Do climate changes alter the distribution and transmission of malaria? Evidence assessment and recommendations for future studies

Malaria, a mosquito-borne infectious disease, is considered a significant global health burden. Climate changes or different weather conditions may impact infectious diseases, specifically those transmitted by insect vectors and contaminated water. Based on the current predictions for climate change associated with the increase in carbon dioxide concentrations in the atmosphere and the increase in atmospheric temperature, the Intergovernmental Panel on Climate Change predicts that in 2050, malaria may threaten some previously unexposed areas worldwide and cause a 50% higher probability of malaria cases. Climatebased distribution models of malaria depict an increase in the geographic distribution of the disease as global environmental temperatures and conditions worsen. Researchers have studied the influence of changes in climate on the prevalence of malaria using different mathematical models that consider different variables and predict the conditions for malaria distribution. In this context, we conducted a mini-review to elucidate the important aspects described in the literature on the influence of climate change in the distribution and transmission of malaria. It is important to develop possible risk management strategies and enhance the surveillance system enhanced even in currently malaria-free areas predicted to experience malaria in the future. © 2019, Sociedade Brasileira de Medicina Tropical. All rights reserved

Delayed healthcare and secondary infections following freshwater stingray injuries: Risk factors for a poorly understood health issue in the Amazon

Introduction: This study aimed to describe the profile of freshwater stingray injuries in the State of Amazonas, Brazilian Amazon, and to identify the associated risk factors for secondary infections. Methods: This cross-sectional study used surveillance data from 2007 to 2014 to identify factors associated with secondary infections from stingray injuries. Results: A total of 476 freshwater stingray injuries were recorded, with an incidence rate of 1.7 cases/100,000 person/year. The majority of injuries were reported from rural areas (73.8%) and 26.1% were related to work activities. A total of 74.5% of patients received medical assistance within the first 3 hours of injury. Secondary infections and necrosis were observed in 8.9% and 3.8%, respectively. Work-related injuries [odds ratio (OR) 4.1, confidence interval (CI); 1.87-9.13] and >24 hours from a sting until receiving medical care (OR; 15.5, CI; 6.77-35.40) were independently associated with the risk of secondary bacterial infection. Conclusions: In this study, work-related injuries and >24 hours from being stung until receiving medical care were independently and significantly associated with the risk of secondary infection. The frequency of infection following sting injuries was 9%. The major factor associated with the risk of secondary bacterial infection was a time period of >24 hours from being stung until receiving medical care. © 2018, Sociedade Brasileira de Medicina Tropical. All rights reserved

G6PD deficiency in Latin America: systematic review on prevalence and variants

Plasmodium vivax radical cure requires the use of primaquine (PQ), a drug that induces haemolysis in glucose-6-phosphate dehydrogenase deficient (G6PDd) individuals, which further hampers malaria control efforts. The aim of this work was to study the G6PDd prevalence and variants in Latin America (LA) and the Caribbean region. A systematic search of the published literature was undertaken in August 2013. Bibliographies of manuscripts were also searched and additional references were identified. Low prevalence rates of G6PDd were documented in Argentina, Bolivia, Mexico, Peru and Uruguay, but studies from Curaçao, Ecuador, Jamaica, Saint Lucia, Suriname and Trinidad, as well as some surveys carried out in areas of Brazil, Colombia and Cuba, have shown a high prevalence (> 10%) of G6PDd. The G6PD A-202A mutation was the variant most broadly distributed across LA and was identified in 81.1% of the deficient individuals surveyed. G6PDd is a frequent phenomenon in LA, although certain Amerindian populations may not be affected, suggesting that PQ could be safely used in these specific populations. Population-wide use of PQ as part of malaria elimination strategies in LA cannot be supported unless a rapid, accurate and field-deployable G6PDd diagnostic test is made available

Severity of Scorpion Stings in the Western Brazilian Amazon: A Case-Control Study.

Scorpion stings are a major public health problem in Brazil, with an increasing number of registered cases every year. Affecting mostly vulnerable populations, the phenomenon is not well described and is considered a neglected disease. In Brazil, the use of anti-venom formulations is provided free of charge. The associate scorpion sting case is subject to compulsory reporting. This paper describes the epidemiology and identifies factors associated with severity of scorpions stings in the state of Amazonas, in the Western Brazilian Amazon.This study included all cases of scorpion stings in the state of Amazonas reported to the Brazilian Diseases Surveillance System from January 1, 2007 to December 31, 2014. A case-control study was conducted to identify factors associated with scorpions sting severity. A total of 2,120 cases were reported during this period. The mean incidence rate in the Amazonas was 7.6 per 100,000 inhabitants/year. Scorpion stings showed a large spatial distribution in the state and represent a potential occupational health problem for rural populations. There was a positive correlation between the absolute number of cases and the altimetric river levels in the Central (p<0.001; Rs = 0.479 linear) and Southwest (p = 0.032; linear Rs = 0.261) regions of the state. Cases were mostly classified as mild (68.6%), followed by moderate (26.8%), and severe (4.6%). The overall lethality rate was 0.3%. Lethality rate among children ≤10 years was 1.3%. Age <10 years [OR = 2.58 (95%CI = 1.47-4.55; p = 0.001)], stings occurring in the rural area [OR = 1.97 (95%CI = 1.18-3.29; p = 0.033) and in the South region of the state [OR = 1.85 (95%CI = 1.17-2.93; p = 0.008)] were independently associated with the risk of developing severity.Scorpion stings show an extensive distribution in the Western Brazilian Amazon threatening especially rural populations, children ≤10 in particular. Thus, the mapping of scorpions fauna in different Amazon localities is essential and must be accompanied by the characterization of the main biological activities of the venoms. Urban and farming planning, in parallel with awareness of workers at risk for scorpion stings on the need for personal protective equipment use should be considered as public policies for preventing scorpionism

Factors Associated with Systemic Bleeding in Bothrops Envenomation in a Tertiary Hospital in the Brazilian Amazon

Bothrops snakebites usually present systemic bleeding, and the clinical&ndash;epidemiological and laboratorial factors associated with the development of this manifestation are not well established. In this study, we assessed the prevalence of Bothrops snakebites with systemic bleeding reported at the Funda&ccedil;&atilde;o de Medicina Tropical Dr. Heitor Vieira Dourado, in Manaus, Amazonas State, Brazil, and the clinical&ndash;epidemiological and laboratorial factors associated with systemic bleeding. This is an observational, cross-sectional study carried out between August, 2013 and July, 2016. Patients who developed systemic bleeding on admission or during hospitalization were considered cases, and those with non-systemic bleeding were included in the control group. Systemic bleeding was observed in 63 (15.3%) of the 442 Bothrops snakebites evaluated. Bothrops snakebites mostly occurred in males (78.2%), in rural areas (89.0%) and in the age group of 11 to 30 years old (40.4%). It took most of the patients (59.8%) less than 3 h to receive medical assistance. Unclottable blood (AOR = 3.11 (95% CI = 1.53 to 6.31; p = 0.002)) and thrombocytopenia (AOR = 4.52 (95% CI = 2.03 to 10.09; p &lt; 0.001)) on admission were independently associated with systemic bleeding during hospitalization. These hemostatic disorders on admission increase the chances of systemic bleeding during hospitalization. Prospective studies are needed to clarify the pathophysiology of systemic bleeding in Bothrops snakebites in the Amazon region

Real-life quantitative G6PD screening in Plasmodium vivax patients in the Brazilian Amazon : a cost-effectiveness analysis

Background As quantitative glucose 6-phosphate dehydrogenase deficiency (G6PDd) screening tools are evaluated in operational studies, questions remain as to whether they are cost-effective. Here, a cost-effectiveness analysis (CEA) was performed to estimate the Incremental Cost-effectiveness Ratio (ICER) of the introduction of quantitative screening test to detect G6PDd among P. vivax carriers in two municipalities in the Brazilian Amazon. Methodology/Principal findings This cost-effectiveness analysis evaluated the use of the Standard G6PD quantitative screening test in vivax malaria treatment units in two municipalities of the Brazilian Amazon. Using the perspective of the Brazilian public health system, the analysis was performed for the outcome ‘PQ-associated hospitalization avoided’, based on a decision tree model. The results indicated that the G6PDd screening strategy compared with the routine strategy was highly cost-effective, with an ICER of US$495 per additional hospitalization avoided, which represented less than 8$6,822). The uncertainties evaluated in the sensitivity analysis did not significantly affect the ICER identified in the base-case. Conclusions/Significance This cost-effectiveness analysis showed the quantitative G6PD testing was effective in avoiding PQ-associated hospitalizations. The incorporation of G6PD screening is of paramount importance towards P. vivax malaria elimination in the Amazon to promote the safe use of primaquine and tafenoquine.Faculdade de Medicina (FMD

Older age and time to medical assistance are associated with severity and mortality of snakebites in the Brazilian Amazon: a case-control study

Submitted by Janaína Nascimento ([email protected]) on 2019-02-15T11:17:05Z No. of bitstreams: 1 ve_Feitosa_Esaú_etal_INI_2015.pdf: 1624394 bytes, checksum: df5b13cfa36f35b77b0def5f96203d08 (MD5)Approved for entry into archive by Janaína Nascimento ([email protected]) on 2019-02-15T13:12:37Z (GMT) No. of bitstreams: 1 ve_Feitosa_Esaú_etal_INI_2015.pdf: 1624394 bytes, checksum: df5b13cfa36f35b77b0def5f96203d08 (MD5)Made available in DSpace on 2019-02-15T13:12:37Z (GMT). No. of bitstreams: 1 ve_Feitosa_Esaú_etal_INI_2015.pdf: 1624394 bytes, checksum: df5b13cfa36f35b77b0def5f96203d08 (MD5) Previous issue date: 2015Fundação de Medicina Tropical Doutor Heitor Vieira Dourado. Departamento de Ensino e Pesquisa. Manaus, AM, Brasil / Universidade do Estado do Amazonas. Escola Superior de Ciências da Saúde. Manaus, AM, Brasil.Fundação de Medicina Tropical Doutor Heitor Vieira Dourado. Departamento de Ensino e Pesquisa. Manaus, AM, Brasil / Universidade do Estado do Amazonas. Escola Superior de Ciências da Saúde. Manaus, AM, Brasil / Fundação de Vigilância em Saúde do Amazonas. Núcleo de Sistemas de Informação. Manaus, AM, Brasil.Emory University. Department of Medicine. Atlanta, GA, USA.Fundação de Medicina Tropical Doutor Heitor Vieira Dourado. Departamento de Ensino e Pesquisa. Manaus, AM, Brasil / Universidade do Estado do Amazonas. Escola Superior de Ciências da Saúde. Manaus, AM, Brasil.Fundação de Medicina Tropical Doutor Heitor Vieira Dourado. Departamento de Ensino e Pesquisa. Manaus, AM, Brasil / Universidade do Estado do Amazonas. Escola Superior de Ciências da Saúde. Manaus, AM, Brasil.Fundação de Medicina Tropical Doutor Heitor Vieira Dourado. Departamento de Ensino e Pesquisa. Manaus, AM, Brasil / Universidade do Estado do Amazonas. Escola Superior de Ciências da Saúde. Manaus, AM, Brasil.Fundação de Medicina Tropical Doutor Heitor Vieira Dourado. Departamento de Ensino e Pesquisa. Manaus, AM, Brasil / Universidade do Estado do Amazonas. Escola Superior de Ciências da Saúde. Manaus, AM, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.Fundação de Medicina Tropical Doutor Heitor Vieira Dourado. Departamento de Ensino e Pesquisa. Manaus, AM, Brasil / Universidade do Estado do Amazonas. Escola Superior de Ciências da Saúde. Manaus, AM, Brasil.Universidade Federal do Amazonas. Instituto de Ciências Biológica. Manaus, AM, Brasil.Fundação de Medicina Tropical Doutor Heitor Vieira Dourado. Departamento de Ensino e Pesquisa. Manaus, AM, Brasil / Universidade do Estado do Amazonas. Escola Superior de Ciências da Saúde. Manaus, AM, Brasil / Fundação Oswaldo Cruz. Instituto Leônidas e Maria Deane. Manaus, AM, Brasil.Fundação de Medicina Tropical Doutor Heitor Vieira Dourado. Departamento de Ensino e Pesquisa. Manaus, AM, Brasil / Universidade do Estado do Amazonas. Escola Superior de Ciências da Saúde. Manaus, AM, Brasil.The Amazon region reports the highest incidence of snakebite envenomings in Brazil. We aimed to describe the epidemiology of snakebites in the state of Amazonas and to investigate factors associated with disease severity and lethality. We used a nested case-control study, in order to identify factors associated with snakebite severity and mortality using official Brazilian reporting systems, from 2007 to 2012. Patients evolving to severity or death were considered cases and those with non-severe bites were included in the control group. During the study period, 9,191 snakebites were recorded, resulting in an incidence rate of 52.8 cases per 100,000 person/years. Snakebites mostly occurred in males (79.0%) and in rural areas (70.2%). The most affected age group was between 16 and 45 years old (54.6%). Fifty five percent of the snakebites were related to work activities. Age ≤15 years [OR=1.26 (95% CI=1.03-1.52); (p=0.018)], age ≥65 years [OR=1.53 (95% CI=1.09-2.13); (p=0.012)], work related bites [OR=1.39 (95% CI=1.17-1.63); (p6 hours [OR=1.73 (95% CI=1.45-2.07); (p6 hours [OR=2.01 (95% CI=1.15-3.50); (p=0.013)] were independently associated with the risk of death. Snakebites represent an occupational health problem for rural populations in the Brazilian Amazon with a wide distribution. These results highlight the need for public health strategies aiming to reduce occupational injuries. Most cases of severe disease occurred in the extremes of age, in those with delays in medical attention and those caused by Micrurus bites. These features of victims of snakebite demand adequate management according to well-defined protocols, including prompt referral to tertiary centres when necessary, as well as an effective response from surveillance systems and policy makers for these vulnerable groups

Characteristics of the 2,120 scorpion stings reported in the State of Amazonas, 2007 to 2014.

<p>Characteristics of the 2,120 scorpion stings reported in the State of Amazonas, 2007 to 2014.</p