Case Report: Fatal Viscerotropic Disease in a Young Woman Following Yellow Fever Vaccination.

Yellow fever is a viral hemorrhagic disease, and vaccination is the most effective way to minimize the impact of the disease. Serious adverse events after yellow fever vaccination are rare. We report the case of a young woman with an unusual presentation of yellow fever 17DD vaccine-associated acute viscerotropic disease, with severe hepatic impairment following a long incubation period. She died more than a month after yellow fever vaccination.

Declining prevalence of hepatitis A and silent circulation of hepatitis E virus infection in southeastern Brazil.

OBJECTIVES: Hepatitis A virus (HAV) infection is considered highly endemic in Brazil, especially in low-income areas. In contrast, only a few human cases of hepatitis E have been reported. This study aimed to estimate the prevalence and potential risk factors of HAV and hepatitis E virus (HEV) infections in an adult population from a rural township of southeastern Brazil. METHODS: We conducted a cross-sectional survey using serum samples from urban and rural residents of Cássia dos Coqueiros, São Paulo state. A total of 990 samples were tested for anti-HAV IgG by chemiluminescent microparticle immunoassay, and a subset of 248 samples tested for anti-HEV IgG, using two commercial ELISA. Variables associated with anti-HAV and anti-HEV positivity were assessed by a multivariate analysis using a binomial logistic regression model. RESULTS: Seroprevalence of HAV and HEV was 89.1% and 20.7%, respectively. Age was significantly associated with HAV infection. Wantai and Mikrogen ELISA yielded comparable HEV seroprevalence results. CONCLUSIONS: Anti-HAV seroprevalence has declined and correlates with age, whereas anti-HEV was significantly higher than that found in previous population-based studies. These results indicate a need for further investigations of the magnitude of HEV infection in Brazil using the currently available, more sensitive diagnostic methods.

Correction to: Malaria and other febrile diseases among travellers: the experience of a reference centre located outside the Brazilian Amazon Region.

Following publication of the original article [1], one of the authors flagged that unfortunately their last name, Doltario, was incorrectly spelled as 'Dotrário'. This has since been corrected in the original article [1].

Malaria and other febrile diseases among travellers: the experience of a reference centre located outside the Brazilian Amazon Region.

BACKGROUND: Malaria is endemic in countries located in tropical and sub-tropical regions. The increasing flow of domestic and international travellers has made malaria a relevant health problem even in non-endemic regions. Malaria has been described as the main diagnosis among travellers presenting febrile diseases after returning from tropical countries. In Brazil, malaria transmission occurs mainly in the Amazon region. Outside this area, malaria transmission is of low magnitude. METHODS: This cross-sectional study aimed to describe the experience in the diagnosis of malaria in a reference centre located outside the Brazilian Amazon Region, emphasizing the differences in clinical and laboratory markers between cases of malaria and those of other febrile diseases (OFD). Medical charts from adult patients (≥18 years) who underwent a thick smear test (TST) for malaria, between January 2001 and December 2014, were retrospectively reviewed. RESULTS: A total of 458 cases referred to perform the TST were included. Malaria was diagnosed in 193 (42 %) episodes. The remaining 265 episodes (58 %) were grouped as OFD. The majority of malaria episodes were acquired in the Brazilian Amazon Region. The median time between the onset of symptoms and the TST was 7 days. Only 53 (11.5 %) episodes were tested within the first 48 h after symptom onset. Comparing malaria with OFD, jaundice, nausea, vomiting, and reports of fever were more prevalent in the malaria group. Low platelet count and elevated bilirubin levels were also related to the diagnosis of malaria. CONCLUSIONS: The results indicate that outside the endemic area travellers presenting febrile disease suspected of being malaria underwent diagnostic test after considerable delay. The reporting of fever combined with a recent visit to an endemic area should promptly evoke the hypothesis of malaria. In these cases, specific diagnostic tests for malaria should be a priority. For cases that jump this step, the presence of elevated bilirubin or thrombocytopaenia should also indicate a diagnosis of malaria.