ABSTRACT
The yellow fever virus (YFV) epidemic in Brazil is the largest in decades. The recent discovery of YFV in Brazilian Aedes species mosquitos highlights a need to monitor the risk of reestablishment of urban YFV transmission in the Americas. We use a suite of epidemiological, spatial, and genomic approaches to characterize YFV transmission. We show that the age and sex distribution of human cases is characteristic of sylvatic transmission. Analysis of YFV cases combined with genomes generated locally reveals an early phase of sylvatic YFV transmission and spatial expansion toward previously YFV-free areas, followed by a rise in viral spillover to humans in late 2016. Our results establish a framework for monitoring YFV transmission in real time that will contribute to a global strategy to eliminate future YFV epidemics.
Subject(s)
Disease Outbreaks/prevention & control , Epidemiological Monitoring , Genomics/methods , Yellow Fever/prevention & control , Yellow Fever/transmission , Yellow fever virus/isolation & purification , Aedes/virology , Age Factors , Animals , Brazil/epidemiology , Disease Outbreaks/statistics & numerical data , Evolution, Molecular , Humans , Phylogeny , Polymerase Chain Reaction , Risk , Sex Factors , Spatio-Temporal Analysis , Yellow Fever/epidemiology , Yellow Fever/virology , Yellow fever virus/classification , Yellow fever virus/geneticsABSTRACT
INTRODUCTION: The real magnitude of maternal mortality in the city of Uberlândia, Brazil, is fairly unknown. The aim is to identify the characteristics of maternal mortality in the city during 1997. METHODS: Death certificates of women between 10-49 years old from Uberlândia were used as a main data source with additional interviews with family members. Only women between 10- 49 years of age at time of death were included. Maternal deaths were further confirmed at the health services level by checking medical records and interviewing physicians. All maternal deaths occurring up to one year after delivery were investigated. Data was collected on delivery conditions, frequency of prenatal care visits, gestational age at death, previous pregnancy complications, site of death, and any avoidable conditions. Maternal mortality rates (MMR) per 100,000 newborns were calculated. RESULTS: There were a total of 204 deaths, but only 173 were from Uberlândia residents. Six maternal deaths were registered, four (66.7%) up to 42 days after delivery, and two (33.3%) up to 43 days to 1 year. Direct obstetric causes (toxemia- 60%; haemorrhage- 40%) were associated with 5 deaths (83.3%), and indirect (16.7%) with 1 death (cardiac disease). The MMR calculated from death certificates was 22.2 but the adjusted rate was 66.6. CONCLUSIONS: The MMR is above the expected. It is necessary to pay more attention to the quality of prenatal and delivery care as well as to the correct way of filling out death certificates.
