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Effectiveness of the CoronaVac vaccine in older adults during a gamma variant associated epidemic of covid-19 in Brazil: test negative case-control study
No full textCorrections: In this paper by Ranzani and colleagues (BMJ 2021;374:n2015, doi:10.1136/bmj.n2015, published 20 August 2021), author Edlaine Faria de Moura Villela should have been shown affiliated with address 5 [not 6], the Disease Control Coordination of the São Paulo State Department of Health, São Paulo, Brazil.OBJECTIVE: To estimate the effectiveness of the inactivated whole virus vaccine, CoronaVac (Sinovac Biotech), against symptomatic covid-19 in the elderly population of São Paulo state, Brazil during widespread circulation of the gamma variant. DESIGN: Test negative case-control study. SETTING: Community testing for covid-19 in São Paulo state, Brazil. PARTICIPANTS: 43774 adults aged ≥70 years who were residents of São Paulo state and underwent reverse transcription polymerase chain reaction (RT-PCR) testing for SARSCoV-2 from 17 January to 29 April 2021. 26433 cases with symptomatic covid-19 and 17622 test negative controls with covid-19 symptoms were formed into 13283 matched sets, one case with to up to five controls, according to age, sex, self-reported race, municipality of residence, previous covid-19 status, and date of RT-PCR test (±3 days). INTERVENTION: Vaccination with a two dose regimen of CoronaVac. MAIN OUTCOME MEASURES: RT-PCR confirmed symptomatic covid-19 and associated hospital admissions and deaths. RESULTS: Adjusted vaccine effectiveness against symptomatic covid-19 was 24.7% (95% confidence interval 14.7% to 33.4%) at 0-13 days and 46.8% (38.7% to 53.8%) at ≥14 days after the second dose. Adjusted vaccine effectiveness against hospital admissions was 55.5% (46.5% to 62.9%) and against deaths was 61.2% (48.9% to 70.5%) at ≥14 days after the second dose. Vaccine effectiveness ≥14 days after the second dose was highest for the youngest age group (70-74 years)—59.0% (43.7% to 70.2%) against symptomatic disease, 77.6% (62.5% to 86.7%) against hospital admissions, and 83.9% (59.2% to 93.7%) against deaths—and declined with increasing age. CONCLUSIONS: Vaccination with CoronaVac was associated with a reduction in symptomatic covid-19, hospital admissions, and deaths in adults aged ≥70 years in a setting with extensive transmission of the gamma variant. Vaccine protection was, however, low until completion of the two dose regimen, and vaccine effectiveness was observe to decline with increasing age among this elderly population
Informativo nr. 149
No full textBoletim informativo desenvolvido pelo Nethis/Fiocruz Brasília com os principais eventos e notícias. Edição publicada no dia 28/07/2021
Improved Performance of ELISA and Immunochromatographic Tests Using a New Chimeric A2-Based Protein for Human Visceral Leishmaniasis Diagnosis
No full textMethods: A total of 1028 sera samples were used for the development and validation of ELISA (321 samples from L. infantum-infected patients, 62 samples from VL/AIDS coinfected patients, 236 samples from patients infected with other diseases, and 409 samples from healthy donors). A total of 520 sera samples were used to develop and validate ICT (249 samples from L. infantum-infected patients, 46 samples from VL/AIDS coinfected patients, 40 samples from patients infected with other diseases, and 185 samples from healthy donors). Findings. Using the validation sera panels, DTL-4-based ELISA displayed an overall sensitivity of 94.61% (95% CI: 89.94-97.28), a specificity of 99.41% (95% CI: 96.39-99.99), and an accuracy of 97.02% (95% CI: 94.61-98.38), while for ICT, sensitivity, specificity, and accuracy values corresponded to 91.98% (95% CI: 86.65-95.39), 100.00% (95% CI: 96.30-100.00), and 95.14% (95% CI: 91.62-97.15), respectively. When testing sera samples from VL/AIDS coinfected patients, DTL-4-ELISA displayed a sensitivity of 77.42% (95% CI: 65.48-86.16), a specificity of 99.41% (95% CI: 96.39-99.99), and an accuracy of 93.51% (95% CI: 89.49%-96.10%), while for DTL-4-ICT, sensitivity was 73.91% (95% CI: 59.74-84.40), specificity was 90.63% (95% CI: 81.02-95.63), and accuracy was 82.00% (95% CI: 73.63-90.91).
Conclusion: DTL-4 is a promising candidate antigen for serodiagnosis of VL patients, including those with VL/AIDS coinfection, when incorporated into ELISA or ICT test formats
Aceptación entre estudiantes del ciclo básico de lo dibujo animado O X na Xistose para el desarrollo del conocimiento sobre la esquistosomiasis
No full textJonatas Pereira Lima da Universidade Federal do Rio Grande do Norte, do Centro de Ciências da Saúde, do Departamento de Odontologia teve seu artigo submetido e aprovado na edição da RECIIS - Dossiê Comunicação, Saúde e Crises Globais: parte 2 v. 15 n.1 (2021)O trabalho dos educadores pode ser enriquecido com o uso de recursos pedagógicos importantes no processo de ensino e aprendizagem. Considerando este aspecto, uma animação baseada no livro O feitiço da lagoa, de Virginia Schall, que trata do tema esquistossomose foi construída para estimular o conhecimento sobre a doença entre escolares e exibida para alunos do ensino básico em quatro municípios endêmicos: Jaboticatubas, Malacacheta e Santa Luzia, em Minas Gerais; e João Pessoa, na Paraíba. Após sua exibição, um questionário foi aplicado com a finalidade de verificar a aceitação e o entendimento do material. De acordo com as respostas, o desenho animado apresentou boa aceitação. Todos identificaram a esquistossomose como a doença retratada e o caramujo como o transmissor do esquistossomo. Os resultados apontaram que o desenho pode ser um importante recurso pedagógico no processo educativo, auxiliando os programas de controle da endemia, especialmente quando desenvolvidos no espaço escolar.The educators' work can be enriched with the use of pedagogical resources which are important in the teaching and learning process. With this aspect in mind, a cartoon with the theme schistosomiasis was created, so as to promote knowledge about the disease among middle school students, and exhibited in four endemic municipalities - Jaboticatubas, Malacacheta and Santa Luzia in the state of Minas Gerais; and João Pessoa in the state of Paraíba. The animation was based on the book O feitiço da lagoa by Virginia Schall and it was shown to students in those four towns. A questionnaire was answered by them after the respective exhibitions in order to verify the acceptance and understanding of the material that was shown. According to the responses, the cartoon presented good acceptance. Everyone identified schistosomiasis as the disease displayed, and the snail that transmits the schistosome. The results showed that the cartoon can be an important pedagogical resource in the educational process, helping endemic control programs, especially when these programs are developed in the school environment.El trabajo de los educadores puede ser enriquecido con el uso de recursos pedagógicos importantes en el proceso de enseñanza y aprendizaje. Considerando este aspecto, un dibujo animado sobre el tema esquistosomiasis fue realizado para estimular el conocimiento, entre estudiantes del ciclo básico, acerca de la enfermedad y exhibido en cuatro municipios endémicos: Jaboticatubas, Malacacheta y Santa Luzia en Minas Gerais; y João Pessoa en Paraíba. La animación fue basada en el libro O feitiço da lagoa de Virginia Schall y fue mostrada a alumnos en las cuatro localidades. Un cuestionario fue aplicado, después de cada proyección, con la finalidad de verificar la aceptación y el entendimiento del material exhibido. De acuerdo con las respuestas, el dibujo tuvo buena aceptación. Todos identificaron la esquistosomiasis como la enfermedad retratada y el caracol como el transmisor del esquistosoma. Los resultados indicaran que el dibujo animado puede ser un importante recurso pedagógico en el proceso educativo, auxiliando a los programas de control de la endemia, especialmente cuando desarrollados en el espacio escola
Government regulation of private health insurance care model in Brazil: context, characteristics and proposals for change
No full textNas últimas décadas, houve mudanças nas relações entre Estado, mercados e a sociedade, que repercutiram nos sistemas de saúde dos diferentes países, incluindo a ampliação do setor privado na provisão de serviços sociais. No Brasil, o Sistema Único de Saúde (SUS) coexiste e interage com um mercado de planos e seguros privados de saúde segmentado e dinâmico, que já vinha se expandindo há décadas, subsidiado pelo Estado e sob escassa regulação estatal. A partir do final dos anos 1990 se registram alterações mais expressivas no marco regulatório do setor. A regulação assistencial é uma das dimensões da regulação estatal que têm importância para a cobertura, o acesso, o escopo e a qualidade da atenção aos beneficiários de planos e seguros de saúde, além de implicações para o SUS. O estudo teve o objetivo geral de analisar o contexto, as características e as propostas de mudanças para a regulação assistencial do setor de saúde suplementar brasileiro no período entre 2000 e 2018. A pesquisa utilizou fontes secundárias, com destaque para documentos oficiais e publicações das empresas do setor, revisão bibliográfica e análise de dados secundários. Observou-se que a Lei 9.656 de 1998 e a criação da Agência Nacional de Saúde Suplementar em 2000 conferiram uma nova institucionalidade para a regulação do setor nas décadas seguintes. A análise da trajetória da regulação assistencial pela ANS revelou continuidades importantes, registrando-se esforços de preservar as estratégias implementadas e propor novas iniciativas. As principais estratégias de regulação assistencial do período foram: a definição e ampliações sucessivas do rol de procedimentos e eventos em saúde; a definição de regras sobre a segmentação assistencial dos planos; iniciativas de promoção da saúde, prevenção de doenças e qualificação da assistência. Durante o período, diferentes atores buscaram influenciar as políticas referentes ao setor, com tensões entre propostas de expansão ou de redução da regulação estatal. A análise de projetos legislativos apresentados mostrou que, apesar dos interesses em disputa, não houve ruptura com o modelo de regulação baseado na Lei 9.656 e na atuação da ANS, com predomínio de mudanças incrementais. A proposta de planos de saúde de baixo custo pelo Ministério da Saúde em 2017-2018 representou uma ameaça, ainda que não tenha se concretizado. Porém, a manutenção de fortes subsídios estatais, as mudanças legais sobre o capital estrangeiro na saúde, o crescimento e o dinamismo do setor, alertam que as estratégias do empresariado têm sido bem sucedidas e que persistem desafios na regulação estatal dos mercados em saúde para que o SUS se consolide como um sistema universal, e a saúde como direito de todos e dever do Estado.In recent decades, there have been changes in the relationship between the State, markets, and society, which had repercussions on the health systems of different countries, including the expansion of the private sector in the provision of social services. In Brazil, the Sistema Único de Saúde (SUS) coexists and interacts with a segmented and dynamic private health insurance market, which has been expanding for decades, subsidized by the State and under scarce regulation. From the end of the 1990s onwards, more expressive changes were registered in the regulatory framework. Healthcare regulation is one of the dimensions of State regulation that are important for coverage, access, scope, and quality of care for clients of health insurance companies, in addition to implications for the SUS. The study had the general objective of analyzing the context, characteristics, and proposals for changes to the care regulation of the Brazilian private health insurance in the period between 2000 and 2018. The research was based on secondary sources, with emphasis on the analysis of official documents and publications of companies, in addition to a literature review and secondary data analysis. It was observed that Law 9.656 of 1998 and the creation of the Agência Nacional de Saúde Suplementar in 2000 provided a new institutional framework for the regulation of the market in the following decades. The analysis of the trajectory of care regulation by the ANS revealed important continuities, registering efforts to preserve the implemented strategies and propose new initiatives. The main care regulation strategies in the period were: the definition and successive expansion of the list of health procedures and events; the definition of rules on the assistance segmentation; Health Promotion, disease prevention and care qualification initiatives. During the period, different actors sought to influence policies related to the sector, with tensions between proposals for expansion or reduction of State regulation. The analysis of legislative projects presented showed that, despite the interests in dispute, there was no rupture with the regulatory model based on Law 9,656 and on the performance of the ANS, with a predominance of incremental changes. The proposal for low-cost health plans by the Ministry of Health in 2017-2018 represented a threat, although it did not materialize. However, the maintenance of strong state subsidies, legal changes on foreign capital in health, the growth and dynamism of the sector, warn that business strategies have been successful and that challenges persist in the state regulation of health markets so that the SUS is consolidated as a universal system, and health as a right for all and a duty of the State
Serum biomarker profile orchestrating the seroconversion status of patients with autoimmune diseases upon planned primary 17DD Yellow fever vaccination
No full textThe present study aimed to investigate whether the serum biomarkers of immune response orchestrate the seroconversion status in patients with autoimmune diseases (AID) upon planned primary 17DD-YF vaccination. For this purpose a total of 161 individuals were enrolled in a prospective study, including patients with Rheumatoid Arthritis (RA = 38), Spondyloarthritis (SpA = 51), Systemic Lupus Erythematosus (SLE = 21) and Sjögren's Syndrome (SS = 30) along with a group of healthy controls (HC = 21). Analysis of plaque reduction neutralization test (PRNT) titers and seropositivity rates along with the 17DD-YF viremia and serum biomarkers were carried out at distinct time points (D0/D3-4/D5-6/D7/D14-28). The results demonstrated an overall lower PRNT titer and seropositivity rate (170 vs. 448; 77 vs. 95%) in AID as compared to HC, especially in SpA and SLE subgroups. No significant differences were observed in the viremia levels amongst groups. In general, a more prominent serum biomarker response was observed in AID as compared to HC, throughout the timeline kinetics. Remarkably, AID/PRNT(-) exhibited higher levels of several biomarkers at baseline as compared to AID/PRNT+. Moreover, while AID/PRNT(+) exhibited earlier increase in serum biomarkers at D3-4/D5-6, the AID/PRNT(-) displayed higher response at later time points (D7/D14-D28). Of note, a synchronic increase of IFN-γ at the peak of viremia (D5-6) was observed in HC and AID/PRNT(+) groups, whereas a later asynchronous IFN-γ response was reported for AID/PRNT(-) at D7. The biomarker profile tends to deflate at post-vaccination timeline, highlighting a putative immunomodulatory effect of live attenuated 17DD-YF vaccine in AID/PRNT(+), but not in AID/PRNT(-). Altogether these data suggested that inflammatory status prior vaccination, low IFN-γ at viremia peak and the occurrence of asynchronous biomarker storm after 17DD-YF vaccination may orchestrate the lack of neutralizing antibody response γ
Trypanosoma rangeli Genetic, Mammalian Hosts, and Geographical Diversity from Five Brazilian Biomes
No full textAbstract: Trypanosoma rangeli is a generalist hemoflagellate that infects mammals and is transmitted
by triatomines around Latin America. Due to its high genetic diversity, it can be classified into two
to five lineages. In Brazil, its distribution outside the Amazon region is virtually unknown, and
knowledge on the ecology of its lineages and on host species diversity requires further investigation.
Here, we analyzed 57 T. rangeli samples obtained from hemocultures and blood clots of 1392 mammals
captured in different Brazilian biomes. The samples were subjected to small subunit (SSU) rDNA
amplification and sequencing to confirm T. rangeli infection. Phylogenetic inferences and haplotype
networks were reconstructed to classify T. rangeli lineages and to infer the genetic diversity of
the samples. The results obtained in our study highlighted both the mammalian host range and
distribution of T. rangeli in Brazil: infection was observed in five new species (Procyon cancrivorous,
Priodontes maximum, Alouatta belzebul, Sapajus libidinosus, and Trinomys dimidiatus), and transmission
was observed in the Caatinga biome. The coati (Nasua nasua) and capuchin monkey (S. libidinosus)
are the key hosts of T. rangeli. We identified all four T. rangeli lineages previously reported in Brazil
(A, B, D, and E) and possibly two new genotypes
Sexual, reproductive health and health status of female sex workers in 12 Brazilian cities, 2016
No full textObjetivo: Investigar diferenças nos indicadores de saúde sexual, reprodutiva e de estado de saúde de mulheres trabalhadoras do sexo em 12 cidades brasileiras. Métodos: Estudo de corte transversal comportamental e biológico, com amostra mínima de 350 mulheres trabalhadoras do sexo por cidade, recrutadas por Respondent-Driven Samplig, em 2016. Na análise de dados, foi considerado o desenho complexo de amostragem. Foram apresentados indicadores e respectivos intervalos de 95% de confiança relacionados à saúde sexual, reprodutiva e ao estado de saúde separadamente por cidade e para a amostra total. Resultados: A amostra total foi de 4.328 mulheres trabalhadoras do sexo. A cobertura de exame de Papanicolau e teste para vírus da imunodeficiência humana e sífilis, e os indicadores de pré-natal apresentaram variação igual ou superior a 20 pontos percentuais. A cobertura de exame de Papanicolau variou de 53,4%, em Recife, a 73%, em Porto Alegre. O maior percentual de mulheres trabalhadoras do sexo que nunca realizaram o teste para vírus da imunodeficiência humana e sífilis foi registrado em Fortaleza (36,8 e 63,8%, respectivamente). A cobertura de pré-natal variou de 61,1%, em Salvador, a 99%, em Curitiba. Em cinco cidades, o percentual de participantes que afirmou já ter sentido discriminação no serviço de saúde por ser trabalhadora do sexo foi superior a 20%. Conclusões: As diferenças entre os indicadores nas 12 cidades acompanharam o perfil da população brasileira, com mulheres trabalhadoras do sexo mais vulneráveis nas regiões Norte e Nordeste. Os resultados mostram que é fundamental considerar as barreiras de acesso à saúde, como o estigma e a discriminação, que impedem a contemplação das necessidades específicas dessas mulheres.Objective: To investigate differences in sexual, reproductive health and health status indicators of female sex workers in 12 Brazilian cities. Methods: Cross-sectional study of biological and behavioral surveillance survey with a minimum sample of 350 female sex workers per city, recruited by respondent driven sampling, in 2016. Complex sample design was considered in the data analysis. Indicators and 95% confidence intervals related to sexual and reproductive health, and health status were described separately by city and for the total sample. Results: The total sample consisted of 4,328 female sex workers. The coverage of Pap smear exam, human immunodeficiency virus and syphilis tests and antenatal care indicators varied by 20 percentages points or more. Pap smear exam coverage ranged from 53.4% in Recife to 73.0% in Porto Alegre. The highest percentage of female sex workers who had never been tested for human immunodeficiency virus and syphilis was in Fortaleza (36.8 and 63.8%, respectively). Antenatal coverage ranged from 61.1% in Salvador to 99.0% in Curitiba. In five cities, the proportion of female sex workers who disclosed their sex work status in health services was over 20.0%. Conclusion: The differences between the indicators in the 12 cities followed the Brazilian population profile, with more vulnerable sex workers in the North and Northeast regions. The results show that it is essential to consider the barriers to accessing health, such as stigma and discrimination, which restrict the addressing of female sex workers specific needs
Process management implementation for RT-qPCR activities in Bio-Manguinhos research and development sector
No full textOs autores externos submeteram sua publicação para apresentação de trabalho no evento “International Symposium on Immunobiologicals”, que foi coordenado e organizado pelo Instituto de Tecnologia em Imunobiológicos (Bio-Manguinhos), da Fundação Oswaldo Cruz
COVID-19: preservar a vida é a melhor maneira de celebrar a Páscoa: a forma mais segura de celebrar a Páscoa é ficar em casa apenas com as pessoas que moram com você
No full textA cartilha traz informações sobre o preparo e manuseio de alimentos, limite de pessoas e ventilação nos ambientes, descarte de lixo e disponibilização de álcool em gel. As recomendações sobre lavagem das mãos permanecem. No fim da cartilha, estão listadas as situações e as condições de saúde que impedem as pessoas de participarem de confraternizações. A principal mensagem é: a forma mais segura de celebrar a Páscoa é ficar em casa, apenas com as pessoas que moram com você. Nenhuma medida é capaz de impedir totalmente a transmissão da COVID-19