV RNA was detected in 18 of 51 newborns tested and in eight of 15 newborns with adverse outcomes. Conclusions: Although other studies have associated many newborn outcomes to ZIKV infection during pregnancy, these same adverse outcomes were rare or non-existent in this study. The clinical presentation in our newborns was mild compared to other reports, suggesting that there is significant heterogeneity of Congenital Zika Infection