17 research outputs found
Dengue nas mulheres em idade fértil : diferenças na evolução da doença em gestantes?
No full textOrientadora: Prof. Dra. Silvia Emiko ShimakuraCoorientadora: Prof. Dra. Denise Siqueira de CarvalhoDissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências da Saúde, Programa de Pós-Graduação em Saúde Coletiva. Defesa : Curitiba, 30/07/2021Inclui referências: p. 90-103Resumo: Introdução: O aumento do número de casos de dengue mundialmente implica maior exposição de grupos de risco, como gestantes. A infecção por dengue no período gestacional tem sido associada a desfechos desfavoráveis, porém persistem indefinições. O estado do Paraná tem sofrido epidemias que se intensificaram nos últimos anos. Como estratégia de enfrentamento, entre 2016 e 2018, uma campanha da vacinação foi implementada. Desta forma, este estado apresenta um número grande de indivíduos expostos à vacina, o que permite avaliar possíveis contribuições em grupos específicos, como mulheres em idade fértil. Objetivo: Caracterizar os casos de dengue em mulheres em idade fértil, comparando o desenvolvimento da doença entre gestantes e não gestantes. Apresentar os casos de gestantes notificadas por dengue e previamente expostas à vacina, comparando com as gestantes não vacinadas. Métodos: Estudo transversal realizado em duas etapas conforme fator de exposição - gestação e vacina. As fontes de dados utilizadas foram as notificações de dengue ao Sistema de Informações de Agravos de Notificação Obrigatória (Sinan), entre 2016 e 2019, no estado do Paraná/Brasil e o banco de dados de vacinados na Campanha de Vacinação contra dengue do estado do Paraná. Variáveis sociodemográficas, clínicas e laboratoriais foram comparadas entre gestantes e não gestantes. Os desfechos avaliados foram classificação final (dengue, dengue com sinais de alarme ou dengue grave) e hospitalização. Para a análise do fator de exposição gestação as demais variáveis foram analisadas por teste Qui-quadrado, e aquelas com valor de p igual a 0,20 ou menos foram levadas para o modelo de análise múltipla por regressão logística. Para a análise do fator de exposição vacina as demais variáveis foram analisadas por teste Qui-quadrado, e os casos que apresentaram desfecho de interesse são apresentados de forma descritiva. Resultados: Encontrou-se 13.587 mulheres não gestantes e 452 gestantes no período avaliado. As gestantes e não gestantes apresentavam diferenças na distribuição etária, predominando a idade entre 20 e 29 anos entre gestantes. A investigação laboratorial foi mais frequente entre gestantes, e o DENV-2 prevaleceu nos dois grupos. A apresentação de Dengue com sinais de alarme/grave e a hospitalização foram maiores entre gestantes, mas apenas hospitalização apresentou significância estatística. O risco de hospitalização é maior entre as gestantes principalmente entre os casos de dengue de baixa gravidade. A macrorregional também foi relacionada com a classificação final. A hospitalização foi relacionada com ano de notificação, macrorregional, idade e presença de diabetes. A exposição a vacina não alterou significativamente o curso clínico da infecção por dengue entre as gestantes. Observou-se maior prevalência de DENV-2 no grupo de gestantes vacinadas. Conclusão: A gestação não apresentou correlação com maior gravidade na apresentação clínica da dengue. A maior hospitalização das gestantes pode refletir maior atenção a este grupo, e pode ter desempenhado papel protetor, em relação ao desenvolvimento de formas graves da infecção por dengue. O número de gestantes expostas a vacina foi um limitante para avaliação do impacto desta nos desfechos da clínica entre as gestantes, contudo, é possível que a influência desta exposição permaneça nos próximos anos, permitindo avaliações futuras.Abstract: Background: The number of Dengue cases grew globally, leading to greater exposure of people with a high risk of developing severe forms of Dengue infection, such as pregnant women. Dengue infection during pregnancy has been progressively associated with poor pregnancy outcomes. However, the impact of pregnancy in clinical evolution remains uncertain. Paraná state has been through epidemics with increasing severity. A vaccination campaign was conducted between 2016 and 2018. Resulting, many individuals that were expose to this vaccine, allowing assessment of potential contribution in a specific population, as women ate childbearing age. Objectives: This study aims to characterize Dengue cases in childbearing age women, comparing clinical outcomes in pregnant and non-pregnant women and evaluating Dengue clinical outcomes in pregnant women previously exposed to Dengue vaccine. Methods: A cross-sectional study was conducted in two steps according to exposition factors - pregnancy and vaccine. Dengue cases in childbearing women, reported between August 2016 and December 2019 and data from Paraná State Dengue Vaccine Campaign in Paraná were analyzed. Sociodemographic and clinical variables were compared among pregnant and non-pregnant women. The outcomes of interest were severe forms and hospitalization. For evaluating pregnancy, we used the Q-square test and all variables presenting p-value of 0,20 or under were included in the logistic regression. For the evaluation of the vaccine, we used the Q-square test, and cases that resulted in an outcome of interest were described. Results: In the period included in this study, there were 13,587 non-pregnant women and 452 pregnant women. Pregnant and non-pregnant women presented differences in age distribution, and pregnant women were predominantly 20-29 years old. Also, laboratorial investigation in pregnant women was more frequent, and DENV-2 more remarkable in both groups. Dengue with warning signs/Severe Dengue and hospitalizations were greater in pregnant women, but only hospitalization showed statistical significance. Hospitalization was more frequent among pregnant women, mainly in clinical presentations without severity signs. Macroregion also was related to clinical presentation. Hospitalization was related to the year of notification, microregion, age, and diabetes. Among pregnant women, previous vaccine exposition did not modify clinical outcomes. DENV-2 was greater among vaccinated pregnant women. Conclusion: Pregnancy was not related to increased severity of dengue infection. Larger hospitalization of pregnant women may be associated with national and international guidelines and could play a protective role against severe forms to this group. The impact of the Dengue vaccine in clinical outcomes of Dengue infection in pregnant women was restricted by group size. However, the influence of Dengue vaccines may remain in this population in further years and could be assessed in future research
Towards global elimination of lymphatic filariasis: a systematic review of the application of spatial epidemiological methods to enhance surveillance and support elimination programmes
No full textBackground In recent decades, spatial epidemiology has increasingly been used to study neglected tropical diseases (NTDs). Spatial methods are particularly relevant when transmission is strongly driven by sociodemographic and environmental factors, resulting in heterogeneous disease distribution. We use lymphatic filariasis (LF)—an NTD targeted for global elimination—as a case study to examine how spatial epidemiology has been used to enhance NTD surveillance.Methods We conducted a systematic literature review of spatial analytical studies of LF published in English across PubMed, Embase, Web of Science and Scopus databases, before 15 November 2022. Additional papers were identified from experts’ suggestions. Studies that employed spatial analytical methods were included, but those that applied only visualisation tools were excluded.Findings Sixty-one eligible studies published between 1997 and 2023 were identified. The studies used a wide range of spatial methods. Thirty-one (50.8%) studies used spatial statistical modelling, with model-based geostatistics being the most common method. Spatial autocorrelation and hotspot analysis were applied in 30 studies (49.2%). The most frequent model outputs were prevalence maps (17 studies, 27.9%), followed by risk maps based on environmental suitability (7 studies, 11.5%) and maps of the odds of seroprevalence being above a predetermined threshold (7 studies, 11.5%).Interpretation By demonstrating the applicability of spatial methods for investigating transmission drivers, identifying clusters and predicting hotspots, we highlight innovative ways in which spatial epidemiology has provided valuable evidence to support LF elimination. Spatial analysis is particularly useful in low-prevalence settings for improving hotspot detection and enhancing postelimination surveillance.PROSPERO registration number CRD42022333804
EVALUATION OF THE CARE GIVEN TO DIABETIC SERVICE USERS IN A HEALTH CARE UNIT
No full textO presente trabalho teve como objetivo avaliar o cuidado programado ao diabético em Unidade Básica de Saúde do Sistema Único de Saúde de um município da região metropolitana de Curitiba, Paraná. Estudantes e professores de projeto de extensão identificaram os diabéticos cadastrados e analisaram o controle da doença pela unidade de saúde. Os usuários que não aderiam aos cuidados ou não obtinham melhora foram visitados para identificação dos motivos, orientação do cuidado e agendamento de consultas ou exames. Após o quarto mês, repetiu-se a análise, verificando-se expressiva melhora na adesão e no controle do diabetes. A partir disso, houve revisão do planejamento e avaliação do cuidado. A abertura do serviço para a participação da universidade constituiu importante espaço de aprendizagem e contribuiu para qualificar o atendimento aos usuários, objetivo maior dos serviços de saúde
Predictive risk mapping of lymphatic filariasis residual hotspots in American Samoa using demographic and environmental factors
No full textA study protocol for developing a spatial vulnerability index for infectious diseases of poverty in the Caribbean region
No full textInfectious diseases of poverty (IDoP) affect disproportionately resource-limited and marginalized populations, resulting in spatial patterns of vulnerability across various geographical areas. Currently, no spatial indices exist to quantify vulnerability to IDoP at a fine geographical level within countries, such as municipalities or provinces. Without such an index, policymakers cannot effectively allocate resources or target interventions in the most vulnerable areas. This protocol aims to specify a methodological approach to measure spatial variation in vulnerability to IDoP. We will evaluate this methodological approach using surveillance and seroprevalence data from the Dominican Republic (DR) as part of a broader effort to develop a regional index for the Caribbean region. The study will consist of three main components. The first component involves identifying the relevant factors associated with IDoP in the Caribbean region through a scoping review, supplemented by expert-elicited opinion. The second component will apply a Fuzzy Analytic Hierarchy Process to weigh the aforementioned factors and develop a spatial composite index, using open data and available national surveys in the DR. In the final component, we will evaluate and validate the index by analysing the prevalence of at least three IDoPs at a fine-grained municipal level in the DR, using seroprevalence data from a 2021 national field study and other national surveillance programs. The spatial vulnerability index framework developed in this study will assess the degree of vulnerability to IDoP across different geographical scales, depending on data availability in each country
Persistent lymphatic filariasis transmission seven years after validation of elimination as a public health problem: a cross-sectional study in TongaResearch in context
No full textSummary: Background: The World Health Organization (WHO) has validated 21 countries as having eliminated lymphatic filariasis (LF) as a public health problem. Post-validation surveillance (PVS) is required in countries where LF has been eliminated. Tonga eliminated LF in 2017, but no PVS strategy has been established. We aimed to identify any persistent LF transmission in Tonga in 2024 and provide evidence to support a PVS strategy. Methods: A four-pronged, targeted, cross-sectional study was conducted in the Tongan districts of Tongatapu, Ha’apai, and Ongo Niuas in May–July 2024 in communities, primary schools, high schools, and an outpatient clinic. Participants were tested for LF antigen (Ag) and microfilariae (Mf). The outcome measure for persistent LF transmission was Ag-positivity. Findings: Between 9 May and 19 July 2024, 1787 participants were recruited from 12 communities, 11 primary schools, five high schools, and one outpatient clinic. Overall, 39 participants (2·2%) were Ag-positive and five (0·3%) were Mf-positive. The highest Ag prevalence was in communities (4·0%; 95% confidence interval [95%CI]: 2·9–5·6), where all Mf-positives (n = 5) were identified. Ag-positivity was associated with male sex (adjusted odds ratio [aOR]:4·86; 95%CI: 2·25–10·46), older age (>50 years vs 5–10 years [aOR:7·51; 95%CI: 2·13–26·47]), and residing in Ha’apai (aOR:15·08; 95%CI: 5·41–42·05) and Ongo Niuas (aOR:10·85; 95%CI: 3·91–30·08). Interpretation: We found persistent LF transmission in Tonga seven years post-validation. Community surveillance yielded the highest Ag and Mf prevalence. Efficiency of PVS could be improved by integrating surveillance activities into the existing health system and conducting community-based surveys, particularly among older males and in high prevalence areas. Funding: Task Force for Global Health, Bill & Melinda Gates Foundation, and the United States Agency for International Development
Ongoing transmission of lymphatic filariasis in Samoa 4.5 years after one round of triple-drug mass drug administration.
No full textBackgroundLymphatic filariasis (LF) remains a significant global issue. To eliminate LF as a public health problem, the World Health Organization (WHO) recommends multiple rounds of mass drug administration (MDA). In certain scenarios, including when elimination targets have not been met with two-drug MDA, triple-drug MDA (using ivermectin, diethylcarbamazine and albendazole) is recommended. In this study, we report on antigen (Ag) and microfilaria (Mf) prevalence in eight primary sampling units (PSUs) in Samoa 4.5 years after one round of triple-drug MDA.MethodologyIn 2023, community surveys were conducted in eight PSUs that had been surveyed previously in 2018 (between 1.5 and 3.5 months post triple-drug MDA) and 2019 (six to eight-months post triple-drug MDA). Fifteen houses were randomly selected in each PSU with household members aged ≥ 5 years invited to participate. Blood samples were tested for Ag and Mf.Principal findingsAg-positive participants were observed in six of the eight PSUs, and Ag prevalence was significantly above the 1% threshold in four PSUs. The presence of Mf-positive participants in five PSUs confirms the presence of residual active infections.Conclusions/significanceThis study provides evidence of persistent LF transmission in Samoa 4.5 years after one round of triple-drug MDA, confirming that one round was insufficient for interruption of transmission in this setting. Our findings highlight the negative impact of delaying MDA rounds, for example, due to public health emergencies
Recurrence of microfilaraemia after triple-drug therapy for lymphatic filariasis in Samoa: Recrudescence or reinfection?
No full textObjectives: Contrasting evidence is emerging on the long-term effectiveness of triple-drug therapy for elimination of lymphatic filariasis (LF) in the Pacific region. We evaluated the effectiveness of ivermectin, diethylcarbamazine and albendazole (IDA) for sustained clearance of microfilariae (Mf) in Samoa. Methods: We enrolled two cohorts of Mf-positive participants. Cohort A were Mf-positive participants from 2018, who received directly observed triple-drug therapy in 2019 and were retested and retreated in 2023 and 2024. Cohort B were Mf-positive and treated in 2023 and retested in 2024. Participants were tested for LF antigen and Mf. Results: In Cohort A, eight of the 14 participants from 2018/2019 were recruited in 2023; six were Mf-positive. In 2024, six participants were retested, and two were Mf-positive. Cohort B included eight participants, and two remained Mf-positive in 2024. Mf prevalence in 2023 for Cohort A (71.4%, 95% CI 29.0%-96.3%) was significantly higher than among their household members (12.0%, 95% CI 2.5%-31.2%). Conclusion: One or two doses of directly observed IDA was not sufficient for sustained clearance of Wuchereria bancrofti Mf in Samoa. The high Mf prevalence in treated individuals compared to household members suggests recrudescence rather than reinfection
Fatal journeys: causes of death in international travellers in South America
No full textBackground: Understanding mortality among travellers is essential for mitigating risks and enhancing travel safety. However, limited evidence exists on severe illnesses and injuries leading to death among travellers, particularly in low- and middle-income countries and remote regions. Methods: We conducted a retrospective census study using country-level observational data from death certificates of travellers of seven South American countries (Argentina, Brazil, Chile, Colombia, Ecuador, Peru and Uruguay) from 2017 to 2021. Causes of death were evaluated using ICD-10 codes, categorized into non-communicable diseases (NCDs), communicable diseases and injuries. We quantified causes of death by demographic characteristics (e.g. age, sex) and geographical variables. Chi-square tests were used to assess differences between categories. We calculated crude mortality rates and incidence rate ratios (IRRs) per country's subregions. Results: A total of 17 245 deaths were reported. NCDs (55%) were the most common cause of death, followed by communicable diseases (23.4%) and injuries (18.1%). NCD-associated deaths increased after age 55 years and were highest among >= 85 years. Communicable diseases were more common at younger age (<20 years). Injury-associated deaths were more common in men (79.9%) and 25-29-year-olds (17.1%). Most deaths (68.2%) could have been avoided by prevention or treatment. Mortality risk was higher among travellers in bordering regions between countries. In Roraima (Brazil) and Norte de Santander (Colombia), locations bordering Venezuela, the death IRR was 863 and 60, respectively. These countries' reference mortality rates in those regions were much lower. More than 80% of the deaths in these border regions of Brazil and Colombia involved Venezuelan citizens. Conclusion: The study identified risk factors and high-risk locations for deaths among travellers in seven countries of South America. Our findings underscore the need for specific health interventions tailored to traveller demographics and destination to optimize prevention of avoidable deaths in South America
Field laboratory comparison of STANDARD Q Filariasis Antigen Test (QFAT) with Bioline Filariasis Test Strip (FTS) for the detection of Lymphatic Filariasis in Samoa, 2023
No full textBackground: To monitor the progress of lymphatic filariasis (LF) elimination programmes, field surveys to assess filarial antigen (Ag) prevalence require access to reliable, user-friendly rapid diagnostic tests. We aimed to evaluate the performance of the new Q Filariasis Antigen Test (QFAT) with the currently recommended Filariasis Test Strip (FTS) for detecting the Ag of Wuchereria bancrofti, the causative agent of LF, under field laboratory conditions.
Methodology/Principal findings: During an LF survey in Samoa, 344 finger-prick blood samples were tested using FTS and QFAT. Microfilariae (Mf) status was determined from blood slides prepared from any sample that reported Ag-positive by either Ag-test. Each test was re-read at 1 hour and the next day to determine the stability of results over time. Overall Ag-positivity by FTS was 29.0% and 30.2% by QFAT. Concordance between the two tests was 93.6% (kappa = 0.85). Of the 101 Mf slides available, 39.6% were Mf-positive, and all were Ag-positive by both tests. Darker test line intensities from Ag-positive FTS were found to predict Mf-positivity (compared to same/lighter line intensities). QFAT had significantly higher reported test result changes than FTS, mostly reported the next day, but fewer changes were reported between 10 minutes to 1hour. The field laboratory team preferred QFAT over FTS due to the smaller blood volume required, better usability, and easier readability.
Conclusion/Significance: QFAT could be a suitable and user-friendly diagnostic alternative for use in the monitoring and surveillance of LF in field surveys based on its similar performance to FTS under field laboratory conditions
