The association between a conditional cash transfer programme and malaria incidence: a longitudinal ecological study in the Brazilian Amazon between 2004 and 2015.

BACKGROUND: Malaria causes 400 thousand deaths worldwide annually. In 2018, 25% (187,693) of the total malaria cases in the Americas were in Brazil, with nearly all (99%) Brazilian cases in the Amazon region. The Bolsa Família Programme (BFP) is a conditional cash transfer (CCT) programme launched in 2003 to reduce poverty and has led to improvements in health outcomes. CCT programmes may reduce the burden of malaria by alleviating poverty and by promoting access to healthcare, however this relationship is underexplored. This study investigated the association between BFP coverage and malaria incidence in Brazil. METHODS: A longitudinal panel study was conducted of 807 municipalities in the Brazilian Amazon between 2004 and 2015. Negative binomial regression models adjusted for demographic and socioeconomic covariates and time trends were employed with fixed effects specifications. RESULTS: A one percentage point increase in municipal BFP coverage was associated with a 0.3% decrease in the incidence of malaria (RR = 0.997; 95% CI = 0.994-0.998). The average municipal BFP coverage increased 24 percentage points over the period 2004-2015 corresponding to be a reduction of 7.2% in the malaria incidence. CONCLUSIONS: Higher coverage of the BFP was associated with a reduction in the incidence of malaria. CCT programmes should be encouraged in endemic regions for malaria in order to mitigate the impact of disease and poverty itself in these settings.

Proposal for classifying the different types of descriptive epidemiological studies. / Proposta de classificação dos diferentes tipos de estudos epidemiológicos descritivos.

Descriptive epidemiological studies are of relevance, given that there are inconsistencies in the literature with regard to their nomenclature and classification. We reviewed 19 international and six national academic textbooks on epidemiology, where the main criterion was to have them available in order to undertake an in-depth review of chapters on descriptive epidemiology and study types. In 11 books, the authors prioritize analytical studies. Twelve foreign texts and two from Brazil include descriptive studies, although the majority did not specifically refer to a category with this name. We propose a classification based on the answers to research questions, including the following types of study: case report, case series, clinical cohort, prevalence study, incidence study (cohort) and descriptive ecological study. We discuss potential uses, implementation of novel data analysis methods and their relevance in health surveillance.

A categoria dos estudos epidemiológicos descritivos é tema relevante, uma vez que existem inconsistências na literatura quanto a sua nomenclatura e classificação. Foram revistos livros de textos acadêmicos de epidemiologia, 19 estrangeiros e seis nacionais, sendo o critério principal tê-los disponíveis para revisão detalhada dos capítulos de epidemiologia descritiva e tipos de estudo. Em 11 livros, os autores dão prioridade aos estudos analíticos. Doze textos estrangeiros e dois brasileiros incluem estudos descritivos, apesar de a maioria não explicitar uma categoria específica com esse nome. Propõe-se uma classificação com base nas respostas a questões norteadoras de pesquisa, incluindo os seguintes tipos de estudos: relato de caso, série de casos, coorte clínica, estudo de prevalência, estudo de incidência (coorte) e estudo ecológico descritivo. Discutem-se as potencialidades do seu uso, a implementação de novos métodos de análise e sua relevância na vigilância à saúde.

La categoría de estudios epidemiológicos descriptivos es relevante para los servicios de atención de salud ya que existen inconsistencias en la literatura con relación a su nomenclatura y clasificación. Se revisaron libros de texto académicos de epidemiología con ejemplares disponibles para revisión detallada de capítulos de epidemiología descriptiva y tipos de estudio: 19 extranjeros y 6 brasileños. En 11 libros, los autores no consideran ningún estudio que no sea analítico. Doce textos extranjeros y dos brasileños abarcan estudios descriptivos, aunque la mayoría no reconozca esa categoría explícitamente. Se propone una clasificación basada en las respuestas a preguntas orientadoras de la investigación incluyendo los siguientes tipos de estudios: relato de caso, serie de casos y cohorte clínica; cuatro de ámbito poblacional/comunitario: estudio de prevalencia, estudio de incidencia (cohorte), estudio descriptivo ecológico. Se discuten las potencialidades del uso, la implementación de nuevos métodos de análisis y su relevancia en la vigilancia epidemiológica.

Entry of dengue virus serotypes and their geographic distribution in Brazilian federative units: a systematic review.

OBJECTIVE: To describe the entry of Dengue virus (DENV) serotypes in Brazil and its federative units. METHODS: A systematic review of studies published between 1980 and 2018 in databases and in the gray literature was performed using descriptors related to the years of entry of the DENV serotypes. Additionally, experts and official sources of information (Brazilian Ministry of Health) were consulted. RESULTS: From 100 publications selected for the systematic review, 26 addressed the entry of DENV serotypes in the North region of the country, 33 in the Northeast, 24 in the Southeast, 14 in the Central-West, and five in the South. DENV-1 and DENV-4 were introduced in the North region in 1981. DENV-2 was introduced in the Southeast in 1990. DENV-3 was introduced in the North in 1999. CONCLUSION: The rapid expansion of dengue throughout the Brazilian territory was verified from the second half of the 1980s, with the gradual entry of the four serotypes, which resulted in the emergence of epidemics of arbovirus, which are currently verified in the country. Considering the epidemiology of the disease, more information should be disseminated and published in the wide-ranging scientific literature for a better understanding of the spread and circulation of DENV serotypes.

Hearing of neonates without risk indicators for hearing loss and use of antimalarial drugs during pregnancy: a historical cohort study in the Northern Region of Brazil / Audição de neonatos sem indicadores de risco para perda auditiva e utilização de antimaláricos na gestação: um estudo de coorte histórica na Região Norte

Abstract Introduction: Studies have demonstrated the ototoxic effects of antimalarial drugs in individuals who receive these drugs, but little is known regarding the toxicity of these drugs in the newborn auditory system when administered to the mother receive the drug during pregnancy. Objective: To verify the incidence of hearing loss in neonates who have no other associated risk indicators, born to mothers treated for malaria during pregnancy. Methods: A retrospective, quantitative cohort study was developed at Hospital de Base Dr. Ary Pinheiro and Clínica Limiar, both located in the municipality of Porto Velho (Rondônia). The sample consisted of 527 newborns divided into two groups: exposed to antimalarials drugs during pregnancy group (n = 32) and non-exposed group (n = 495). Data collection took place from September 2014 to December 2015, through an interview with the mothers and/or guardians of the newborn, through the newborns' and the mothers' records, and the neonatal hearing screening database of the above-mentioned institutions. Results: All the neonates in the exposed group, assessed through the recording of transient otoacoustic emissions associated with the automated brainstem auditory evoked potential test, underwent neonatal hearing screening in the first examination. Among the newborns in the non-exposed group, 30 showed failure and were retested. Of these, one continued to fail and was referred for diagnosis, in whom the results showed to be within the normal range. Among the neonates of the exposed group, infection with Plasmodium vivax was the most frequent, and was similarly distributed among the gestational trimesters, and chloroquine was the most commonly used antimalarial drug treatment more often given during the third trimester; these findings did not show any influence on the audiological findings of the studied neonates. Conclusion: The present study did not identify any cases of hearing loss in neonates born to mothers who used antimalarial drugs during gestation.

Resumo Introdução: Estudos comprovam os efeitos ototóxicos dos antimaláricos em pessoas que fazem uso destes medicamentos, porém pouco se sabe sobre a toxicidade destes fármacos no sistema auditivo de neonatos quando ingeridos pelas mães no período gestacional. Objetivo: Verificar a incidência de perda auditiva em neonatos de mães tratadas para malária durante a gestação sem outros indicadores de risco associados. Método: Estudo quantitativo, de coorte retrospectivo, desenvolvido no Hospital de Base Dr. Ary Pinheiro e na Clínica Limiar, ambos em Porto Velho (Rondônia). Compuseram a amostra 527 recém-nascidos divididos em dois grupos: grupo exposto (n = 32) e grupo não exposto (n = 495). A coleta de dados ocorreu de setembro de 2014 a dezembro de 2015, através de entrevista com as genitoras e/ou responsáveis pelo recém-nascido, investigação nos prontuários dos neonatos e das genitoras e no banco de dados da triagem auditiva neonatal das instituições supracitadas. Resultados: Todos os neonatos do grupo exposto, avaliados através do registro das emissões otoacústicas transientes associado a realização do potencial evocado auditivo de tronco encefálico automático passaram na triagem auditiva neonatal no primeiro exame. Já, entre os recém-nascidos do grupo não exposto, 30 apresentaram falha e foram retestados. Destes, um continuou falhando e foi encaminhado para diagnóstico, no qual foram evidenciados resultados dentro da normalidade. Nos neonatos do grupo exposto, a infecção pelo Plasmodium vivax foi a mais frequente, mostrando distribuição semelhante entre os trimestres gestacionais, sendo a cloroquina o antimalárico mais utilizado e o tratamento medicamentoso realizado mais frequentemente no terceiro trimestre, porém tais achados não mostraram influência sobre os achados audiológicos dos neonatos estudados. Conclusão: O presente estudo não identificou casos de perda auditiva nos neonatos de mães que utilizaram antimaláricos na gestação.

Hearing of neonates without risk indicators for hearing loss and use of antimalarial drugs during pregnancy: a historical cohort study in the Northern Region of Brazil.

INTRODUCTION: Studies have demonstrated the ototoxic effects of antimalarial drugs in individuals who receive these drugs, but little is known regarding the toxicity of these drugs in the newborn auditory system when administered to the mother receive the drug during pregnancy. OBJECTIVE: To verify the incidence of hearing loss in neonates who have no other associated risk indicators, born to mothers treated for malaria during pregnancy. METHODS: A retrospective, quantitative cohort study was developed at Hospital de Base Dr. Ary Pinheiro and Clínica Limiar, both located in the municipality of Porto Velho (Rondônia). The sample consisted of 527 newborns divided into two groups: exposed to antimalarials drugs during pregnancy group (n = 32) and non-exposed group (n = 495). Data collection took place from September 2014 to December 2015, through an interview with the mothers and/or guardians of the newborn, through the newborns' and the mothers' records, and the neonatal hearing screening database of the above-mentioned institutions. RESULTS: All the neonates in the exposed group, assessed through the recording of transient otoacoustic emissions associated with the automated brainstem auditory evoked potential test, underwent neonatal hearing screening in the first examination. Among the newborns in the non-exposed group, 30 showed failure and were retested. Of these, one continued to fail and was referred for diagnosis, in whom the results showed to be within the normal range. Among the neonates of the exposed group, infection with Plasmodium vivax was the most frequent, and was similarly distributed among the gestational trimesters, and chloroquine was the most commonly used antimalarial drug treatment more often given during the third trimester; these findings did not show any influence on the audiological findings of the studied neonates. CONCLUSION: The present study did not identify any cases of hearing loss in neonates born to mothers who used antimalarial drugs during gestation.

Proposta de classificação dos diferentes tipos de estudos epidemiológicos descritivos / Propuesta de clasificación de los diferentes tipos de estudios epidemiológicos descriptivos / Proposal for classifying the different types of descriptive epidemiological studies

A categoria dos estudos epidemiológicos descritivos é tema relevante, uma vez que existem inconsistências na literatura quanto a sua nomenclatura e classificação. Foram revistos livros de textos acadêmicos de epidemiologia, 19 estrangeiros e seis nacionais, sendo o critério principal tê-los disponíveis para revisão detalhada dos capítulos de epidemiologia descritiva e tipos de estudo. Em 11 livros, os autores dão prioridade aos estudos analíticos. Doze textos estrangeiros e dois brasileiros incluem estudos descritivos, apesar de a maioria não explicitar uma categoria específica com esse nome. Propõe-se uma classificação com base nas respostas a questões norteadoras de pesquisa, incluindo os seguintes tipos de estudos: relato de caso, série de casos, coorte clínica, estudo de prevalência, estudo de incidência (coorte) e estudo ecológico descritivo. Discutem-se as potencialidades do seu uso, a implementação de novos métodos de análise e sua relevância na vigilância à saúde.

La categoría de estudios epidemiológicos descriptivos es relevante para los servicios de atención de salud ya que existen inconsistencias en la literatura con relación a su nomenclatura y clasificación. Se revisaron libros de texto académicos de epidemiología con ejemplares disponibles para revisión detallada de capítulos de epidemiología descriptiva y tipos de estudio: 19 extranjeros y 6 brasileños. En 11 libros, los autores no consideran ningún estudio que no sea analítico. Doce textos extranjeros y dos brasileños abarcan estudios descriptivos, aunque la mayoría no reconozca esa categoría explícitamente. Se propone una clasificación basada en las respuestas a preguntas orientadoras de la investigación incluyendo los siguientes tipos de estudios: relato de caso, serie de casos y cohorte clínica; cuatro de ámbito poblacional/comunitario: estudio de prevalencia, estudio de incidencia (cohorte), estudio descriptivo ecológico. Se discuten las potencialidades del uso, la implementación de nuevos métodos de análisis y su relevancia en la vigilancia epidemiológica.

Descriptive epidemiological studies are of relevance, given that there are inconsistencies in the literature with regard to their nomenclature and classification. We reviewed 19 international and six national academic textbooks on epidemiology, where the main criterion was to have them available in order to undertake an in-depth review of chapters on descriptive epidemiology and study types. In 11 books, the authors prioritize analytical studies. Twelve foreign texts and two from Brazil include descriptive studies, although the majority did not specifically refer to a category with this name. We propose a classification based on the answers to research questions, including the following types of study: case report, case series, clinical cohort, prevalence study, incidence study (cohort) and descriptive ecological study. We discuss potential uses, implementation of novel data analysis methods and their relevance in health surveillance.

Entry of dengue virus serotypes and their geographic distribution in Brazilian federative units: a systematic review / Entrada e distribuição geográfica dos sorotipos do vírus da dengue nas unidades federativas brasileiras: uma revisão sistemática

Objective: To describe the entry of Dengue virus (DENV) serotypes in Brazil and its federative units. Methods: A systematic review of studies published between 1980 and 2018 in databases and in the gray literature was performed using descriptors related to the years of entry of the DENV serotypes. Additionally, experts and official sources of information (Brazilian Ministry of Health) were consulted. Results: From 100 publications selected for the systematic review, 26 addressed the entry of DENV serotypes in the North region of the country, 33 in the Northeast, 24 in the Southeast, 14 in the Central-West, and five in the South. DENV-1 and DENV-4 were introduced in the North region in 1981. DENV-2 was introduced in the Southeast in 1990. DENV-3 was introduced in the North in 1999. Conclusion: The rapid expansion of dengue throughout the Brazilian territory was verified from the second half of the 1980s, with the gradual entry of the four serotypes, which resulted in the emergence of epidemics of arbovirus, which are currently verified in the country. Considering the epidemiology of the disease, more information should be disseminated and published in the wide-ranging scientific literature for a better understanding of the spread and circulation of DENV serotypes.

RESUMO: Objetivo: Descreveu-se a entrada de sorotipos do vírus da Dengue (DENV) no Brasil e em suas unidades federativas. Métodos: Realizou-se uma revisão sistemática de estudos publicados entre 1980 e 2018 em bancos de dados e na literatura cinzenta, utilizando-se descritores relacionados aos anos de entrada dos sorotipos do DENV. Além disso, consultou-se especialistas e fontes oficiais de informação (Ministério da Saúde do Brasil). Resultados: Das 100 publicações selecionadas para a revisão sistemática, 26 abordaram a entrada de sorotipos de DENV na região Norte do país, 33 no Nordeste, 24 no Sudeste, 14 no Centro-Oeste e cinco no Sul. O DENV-1 e o DENV-4 foram introduzidos na região Norte em 1981. O DENV-2 foi introduzido no Sudeste em 1990. O DENV-3 foi introduzido no Norte em 1999. Conclusão: A rápida expansão da dengue por todo o território brasileiro foi verificada a partir da segunda metade dos anos de 1980, com a entrada gradativa dos quatro sorotipos, o que resultou no surgimento de epidemias da arbovirose, que são atualmente verificadas no país. Considerando a epidemiologia da doença, mais informações devem ser divulgadas e publicadas na literatura científica de amplo alcance, para melhor entendimento da propagação e circulação dos sorotipos de DENV.

Leprosy in children under 15 years of age in a municipality in northeastern Brazil: evolutionary aspects from 2003 to 2015.

INTRODUCTION: The Integrated Program of Leprosy Control was initiated in 2003 in the municipality of Buriticupu, Maranhão, Brazil, an area considered hyperendemic for leprosy. Here, we present the evolution of the indicators of leprosy within the established period in children aged <15 years. METHODS: This is a descriptive study based on an active search for cases and spontaneous healthcare demand for leprosy, with an evolutionary analysis of the detection coefficient of new cases. We considered individuals aged <15 years diagnosed with leprosy from January 2003 to December 2015. To evaluate the factors associated with clinical and operational forms, Chi-square, Fisher's exact, or Fisher-Freeman-Halton tests were performed. RESULTS: A total of 61 new cases were detected (6.9% of the total leprosy cases diagnosed in the municipality during the study period), and the majority was found in males (62.3%). The most frequent operational classification was paucibacillary (67.2%), and this association increased with age. The tuberculoid clinical form was the most prevalent in both sexes and in the age range of 10 to <15 years. There was a reduction in the detection coefficient from 21.84/100,000 inhabitants in 2003 to 2.79/100,000 in 2015. CONCLUSIONS: Despite the progress in the control of leprosy, this historical series shows that it is necessary to strengthen educational measures and implement control actions, so that the disease ceases to be a public health problem in the population aged <15 years.

Changes in malaria patterns in Brazil over 28 years (1990-2017): results from the Global Burden of Disease Study 2017.

BACKGROUND: This study presents the malaria burden in Brazil from 1990 to 2017 using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), by analyzing disease burden indicators in federated units of the Legal Amazon and Extra-Amazon regions, as well as describing malaria cases according to Plasmodium species occurring in the country. METHODS: We used estimates from the GBD 2017 to report years of life lost due to premature death (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) for malaria in Brazil, grouped by gender, age group, and Brazilian federated unit, from 1990 to 2017. Results are presented as absolute numbers and age-standardized rates (per 100,000 inhabitants) with 95% uncertainty intervals (UI). RESULTS: At the national level, the age-standardized DALYs rate due to malaria decreased by 92.0%, from 42.5 DALYs per 100,000 inhabitants (95% UI 16.6-56.9) in 1990 to 3.4 DALYs per 100,000 inhabitants (95% UI 2.7-4.7) in 2017. The YLLs were the main component of the total DALYs rate for malaria in 1990 (67.3%), and the YLDs were the main component of the metric in 2017 (61.8%). In 2017, the highest sex-age DALYs rate was found among females in the "< 1-year-old" age group, with a 6.4 DALYs per 100,000 inhabitants (95% UI 1.8-14.7) and among males in the age group of "20 to 24 years old", with a 4.7 DALYs per 100,000 inhabitants (95% UI 3.3-9.9). Within the Brazilian Amazon region, the three federated units with the highest age-standardized DALYs rates in 2017 were Acre [28.4 (95% UI 14.2-39.1)], Roraima [28.3 (95% UI 13.5-40.2)], and Rondônia [24.7 (95% UI 11.4-34.8)]. Concerning the parasite species that caused malaria, 73.5% of the total of cases registered in the period had Plasmodium vivax as the etiological agent. CONCLUSIONS: The results of the GBD 2017 show that despite the considerable reduction in the DALYs rates between 1990 and 2017, malaria remains a relevant and preventable disease, which in recent years has generated more years of life lost due to disability than deaths. The states endemic for malaria in the Amazon region require constant evaluation of preventive and control measures. The present study will contribute to the direction of current health policies aimed at reducing the burden of malaria in Brazil, as knowing the geographical and temporal distribution of the risk of death and disability of this disease can facilitate the planning, implementation, and improvement of control strategies aimed at eliminating the disease.

Leprosy in children under 15 years of age in a municipality in northeastern Brazil: evolutionary aspects from 2003 to 2015

Abstract INTRODUCTION The Integrated Program of Leprosy Control was initiated in 2003 in the municipality of Buriticupu, Maranhão, Brazil, an area considered hyperendemic for leprosy. Here, we present the evolution of the indicators of leprosy within the established period in children aged <15 years. METHODS: This is a descriptive study based on an active search for cases and spontaneous healthcare demand for leprosy, with an evolutionary analysis of the detection coefficient of new cases. We considered individuals aged <15 years diagnosed with leprosy from January 2003 to December 2015. To evaluate the factors associated with clinical and operational forms, Chi-square, Fisher's exact, or Fisher-Freeman-Halton tests were performed. RESULTS A total of 61 new cases were detected (6.9% of the total leprosy cases diagnosed in the municipality during the study period), and the majority was found in males (62.3%). The most frequent operational classification was paucibacillary (67.2%), and this association increased with age. The tuberculoid clinical form was the most prevalent in both sexes and in the age range of 10 to <15 years. There was a reduction in the detection coefficient from 21.84/100,000 inhabitants in 2003 to 2.79/100,000 in 2015. CONCLUSIONS Despite the progress in the control of leprosy, this historical series shows that it is necessary to strengthen educational measures and implement control actions, so that the disease ceases to be a public health problem in the population aged <15 years.

Clinical and epidemiological aspects of tuberculosis in the Federal District (Brazil, 2006 to 2015). / Aspectos clínicos e epidemiológicos da tuberculose no Distrito Federal (2006 a 2015).

INTRODUCTION: Despite the low incidence rates of tuberculosis (TB) in the Federal District (FD), there are socioeconomic discrepancies allied to intense population growth in recent years, which demonstrates the need to study the trend of the disease in different regions of the FD. OBJECTIVE: To describe the trend of morbidity and mortality due to TB in the FD from 2006 to 2015. METHODS: Ecological study, with descriptive and analytical components, historical series type. RESULTS: There was a decreasing trend in incidence rates (IR) (from 15.1 per 100,000 inhabitants to 11.7 per 100,000 inhabitants, r = -0.50) and in the cure rate (from 86.0% to 74.7, r = -0.91); people experiencing homelessness and incarceration have relative risks from 5 to 16 times higher than the general population; higher IR were found in Paranoá (27.5 per 100,000 inhabitants) and in Estrutural (17.3 per 100,000 inhabitants), areas with poor socioeconomic indicators and demografic explosion during the study period. A higher mean lethality rate was found in Águas Claras (8.5%) and in Lago Sul (7.0%), regions that have a high concentration of homeless and elderly people. CONCLUSION: TB persists as an important public health problem in the FD, especially in impoverished areas, with significant population growth or a high concentration of elderly or vulnerable populations.

INTRODUÇÃO: Apesar dos baixos coeficientes de incidência de tuberculose (TB) no Distrito Federal (DF), há discrepâncias socioeconômicas aliadas ao intenso crescimento populacional nos últimos anos que evidenciam a necessidade de estudar a tendência da doença nos diferentes cenários do DF. OBJETIVO: Descrever a tendência de morbimortalidade por TB no DF de 2006 a 2015. MÉTODOS: Estudo ecológico com componentes descritivo e analítico, do tipo série histórica. RESULTADOS: Houve tendência temporal de queda dos coeficientes de incidência (CI) (15,1/100 mil habitantes para 11,7/100 mil habitantes; r = -0,50) e na proporção de cura (86,0 para 74,7%; r = -0,91); populações em situação de rua e privados de liberdade têm riscos relativos de 5 a 16 vezes maior do que a população geral; maiores CI foram observados no Paranoá (27,5/100 mil habitantes) e na Estrutural (17,3/100 mil habitantes), áreas com indicadores socioeconômicos ruins e com explosão populacional no período; e maiores taxas médias de letalidade foram encontradas em Águas Claras (8,5%) e no Lago Sul (7,0%), regiões que concentram populações em situação de rua e idosos. CONCLUSÃO: A TB persiste como importante problema de saúde pública no DF, especialmente em áreas empobrecidas, com crescimento populacional expressivo ou com alta concentração de idosos ou de populações vulneráveis.

Short-Lived Immunity After 17DD Yellow Fever Single Dose Indicates That Booster Vaccination May Be Required to Guarantee Protective Immunity in Children.

The Yellow Fever (YF) vaccination is recommended for people living in endemic areas and represents the most effective strategy to reduce the risk of infection. Previous studies have warned that booster regimens should be considered to guarantee the long-term persistence of 17DD-YF-specific memory components in adults living in areas with YF-virus circulation. Considering the lower seroconversion rates observed in children (9-12 months of age) as compared to adults, this study was designed in order to access the duration of immunity in single-dose vaccinated children in a 10-years cross-sectional time-span. The levels of neutralizing antibodies (PRNT) and the phenotypic/functional memory status of T and B-cells were measured at a baseline, 30-45 days, 1, 2, 4, 7, and 10 years following primary vaccination. The results revealed that a single dose induced 85% of seropositivity at 30-45 days and a progressive time-dependent decrease was observed as early as 2 years and declines toward critical values (below 60%) at time-spans of ≥4-years. Moreover, short-lived YF-specific cellular immunity, mediated by memory T and B-cells was also observed after 4-years. Predicted probability and resultant memory analysis emphasize that correlates of protection (PRNT; effector memory CD8+ T-cells; non-classical memory B-cells) wane to critical values within ≥4-years after primary vaccination. Together, these results clearly demonstrate the decline of 17DD-YF-specific memory response along time in children primarily vaccinated at 9-12 months of age and support the need of booster regimen to guarantee the long-term persistence of memory components for children living in areas with high risk of YF transmission.

17DD Yellow Fever Revaccination and Heightened Long-Term Immunity in Populations of Disease-Endemic Areas, Brazil.

We evaluated the duration of neutralizing antibodies and the status of 17DD vaccine-specific T- and B-cell memory following primary and revaccination regimens for yellow fever (YF) in Brazil. We observed progressive decline of plaque-reduction neutralization test (PRNT) seropositivity and of the levels of effector memory CD4+ and CD8+ T cells, as well as interferon-γ+CD8+ T cells, 10 years after primary vaccination. Revaccination restored PRNT seropositivity as well as the levels of effector memory CD4+, CD8+, and interferon-γ+CD8+ T cells. Moreover, secondary or multiple vaccinations guarantee long-term persistence of PRNT positivity and cell-mediated memory 10 years after booster vaccination. These findings support the relevance of booster doses to heighten the 17DD-YF-specific immune response to guarantee the long-term persistence of memory components. Secondary or multiple vaccinations improved the correlates of protection triggered by 17DD-YF primary vaccination, indicating that booster regimens are needed to achieve efficient immunity in areas with high risk for virus transmission.

Precarisation of dentistry in private healthcare: bioethical analysis. / Precarização do trabalho odontológico na saúde suplementar: uma análise bioética.

The present study highlighted the labour process of the dental surgeon (DS) in the private healthcare sector from the healthcare professional's perspective based on intervention bioethics. An observational, cross-sectional survey study was performed within the Federal District (Distrito Federal) region. Data were collected from 108 questionnaires completed by DSs affiliated with two types of private health insurers, self-insurance and group insurance, to assess job perception and the degree of job satisfaction in the dentistry market. The main source of dissatisfaction for healthcare professionals was related to the pay for dental procedures by insurers. For self-insurer 1, 38.1% healthcare professionals replied that the pay was satisfactory, whereas in self-insurance 2 and in the group insurance, 100% of healthcare professionals were dissatisfied. Another finding was that the group insurer considerably restricted elective treatments. In conclusion, loss of professional autonomy, depreciation of insurance claims and precarisation of dentistry occurs in the private healthcare sector, thus demonstrating the ethical conflicts in this relationship.

O presente trabalho evidenciou o processo de trabalho do cirurgião-dentista (CD) no setor de saúde suplementar a partir da visão do profissional, sob a luz da Bioética de Intervenção. Foi realizado um estudo observacional-seccional do tipo inquérito circunscrito à região do Distrito Federal. Os dados foram coletados por meio de 108 questionários respondidos por CDs credenciados à duas modalidades de operadora: autogestão e odontologia de grupo, com a finalidade de conhecer a percepção e o grau de satisfação profissional diante do mercado de trabalho odontológico. A insatisfação maior por parte dos profissionais foi relacionada à remuneração dos trabalhos odontológicos pelas operadoras. Para a operadora de autogestão 1, 38,1% dos profissionais responderam que a remuneração era satisfatória, enquanto para a de autogestão 2 e odontologia de grupo, houve 100% de insatisfação. Outro dado encontrado foi que a operadora de odontologia de grupo restringiu os tratamentos selecionados aos pacientes de forma expressiva. Conclui-se que existe a perda de autonomia profissional, desvalorização dos ressarcimentos e precarização do trabalho odontológico na saúde suplementar, demonstrando conflitos éticos nessa relação de trabalho.

Precarização do trabalho odontológico na saúde suplementar: uma análise bioética / Precarisation of dentistry in private healthcare: bioethical analysis

Resumo O presente trabalho evidenciou o processo de trabalho do cirurgião-dentista (CD) no setor de saúde suplementar a partir da visão do profissional, sob a luz da Bioética de Intervenção. Foi realizado um estudo observacional-seccional do tipo inquérito circunscrito à região do Distrito Federal. Os dados foram coletados por meio de 108 questionários respondidos por CDs credenciados à duas modalidades de operadora: autogestão e odontologia de grupo, com a finalidade de conhecer a percepção e o grau de satisfação profissional diante do mercado de trabalho odontológico. A insatisfação maior por parte dos profissionais foi relacionada à remuneração dos trabalhos odontológicos pelas operadoras. Para a operadora de autogestão 1, 38,1% dos profissionais responderam que a remuneração era satisfatória, enquanto para a de autogestão 2 e odontologia de grupo, houve 100% de insatisfação. Outro dado encontrado foi que a operadora de odontologia de grupo restringiu os tratamentos selecionados aos pacientes de forma expressiva. Conclui-se que existe a perda de autonomia profissional, desvalorização dos ressarcimentos e precarização do trabalho odontológico na saúde suplementar, demonstrando conflitos éticos nessa relação de trabalho.

Abstract The present study highlighted the labour process of the dental surgeon (DS) in the private healthcare sector from the healthcare professional's perspective based on intervention bioethics. An observational, cross-sectional survey study was performed within the Federal District (Distrito Federal) region. Data were collected from 108 questionnaires completed by DSs affiliated with two types of private health insurers, self-insurance and group insurance, to assess job perception and the degree of job satisfaction in the dentistry market. The main source of dissatisfaction for healthcare professionals was related to the pay for dental procedures by insurers. For self-insurer 1, 38.1% healthcare professionals replied that the pay was satisfactory, whereas in self-insurance 2 and in the group insurance, 100% of healthcare professionals were dissatisfied. Another finding was that the group insurer considerably restricted elective treatments. In conclusion, loss of professional autonomy, depreciation of insurance claims and precarisation of dentistry occurs in the private healthcare sector, thus demonstrating the ethical conflicts in this relationship.

Factors associated with leprosy in a municipality of the Pre-Amazon region, state of Maranhão, Brazil.

INTRODUCTION: The Integrated Program of Leprosy Control was initiated in the municipality of Buriticupu, Maranhão, Brazil, an area considered hyperendemic for leprosy in 2003. It aims at assessing the clinical and epidemiological characteristics of the disease to reduce the detection rate of new cases until 2015. Here, we present the evolution of the indicators of leprosy within the period from 2003 to 2015. METHODS: We conducted a descriptive analytical study based on the active search for and voluntary referral of cases of leprosy. The detection rate of new cases was analyzed over time. We included individuals diagnosed with leprosy between January 2003 and December 2015. The association between categorical variables was assessed using the chi-square test of independence, considering a level of significance of 5%. When the association was significant, the detection rate (with a confidence interval of 95%) was calculated. RESULTS: Overall, 879 new leprosy cases were detected; the majority of the affected individuals were men (65.9%). Multibacillary leprosy was the most common type of the disease, according to the operational classification (55.5%); it showed the strongest association with an age ≥60 years. We also detected an association between the male sex and both, lepromatous and multibacillary leprosy. The detection rate reduced from 211.09/100,000 population in 2003 to 50.26/100,000 population in 2015. CONCLUSIONS: We found an improvement in leprosy control, with a reduction in the detection rate and the absolute number of cases. Strengthening of disease control measures should be prioritized to eliminate leprosy as a public health concern in this municipality.

Factors associated with leprosy in a municipality of the Pre-Amazon region, state of Maranhão, Brazil

Abstract INTRODUCTION: The Integrated Program of Leprosy Control was initiated in the municipality of Buriticupu, Maranhão, Brazil, an area considered hyperendemic for leprosy in 2003. It aims at assessing the clinical and epidemiological characteristics of the disease to reduce the detection rate of new cases until 2015. Here, we present the evolution of the indicators of leprosy within the period from 2003 to 2015. METHODS: We conducted a descriptive analytical study based on the active search for and voluntary referral of cases of leprosy. The detection rate of new cases was analyzed over time. We included individuals diagnosed with leprosy between January 2003 and December 2015. The association between categorical variables was assessed using the chi-square test of independence, considering a level of significance of 5%. When the association was significant, the detection rate (with a confidence interval of 95%) was calculated. RESULTS: Overall, 879 new leprosy cases were detected; the majority of the affected individuals were men (65.9%). Multibacillary leprosy was the most common type of the disease, according to the operational classification (55.5%); it showed the strongest association with an age ≥60 years. We also detected an association between the male sex and both, lepromatous and multibacillary leprosy. The detection rate reduced from 211.09/100,000 population in 2003 to 50.26/100,000 population in 2015. CONCLUSIONS: We found an improvement in leprosy control, with a reduction in the detection rate and the absolute number of cases. Strengthening of disease control measures should be prioritized to eliminate leprosy as a public health concern in this municipality.

Yellow fever outbreak in Brazil: the puzzle of rapid viral spread and challenges for immunisation.

We discuss the complex eco-social factors involved in the puzzle of the unexpected rapid viral spread in the ongoing Brazilian yellow fever (YF) outbreak, which has increased the reurbanisation risk of a disease without urban cases in Brazil since 1942. Indeed, this rapid spatial viral dissemination to the Southeast and South regions, now circulating in the Atlantic Forest fragments close to peri-urban areas of the main Brazilian megalopolises (São Paulo and Rio de Janeiro) has led to an exponential increase in the number of yellow fever cases. In less than 18 months, 1,833 confirmed cases and 578 deaths were recorded most of them reported in the Southeast region (99,9%). Large epizooties in monkeys and other non-human primates (NHPs) were communicated in the country with 732 YF virus (YFV) laboratory confirmed events only in the 2017/2018 monitoring period. We also discuss the peculiarities and similarities of the current outbreak when compared with previous great epidemics, examining several hypotheses to explain the recent unexpected acceleration of epizootic waves in the sylvatic cycle of the YFV together with the role of human, NHPs and mosquito mobility with respect to viral spread. We conclude that the most feasible hypothesis to explain this rapidity would be related to human behavior combined with ecological changes that promoted a significant increase in mosquito and NHP densities and their contacts with humans. We emphasize the urgent need for an adequate response to this outbreak such as extending immunisation coverage to the whole Brazilian population and developing novel strategies for immunisation of NHPs confined in selected reserve areas and zoos. Finally, we stress the urgent need to improve the quality of response in order to prevent future outbreaks and a catastrophic reurbanisation of the disease in Brazil and other South American countries. Continuous monitoring of YFV receptivity and vulnerability conditions with effective control of the urban vector Aedes aegypti and significant investments in YF vaccine production capacity and research and development for reduction of adverse effects are of the highest priority.