ZikaPLAN: addressing the knowledge gaps and working towards a research preparedness network in the Americas.

Zika Preparedness Latin American Network (ZikaPLAN) is a research consortium funded by the European Commission to address the research gaps in combating Zika and to establish a sustainable network with research capacity building in the Americas. Here we present a report on ZikaPLAN`s mid-term achievements since its initiation in October 2016 to June 2019, illustrating the research objectives of the 15 work packages ranging from virology, diagnostics, entomology and vector control, modelling to clinical cohort studies in pregnant women and neonates, as well as studies on the neurological complications of Zika infections in adolescents and adults. For example, the Neuroviruses Emerging in the Americas Study (NEAS) has set up more than 10 clinical sites in Colombia. Through the Butantan Phase 3 dengue vaccine trial, we have access to samples of 17,000 subjects in 14 different geographic locations in Brazil. To address the lack of access to clinical samples for diagnostic evaluation, ZikaPLAN set up a network of quality sites with access to well-characterized clinical specimens and capacity for independent evaluations. The International Committee for Congenital Anomaly Surveillance Tools was formed with global representation from regional networks conducting birth defects surveillance. We have collated a comprehensive inventory of resources and tools for birth defects surveillance, and developed an App for low resource regions facilitating the coding and description of all major externally visible congenital anomalies including congenital Zika syndrome. Research Capacity Network (REDe) is a shared and open resource centre where researchers and health workers can access tools, resources and support, enabling better and more research in the region. Addressing the gap in research capacity in LMICs is pivotal in ensuring broad-based systems to be prepared for the next outbreak. Our shared and open research space through REDe will be used to maximize the transfer of research into practice by summarizing the research output and by hosting the tools, resources, guidance and recommendations generated by these studies. Leveraging on the research from this consortium, we are working towards a research preparedness network.

The cost of a disease targeted for elimination in Brazil: the case of schistosomiasis mansoni.

BACKGROUND: Schistosomiasis mansoni is a poverty-related parasitic infection that has a variety of clinical manifestations. We consider the disability and deaths caused by schistosomiasis unacceptable for a tool-ready disease. Its condition in Brazil warrants an analysis that will enable better understanding of the local health losses and contribute to the complex decision-making process. OBJECTIVE: This study estimates the cost of schistosomiasis in Brazil in 2015. METHODS: We conducted a cost of illness study of schistosomiasis mansoni in Brazil in 2015 based on a prevalence approach and from a societal perspective. The study included 26,499 schistosomiasis carriers, 397 hepatosplenic cases, 48 cases with the neurological form, 284 hospitalisations, and 11,368.26 years of life lost (YLL) of which 5,187 years are attributable to economically active age groups. RESULTS: The total cost of schistosomiasis mansoni in Brazil was estimated to be US$ 41,7million in 2015 with 94.61% of this being indirect costs. CONCLUSIONS: The economic burden of schistosomiasis mansoni in Brazil is high and results in the loss of productivity. Its persistence in Brazil is a challenge to public health and requires inter-sectorial interventions in areas such as indoor water supply, basic sanitation, and education.

The cost of a disease targeted for elimination in Brazil: the case of schistosomiasis mansoni

BACKGROUND Schistosomiasis mansoni is a poverty-related parasitic infection that has a variety of clinical manifestations. We consider the disability and deaths caused by schistosomiasis unacceptable for a tool-ready disease. Its condition in Brazil warrants an analysis that will enable better understanding of the local health losses and contribute to the complex decision-making process. OBJECTIVE This study estimates the cost of schistosomiasis in Brazil in 2015. METHODS We conducted a cost of illness study of schistosomiasis mansoni in Brazil in 2015 based on a prevalence approach and from a societal perspective. The study included 26,499 schistosomiasis carriers, 397 hepatosplenic cases, 48 cases with the neurological form, 284 hospitalisations, and 11,368.26 years of life lost (YLL) of which 5,187 years are attributable to economically active age groups. RESULTS The total cost of schistosomiasis mansoni in Brazil was estimated to be US$ 41,7million in 2015 with 94.61% of this being indirect costs. CONCLUSIONS The economic burden of schistosomiasis mansoni in Brazil is high and results in the loss of productivity. Its persistence in Brazil is a challenge to public health and requires inter-sectorial interventions in areas such as indoor water supply, basic sanitation, and education.

Quality of life and quality-adjusted life years of chronic schistosomiasis mansoni patients in Brazil in 2015.

Background: Measures of health-related quality of life (HRQoL) have been used to express the impact of neglected diseases and to generate indicators for health economic assessments. Schistosomiasis mansoni is a neglected disease with various clinical manifestations, including severe repercussions, caused by parasitic worms. Here we describe the quality of life of chronic schistosomiasis mansoni patients and estimate the quality-adjusted life years (QALYs) associated with chronic schistosomiasis mansoni in Brazil in 2015. Methods: A HRQoL study was carried out using the three-level European Quality of Life 5-Dimensions (EQ-5D-3L) questionnaire in 147 chronic schistosomiasis mansoni patients at an outpatient monitoring facility of an endemic state for schistosomiasis. Results: Losses in HRQoL were observed in all five dimensions of the EQ-5D-3L. Patients >60 y and 40-49 y of age reported the highest frequencies of problems. The average utility index was 0.71, and the median index was significantly lower among female patients and patients with comorbidities (0.68; p<0.05) compared with the entire sample. Approximately 26.7 QALYs were estimated for the study population and 31.2 QALYs for the chronic schistosomiasis mansoni patients in Brazil. Conclusions: The advanced forms of schistosomiasis mansoni, even during treatment, contribute to important health losses in the population dealing with the disease.

Measuring the accuracy of a point system to diagnose tuberculosis in children with a negative smear or with no smear or culture.

In Brazil, a scoring system was adopted to diagnose tuberculosis in childhood. This study determined the accuracy in diagnosing tuberculosis in children with either a negative smear or with no smear or culture conducted in a reference center in João Pessoa Paraíba - Brazil. It is a phase III validation study, using a cross-section design. The study population consisted of 167 patients attending the outpatient clinics suspected of having tuberculosis. The reference standard for the diagnosis of tuberculosis was a blind and independent review of the medical records, radiology and tuberculin test by two experts. Of the 167 patients, 60 were considered to have tuberculosis (by the reference standard diagnostics). The results for the scoring system with the cut-off of 30 points were: sensitivity 78.57% (95%-CI: 65.56-88.41%), specificity 69.16% (95%-CI: 59.50-77.73%), positive predictive value (PPV): 57.14% (95%-CI: 45.35-68.37%), negative predictive value (NPV): 86.05% (95%-CI: 76.89-92.58%), likelihood ratio (+): 2,55, pre-test probability: 34.36%, and post-test probability (+): 57.14%. This supports the current recommendation for the use of this scoring system in Brazil and similar sites with the cut-off of 30 points. However, as the discriminatory power of the point scoring system may vary across settings, it would be advisable to replicate this phase III study in different settings.

Cost-effectiveness analysis of universal childhood hepatitis A vaccination in Brazil: regional analyses according to the endemic context.

OBJECTIVE: To conduct a cost-effectiveness analysis of a universal childhood hepatitis A vaccination program in Brazil. METHODS: An age and time-dependent dynamic model was developed to estimate the incidence of hepatitis A for 24 years. The analysis was run separately according to the pattern of regional endemicity, one for South+Southeast (low endemicity) and one for the North+Northeast+Midwest (intermediate endemicity). The decision analysis model compared universal childhood vaccination with current program of vaccinating high risk individuals. Epidemiologic and cost estimates were based on data from a nationwide seroprevalence survey of viral hepatitis, primary data collection, National Health Information Systems and literature. The analysis was conducted from both the health system and societal perspectives. Costs are expressed in 2008 Brazilian currency (Real). RESULTS: A universal immunization program would have a significant impact on disease epidemiology in all regions, resulting in 64% reduction in the number of cases of icteric hepatitis, 59% reduction in deaths for the disease and a 62% decrease of life years lost, in a national perspective. With a vaccine price of R$16.89 (US$7.23) per dose, vaccination against hepatitis A was a cost-saving strategy in the low and intermediate endemicity regions and in Brazil as a whole from both health system and society perspective. Results were most sensitive to the frequency of icteric hepatitis, ambulatory care and vaccine costs. CONCLUSIONS: Universal childhood vaccination program against hepatitis A could be a cost-saving strategy in all regions of Brazil. These results are useful for the Brazilian government for vaccine related decisions and for monitoring population impact if the vaccine is included in the National Immunization Program.

Factors associated with treatment failure, dropout, and death in a cohort of tuberculosis patients in Recife, Pernambuco State, Brazil

A cohort of cases initiating tuberculosis treatment from May 2001 to July 2003 was followed in Recife, Pernambuco State, Brazil, to investigate biological, clinical, social, lifestyle, and healthcare access factors associated with three negative tuberculosis treatment outcomes (treatment failure, dropout, and death) separately and as a group. Treatment failure was associated with treatment delay, illiteracy, and alcohol consumption. Factors associated with dropout were age, prior TB treatment, and illiteracy. Death was associated with age, treatment delay, HIV co-infection, and head of family's income. Main factors associated with negative treatment outcomes as a whole were age, HIV co-infection, illiteracy, alcoholism, and prior TB treatment. We suggest the following strategies to increase cure rates: further training of the Family Health Program personnel in TB control, awareness-raising on the need to tailor their activities to special care for cases (e.g., literacy training); targeting use of directly observed therapy for higher risk groups; establishment of a flexible referral scheme to handle technical and psychosocial problems, including alcoholism; and increased collaboration with the HIV/AIDS program.

Acompanhou-se uma coorte de casos de tuberculose que iniciou o tratamento entre maio de 2001 e julho de 2003, em Recife, Pernambuco, Brasil, com o objetivo de investigar a associação de fatores biológicos, clínicos, sociais, de hábitos de vida e acesso aos serviços de saúde com falência terapêutica, abandono e óbito, separadamente e de forma agregada. Falência do tratamento esteve associada com demora para o início do tratamento, analfabetismo e consumo de álcool. Associação com o óbito foi encontrada com grupo etário, demora para o início do tratamento, co-infecção pelo HIV e renda do chefe da família. Fatores associados ao abandono foram grupo etário, tratamento prévio para tuberculose e analfabetismo. Os fatores associados aos desfechos de forma agregada foram grupo etário, co-infecção pelo HIV, analfabetismo, consumo de álcool e tratamento prévio para tuberculose. Sugere-se, para aumentar os percentuais de cura, a capacitação continuada das equipes do Programa Saúde da Família para o controle da tuberculose, adaptação das atividades de controle para situações especiais como analfabetismo, alcoolismo e co-infecção pelo HIV, direcionando o uso da terapia diretamente observada para estes grupos de risco.

Factors associated with treatment failure, dropout, and death in a cohort of tuberculosis patients in Recife, Pernambuco State, Brazil.

A cohort of cases initiating tuberculosis treatment from May 2001 to July 2003 was followed in Recife, Pernambuco State, Brazil, to investigate biological, clinical, social, lifestyle, and healthcare access factors associated with three negative tuberculosis treatment outcomes (treatment failure, dropout, and death) separately and as a group. Treatment failure was associated with treatment delay, illiteracy, and alcohol consumption. Factors associated with dropout were age, prior TB treatment, and illiteracy. Death was associated with age, treatment delay, HIV co-infection, and head of family's income. Main factors associated with negative treatment outcomes as a whole were age, HIV co-infection, illiteracy, alcoholism, and prior TB treatment. We suggest the following strategies to increase cure rates: further training of the Family Health Program personnel in TB control, awareness-raising on the need to tailor their activities to special care for cases (e.g., literacy training); targeting use of directly observed therapy for higher risk groups; establishment of a flexible referral scheme to handle technical and psychosocial problems, including alcoholism; and increased collaboration with the HIV/AIDS program.

Vigilância da hanseníase em Olinda, Brasil, utilizando técnicas de análise espacial / Leprosy surveillance in Olinda, Brazil, using spatial analysis techniques

Contribui-se com o sistema de Vigilância Epidemiológica em nível local por meio de análise espacial em razäo do predomínio do caráter urbano da hanseníase em nosso meio e por sua distribuiçäo näo homogênea - em parte, pela forma de ocupaçäo e transformaçäo do espaço urbano. Trabalha-se o conceito de risco coletivo pela definiçäo de micro-áreas homogêneas mediante o indicador de carência social, verificando-se sua coerência com padröes da distribuiçäo da hanseníase obtidos da base de dados do SINAN para o Município de Olinda no período 1991-96. Para cada estrato, definido segundo níveis semelhantes dos indicadores, foi calculado o coeficiente de detecçäo médio para o período. Ao exame da associaçäo entre carência social (risco) e coeficiente de detecçäo de hanseníase obteve-se coeficiente de explicaçäo de 66,1 por cento no modelo multiplicativo, acrescido para 84,3 por cento com a variável renda. Para atender à lógica de intervençäo, definiram-se estratos de alto, médio e baixo risco nos distritos sanitários e área programática. A construçäo desses mapas mostrou-se útil a instrumentalizar o planejamento em nível local.

Vigilância de doenças endêmicas em áreas urbanas: a interface entre mapas de setores censitários e indicadores de morbidade / Surveillance of endemic diseases in urban areas: the interface between census tract maps and morbidity data

Discute-se o eixo metodológico utilizado na construçäo de modelo de vigilância de endemias em áreas urbanas, orientado por uma análise de situçöes de risco e por indicadores epidemiológicos espaciais. Säo apresentadas as premissas básicas do modelo, os critérios de seleçäo de variáveis sócio-econômicas e as etapas metodológicas necessárias na construçäo do indicador sintético de risco. Comenta-se, também, como algumas questöes operacionais relativas à construçäo de mapas digitais de setores censitários e vinculaçäo de bancos de dados foram equacionadas. Essa abordagem, incorporando o componente da organizaçäo do espaço na vigilância de doenças endêmicas, tendo como exemplo a hanseníase e a tuberculose, privilegia o uso integrado de sistemas de informaçäo já existentes, na perspectiva de estratificar áreas urbanas diferenciadas que permite discriminar riscos desiguais para ocorrência de endemias. Essa é uma ferramenta para o planejamento e o gerenciamento das açöes voltadas para o controle das endemias nas cidades.