Factors associated with hospitalization in the acute phase of Chikungunya.

OBJECTIVE: Determine characteristics associated with hospitalization in the acute phase of Chikungunya. METHODS: Cross-sectional study including data on Chikungunya cases reported in Vitória, Espírito Santo state, Brazil, between March 2016 and December 2021. RESULTS: Hospitalizations accounted for 1.42% (n = 41) of the 2,868 cases included. There were statistically significant differences between hospitalized and non-hospitalized regarding age (P 0.001), which was lower among hospitalized patients, and pregnancy, which was more frequent in the hospitalized group (P 0.010). Patients younger than two years old and older than 65 years corresponded to 31.7% of hospitalizations. Back pain (OR = 0.134; 95% CI = 0.044-0.409) and arthralgia (OR = 0.226; 95% CI = 0.083-0.613) were protective factors for hospitalization. CONCLUSION: Groups at risk of severe Chikungunya, including those under two and over 65 years of age, may require more hospitalization, even with milder manifestations.

Enhancing interventions for prevention of mother-to-child- transmission of hepatitis B virus.

Prevention of mother-to-child transmission of hepatitis B virus (HBV) infection is a cornerstone of efforts to support progress towards elimination of viral hepatitis. Current guidelines recommend maternal screening, antiviral therapy during the third trimester of high-risk pregnancies, universal and timely HBV birth dose vaccination, and post-exposure prophylaxis with hepatitis B immunoglobulin for selected neonates. However, serological and molecular diagnostic testing, treatment and HBV vaccination are not consistently deployed, particularly in many high endemicity settings, and models predict that global targets for reduction in paediatric incidence will not be met by 2030. In this article, we briefly summarise the evidence for current practice and use this as a basis to discuss areas in which prevention of mother-to-child transmission can potentially be enhanced. By reducing health inequities, enhancing pragmatic use of resources, filling data gaps, developing advocacy and education, and seeking consistent investment from multilateral agencies, significant advances can be made to further reduce vertical transmission events, with wide health, societal and economic benefits.

Use of Interrupted Time Series Analysis in Understanding the Course of the Congenital Syphilis Epidemic in Brazil.

Background: To fight against the rising incidence of syphilis, the Brazilian Ministry of Health (MoH) launched the "Syphilis No!" Project (SNP), with specific resources funded by a parliamentary amendment. Then, in 2018, a national rapid response started to be implemented on the Brazilian Unified Health System (SUS, Sistema Único de Saúde) in two strategic lines (1) to reinforce SUS's universal actions and (2) to implement specific ones to 100 municipalities chosen by the MoH as priorities for syphilis congenital response. In 2015, such localities represented 6895% of congenital syphilis cases in Brazil. In this context, SNP has implemented actions to strengthen epidemiological surveillance of acquired syphilis and congenital syphilis by instituting an integrated and collaborative response through health services networks and reinforcing interstate relations. Methods: A quasi-experimental study using time series analysis was conducted to assess immediate impacts and changes to the trend in national congenital syphilis before and after the project, from September 2016 to December 2019. Data were assessed considering rates of congenital syphilis per 1,000 live births in all priority municipalities (n=100) covered by the project and in non-priority municipalities (n=5,470) from all five macro-regions of Brazil. Findings: Priority municipalities showed a greater reduction (change in trend) in comparison to non-priority. The linear regression model revealed trend changes after the intervention, with both groups of municipalities showing a drop in the average monthly number of cases per 1,000 live births, with a reduction of -0·21 (CI 95% -0·33 to -0·09; p=0·0011) in priority municipalities and of -0·10 (CI 95% -0.19 to -0.02; p=0·0216) in non-priority municipalities. Interpretation: The study using ITS provides important evidence on the direction, timing, and magnitude of the effects of interventions introduced as part of the SNP on congenital syphilis in Brazil. Our results suggest that the Syphilis No! Project influenced the trends of congenital syphilis in Brazil from 2018, with higher reductions achieved in the priority municipalities. Funding: The research is funded by a grant to the Syphilis No! Project from Brazilian Ministry of Health (Project Number: 54/2017). The funders had no role in study design, analysis, decision to publish, or preparation of the manuscript.

Prevalencia de sífilis y características del comportamiento de los jóvenes indígenas del Paraguay, 2016 / Prevalence of syphilis and characteristics of the behavior of indigenous young people of Paraguay, 2016

El objetivo fue determinar la prevalencia de sífilis y características de comportamiento de los jóvenes indígenas del Paraguay en el 2016. Se realizó un estudio observacional, descriptivo de corte transversal con muestro probabilístico estratificado bietapico, que incluyó a jóvenes indígenas de 15 a 18 años de cinco familias lingüísticas de Paraguay. Se utilizó un cuestionario estructurado y para el tamizaje de sífilis se utilizó una test rápido treponémico y para confirmar los resultados reactivos se realizó VDRL, considerando como resultado positivo si el test rápido era positivo + VDRL positivo a una dilución de 1:4 o mayor y si la VDRL era menor a 1:4 con TPHA positivo. Los resultados se expresan como medidas de tendencia central, dispersión y proporciones. Ingresaron al estudio 546 jóvenes de 15 a 18 años, el 67,03% era del sexo femenino. Se identificaron 36 casos de sífilis, que representa una prevalencia de 6,6% (IC95%: 4,7-9,0). Mayor prevalencia de sífilis se observó en los jóvenes que consumieron alcohol en la última relación sexual 20,6% (14/68) (p<0,001), sexo transaccional 40% (2/5) (p=0,010) y no utilización de condón 20,6% (14/68) (p<0,001). Se encontró una alta prevalencia de sífilis en la población juvenil indígena, relacionada al consumo de alcohol en la última relación, práctica de sexo transaccional y no utilización de preservativos. Se recomienda la implementación de estrategias específicas con abordaje intercultural apropiadas para una población joven, orientadas a disminuir las prácticas de riesgo y promocionar la utilización de preservativos(AU)

Violência sexual e doméstica em mulheres atendidas em uma clínica de DST/AIDS em Vitória, Brasil / Sexual and domestic violence among women attending a sti/aids clinic in Vitória, Brazil

A violência contra as mulheres pode assumir várias formas, desde assédio sexual, discriminação e desrespeito até formas mais graves tais como violência física e sexual. Objetivo: Descrever a frequência de violência doméstica e sexual relatadas por mulheres atendidas em um clínica de doenças sexualmente transmissíveis (DST) em Vitória, Brasil. Métodos: As mulheres que buscaram atendimento clínico na clínica de DST/AIDS, durante o período de estudo, foram convidadas a participar e responderam a uma entrevista após assinar um termo de consentimento informado. O questionário utilizado incluiu dados sobre as características sócio-demográficas e clínicas, os comportamentos de risco para DST e a história de violências domésticas e sexuais. Resultados: Um total de 276 (96,8%) mulheres concordaram em participar do estudo, das quais 109 (39,5%) eram HIV-positivas e 167 (60,5%) eram HIV-negativas. História de violência doméstica foi relatada por 52,6% das mulheres, principalmente relacionada ao abuso de álcool (41,6%), uso de drogas ilícitas (27,2%), e problemas psiquiátricos (25,3%). Violência sexual prévia foi relatada por 28,6% das mulheres, e 31,6% desses casos ocorreu quando as participantes tinham menos de 14 anos de idade. Um total de 69,2% das mulheres tinham entre 18 e 34 anos; 11,2% relataram o uso frequente de álcool; 21% o uso de drogas ilícitas e 2,2% relataram o uso de drogas injetáveis. Em relação ao uso de preservativos, as mulheres HIV-positivas tinham menos receio de pedir ao parceiro para usar preservativos em comparação com mulheres HIV-negativas (31,2 versus 41,9%, p=0,022). Conclusão: História de violência doméstica e sexual foi frequentemente relatada neste estudo. Os efeitos da violência sobre a saúde física e mental das mulheres são amplamente conhecidos como um grave problema de saúde pública. Para além dessa importância, a violência é um problema invisível em nossa sociedade e precisamos aprender como abordá-lo na prática clínica.

Violence against women can take several forms; ranging from sexual harassment, discrimination, and discounting to even more serious forms such as those physical and sexual in nature. Objective: To describe the frequency of domestic and sexual violence reported by women attending a sexually transmitted infections (STI) clinic in Vitória, Brazil. Methods: Women attending the STI/AIDS clinic during the period of study were invited to participate and were interviewed after signing a written consent form. The assessment questionnaire included information on socio-demographic characteristics such as risk behaviors for STI and clinical, domestic, and sexual violence reports. Results: A total of 276 (96.8%) women agreed to participate, of which 109 (39.5%) were HIV-positive and 167 (60.5%) were HIV-negative. History of domestic violence was reported by 52.6% of women, mainly related to alcohol abuse (41.6%), use of illicit drugs (27.2%), and psychiatric problems (25.3%). Previous sexual violence was reported by 28.6%, and 31.6% of these cases occurred when the participants were younger than 14 years old. A total of 69.2% of women were between 18 and 34 years old; 11.2% reported frequent use of alcohol; 21% use of illicit drugs and 2.2% reported injectable drugs. Regarding the use of condoms, HIV-positive women were less afraid to ask the partner to use condoms compared with HIV-negative women (31.2% versus 41.9%, p=0.022). Conclusion: History of domestic and sexual violence was frequently reported in this study. The effects of violence to women's physical and mental health are widely known as a serious public health problem. In addition to its importance, violence is an invisible problem in our society and we need to learn how to approach it during clinical consultation.

Human papillomavirus in women with and without HIV-1 infection attending an STI clinic in Vitoria, Brazil.

We conducted a cross-sectional study in Vitória, Brazil, to assess the prevalence of human papillomavirus (HPV) infection in HIV-positive and HIV-negative women attending a sexually transmitted infection (STI)/AIDS clinic. We also investigated the presence of HPV genotypes and assessed covariates for HIV infection. Enrolled patients received a gynecological evaluation, and cervical scrape samples were collected for cytological analysis and HPV-DNA polymerase chain reaction (PCR). A blood sample was obtained to determine HIV status. HPV infection and squamous intraepithelial lesions were studied in 284 women, 112 (39.4%) HIV-positive women and 172 (60.5%) HIV-negative women. HPV-DNA was detected in 133 (46.8%). HIV-infected women were almost twice as likely to be concurrently infected with HPV than HIV-negative women (OR = 1.87 95% CI: 1.16-3.03). The high proportion of HPV detected among women attending an STI/AIDS clinic, particularly among HIV-infected women, proves the importance of screening this high-risk group in the hope of earlier detection and treatment of cervical intraepithelial neoplasia (CIN).

Completude do sistema de informação de agravos de notificação compulsória de gestante hiv positivo entre 2001 e 2006, no Espírito Santo, Brasil / Completeness of information system for agravos for notification of pregnancy compulsória hiv positive between 2001 and 2006, in the Espirito Santo, Brazil

O objetivo foi analisar a completude dos campos das investigaçõesda base de dados de gestante Vírus da Imunodeficiência Humana(HIV) positivoe criança exposta do Sistema de Informação de Agravos de NotificaçãoCompulsória (SINAN), no Espírito Santo, entre 2001 a 2006. Estudo descritivo,retrospectivo, com utilização de dados secundários. Para avaliar a completude,foram utilizados os parâmetros: excelente (maior que 90%), regular (entre 70%e 89%) e ruim (abaixo de 70%). Calculou-se a média de completude de 34 variáveis,utilizando-se a base nacional do SINAN. As variáveis analisadas foramsubdivididas em blocos: informação da notificação; informação da mãe; AIDSna gravidez; informação da criança; aleitamento; histórico da criança; dados laboratoriaise acompanhamento. As variáveis raça/cor e escolaridade apresentaramcompletude excelente no Estado. Dentre os fatores que contribuem para aredução da transmissão vertical do HIV, as variáveis evolução da gravidez, inícioda profilaxia no recém-nascido e aleitamento materno foram classificadas comoregular, enquanto o aleitamento cruzado foi considerado ruim. As informaçõesreferentes à criança exposta ao vírus foram as que apresentaram menor grau depreenchimento. Conclui-se que dados relativos à prevenção da TV estão incompletos.A notificação, por ser realizada na maioria das vezes no período gestacional,apresenta falhas nas informações referentes à criança. Há necessidade demaiores esclarecimentos aos profissionais de saúde sobre a importância do preenchimentodos campos, para que seja possível traçar estratégias para prevençãoe controle da TV no Espírito Santo.

The objective was to analyze thecompleteness of the s of investigations ofthe database of HIV positive pregnant womenand children exposed to the Information SystemDiseases Notification Compulsória (SINAN),in the Espirito Santo, from 2001 to 2006. Descriptivestudy, retrospective, the use of secondarydata. To evaluate the completeness were usedthese parameters: excellent (greater than 90%),regular (between 70% and 89%) and poor (below70%) calculated the mean of completion of 34variables, using the base ?s national SINAN.The variables examined were divided into blocks:information of the notification; information of themother; AIDS in pregnancy; information of thechild; lactation; history of the child; laboratorydata and monitoring. Variables race / color andcompleteness showed excellent schooling in the state.Among the factors that contribute to the reductionof vertical transmission of HIV, the variablesevolution of pregnancy, initiation of prophylaxisin newborns and breastfeeding were classified asregular, while breastfeeding cross was consideredbad. Information regarding child exposed to thevirus were those who had lower degree of filling.It is concluded that data on the prevention of TVare incomplete. The notification to be performedmost often in the gestational period shows flaws inthe information concerning the child. There is needfor further clarification to health care professionalson the importance of filling in the s, in orderto draw strategies for prevention and control of theTV in the Holy Spirit.