Oral Chagas disease outbreak by bacaba juice ingestion: A century after Carlos Chagas' discovery, the disease is still hard to manage.

BACKGROUND: Orally transmitted acute Chagas disease (ACD) primarily affects low-visibility and low-income individuals in tropical and subtropical zones. Managing ACD remains challenging even after more than 100 years of its discovery. Its spread to non-endemic areas has made it a global health issue. The aim of this work is to demonstrate the difficulties encountered in handling a real-life situation. METHODOLOGY AND FINDINGS: This report examines an outbreak of 39 cases of ACD due to oral transmission by bacaba juice ingestion that occurred in Pedro do Rosário, Maranhão, Brazil. A clinical and epidemiological investigation, including an entomological search, was conducted. Diagnosis criteria included positive peripheral blood smear (PBS), seroconversion of IgG, and a two-fold increase in IgG titer (laboratory criteria); and clinical findings, epidemiological exposure, and at least one positive IgG test (clinical-epidemiological criteria). In-house conventional polymerase chain reaction (PCR) was performed on 33 samples. All patients were treated with benznidazole. After 4.5 years, IgG levels were reassessed in 26 individuals. The mean age was 33.6 years, with no gender difference. The mean incubation period was 13.8 days, and the mean between symptom onset and treatment was 16.6 days. The most common symptoms were fever and lymphadenopathy (90%). Diagnostic success rates were 66.6% (laboratory criteria), 23% (clinical-epidemiological criteria), and 10.2% (high clinical suspicion despite negative tests). Test positivity rates were 69.7% (PBS), 91.4% (serology), and 100% (PCR). There were no deaths. Serological cure was achieved in 34.6% of cases, and IgG titers decreased in 15.3%. CONCLUSIONS AND SIGNIFICANCE: We encountered several barriers in managing ACD, including population vulnerability, reliance on outdated diagnostic techniques, lack of standardized molecular biology methods, and limited therapeutic options. This report underscores the importance of rapid surveillance and early treatment to prevent fatalities. We recommend the standardization of conventional PCR in diagnostic routines.

ASSESSMENT OF THE COMPLETENESS OF RECORDS OF AMERICAN TEGUMENTARY LEISHMANIASIS IN ENDEMIC AREA OF MARANHÃO FROM 2017 TO 2020 / AVALIAÇÃO DA COMPLETUDE DOS REGISTROS DE LEISHMANIOSE TEGUMENTAR AMERICANA EM ÁREA ENDÊMICA DO MARANHÃO DE 2017 A 2020

This study aims to evaluate the completeness of the compulsory notification forms of Cutaneous Leishmaniasis (CL) data in an endemic area in Maranhão during the period of 2017 to 2020. Descriptive and quantitative study based on data from the notification forms of patients diagnosed with CL registered at Regional de Saúde de Pinheiro - MA in the mentioned period. The fields for filling out the forms were categorized into key fields, mandatory filling and essential filling fields. Data completeness was evaluated in good, regular, low and very low completeness. The data was coded and inserted into the program Excel for Windows® 2016, version 1807, according to the variables of interest in the study. The statistical analysis was performed on Excel program and in the SPSS software, version 24.0, including the incidence calculation of each year and the absolute and relative frequencies, presented as tables. Good completeness predominated in general and for the mandatory variables, but the essential variables presented expressive scores of regular, low and very low completeness. By training the form fillers and updating the filling instructions, it is expected to improve the quality of information related to CL in the state.

Este trabalho objetiva avaliar a completude dos dados das fichas de notificação compulsória de Leishmaniose Tegumentar Americana (LTA) em área endêmica do Maranhão no período de 2017 a 2020. Estudo descritivo e quantitativo realizado a partir de dados das fichas de notificação de diagnosticados com LTA registradas na Regional de Saúde de Pinheiro ­ MA no período referido. Os campos de preenchimento das fichas foram categorizados em campos-chave, de preenchimento obrigatório e de preenchimento essencial. A completude dos dados foi avaliada em completude boa, regular, baixa e muito baixa. Os dados foram codificados e inseridos no programa Excel for Windows® 2016, versão 1807, segundo as variáveis de interesse no estudo. A análise estatística foi realizada no programa Excel e no software SPSS, versão 24.0, incluindo o cálculo de incidência de cada ano e o de frequências absolutas e relativas, apresentadas na forma de tabelas. Predominou a completude boa geral das fichas e das variáveis obrigatórias, porém as variáveis essenciais apresentaram escores expressivos de completude regular, baixa e muito baixa. Com a capacitação dos preenchedores e atualização no instrucional de preenchimento, espera-se melhorar a qualidade das informações referentes à LTA no Estado.

Population-based seroprevalence of SARS-CoV-2 and the herd immunity threshold in Maranhão.

OBJECTIVE: To estimate the seroprevalence of SARS-CoV-2 in the state of Maranhão, Brazil. METHODS: A population-based household survey was performed, from July 27, 2020 to August 8, 2020. The estimates considered clustering, stratification and non-response. Qualitative detection of IgM and IgG antibodies was performed in a fully-automated Elecsys® Anti-SARS-CoV-2 electrochemiluminescence immunoassay on the Cobas® e601 analyzer (Roche Diagnostics). RESULTS: In total, 3,156 individuals were interviewed. Seroprevalence of total antibodies against SARS-CoV-2 was 40.4% (95%CI 35.6-45.3). Population adherence to non-pharmaceutical interventions was higher at the beginning of the pandemic than in the last month. SARS-CoV-2 infection rates were significantly lower among mask wearers and among those who maintained social and physical distancing in the last month compared to their counterparts. Among the infected, 26.0% were asymptomatic. The infection fatality rate (IFR) was 0.14%, higher for men and older adults. The IFR based on excess deaths was 0.28%. The ratio of estimated infections to reported cases was 22.2. CONCLUSIONS: To the best of our knowledge, the seroprevalence of SARS-CoV-2 estimated in this population-based survey is one of the highest reported. The local herd immunity threshold may have been reached or might be reached soon.

Population-based seroprevalence of SARS-CoV-2 and the herd immunity threshold in Maranhão

ABSTRACT OBJECTIVE: To estimate the seroprevalence of SARS-CoV-2 in the state of Maranhão, Brazil. METHODS: A population-based household survey was performed, from July 27, 2020 to August 8, 2020. The estimates considered clustering, stratification and non-response. Qualitative detection of IgM and IgG antibodies was performed in a fully-automated Elecsys® Anti-SARS-CoV-2 electrochemiluminescence immunoassay on the Cobas® e601 analyzer (Roche Diagnostics). RESULTS: In total, 3,156 individuals were interviewed. Seroprevalence of total antibodies against SARS-CoV-2 was 40.4% (95%CI 35.6-45.3). Population adherence to non-pharmaceutical interventions was higher at the beginning of the pandemic than in the last month. SARS-CoV-2 infection rates were significantly lower among mask wearers and among those who maintained social and physical distancing in the last month compared to their counterparts. Among the infected, 26.0% were asymptomatic. The infection fatality rate (IFR) was 0.14%, higher for men and older adults. The IFR based on excess deaths was 0.28%. The ratio of estimated infections to reported cases was 22.2. CONCLUSIONS: To the best of our knowledge, the seroprevalence of SARS-CoV-2 estimated in this population-based survey is one of the highest reported. The local herd immunity threshold may have been reached or might be reached soon.