Population Prevalence of Trachoma in Nine Rural Non-Indigenous Evaluation Units of Brazil.

Purpose: To assess the contemporary prevalence of trachoma in Brazil's non-indigenous population, surveys of those thought to be at greatest risk of disease were conducted.Methods: Rural census tracts of non-indigenous population from nine mesoregions were selected to compose the survey evaluation units (EUs) by considering previously endemic municipalities at greatest risk of trachoma. In each of the nine EUs, we conducted a population-based prevalence survey. Every resident of selected households aged ≥1 year was examined for trachomatous inflammation - follicular (TF) and trachomatous trichiasis (TT). Additionally, data were collected on household-level access to water, sanitation, hygiene (WASH) and education.Results: A total of 27,962 individuals were examined across nine EUs. The age-adjusted TF prevalence in 1-9-year-olds was 99% of surveyed children.Conclusions: The prevalence of TF was well below the target for elimination as a public health problem in all EUs. Because EUs surveyed were selected to represent the highest-risk non-indigenous areas of the country, TF prevalence is unlikely to be ≥5% in non-indigenous populations elsewhere. In one EU, the prevalence of TT was above the target threshold for elimination. Further investigation and possibly improvement in TT surgical provision are required in that EU

Prevalência do tracoma em escolares e comunicantes e fatores associados em três municípios do Arquipélago do Marajó, Pará: estudo comparativo entre os anos 2008 e 2016

Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.O tracoma é a principal causa infecciosa de cegueira no mundo e está associado a precárias condições de vida nos países em desenvolvimento. O diagnóstico da doença é baseado na avaliação clínica. Entretanto, a confirmação laboratorial é necessária para a constatação da circulação do agente etiológico na comunidade. O objetivo do presente estudo foi avaliar a prevalência de tracoma em três municípios do Arquipélago de Marajó, localizado no estado do Pará, nos anos de 2008 e 2016 e comparar um teste laboratorial com a metodologia qPCR em desenvolvimento. Em 2008, 2.054 escolares do sistema público de ensino primário da área urbana da região do Marajó e seus comunicantes foram examinados clinicamente, apresentando uma prevalência de tracoma de 3,4% (69 casos), sendo mais frequente em crianças entre seis e nove anos e no sexo feminino; entre os comunicantes, uma prevalência de 16,5% foi observada. Em 2016, foram examinados 1.502 escolares, onde foram diagnosticados três casos de tracoma (prevalência de 0,2%), encontrados apenas no município de Soure (área endêmica). A presença de anticorpos contra o gênero Chlamydia foi avaliada por imunofluorescência indireta (IFI), e os sorotipos foram determinados por microimunofluorescência (MIF). Os casos positivos observados durante a avaliação clínica foram confirmados por testes laboratoriais de imunofluorescência direta (IFD). Para a comparação entre os testes de diagnóstico para C. trachomatis foram utilizadas a imunofluorescência direta (IFD), como padrão-ouro e a qPCR para a detecção simultânea do plasmídio críptico presente no genoma da bactéria e a detecção de rRNA 18S humano, utilizado como controle interno das reações. Foram testadas 62 crianças investigadas com ou sem indicativo clínico de tracoma, 50 de área endêmica (Marajó, Pará) e 12 de área não endêmica (Curitiba, Paraná), coletadas entre o período de 2016 e 2017. Todas as amostras positivas na clínica e na IFD foram detectadas pela qPCR, conferindo uma sensibilidade de 100% nas amostras testadas. Entretanto, algumas amostras são consideradas negativas devido ao baixo número de EB (<5). Estas amostras também foram detectadas pela qPCR. Os resultados do presente estudo mostraram que, em 2008, o tracoma apresentou baixa prevalência em escolares da área urbana do Arquipélago de Marajó; oito anos após a primeira avaliação e a introdução de medidas de controle e prevenção (estratégia SAFE), houve uma redução drástica no número de casos. A necessidade de monitoramento constante e medidas efetivas para a eliminação do tracoma e a detecção de DNA bacteriano na infecção ativa são de fundamental importância, mostrando que a PCR em Tempo Real consegue identificar sinais da presença de C. trachomatis em mais amostras do que as outras técnicas, possibilitando um tratamento precoce

Preliminary evidence that synanthropic flies contribute to the transmission of trachoma-causing Chlamydia trachomatis in Latin America

Synanthropic flies have been shown to be important mechanical vectors of Chlamydia trachomatis, which causes trachoma. However entomological studies have not been forthcoming in Latin America. This study assesses the relationship between household dipteran fly densities and active childhood trachoma in a village on Marajo Island, Para state, Brazil. For 78 households, members were examined for signs of trachoma, relative abundance of potential trachoma vectors (Diptera, Chloropidae and Diptera, Muscidae) was quantified by trap counts, and additional measures of household hygiene associated with C. trachomatis transmission were assessed. Active childhood trachoma prevalence was 24.1% (45/187), present in 46.2% of sampled households with evidence of case clustering. Childhood prevalence was positively associated with increased fly densities, whereas indirect measures of sanitary conditions (latrine ownership and perceived importance of flies) showed a protective effect. This study indicates that C. trachomatis can be transmitted by synanthropic flies in this region of Latin America

Prevalence of trachoma in schoolchildren in Brazil

Brazilian Public Health System (Sistema Único de Saúde – SUS)University of São Paulo. São, SP, Brazil.Ministry of Health. Control Program. Brasília, DF, Brazil.São Paulo State Health Secretariat. Epidemiology Surveillance Center. Sanitary Ophthalmology Center. São, SP, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.University of São Paulo. Public Health School. São Paulo, SP, Brazil.Purpose: Trachoma was hyperendemic in Brazil until the 20th century. The prevalence has declined sharply in the past decades. The aim of this study was to estimate trachoma prevalence in schoolchildren in Brazilian municipalities with a Human Development Index (HDI) below the national mean. Methods: A cluster random sampling survey on trachoma prevalence was carried out. Brazilian municipalities with HDI below the national mean, within each of the 27 states, were stratified into three strata according to population size. In each stratum, schools were systematically selected to comprise a sample of 2400 schoolchildren, totaling 7200 per state. In each selected school, children enrolled from 1st to 4th grade were examined for trachoma. The simplified trachoma grading system was used. At a meeting held in each school, the study was explained to parents, and verbal consent sought. Results: A total of 185,862 children were enrolled in the selected schools. Of these, 171,973 (92.5%) participated in the study. The overall prevalence of trachomatous inflammation – follicular was 5.0% (95% confidence interval 4.7–5.3%), varying from 1.5% to 9.0% among the states. Prevalence was significantly associated with the sampling stratum (being higher in small municipalities), the zone in which the school was located (higher in rural schools), and with age (higher among younger children). Conclusion: Trachoma is still a public health problem in Brazil, although at a low level of endemicity. As the country advances towards the elimination of blinding trachoma, this survey provides a baseline for evaluation of ongoing and future elimination interventions

Prevalence of trachoma in school children in the Marajó Archipelago, Brazilian Amazon, and the impact of the introduction of educational and preventive measures on the disease over eight years.

Trachoma is the leading infectious cause of blindness in the world and is associated with precarious living conditions in developing countries. The aim of the present study was to evaluate the prevalence of trachoma in three municipalities of the Marajó Archipelago, located in the state of Pará, Brazil. In 2008, 2,054 schoolchildren from the public primary school system of the urban area of the region and their communicants were clinically examined; in 2016, 1,502 schoolchildren were examined. The positive cases seen during the clinical evaluation were confirmed by direct immunofluorescence (DIF) laboratory tests. The presence of antibodies against the genus Chlamydia was evaluated by indirect immunofluorescence (IIF), and the serotypes were determined by microimmunofluorescence (MIF). In 2008, the prevalence of trachoma among schoolchildren was 3.4% (69 cases) and it was more frequent in children between six and nine years of age and in females; among the communicants, a prevalence of 16.5% was observed. In 2016, three cases of trachoma were diagnosed (prevalence of 0.2%), found only in the municipality of Soure. The results of the present study showed that in 2008, trachoma had a low prevalence (3.4%) among schoolchildren in the urban area of Marajó Archipelago; eight years after the first evaluation and the introduction of control and prevention measures (SAFE strategy), there was a drastic reduction in the number of cases (0.2%), demonstrating the need for constant monitoring and effective measures for the elimination of trachoma

Genome sequencing of dengue virus serotype 4 in a bat brain sample (Platyrrhinus helleri) from the Brazilian Amazon

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES - grant number 3274/2013) and National Council for Scientific and Technological Development (CNPq - grant number 302584/2015-3). NRF was supported by a Wellcome Trust and Royal Society Sir Henry Dale Fellowship (204311/Z/16/Z) and by a Medical Research Council-São Paulo Research Foundation (FAPESP) CADDE partnership award (MR/S0195/1 and FAPESP 18/14389-0)Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Federal University of Pará. Belém, PA, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Ananindeua, PA, Brasil.University of São Paulo. Faculty of Public Health. São Paulo, SP, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Ananindeua, PA, Brasil.University of Oxford. Department of Zoology. Oxford, UK.Ministério da Saúde. Secretaria de Vigilância em Saúde e Ambiente. Instituto Evandro Chagas. Ananindeua, PA, Brasil.The existence of sylvatic transmission of dengue virus in communities of neotropical bats remains uncertain. In this work we present a near-complete genome of dengue virus serotype 4 obtained from the brain sample of a bat from Platyrrhinus helleri specie collected in the Brazilian Amazon region. The presence of the virus in the brain sample may indicate a possible tropism for the central nervous system in bats, which may justify negative results in previous studies that focused on analysis of other tissues, such as liver and spleen. Besides the duration of dengue virus circulation in the Americas (circa 40 years) may be too short for an implementation of a sylvatic dengue virus cycle. Our findings suggest that continued monitoring is needed to confirm with the neotropical bats could potentially act as a natural reservoir of dengue in the regio

Epidemiology and control of trachoma in the state of Ceará, Northeast Brazil, 2007–2021

Universidade Federal do Ceará. Faculdade de Medicina. Programa de pós-graduação em Saúde Pública. Fortaleza, CE, Brasil / Secretária Municipal de Saúde. Russas, CE, Brasil.Universidade Federal do Ceará. Faculdade de Medicina. Programa de pós-graduação em Saúde Pública. Fortaleza, CE, Brasil / Universidade Federal do Ceará. Faculdade de Medicina. Departamento de Saúde Comunitária. Fortaleza, CE, Brasil.Universidade Federal do Ceará. Faculdade de Medicina. Programa de pós-graduação em Saúde Pública. Fortaleza, CE, Brasil / Secretaria de Estado da Saúde. Fortaleza, CE, Brasil.Universidade Federal do Ceará. Faculdade de Medicina. Programa de pós-graduação em Saúde Pública. Fortaleza, CE, Brasil.Universidade Estadual do Ceará. Mestrado Profissional em Saúde da Criança e do Adolescente. Fortaleza, CE, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Brasília, DF, Brasil.Ministério da Saúde. Secretaria de Ciência, Tecnologia e Insumos Estratégico. Instituto Evandro Chagas. Ananinideua, PA, Brasil.Universidade Federal do Ceará. Instituto de Cultura e Arte. Fortaleza, CE, Brasil.Universidade Federal do Ceará. Departamento de Enfermagem. Fortaleza, CE, Brasil.Universidade Federal do Ceará. Faculdade de Medicina. Programa de pós-graduação em Saúde Pública. Fortaleza, CE, Brasil / Universidade Federal do Ceará. Faculdade de Medicina. Departamento de Saúde Comunitária. Fortaleza, CE, Brasil.Background: To analyze the epidemiology, surveillance, and control strategies for trachoma in the state of Ceará, northeast Brazil, from 2007 to 2021. Methods: This ecological study was based on secondary data from the Information System on Notifiable Diseases of the Secretary of Health of the state of Ceará. Data from school and home surveys for trachoma detection obtained during the study period were analyzed, the percentage of positivity was estimated, and sociodemographic and clinico-epidemiological factors were investigated. Results: The coverage of trachoma surveillance and control actions in Ceará municipalities increased from 12.5% in 2007 to 55.9% in 2019, but with an average restriction of 8.0% during the COVID-19 pandemic. The estimated trachoma positivity (mean overall positivity) was less than 5.0% (2.76%, 95% CI 1.2–5.2), with a higher proportion of cases in the 5–9-year age group (45.0%, 95% CI 44.6–45.4), in females (53.2%, 95% CI 52.8–53.6), and rural areas (52.6%, 95% CI 52.2–53.0). Positivity above 10.0% was observed in the Litoral Leste/Jaguaribe and Sertão Central regions, with a higher occurrence of the follicular inflammatory clinical form (98.1%, 95% CI 98.0–98.2). Conclusions: Trachoma remains in the state of Ceará and is likely underreported. Despite recent advances, the fragility of health surveillance activities compromises the recognition of the actual magnitude and distribution of trachoma in the state. Accurate information is fundamental for planning, monitoring, and evaluating surveillance and disease control

Geographic location of the municipalities of the Marajó Archipelago included in the study in relation to the city of Belém, capital of the state of Pará.

<p>Geographic location of the municipalities of the Marajó Archipelago included in the study in relation to the city of Belém, capital of the state of Pará.</p

Assessment of the Accuracy, Usability and Acceptability of a Rapid Test for the Simultaneous Diagnosis of Syphilis and HIV Infection in a Real-Life Scenario in the Amazon Region, Brazil

We field-assessed the accuracy, acceptability, and feasibility of the SD BIOLINE HIV/Syphilis Duo rapid diagnostic test in three groups: pregnant women, female sex workers (FSW), and men who have sex with men (MSM). Venous blood samples collected in the field were compared with the respective gold standard methods: SD BIOLINE HIV/Syphilis Duo Treponemal Test versus FTA-abs (Wama brand) treponemal laboratory test for syphilis, and SD BIOLINE HIV/Syphilis Duo Test versus the fourth generation Genscreen Ultra HIV Ag-Ag (Bio-Rad brand) laboratory test for HIV. From a total of 529 participants, 397 (75.1%) were pregnant women, 76 (14.3%) FSW and 56 (10.6%) MSM. Sensitivity and specificity parameters of HIV were 100.0% (95% CI: 82.35–100.0%) and 100.0% (95% CI: 99.28–100.0%), respectively. Sensitivity and specificity parameters found for TP antibody detection were 95.00% (95% CI: 87.69–98.62%) and 100.0% (95% CI: 98.18–100.0%), respectively. The SD BIOLINE HIV/Syphilis Duo Test showed high acceptability among participants (85.87%) and health professionals (85.51%), as well as easy usability by professionals (91.06%). The usability of the SD BIOLINE HIV/Syphilis Duo Test kit would not be a barrier to accessing rapid testing, if the product were incorporated into the list of health service supplies