Influence of environmental and sociocultural factors related to the processes of transmission of schistosomiasis mansoni in area of low endemicity in the State of CearÃ

A esquistossomose mansoni apresenta-se como uma doenÃa parasitÃria de importÃncia para a saÃde pÃblica, nÃo sà por sua ampla distribuiÃÃo no mundo, mas tambÃm pelos impactos causados por ela nas atividades da populaÃÃo infectada. A esquistossomose deve ser analisada como um processo dependente da interaÃÃo de vÃrios fatores, como fatores ambientais, sociais e econÃmicos, importantes para reduzir a transmissÃo da doenÃa bem como para interromper o ciclo do parasito. O objetivo do estudo foi avaliar a influÃncia de fatores ambientais e socioculturais na transmissÃo da esquistossomose em Ãrea de baixa endemicidade no Estado do CearÃ, na localidade do Planalto do Cajueiro, atravÃs da anÃlise de questionÃrios aplicados no ano de 2009 e em 2012. O estudo foi desenvolvido em duas etapas. A primeira consiste em um estudo transversal, onde foram analisados 167 questionÃrios dos pacientes que forneceram material sorolÃgico para a realizaÃÃo do mÃtodo ELISA, que serviu como triagem. A segunda etapa consiste em um estudo de caso controle, onde foram aplicados e analisados questionÃrios em 54 indivÃduos ELISA reativo e nÃo reativo que entregaram amostra fecal para anÃlise. As anÃlises dos questionÃrios das 167 pessoas mostraram que a maioria delas eram adultos jovens (19,76% na faixa etÃria de 15 a 25anos e 29,94% entre 26 a 46 anos), do sexo feminino (67,66%) e que 29% nÃo eram naturais de Maranguape. Em torno de 52,5% dos pacientes que afirmaram utilizar Ãgua do rio, tiveram resultado Elisa reativo para esquistossomose. Na segunda etapa, observou-se que a diferenÃa entre os sexos masculinos e femininos era insignificante, nos casos positivos para esquistossomose. Com relaÃÃo à escolaridade, a maioria (68,32%) possuÃa apenas o ensino fundamental incompleto. Nas associaÃÃes entre variÃveis ambientais e resultado positivo para a doenÃa, observou-se que 34,2% dos indivÃduos responderam nÃo ter contato com coleÃÃes hÃdricas e 37,5% disseram que tiveram contato. Este ponto ainda està em anÃlise mais aprofundada. A comunidade do Planalto do Cajueiro em Maranguape-CE mantÃm caracterÃsticas ambientais semelhantes à de comunidades rurais (mesmo sendo peri-urbana) e a transmissÃo da esquistossomose sofre grande influencia dos fatores comportamentais.Schistosomiasis mansoni is presented as a parasitic disease of public health importance, not only for its wide distribution in the world, but also the impacts caused by it in the activities of the infected population. Schistosomiasis should be analyzed as a process dependent on the interaction of various factors, such as environmental, social and economic importance to reduce transmission of the disease and to stop the cycle of the parasite. The aim of the study was to evaluate the influence of environmental and sociocultural factors in the transmission of schistosomiasis in low endemic area in the state of CearÃ, in the locality of the Planalto do Cajueiro- Maranguape-Ce, through the analysis of questionnaires applied in 2009 and 2012. The study was conducted in two stages. The first consists of a cross-sectional study, which analyzed 167 questionnaires from patients who provided material for the realization of the serological ELISA, which served as a screen. The second stage consists of a case-control study where questionnaires were applied and analyzed in 54 individuals ELISA reactive and nonreactive who delivered fecal sample for analysis. The analysis of the questionnaires of 167 people showed that most of them were young adults (19.76% in the age group of 15 to 25years and 29.94% between 26-46 years), female (67.66%) and 29% were not natives of Maranguape. Around 52.5% of patients reported using water from the river, had reactive ELISA result for schistosomiasis. In the second stage, it was observed that the difference between male and female sexes was negligible in cases positive for schistosomiasis. With regard to education, the majority (68.32%) had only elementary education. Associations between environmental variables and positive for the disease, it was observed that 34.2% of subjects reported not to have contact with water collections and 37.5% said they had contact. This point is still under further investigation. The community of Planalto do Cajueiro, Maranguape-Ce maintains environmental characteristics similar to rural communities (even as peri-urban) and schistosomiasis transmission is greatly influences behavioral factors

Fatal outcome of chikungunya virus infection in Brazil

Federal University of Ceará. Fortaleza, CE, Brazil / Central Public Health Laboratory of Ceará State. Fortaleza, CE, Brazil.University of São Paulo. Virology Research Center. Ribeirão Preto, SP, Brazil.Federal University of Ceará. Fortaleza, CE, Brazil.University of Oxford. Department of Zoology. oxford, United Kingdom.University of São Paulo. Virology Research Center. Ribeirão Preto, SP, Brazil.University of Oxford. Department of Zoology. oxford, United Kingdom / Gorgas Memorial Institute of Health Studies. Department of Research in Virology and Biotechnology. Panama City, Panama.Central Public Health Laboratory of Ceará State. Fortaleza, CE, Brazil.Central Public Health Laboratory of Ceará State. Fortaleza, CE, Brazil / Centro Universitário Christus. Faculdade de Medicina. Fortaleza, CE, Brazil.Central Public Health Laboratory of Ceará State. Fortaleza, CE, Brazil.Federal University of Ceará. Fortaleza, CE, Brazil.State Health Secretariat of Ceará. Death Verification Service Dr Rocha Furtado. Fortaleza, CE, Brazil.Federal University of Ceará. Fortaleza, CE, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Federal University of Ceará. Fortaleza, CE, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Centro Universitário Christus. Faculdade de Medicina. Fortaleza, CE, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Centro Universitário Christus. Faculdade de Medicina. Fortaleza, CE, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Centro Universitário Christus. Faculdade de Medicina. Fortaleza, CE, Brazil.Centro Universitário Christus. Faculdade de Medicina. Fortaleza, CE, Brazil.Centro Universitário Christus. Faculdade de Medicina. Fortaleza, CE, Brazil.Federal University of Ceará. Fortaleza, CE, Brazil.Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brazil.Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brazil / Ministry of Health. Brasilia, DF, Brazil.Ministry of Health. Brasilia, DF, Brazil.Ministry of Health. Brasilia, DF, Brazil.Ministry of Health. Brasilia, DF, Brazil.Faculdade de Medicina São Leopoldo Mandic. Campinas, SP, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.University of Oxford. Department of Zoology. Oxford, United Kingdom.University of São Paulo. Virology Research Center. Ribeirão Preto, SP, Brazil.University of Oxford. Department of Zoology. Oxford, United Kingdom / Imperial College London. Department of Infectious Disease Epidemiology. London, United Kingdom.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Federal University of Ceará. Fortaleza, CE, Brazil.Federal University of Ceará. Fortaleza, CE, Brazil / Oswaldo Cruz Foundation - Branch Ceará. Fortaleza, CE, Brazil.BACKGROUND: Chikungunya virus (CHIKV) emerged in the Americas in 2013 and has caused approximately 2.1 million cases and >600 deaths. A retrospective investigation was undertaken to describe clinical, epidemiological, and viral genomic features associated with deaths caused by CHIKV in Ceará state, northeast Brazil. METHODS: Sera, cerebrospinal fluid (CSF), and tissue samples from 100 fatal cases with suspected arbovirus infection were tested for CHIKV, dengue virus (DENV), and Zika virus (ZIKV). Clinical, epidemiological, and death reports were obtained for patients with confirmed CHIKV infection. Logistic regression analysis was undertaken to identify independent factors associated with risk of death during CHIKV infection. Phylogenetic analysis was conducted using whole genomes from a subset of cases. RESULTS: Sixty-eight fatal cases had CHIKV infection confirmed by reverse-transcription quantitative polymerase chain reaction (52.9%), viral antigen (41.1%), and/or specific immunoglobulin M (63.2%). Co-detection of CHIKV with DENV was found in 22% of fatal cases, ZIKV in 2.9%, and DENV and ZIKV in 1.5%. A total of 39 CHIKV deaths presented with neurological signs and symptoms, and CHIKV-RNA was found in the CSF of 92.3% of these patients. Fatal outcomes were associated with irreversible multiple organ dysfunction syndrome. Patients with diabetes appear to die at a higher frequency during the subacute phase. Genetic analysis showed circulation of 2 CHIKV East-Central-South African (ECSA) lineages in Ceará and revealed no unique virus genomic mutation associated with fatal outcome. CONCLUSIONS: The investigation of the largest cross-sectional cohort of CHIKV deaths to date reveals that CHIKV-ECSA strains can cause death in individuals from both risk and nonrisk groups, including young adults. © The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America