Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Eficácia e segurança de uma vacina oral de rotavírus humano atenuado contra gastroenterite grave por rotavírus, durante os primeiros dois anos de vida em crianças em Belém, Pará, Brasil

Rotaviruses are recognised as the leading cause of severe gastroenteritis in children aged less than five years in both developed and developing countries, with highest incidence rates between 6 and 24 months of life. On a global scale, recent estimates indicate that annually rotaviruses cause at least 500,000 deaths. A large phase III clinical trial was undertaken in 11 Latin American countries and Finland with an attenuated, human-derived vaccine strain, including recruitment of more than 63,000 children. This was a randomised, double-blind, placebo-controlled trial in which more than 63,000 infants were randomly assigned to receive two oral doses of either RIX4414 or placebo at a proportion of 1:1. The main purposed of this study was to evaluate both protective efficacy and safety of RIX4414. As part of the original study, 3,218 children were enrolled in Belém, Pará, to whom two doses of either vaccine or placebo were administered at 2 and 4 months of age. A subset of infants (n = 653) was evaluated throughout 1 – 2 years in order to assess efficacy of RIX4414 vaccine. Overall, 37 gastroenteritis episodes of severe rotavirus gastroenteritis were recorded of which 75.6% (28/37) and 24% (9/37) in the placebo and vaccine recipients, respectively. The level of rotavirus vaccine protection was higher [83% (CI95% 22 – 96)] against very severe rotavirus gastroenteritis, yielding a ≥ 15 score as calculated with a 20-point Ruuska & Vesikari scale. The cumulative hazard of a first episode of severe gastroenteritis was about four-fold lower in the vaccine group throughout the 2-years’ efficacy period, as compared to the placebo group. The protection rates against severe gastroenteritis caused by G1- and- non-G1 serotypes were 51% (CI95% -30-81) and 82% (CI95% 37-95), respectively, denoting efficacies against rotavirus strains both homologous and heterologous to the vaccine strain. Of importance, the vaccine afforded significant protection [93% (CI95%47-99)] against G9 serotype which has been regarded as a globally emergent strain, besides of being related to more severe gastroenteritis. Also reflecting a vaccine efficacy, there was a significant reduction, by 35.3% (CI95% 11.6-52.9), in the rate of allcause hospitalisation for gastroenteritis, a finding of potential major public health impact. With regards to safety of RIX4414 vaccine, there were no overall statistically significant differences when the rates of serious adverse events were compared for vaccine group and placebo group. No cases of intussusception were reported during the entire follow-up period, through broad and active surveillance in paediatric clinics in the study area. Results obtained in this study confirm previous findings from worldwide several multi-centric trials that sustain both protective efficacy and safety of RIX4414 when administered in a 2-dose schema to healthy infants.Os rotavírus se constituem nos principais agentes causadores de gastroenterite grave entre crianças com idades inferiores a 5 anos, tanto nos países desenvolvidos quanto naqueles em desenvolvimento, com pico de incidência entre 6 e 24 meses de vida. Em termos globais, estima-se que pelo menos 500.000 óbitos por ano se associem a esse enteropatógeno. Um extenso ensaio clínico de fase 111, randomizado na proporção de 1 :1, controlado por placebo e duplo-cego, envolvendo 11 países da América Latina e a Finlândia se levou a efeito objetivando-se avaliar a eficácia e segurança de uma vacina atenuada, de origem humana, contra rotavírus, denominada RIX4414. Na totalidade, recrutaram-se mais de 63.000 crianças. Em Belém, Pará, tais estudos envolveram 3.218 indivíduos aos quais se administraram duas doses de vacina ou placebo, no segundo e quarto meses de idade. Desse total avaliou-se um subgrupo de 653 crianças quanto à eficácia da vacina, com acompanhamento ao longo de 1 a 2 anos, quando se registraram 37 episódios de GE grave por rotavírus, 75,6% (28/37) dos quais no grupo placebo e 24,3% (9/37) entre os vacinados, daí se inferindo eficácia da vacina de 68,8% (IC95% 32.0-87,0) nos primeiros dois anos de vida. No que se refere à intensidade desses episódios, notou-se maior eficácia contra os classificados como muito graves (escore de Ruuska & Vesikari ≥ 15), alcançando níveis de 83% (IC95% 22-96). No grupo placebo observou-se risco cumulativo, quanto ao desenvolvimento de gastroenterite grave por rotavírus, 4 vezes superior em relação ao vacinado. Quanto aos sorotipos de rotavírus G1 e não-G1, evidenciou-se proteção de 51 % (IC95% -30 - 81) e 82% (IC95% 37-95), respectivamente, denotando-se proteção tanto homotípica quanto heterotípica. De particular relevância se constituiu a proteção frente ao G9 [93% (IC95% 47-99)], dado o caráter emergente global desse sorotipo, além do seu potencial quanto a desencadear quadros diarréicos rotineiramente mais graves. A eficácia da vacina contra episódios de GE de qualquer etiologia alcançou 35,3% (IC95% 11,6-52,9), do que se depreende o expressivo impacto em potencial da vacinação contra rotavírus em termos de saúde pública. No que se refere à segurança desse imunizante, não se observaram diferenças significativas do ponto de vista estatístico, entre os grupos vacina e placebo, no que concerne à ocorrência de eventos adversos graves. Não se registrou qualquer caso de intussuscepção entre os sujeitos participantes, mercê de extensiva vigilância ativa nos hospitais de referência. Os resultados encontrados nesse estudo corroboram os já descritos em ensaios multicêntricos como um todo, em vários continentes, consolidando os indicadores quanto à eficácia e segurança da vacina RIX4414 quando administrada em duas doses a crianças saudáveis

Efetividade da vacina oral contra rotavírus humano espécie A e monitoramento das amostras v irais circulantes em Belém, Pará, Brasil

Made available in DSpace on 2018-08-06T13:16:37Z (GMT). No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) maria_justino_ipec_dout_2013.pdf: 1767334 bytes, checksum: 6b2aeebe51aaf2fb58ebeebba0f5b1b3 (MD5) Previous issue date: 2013Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Globalmente, os rotavírus da espécie A (RVA) são a principal causa de doença diarreica aguda grave em crianças abaixo de cinco anos de idade, sendo responsáveis por mais de um terço de todas as hospitalizações por diarreia e 453.000 óbitos a cada ano, principalmente nos países em desenvolvimento. Ensaios clínicos multicêntricos envolvendo aproximadamente 100.000 crianças na América Latina, Europa, África e Ásia demonstraram a segurança e a eficácia da vacina monovalente contra RVA de origem humana (Rotarix ® , GlaxoSmithKline, Bélgica), em prevenir gastroenterite grave causada por esse agente viral em crianças. No Brasil essa vacina foi introduzida no Programa Naci onal de Imunizações em 6 de março de 2006, sob a denominação de Vacina Oral contra Rotavírus Humano (VORH). Realizou-se estudo caso-controle de base hospitalar que avaliou a efetividade da vacina através da vigilância diária das hospitalizações por gastroenterite ocorridas entre crianças nascidas após seis de março de 2006, em quatro clínicas selecionadas em Belém, Pará. Consentimento por escrito foi obtido dos pais/responsável legal pela criança antes de sua inclusão no estudo. Após a hospitalização, amostras de fezes dessas crianças foram coletadas e enviadas à Seção de Virologia do Instituto Evandro Chagas para detecção dos RVA por ensaio imunoenzimático (ELISA). As amostras positivas foram posteriormente genotipadas por reação em cadeia da polimerase precedida de transcrição reversa (RT-PCR). No primeiro ano (2008-2009), 538 crianças foram incluídas no estudo como casos (gastroenterite grave por RVA) e pareadas, de acordo com a idade, a 507 controles hospitalares e 346 domiciliares; estes, sem quaisquer sintomas de gastroenterite. Haviam recebido esquema vacinal completo quanto a VORH (duas doses) 54%, 61% e 74% dos casos, controles hospitalares e domiciliares, respectivamente Ressaltem-se as taxa s de cobertura vacinal de 81,18% e 84,38% em 2008 e 2009, respectivamente. A efetividade da vacina foi de 75,8% (IC95%: 58,1-86,0) utilizando-se controles domiciliares e 4 0,0% (IC95%: 14,2-58,1) frente aos hospitalares. Entre crianças de 3-11 meses e maiore s de 12 meses de idade as taxas de efetividade alcançaram 95,7% (IC95%: 67,8-99,4) e 6 5,1% (IC95%: 37,2-80,6), respectivamente, usando controles domiciliares. Menor efetividade foi observada ao utilizar controles hospitalares, sendo de 55,6% (IC95%: 12,3 -77,5) nos grupos etários de 3-11 meses. Houve diferença estatisticamente significativa na duração dos sintomas de febre, diarreia, vômitos, alteração do estado geral e tempo de hospi talização entre os pacientes que receberam esquema completo com a VORH (duas doses) em relação àqueles que receberam somente uma dose e os que não foram imunizados. Foi realiza do o monitoramento dos genótipos circulantes de RVA através de vigilância dos casos de gastroenterite por um período de três anos (2008 a 2011). No primeiro ano, o genótipo G2P [4] predominou representando 82,0% das hospitalizações, e a efetividade vacinal especí fica frente a este genótipo alcançou 75,4% (IC95%: 56,7-86,0) usando controles domiciliares e 38,9% (IC95%: 11,1-58,0) entre controles hospitalares Nos anos seguintes observou-se predomínio do genótipo G1P[8] e dos padrões mistos no que se refere à especificidade G ou P. Os resultados obtidos nesse estudo demonstraram a boa efetividade da vacina VORH frent e aos casos graves de gastroenterite causada por RVA em condições reais na população est udada, inclusive contra genótipo distinto daquele contido na composição da vacina. A lém disso, permitiu o monitoramento da circulação de amostras virais no período de três anos consecutivos em Belém, Pará, demonstrando variação nos genótipos circulantes ao longo do estudo; o que corrobora a hipótese de flutuação natural das amostras circulantes ao longo do tempoWorldwide especies A rotavirus (RVA) remains the most important cause of acute, severe diarrheal disease among children aged less than five years, accounting for over one-third of diarrhea-related hospitalizations and 453,000 deaths annually. Multi-centric clinical trials involving around 100,000 children in Latin America, Europe, Africa, and Asia have demonstrated the safety and efficacy of the monovalent vaccine with an attenuated human species A G1P[8] RVA strain (RotarixTM, GlaxoSmithKline, Rixensart, Belgium). Efficacy was particularly significant against severe childhood gastroenteritis. This vaccine was introduced into the Brazilian National Immunization Program on March 6, 2006, thereafter being nationally named \201CVacina oral contra Rotavirus Humano\201D (\201CVORH\201D). A hospitalbased, case-control study was conducted in four pediatric clinics located in Belém, Pará, with the main objective of assessing the effectiveness of RotarixTM. This study involved children born after 6 March 2006, and included daily surveillance for gastroenteritis-related hospitalizations in the study area. Written informed consent was obtained from the parents or legal guardians of children before enrolment. Fecal samples were obtained following hospitalization and transported to the Virology Section of \201CInstituto Evandro Chagas\201D for detection of RVA by enzyme-linked immunosorbent assay (ELISA). Rotavirus-positive samples were subsequently genotyped using the reverse-transcription, polymerase chain reaction (RT-PCR). During the first year of the study (2008-2009), 538 children were included as cases, that is, laboratory-confirmed rotavirus-related gastroenteritis, and paired with age-matched hospital-controls (n=507) and neighborhood controls (n=346) without any gastroenteritis symptoms. A full RVA vaccination course (2 doses) was provided to 54%, 61% and 74% of cases, hospital controls and neighborhood controls, respectively Official rotavirus vaccine coverage rates for the region were reported to be 81.18% and 84.38% in 2008 and 2009, respectively. Vaccine effectiveness rates of 75.8% (95%CI: 58.1-86.0) and 40% (95%CI 14.2-58.1) were achieved using neighborhood and hospital controls, respectively. Using neighborhood controls, vaccine effectiveness rates were 95.7% (95%CI: 67.8-99.4) and 65.1% (95%CI: 37.2-80.6) among children aged 3-11 months and >12 months, respectively. Lower vaccine effectiveness was achieved when using hospital controls: 55.6% (95%CI: 12.3-77.5). There was a statistically significant difference in duration of symptoms of fever, diarrhea, vomiting, days of behaviour change and hospitalization among patients who received full series vaccination compared to those who received only one dose and those who were not immunized. Monitoring of circulating rotavirus strains was conducted concurrently with the case-control study and extended up to 2011. During the first year of surveillance G2P[4] strains were predominant, accounting for 82.0% of circulating strains among hospitalized children. Vaccine effectiveness against gastroenteritis caused by this genotype yielded 75.4% (95%CI: 56.7-86.0) and 38.9% (95%CI: 11.1-58.0) as based on analyses using neighborhood and hospital controls, respectively. In the following two years there was a trend for increasing prevalence of G1P[8] strains, and a significant proportion of species A rotaviruses bearing mixed G- and P-genotype specificities. In conclusion, this study showed a good vaccine efficacy of \201CVORH\201D, \201Cunder real conditions\201D, against severe rotavirus gastroenteritis in children in Belém, Brazil, including a significant heterotypic protection against G2P[4] strains which are fully distinct from the vaccine composition. The long-term monitoring of circulating rotavirus strains showed a variation of genotypes during the study; this strongly suggests a natural fluctuation of strains over tim

Reoviruses: Rotaviruses

Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Rotaviruses still remain a leading cause of severe gastroenteritis in children aged 90% of rotavirus-related deaths occur in the latter regions. Longitudinal studies have shown that multiple rotavirus infections occur throughout life, and that 100% protection is yielded after two natural rotavirus infections. Rotaviruses infect primarily the enterocytes on the absorptive intestinal villi of the small intestine, and four mechanisms appear to be involved in the rotavirus diarrhea induction, including malabsorption, villus ischemia, NSP4-induced secretory diarrhea, and activation of the enteric nervous system. Rotaviruses may spread beyond the gastrointestinal tract, eventually leading to viremia and the appearance of unusual extraintestinal manifestations. The immune correlates of protection against rotavirus reinfection and recovery remain poorly understood, even though the levels of serum rotavirus-specific IgA appear to be the best marker of protection against rotavirus disease. The mainstay of treatment of acute rotaviral gastroenteritis relies on the use of oral rehydration and early introduction of feeding. Currently, there are four rotavirus vaccines available for global use, and to date, almost 100 countries have introduced rotavirus vaccines, and substantial declines in hospitalizations and deaths due to rotavirus gastroenteritis and all-cause diarrhea have been observed across high-, middle-, and low-income countries

Rotavirus vaccination in Brazil: effectiveness and health impact seven years post-introduction

Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Before vaccine introduction in Brazil, rotavirus caused approximately 650,000 outpatient visits, 92,000 hospitalizations and 850 deaths annually among children aged 5 years. Brazil was one of the first countries to introduce rotavirus vaccination into the National Immunisation Program (NIP), in 2006, but estimated coverage (87.1 percent) for 2011 remained lower if compared with other routine immunizations (95 percent). Case-control studies reached effectiveness rates as high as 85 percent. Observational studies showed a significant reduction in gastroenteritis-related hospitalizations and deaths among children aged 1 year, at rates as high as 48 and 54 percent, respectively. There was a significant increase in the relative prevalence of G2P[4] genotype after vaccine introduction, reaching 100 percent of strains in some settings. A small increase in intussusception incidence was seen within 1 week following the second vaccine dose, but benefits far outweigh any potential risk. This article provides an in-depth review of postlicensure studies conducted in Brazil 7-year postintroduction

Vacunas anti-Rotavirus: el gran impacto en la salud pública seis años después de licenciadas

Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil

Vacinação contra rotavírus: achados recentes, impacto em saúde pública, perspectivas e desafios uma década depois

Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil

Rotaviruses

Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas, Belém, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas, Belém, PA, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas, Belém, PA, Brasil