Vertical Transmission of Oropouche Virus in a Newly Affected Extra-Amazon Region: A Case Study of Fetal Infection and Death in Ceará, Brazil / Transmisión vertical del virus Oropouche en una región extraamazónica recientemente afectada: un estudio de caso de infección y muerte fetal en Ceará, Brasil / Transmissão vertical do vírus Oropouche em uma região extra-amazônica recentemente afetada: um estudo de caso de infecção fetal e morte no Ceará, Brasil

The recent geographic spread of Oropouche virus (OROV), coupled with an increase in cases and the emergence of previously unrecognized severe manifestations, has raised significant public health concerns. We report the case of a 40-year-old family farmer at 31 weeks of gestation who presented with fever, myalgia, and headache. OROV infection was confirmed by RT-qPCR, with other infections ruled out. Initially, maternal and fetal health assessments revealed no complications. However, within a week, the patient noted decreased fetal movements, and ultrasound confirmed fetal demise. Molecular diagnostics identified OROV RNA in multiple fetal tissues, confirming vertical transmission. This case highlights the urgent need to protect pregnant women against viral vectors and include OROV into the differential diagnosis of febrile illnesses. Furthermore, it is critical to further investigate the pathogenic mechanisms of this virus, which may lead to changes in public health policies and clinical guidelines.

La reciente propagación geográfica del virus Oropouche (OROV), junto con un aumento de casos y la aparición de manifestaciones graves no reconocidas previamente, ha suscitado importantes preocupaciones de salud pública. Informamos del caso de un agricultor familiar de 40 años de edad con 31 semanas de gestación que presentó fiebre, mialgia y dolor de cabeza. La infección por OROV se confirmó mediante RT-qPCR, y se descartaron otras infecciones. Inicialmente, las evaluaciones de salud materna y fetal no revelaron complicaciones. Sin embargo, en una semana, la paciente notó una disminución de los movimientos fetales y la ecografía confirmó la muerte fetal. Los diagnósticos moleculares identificaron ARN de OROV en múltiples tejidos fetales, lo que confirmó la transmisión vertical. Este caso destaca la necesidad urgente de proteger a las mujeres embarazadas contra los vectores virales e incluir OROV en el diagnóstico diferencial de enfermedades febriles. Además, es fundamental investigar más a fondo los mecanismos patogénicos de este virus, lo que puede conducir a cambios en las políticas de salud pública y las pautas clínicas.

A recente disseminação geográfica do vírus Oropouche (OROV), juntamente com um aumento de casos e o surgimento de manifestações graves não reconhecidas anteriormente, levantou preocupações significativas de saúde pública. Relatamos o caso de uma agricultora familiar de 40 anos com 31 semanas de gestação que apresentou febre, mialgia e dor de cabeça. A infecção por OROV foi confirmada por RT-qPCR, com outras infecções descartadas. Inicialmente, as avaliações de saúde materna e fetal não revelaram complicações. No entanto, dentro de uma semana, a paciente notou diminuição dos movimentos fetais, e o ultrassom confirmou a morte fetal. O diagnóstico molecular identificou o RNA do OROV em vários tecidos fetais, confirmando a transmissão vertical. Este caso destaca a necessidade urgente de proteger as mulheres grávidas contra vetores virais e incluir o OROV no diagnóstico diferencial de doenças febris. Além disso, é fundamental investigar mais profundamente os mecanismos patogênicos deste vírus, o que pode levar a mudanças nas políticas de saúde pública e diretrizes clínicas.

O ensino da saúde coletiva no Brasil: uma revisão integrativa / Teaching public health in Brazil: an integrative review

RESUMO O ensino da saúde coletiva no Brasil contribui para o desenvolvimento técnico-científico do campo, transcendendo a mera abordagem de programas de saúde de forma fragmentada. Assim, objetivou-se neste estudo compreender a operacionalização do ensino em saúde coletiva, na graduação e pós-graduação stricto sensu, no Brasil. Trata-se de uma revisão integrativa de literatura a partir da busca nas bases de dados PubMed, Scopus, PsycINFO, Literatura Latino-americana e do Caribe em Ciências da Saúde (Lilacs), Scientific Electronic Library Online (SciELO) e Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde (Bireme). Foram analisados 21 artigos por título, autor, ano, caracterização e/ou objetivo, metodologia e principais resultados. Conclui-se que a institucionalização de cursos de pós-graduação no campo da saúde coletiva seguiu o movimento educacional da universidade e a Reforma Sanitária Brasileira, ao passo que cursos de graduação só ocorreram na última década. O marco constitucional de 1988 define o ordenamento de recursos humanos para a formação profissional no e para o sistema de saúde no País.

ABSTRACT The teaching of public health in Brazil contributes to the technical-scientific development of the field, transcending the mere approach of health programs in a fragmented way. Thus, the objective of this study was to understand the operationalization of teaching in public health, in the stricto sensu undergraduate and graduate programs, in Brazil. This is an integrative literature review based on a search in PubMed, SCOPUS, PsycINFO, Latin American and Caribbean Health Sciences (LILACS), Scientific Electronic Library Online (SciELO) databases, and the Latin American and Caribbean Center on Health Sciences Information (BIREME). Twenty-one articles were analyzed by title, author, year, characterization and/or objective, methodology, and main results. It is concluded that the institutionalization of graduate courses in the field of public health followed the educational movement of the university and the Brazilian Health Reform, while undergraduate courses only took place in the last decade. The 1988 constitutional framework defines the ordering of human resources for professional training in and for the country's health system.

Perfil epidemiológico das mães e crianças constantes nas declarações de nascidos vivos e nas declarações de óbito / Epidemiological profile of mothers and children contained in the declarations of live births and the death certificates

Objetivo: Analisar o perfil epidemiológico das mães e das crianças constantes nas declarações de nascidos vivos e nas declarações de óbito. Métodos: Trata-se de um estudo transversal com dados secundários obtidos no Sistema de Informação de Nascidos Vivos (SINASC) e no Sistema de Informação de Mortalidade (SIM) da Secretaria Municipal de Saúde de Fortaleza - CE. A amostra foi constituída por 588 registros, sendo 147 óbitos e 441 não óbitos. As variáveis analisadas foram: idade, escolaridade, estado civil materno, tipo de gestação, número de consultas de pré-natal, idade gestacional, tipo de parto, sexo da criança, índice de Apgar no 1o e no 5° minuto e peso ao nascer. Na análise descritiva, utilizaram-se valores absolutos e relativos, média e desvio padrão. Na análise inferencial utilizou-se o teste do Qui-quadrado, ao nível de significância de 5%. Resultados: Das variáveis estudadas, aquelas que apresentaram associação significativa com o desfecho foram: escolaridade (p < 0,001), tipo de gestação (p < 0,001), número de consultas de pré-natal (p = 0,025), idade gestacional (p < 0,001), tipo de parto (p < 0,001) e peso ao nascer (p < 0,001). Conclusão: Concluiu-se que, diferente do perfil epidemiológico dos não óbitos, os óbitos são caraterizados por serem de mães jovens, vivendo sem companheiro, pouco grau de instrução, com gravidez gemelar, idade gestacional menor que 36 semanas, parto vaginal e baixo peso do recém-nascido ao nascer.

Objective: To analyze the epidemiological profile of mothers and children in declarations of live births and death certificates. Methods: This is a cross-sectional study with secondary data obtained from the Live Birth Information System (SINASC) and the Mortality Information System (SIM) of the Municipal Health Secretariat Office of Fortaleza-CE. The sample consisted of 588 records, 147 deaths and 441 non-deaths. The variables analyzed were: age, education, maternal marital status, gestation type, number of prenatal consultations, gestational age, type of delivery, gender, Apgar score at 1 and 5 minutes, and birth weight. In the descriptive analysis, absolute and relative values, mean and standard deviation were used. In the inferential analysis, the chi-square test was used at a significance level of 5%. Results: Among the variables studied, those that were significantly associated with the outcome were: education (p<0.001), type of pregnancy (p<0.001), number of prenatal consultations (p=0.025), gestational age (p<0.001), type of delivery (p<0.001) and birth weight (p<0.001). Conclusion: It is concluded that different from the epidemiological profile of non- death, deaths are characterized by being of young mothers, living without a partner, little education, twin pregnancy, gestational age less than 36 weeks, vaginal delivery, and low birth weight born of the newborn at birth.

Neurological growth and development of children asymptomatic at birth whose mothers had Zika during pregnancy.

INTRODUCTION: Newborn who had Zika vírus but did not show microcephaly at birth may have neuropsychomotor development problems. We aimed to evaluate the developmental and anthropometric milestones of asymptomatic children whose mothers had Zika during pregnancy in Northeastern Brazil in 2015 and 2016. METHODS: We conducted a descriptive cross-sectional case series study of children in Fortaleza born without microcephaly whose mothers had Zika during pregnancy. Home visits were undertaken to evaluate the developmental milestones and gather anthropometric data of the children and to conduct semi-structured interviews with the mothers to identify their socioeconomic and gestational profiles and assess the newborns after birth. RESULTS: In total, 30 cases were identified. Of these, 17 children and their mothers participated in the study. The median age of the mothers at the time of delivery was 26 years. All were symptomatic, and TORCH was negative. At the time of the home visit, all had growth profiles suitable for their age. However, nearly all children (15/17, 88.2%) presented at least one developmental delay, considering their age group. CONCLUSIONS: There were late changes in the neuropsychomotor development of children born to mothers who had Zika during pregnancy, suggesting the need for specialized medical follow-ups.

Neurological growth and development of children asymptomatic at birth whose mothers had Zika during pregnancy

Abstract INTRODUCTION: Newborn who had Zika vírus but did not show microcephaly at birth may have neuropsychomotor development problems. We aimed to evaluate the developmental and anthropometric milestones of asymptomatic children whose mothers had Zika during pregnancy in Northeastern Brazil in 2015 and 2016. METHODS: We conducted a descriptive cross-sectional case series study of children in Fortaleza born without microcephaly whose mothers had Zika during pregnancy. Home visits were undertaken to evaluate the developmental milestones and gather anthropometric data of the children and to conduct semi-structured interviews with the mothers to identify their socioeconomic and gestational profiles and assess the newborns after birth. RESULTS: In total, 30 cases were identified. Of these, 17 children and their mothers participated in the study. The median age of the mothers at the time of delivery was 26 years. All were symptomatic, and TORCH was negative. At the time of the home visit, all had growth profiles suitable for their age. However, nearly all children (15/17, 88.2%) presented at least one developmental delay, considering their age group. CONCLUSIONS: There were late changes in the neuropsychomotor development of children born to mothers who had Zika during pregnancy, suggesting the need for specialized medical follow-ups.

Maternal and infant death after probable vertical transmission of chikungunya virus in Brazil - case report.

BACKGROUND: Chikungunya virus infection in neonates is relatively rare and can lead to death. CASE PRESENTATION: We report the occurrence of the first death of a mother and child after probable vertical transmission of chikungunya virus in Brazil. A 28-year-old pregnant woman with hypertension presented with symptoms compatible with an arboviral disease at 34 weeks' gestation. She developed preeclampsia with severe respiratory failure which resulted in the emergency cesarean section, and the patient died 12 days after the onset of symptoms. The pre-term newborn weighed 2535 g, with an Apgar score of 4/8. He was referred to the neonatal ICU with neutrophilia and thrombocytopenia, several seizure episodes, and hemorrhagic disorders, which resulted in death. Chikungunya IgM antibody was detected in the cerebrospinal fluid. CONCLUSIONS: We present the first documented maternal and neonatal death in Brazil after probable chikungunya infection during pregnancy.

Fatores associados à mortalidade neonatal com ênfase no componente da atenção hospitalar ao recém-nascido / Factors associated with neonatal moratality with empashis on hospital care component newborn

Analisar os fatores associados à mortalidade neonatal com ênfase no componente da atenção hospitalar ao recém-nascido. Estudo do tipo caso-controle que investigou à ocorrência de óbito hospitalar de recém-nascidos até o 27º dia de vida. Foram realizados testes de associação ao nível de significância de 5%. Adotou-se como critério de entrada das variáveis no modelo o p<0,20 e para permanecerem o valor de p<0,05. Na regressão logística, utilizou-se a medida da força de associação dada pela Odds Ratio (OR) bruta e ajustada. Por fim, realizou-se a regressão logística múltipla, apenas com as variáveis significativas, de cada nível hierarquizado. As variáveis associadas ao desfecho mortalidade neonatal hospitalar que compuseram o modelo final da regressão logística foram: indução ao parto (p=0,01), Apgar no 5º minuto de vida menor que sete (p=0,002), presença de malformação congênita (p=0,002) e necessidade de uso de surfactante (p=0,001). O modelo apresentado com estas variáveis apresentou um Pseudo R2=0,7549, indicando que consegue explicar 75,49% dos óbitos neonatais. Conclui-se que o modelo final foi composto pelas variáveis: indução do parto, Apgar no 5º minuto de vida menor que sete, presença de malformação congênita e necessidade de uso de surfactante, como fatores que aumentam significativamente as chances de ocorrência de morte no período neonatal.

To analyze the factors associated with neonatal mortality with emphasis on the component of hospital care to the newborn. Study of case-control which investigated the occurrence of hospital mortality of infants up to the 27th day of life. association tests were performed at a significance level of 5%. It was adopted as entry criteria of the variables in the model p <0.20 and to remain the value of p <0.05. Logistic regression was used to measure the strength of association given by the Odds Ratio (OR) and adjusted gross. Finally, there was the multiple logistic regression, only the significant variables of each hierarchical level. The variables associated with the outcome hospital neonatal mortality that included the final logistic regression model were to labor induction (p = 0.01), Apgar score at 5 minutes of life less than seven (p = 0.002), presence of congenital malformation (p = 0.002) and need for surfactant use (p = 0.001). The model presented in these variables presented a Pseudo R2 = 0.7549, indicating that can explain 75.49% of neonatal deaths. It follows that the final model included the variables: induction of labor, Apgar score at 5 minutes of life less than seven, the presence of congenital malformation and need for surfactant use, as factors that significantly increase the chances of occurrence of death in the period neonatal.