The First Isolation of Insect-Specific Alphavirus (Agua Salud alphavirus) in Culex (Melanoconion) Mosquitoes in the Brazilian Amazon.

Advances in diagnostic techniques coupled with ongoing environmental changes have resulted in intensified surveillance and monitoring of arbovirus circulation in the Amazon. This increased effort has resulted in increased detection of insect-specific viruses among hematophagous arthropods collected in the field. This study aimed to document the first isolation of Agua Salud alphavirus in mosquitoes collected within the Brazilian Amazon. Arthropods belonging to the family Culicidae were collected within a forest fragment located in the Environmental Protection Area of the metropolitan region of Belem. Subsequently, these specimens were meticulously identified to the species level. Afterward, the collected batches were macerated, and the resulting supernatant was then inoculated into C6/36 and Vero cell cultures to facilitate viral isolation. The presence of arboviruses within the inoculated cell cultures was determined through indirect immunofluorescence analysis. Furthermore, positive supernatant samples underwent nucleotide sequencing to precisely identify the viral strains present. Notably, a batch containing Culex (Melanoconion) mosquitoes was identified to be positive for the genus Alphavirus via indirect immunofluorescence. This study is the first report on insect-specific alphavirus isolation in Brazil and the first-ever description of Agua Salud alphavirus isolation within Amazon Forest remnants.

Equal Maintenance of Anti-SARS-CoV-2 Antibody Levels Induced by Heterologous and Homologous Regimens of the BNT162b2, ChAdOx1, CoronaVac and Ad26.COV2.S Vaccines: A Longitudinal Study Up to the 4th Dose of Booster.

Several technological approaches have been used to develop vaccines against COVID-19, including those based on inactivated viruses, viral vectors, and mRNA. This study aimed to monitor the maintenance of anti-SARS-CoV-2 antibodies in individuals from Brazil according to the primary vaccination regimen, as follows: BNT162b2 (group 1; 22) and ChAdOx1 (group 2; 18). Everyone received BNT162b2 in the first booster while in the second booster CoronaVac, Ad26.COV2.S, or BNT162b2. Blood samples were collected from 2021 to 2023 to analyze specific RBD (ELISA) and neutralizing antibodies (PRNT50). We observed a progressive increase in anti-RBD and neutralizing antibodies in each subsequent dose, remaining at high titers until the end of follow-up. Group 1 had higher anti-RBD antibody titers than group 2 after beginning the primary regimen, with significant differences after the 2nd and 3rd doses. Group 2 showed a more expressive increase after the first booster with BNT162B2 (heterologous booster). Group 2 also presented high levels of neutralizing antibodies against the Gamma and Delta variants until five months after the second booster. In conclusion, the circulating levels of anti-RBD and neutralizing antibodies against the two variants of SARS-CoV-2 were durable even five months after the 4th dose, suggesting that periodic booster vaccinations (homologous or heterologous) induced long-lasting immunity.

First Isolation and Molecular Characterization of Umatilla Virus (Sedoreoviridae, Orbivirus) in Brazil.

In this study, we provide a genomic description of the first isolation of the Umattila virus (UMAV) in Brazil. The virus was obtained from the blood of a bird (Turdus fumigatus) and isolated in a C6/36 cell culture. The viral genome contains ten segments, and its organization is characteristic of viruses of the genus Orbivirus (family Sedoreoviridae). The coding region of each segment was sequenced, demonstrating the nucleotide identity with UMAV. The phylogenetic inference results were in line with these findings and demonstrated the formation of two distinct monophyletic clades containing strains isolated around the world, where our isolate, belonging to the same clade as the prototype strain, was allocated to a different subclade, highlighting the genetic divergence between them. This work reports the first isolation of UMAV in Brazil, and due to the scarcity of information on this viral agent in the scientific literature, it is essential to carry out further studies to better understand its epidemiology, dispersion, and, in particular, its interactions with vertebrate hosts, vectors, and the environment.

Ilheus Virus (ILHV) Resistance in Culex quinquefasciatus from the Northern Region of Brazil.

BACKGROUND: Orthoflavivirus ilheusense (ILHV) is a member of the Flaviviridae family. It was first isolated in 1944 from pools of Aedes serratus and Psorophora ferox mosquitoes; however, it has also been detected in species of the genus Culex, such as Cx. portesi and Cx. coronator. The objective of this study was to examine the vector competence of Cx. quinquefasciatus mosquitoes to ILHV infection and the subsequent transmission of the virus through their saliva during feeding on blood. METHODS: F1 generation females of Cx. quinquefasciatus (Ananindeua/PA) were orally infected with goose blood infected with strain BeH7445, and body, head and saliva samples were analyzed at 7, 14, and 21 dpi using the techniques of virus isolation in cells and indirect immunofluorescence. RESULTS: The presence of ILHV was not detected in the body and head samples of Cx. quinquefasciatus females at any of the three dpi's analyzed, indicating that the lineage of mosquitoes analyzed was resistant to ILHV. CONCLUSIONS: According to the results obtained in this study, the species Cx. quinquefasciatus proved resistant to ILHV, regardless of the virus titers to which it was exposed, which suggests the possibility that this species does not act as a vector in the ILHV transmission cycle.

Negevirus Piura Suppresses Zika Virus Replication in Mosquito Cells.

We investigated the interaction between the insect-specific virus, Piura virus (PIUV), and the arbovirus Zika virus (ZIKV) in Aedes albopictus cells. We performed coinfection experiments in C6/36 cells. Piura virus (Cor 33 strain, Colombia) and ZIKV (PRVABC58 strain, Puerto Rico) were co-inoculated into C6/36 cells using two multiplicity of infection (MOI) combinations: 0.1 for both viruses and 1.0 for ZIKV, 0.1 for PIUV. Wells were infected in triplicate with either PIUV and ZIKV coinfection, ZIKV-only, or PIUV-only. Mock infected cells served as control wells. The cell suspension was collected daily 7 days post-infection. Zika virus load was titrated by TCID50 on Vero 76 cells. The ZIKV-only infection and PIUV and ZIKV coinfection experiments were also quantified by RT-qPCR. We also investigated whether ZIKV interfered in the PIUV replication. PIUV suppressed the replication of ZIKV, resulting in a 10,000-fold reduction in ZIKV titers within 3 days post-infection. PIUV viral loads were not reduced in the presence of ZIKV. We conclude that, when concurrently infected, PIUV suppresses ZIKV in C6/36 cells while ZIKV does not interfere in PIUV replication.

Viral Interference between the Insect-Specific Virus Brejeira and the Saint Louis Encephalitis Virus In Vitro.

The Saint Louis encephalitis virus (SLEV) is an encephalitogenic arbovirus (Flaviviridae family) that has a wide geographical distribution in the western hemisphere, especially in the Americas. The negevirus Brejeira (BREV) was isolated for the first time in Brazil in 2005. This study aimed to verify the existence of a possible interfering effect of BREV on the course of SLEV infection and vice versa. We used clone C6/36 cells. Three combinations of MOIs were used (SLEV 0.1 × BREV 1; SLEV 1 × BREV 0.1; SLEV 1 × BREV 1) in the kinetics of up to 7 days and then the techniques of indirect immunofluorescence (IFA), a plaque assay on Vero cells, and RT-PCR were performed. Our results showed that the cytopathic effect (CPE) caused by BREV was more pronounced than the CPE caused by SLEV. Results of IFA, the plaque assay, and RT-PCR showed the suppression of SLEV replication in the co-infection condition in all the MOI combinations used. The SLEV suppression was dose-dependent. Therefore, the ISV Brejeira can suppress SLEV replication in Aedes albopictus cells, but SLEV does not negatively interfere with BREV replication.

Isolation of Flaviviruses and Alphaviruses with Encephalitogenic Potential Diagnosed by Evandro Chagas Institute (Pará, Brazil) in the Period of 1954-2022: Six Decades of Discoveries.

Viruses with encephalitogenic potential can cause neurological conditions of clinical and epidemiological importance, such as Saint Louis encephalitis virus, Venezuelan equine encephalitis virus, Eastern equine encephalitis virus, Western equine encephalitis virus, Dengue virus, Zika virus, Chikungunya virus, Mayaro virus and West Nile virus. The objective of the present study was to determine the number of arboviruses with neuroinvasive potential isolated in Brazil that corresponds to the collection of viral samples belonging to the Department of Arbovirology and Hemorrhagic Fevers, Evandro Chagas Institute (SAARB/IEC) of the Laboratory Network of National Reference for Arbovirus Diagnosis from 1954 to 2022. In the analyzed period, a total of 1,347 arbovirus samples with encephalitogenic potential were isolated from mice; 5,065 human samples were isolated exclusively by cell culture; and 676 viruses were isolated from mosquitoes. The emergence of new arboviruses may be responsible for diseases still unknown to humans, making the Amazon region a hotspot for infectious diseases due to its fauna and flora species characteristics. The detection of circulating arboviruses with the potential to cause neuroinvasive diseases is constant, which justifies the continuation of active epidemiological surveillance work that offers adequate support to the public health system regarding the virological diagnosis of circulating arboviruses in Brazil.

Percepção de Hipertensos e Diabéticos sobre a Adesão ao Tratamento Farmacológico e Não Farmacológico

Objetivo: Identificar a percepção dos pacientes hipertensos e diabéticos acompanhados pela Estratégia Saúde da Família (ESF) sobre os motivos de não adesão ao tratamento farmacológico e não farmacológico. Método: Trata-se de uma pesquisa exploratória de abordagem qualitativa realizada com hipertensos e diabéticos acompanhados pela ESF em um município do interior do Estado de São Paulo. Para a coleta de dados utilizou-se um roteiro semiestruturado, as entrevistas foram gravadas e transcritas e as respostas analisadas de acordo com a análise de conteúdo proposta por Minayo. Resultados: A maioria dos entrevistados 12 (92,31%) refere que recebe orientações sobre o tratamento da hipertensão e diabetes da equipe de saúde. 4 (30,77%) dos entrevistados referem que apresentam complicações decorrentes dessas doenças como insuficiência cardíaca, úlceras diabéticas nos pés e amputação de dedos dos pés. 12 (92,31%) referem tomar medicamentos para controle da hipertensão e diabetes, enquanto 1 (7,69%) relata que não faz uso de medicações. Considerações finais: A maioria dos pacientes somente utilizam a medicação para controle da hipertensão e diabetes, pois entendem que é o suficiente. E Alguns pacientes não entendem o significado da doença nem sua consequência, sendo esses os principais motivos da não adesão ao tratamento não farmacológico.

Discovery and genome sequencing of a new virus related to members of the family Tymoviridae, isolated from mosquitoes of the genus Mansonia in Brazil.

A new virus, named Mutum virus, related to members of the family Tymoviridae, was isolated from mosquitoes (Mansonia spp.) in clone C6/36 cells, and its complete genome was sequenced. Its genome is 6494 nt in size with an organization resembling that of tymovirids. The isolated virus is phylogenetically related to two viruses isolated from Culex spp. mosquitoes: Ek Balam virus, reported in Mexico, and Culex-originated Tymoviridae-like virus, isolated in China. The results of this study suggest that this virus is a new member of the family Tymoviridae.

Absence of Anti-RBD Antibodies in SARS-CoV-2 Infected or Naive Individuals Prior to Vaccination with CoronaVac Leads to Short Protection of Only Four Months Duration.

The COVID-19 pandemic is the biggest public health threat facing the world today. Multiple vaccines have been approved; however, the emergence of viral variants such as the recent Omicron raises the possibility of booster doses to achieve adequate protection. In Brazil, the CoronaVac (Sinovac, Beijing, China) vaccine was used; however, it is important to assess the immune response to this vaccine over time. This study aimed to monitor the anti-SARS-CoV-2 antibody responses in those immunized with CoronaVac and SARS-CoV-2 infected individuals. Samples were collected between August 2020 and August 2021. Within the vaccinated cohort, some individuals had a history of infection by SARS-CoV-2 prior to immunization, while others did not. We analyzed RBD-specific and neutralizing-antibodies. Anti-RBD antibodies were detected in both cohorts, with a peak between 45-90 days post infection or vaccination, followed by a steady decline over time. In those with a previous history of COVID-19, a higher, longer, more persistent response was observed. This trend was mirrored in the neutralization assays, where infection, followed by immunization, resulted in higher, longer lasting responses which were conditioned on the presence of levels of RBD antibodies right before the vaccination. This supports the necessity of booster doses of CoronaVac in due course to prevent serious disease.

Arbovirus outbreak in a rural region of the Brazilian Amazon.

BACKGROUND: An outbreak of febrile illness was reported from January to February 2018 in the Expedito Ribeiro Settlement, ​​Santa Bárbara do Pará municipality, Pará State, Brazil. OBJECTIVE: This study aimed to investigate the pathogenic agent responsible for the outbreak and the circulation of arboviruses in the region. STUDY DESIGN: We analyzed 94 individuals through laboratory tests for arboviruses. Forty out of 94 individuals were asymptomatic but were living with or near febrile cases, and 55 participants were symptomatic. RESULTS: Our results showed that 51.1% of the investigated individuals were positive for arboviruses (Oropouche, Mayaro, and Chikungunya), of which 77.8% were symptomatic. We detected 93.7% of positive cases for Oropouche infection, 2.1% for Mayaro fever, and 4.2% were positive for both Oropouche and Chikungunya infection. CONCLUSION: Oropouche virus was mainly responsible for the outbreak; however, we also detected a few Chikungunya and Mayaro fever cases. Serologic assays showed evidence of arboviruses circulation of different genera in the area.

Physiotherapeutic approaches to treat anal incontinence in women after obstetric trauma

Introduction: Anal incontinence is defined as the loss of voluntary control of fecal matter or gases with a recurrence period longer than 3 months in individuals aged ≥ 4 years; it has a female predominance. Among the treatment modalities is pelvic physiotherapy, the second line of treatment, which promotes the reeducation, coordination, and strengthening of the muscles of the pelvic floor to enable patients to return to their regular activities of daily living. Objective: To perform a systematic review on the physiotherapeutic treatments used in women between the ages of 18 and 65 years with a diagnosis of anal incontinence. Material and methods Clinical studies written in Portuguese, Spanish and English were searched on the the following databases: Science Direct, Medical Literature Analysis and Retrieval System Online (Medline) via PubMed, Physiotherapy Evidence Database (PEDro), Scientific Electronic Library Online (SciELO), and Scopus. Results: Of the 998 articles found, only 4 studies met the inclusion criteria of the present systematic review. The physiotherapeutic approaches to treat women with anal incontinence are biofeedback, Kegel exercises, electrostimulation, and training of the pelvic floor muscles. The average score on the PEDro scale was of 6.25, which indicates that the methodological quality was good. Conclusion: Although pelvic physiotherapy is effective to treat anal incontinence, it must be promoted through the performance of evidence-based scientific research. (AU)

Negeviruses isolated from mosquitoes in the Brazilian Amazon.

BACKGROUND: There are several groups of viruses including Insect Specific Viruses (ISV) such as the taxon Negevirus, a group of viruses phylogenetically related to plant viruses. Negeviruses replicate in mosquito cells, but not in vertebrate cells. METHODS: Pools of hematophagous arthropods were inoculated in Vero and C6/36 cells. The cells were observed to detect possible cytopathic effect. Then, indirect immunofluorescence, RT-PCR, and nucleotide sequencing were performed. RESULTS: Seven samples which presented negative results for flaviviruses, alphaviruses and bunyaviruses, but showed cytopathic effect in C6/36 cells were sequenced. We identified the occurrence of a variety of ISVs, most of them belonging to the taxon Negevirus: The Brejeira, Negev, Cordoba and Wallerfield viruses, including a new virus for science, tentatively named Feitosa virus. CONCLUSIONS: We detected negeviruses in the Amazon region, including two viruses that were isolated for the first time in Brazil: Cordoba virus and the Negev virus and, a new virus for science: the Feitosa virus.

Perspectives on New Vaccines against Arboviruses Using Insect-Specific Viruses as Platforms.

Arthropod-borne viruses (arboviruses) are global pathogens circulating endemically with local explosive outbreaks and constant encroachment into new locations. Few vaccines against arboviruses exist; most for humans are in development or clinical trials. Insect-specific viruses (ISVs) offer a unique platform for expression of arbovirus proteins, through the creation of ISV/arbovirus chimeras. Studies have shown promising results of these vaccines with several advantages over their wild-type counterparts. In this review, we discuss the current status of these potential vaccines using ISVs.

Insect-Specific Viruses: An overview and their relationship to arboviruses of concern to humans and animals.

The group of Insect-specific viruses (ISVs) includes viruses apparently restricted to insects based on their inability to replicate in the vertebrates. Increasing numbers of ISVs have been discovered and characterized representing a diverse number of viral families. However, most studies have focused on those ISVs belonging to the family Flaviviridae, which highlights the importance of ISV study from other viral families, which allow a better understanding for the mechanisms of transmission and evolution used for this diverse group of viruses. Some ISVs have shown the potential to modulate arboviruses replication and vector competence of mosquitoes. Based on this, ISVs may be used as an alternative tool for biological control, development of vaccines, and diagnostic platforms for arboviruses. In this review, we provide an update of the general characteristics of ISVs and their interaction with arboviruses that infect vertebrates.

Spatio-temporal distribution of human American visceral leishmaniasis in the Western region of Sao Paulo State, from 2004 to 2018.

Leishmaniasis comprises a group of zoonotic diseases caused by protozoa belonging to the Leishmania genus, noting that the visceral form is the most severe and lethal, if untreated. Nowadays visceral leishmaniasis is widespread in Brazil and the Adamantina microregion, located in the west of Sao Paulo State, has been affected by Human American Visceral Leishmaniasis (HAVL) since 2004. We evaluated the epidemiological profile of HAVL in the Adamantina microregion through a Geographic Information Systems (GIS) and established its incidence rate by location and time. Notified cases were provided by the Sao Paulo State Epidemiological Surveillance Center. Home addresses of patients who tested positive to HAVL were converted into geographic coordinates through the Google Geocoding Application Programming Interface submitted to ArcMap 10.5 System for georeferencing. Kernel spatial analyses were performed to obtain the incidence distribution and the total area involvement rate. From 2004 to 2018, 325 cases of HAVL were diagnosed in 11 of the 12 municipalities belonging to the of Adamantina microregion. The disease has disseminated to the Northwest and East-Southeast directions, taking place along the Comandante Joao Ribeiro de Barros highway, with higher incidences rates in the municipalities where the highway passes. HAVL incidence was higher in children aged between 0 to 9 years and in the elderly; there was no difference in relation to sex and the majority of cases were located in urban areas. The determination of the epidemiological profile and the the spread of disease patterns can indicate possible areas of vulnerability, in order to contribute to the management and prevention of the disease through a strategic resources optimization.

Dilemas de profissionais de unidade de terapia intensiva diante da terminalidade / The dilemmas of the professionals of the intensive care unit in face of the terminality / Dilemas de los profesionales de una unidad de terapia intensiva frente a la terminalidad

Resumo O objetivo geral deste artigo é compreender como profissionais intensivistas vivenciam a terminalidade e seus impasses bioéticos. O estudo apresenta resultados de pesquisa de campo quali-quantitativa com 12 intensivistas de um hospital público estadual. Foram utilizados na coleta de dados questionário sociodemográfico e entrevista semiestruturada, gravada em áudio e transcrita posteriormente. Os dados foram processados com auxílio do software Iramuteq, que analisa textos estatisticamente. O estudo evidencia como os profissionais compreendem de forma superficial o fim da vida e os dilemas bioéticos decorrentes, faltando base para decisões terapêuticas. Pode-se perceber que a vivência dos profissionais é permeada por dificuldades e sentimentos diversos. Por fim, conclui-se que é necessário investir em educação continuada para trabalhar temas da bioética como a terminalidade. Aprovação CEP-Uespi 2.153.848

Abstract The intensivists are in a context that involves terminality and its bioethical impasses. This article presents the results of a field study, with a quantitative and qualitative approach, carried out with 12 intensivists of a state public hospital. A sociodemographic questionnaire and a semi structured interview, recorded in audio and later transcribed, were used for the research. Content analysis was performed using the Iramuteq software to treat the collected data. The study shows that the professionals understand the end of life and the resulting ethical dilemmas in a superficial way, lacking the basis for the decisions about the best therapy for the patient. It was possible to perceive that the experiences of professionals are permeated by different difficulties and feelings. It is necessary that there be investment in continuing education to work on the themes of bioethics and terminality. Aprovação CEP-Uespi 2.153.848

Resumen El objetivo general de este artículo es comprender cómo los profesionales intensivistas vivencian la terminalidad y sus impases bioéticos. El estudio presenta resultados de un estudio de campo cuali-cuantitativo con 12 intensivistas de un hospital público estadual. Para la recolección de datos se utilizaron un cuestionario sociodemográfico y una entrevista semiestructurada, grabada en audio y transcripta posteriormente. Los datos fueron procesados con ayuda del software Iramuteq, que analiza textos estadísticamente. El estudio evidencia cómo los profesionales comprenden de forma superficial el fin de la vida y los dilemas bioéticos resultantes, careciendo de una base para las decisiones terapéuticas. Se puede percibir que la vivencia de los profesionales está permeada por dificultades y sentimientos diversos. Finalmente, se concluye que es necesario invertir en formación continua para trabajar temas de bioética como la terminalidad. Aprovação CEP-Uespi 2.153.848

Experimental infection of golden hamsters with Guama virus (Peribunyaviridae, Orthobunyavirus).

The Guama virus (GMAV) is a member of Peribunyaviridae family, Orthobunyavirus genus. Several strains of the virus were isolated in South and Central Americas from several hosts, such as humans, wild animals, including nonhuman primates, wild rodents and mosquitoes as well as mice used as sentinels. The virus is able to cause febrile disease in humans. Here we describe for the first time pathologic and biochemical findings in golden hamsters (Mesocricetus auratus) infected with the prototype GMAV. Blood and organs of infected and control animals were collected every 24 h after infection from the 1st to the 7th day post infection (dpi) and at 21 dpi when experiment was ended. The tissues were processed for histopathology and immunohistochemistry. The blood and serum were used to determine viremia and biochemical markers plus to detect anti-GMAV antibodies. The viremia was early detected already on the 1st dpi and it was no longer detected on the 3rd dpi. Total anti-GMAV antibodies were detected from the 6th dpi. Hepatic markers as ALT of infected animals were increased and showed statistically significant difference in comparison with control animals, indicating damage of the liver; indeed the liver was the most affected organ, but other organs presented lesions and positive GMAV immunostaining as brain, lung, liver, spleen, and kidney. Our findings indicate that golden hamsters are a good animal model for experimental infection of the GMAV.

Contracepção de emergência: conhecimento do fármaco por adolescentes / Emergency contraception: knowledge of the drug by adolescents

Objetivo: Identificar o conhecimento de adolescentes sobre a contracepção de emergência. Método: pesquisa com delineamento transversal e descritiva com a participação de 24 adolescentes do sexo feminino, com média de idade de 17 anos. Utilizou-se para a coleta de dados um questionário elaborado pelos próprios autores, contendo escala do tipo Likert que disponibilizava cinco opções de respostas, sendo elas: sim, provavelmente sim, provavelmente não, não e não sei. Resultados: 91,67% das adolescentes referiram já ter ouvido falar sobre contraceptivos de emergência (CE), 70% responderam saber sua função, porém 41,67% referiram que não sabem se o fármaco possui contraindicações. Sobre a disponibilização da pílula no Sistema Único de Saúde 33,33% revelou não saber e 25% assinalou que provavelmente sim, o que mostra dúvida sobre a disponibilização do medicamento. 54,17% das alunas responderam que anticoncepcionais de uso diário são fármacos distintos dos CE, 50% respondeu que o CE deve ser utilizado até 72 horas após a relação sexual desprotegida, 58,33 refere que não há limite de tempo para a eficácia do fármaco e 45,83% referiu que já fez uso do método. Conclusão: Parte significativa das adolescentes conhece o CE, no entanto há fragilidades no conhecimento das contraindicações, eficácia e utilização.

Objective: to identify the knowledge of adolescents about emergency contraception. Method: this is a crosssectional and descriptive study with participation of 24 female adolescents, with a mean age of 17 years. A questionnaire elaborated by the authors (Likert-type) was used to data collection, which provided five options of answers, being: "yes", "it is likely", "No", it is not likely", "and "I don?t know". Results: 91.67% of the adolescents reported that they have already heard about emergency contraception (EC), 70% said that they had known their function, but 41.67% said that they didn?t know if the drug could have contraindications. Regarding the availability of the pill in the Unified Health System 33,33% revealed not knowing, 25% choose the alternative "It is not likely", which shows doubts about the availability of the medicine, 54.17% of the female students answered that daily contraceptives are drugs different than ECs, 50% answered that EC should be used up to 72 hours after unprotected sexual intercourse, 58,33 states that there is no time limit for the efficacy of the medicine and 45.83% reported that they have already used the method. Conclusion: A significant number of adolescents are familiar with EC, but there are weaknesses in relation to the knowledge about contraindications, efficacy and use.