Seroprevalence of Chikungunya virus and living conditions in Feira de Santana, Bahia-Brazil.

BACKGROUND: Chikungunya is an arbovirus, transmitted by Aedes mosquitoes, which emerged in the Americas in 2013 and spread rapidly to almost every country on this continent. In Brazil, where the first cases were detected in 2014, it currently has reached all regions of this country and more than 900,000 cases were reported. The clinical spectrum of chikungunya ranges from an acute self-limiting form to disabling chronic forms. The purpose of this study was to estimate the seroprevalence of chikungunya infection in a large Brazilian city and investigate the association between viral circulation and living condition. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a population-based ecological study in selected Sentinel Areas (SA) through household interviews and a serologic survey in 2016/2017. The sample was of 1,981 individuals randomly selected. The CHIKV seroprevalence was 22.1% (17.1 IgG, 2.3 IgM, and 1.4 IgG and IgM) and varied between SA from 2.0% to 70.5%. The seroprevalence was significantly lower in SA with high living conditions compared to SA with low living condition. There was a positive association between CHIKV seroprevalence and population density (r = 0.2389; p = 0.02033). CONCLUSIONS/SIGNIFICANCE: The seroprevalence in this city was 2.6 times lower than the 57% observed in a study conducted in the epicentre of the CHIKV epidemic of this same urban centre. So, the herd immunity in this general population, after four years of circulation of this agent is relatively low. It indicates that CHIKV transmission may persist in that city, either in endemic form or in the form of a new epidemic, because the vector infestation is persistent. Besides, the significantly lower seroprevalences in SA of higher Living Condition suggest that beyond the surveillance of the disease, vector control and specific actions of basic sanitation, the reduction of the incidence of this infection also depends on the improvement of the general living conditions of the population.

Symptoms of anxiety and depression among medical students: study of prevalence and associated factors / Sintomas de ansiedade e depressão entre estudantes de medicina: estudo de prevalência e fatores associados

Abstract: Introduction: Common Mental Disorders (CMDs) imply psychological distress, interfering with daily activities, interpersonal relationships and quality of life. It is estimated that CMDs affect 9% to 12% of the world's population and 12% to 15% of the Brazilian population in all age groups. Among different social groups, university students are more vulnerable to the development of anxiety and depression disorders. Objective: Therefore, this study proposed to estimate the prevalence rates and factors associated with symptoms of anxiety and depression in medical students in a capital city of northeast Brazil. Methods: This is a prevalence study, with a probabilistic sample of 1,339 students who regularly attended the 12 semesters of medical school in January 2018. Data were collected by applying a socioeconomic, behavioral and demographic survey and Beck Anxiety and Depression Inventories. The chi-square test was used to check for differences between anxiety and depression symptoms and socioeconomic and behavioral variables. The prevalence rates (total and by level of severity) and the crude and adjusted prevalence ratio (PR) were used as an association measure. Linear trend analysis was used to verify the existence of an association between anxiety and depression symptoms and semesters of the medical school. The variables that showed a crude PR with p <0.20 were incorporated into the multivariate analysis, using the robust Poisson regression model, to determine the adjusted PR. Results: The prevalence of symptoms of anxiety was 30.8%, whereas depression was 36.0%. The crude and adjusted PR for anxiety symptoms showed a statistically significant association with gender, age and sexual orientation. The crude and adjusted PR for symptoms of depression showed a statistically significant association with gender, ethnicity/skin color and sexual orientation. The correlation analyses between the semesters of the course and the presence of anxiety and depression symptoms indicated a weak coefficient of determination, with a descending characteristic and without statistical significance. Conclusions: As this is a prevalence study, this investigation does not allow conclusions on causality. Additional follow-up studies are needed to elucidate the course of anxiety and depression throughout the school semesters.

Resumo: Introdução: Os transtornos mentais comuns (TMC) implicam sofrimento psíquico e interferem nas atividades diárias, nos relacionamentos interpessoais e na qualidade de vida. Estima-se que os TMC atinjam de 9% a 12% da população mundial e de 12% a 15% da brasileira em todas as faixas etárias. Dentre os diferentes grupos sociais, os estudantes universitários possuem maior vulnerabilidade para desenvolver transtornos de ansiedade e depressão. Objetivo: Diante disso, este estudo se propôs a estimar a prevalência e os fatores associados a sintomas de ansiedade e depressão em estudantes de Medicina de uma capital do Nordeste brasileiro. Métodos: Trata-se de um estudo de prevalência, com uma amostra probabilística dos 1.339 alunos que frequentavam regularmente os 12 semestres do curso de Medicina em janeiro de 2018. Os dados foram coletados por meio da aplicação de questionário socioeconômico, comportamental e demográfico e dos Inventários de Ansiedade e de Depressão de Beck. Utilizou-se o teste de qui-quadrado para verificação de diferenças entre sintomas de ansiedade e depressão e variáveis socioeconômicas e comportamentais e as prevalências (total e por nível de gravidade) e a razão de prevalência (RP) bruta e ajustada como medida de associação. A análise de tendência linear foi empregada para verificar a existência de relação entre sintomas de ansiedade e depressão e semestres do curso. As variáveis que apresentaram RP bruta com p < 0,20 foram incorporadas na análise multivaridada, no modelo de regressão de Poisson robusto, para determinação da RP ajustada. Resultados: Quanto à prevalência de sintomas, constatou-se o seguinte: 30,8% para ansiedade e 36,0% para depressão. A RP bruta e ajustada para sintomas de ansiedade teve associação estatisticamente significante para sexo, idade e orientação sexual. A RP bruta e ajustada para sintomas de depressão teve associação estatisticamente significante para sexo, raça/cor da pele e orientação sexual. As análises de correlação entre os semestres do curso e a presença de sintomas de ansiedade e depressão indicaram fraco coeficiente de determinação, caráter descendente e sem significância estatística. Conclusões: Por se tratar de um estudo de prevalência, esta investigação não possibilita conclusões sobre causalidade. Estudos de acompanhamento adicionais são necessários para elucidar o curso da ansiedade e depressão ao longo dos semestres letivos.

Seroprevalence of Chikungunya Virus after Its Emergence in Brazil.

Chikungunya has had a substantial impact on public health because of the magnitude of its epidemics and its highly debilitating symptoms. We estimated the seroprevalence, proportion of symptomatic cases, and proportion of chronic form of disease after introduction of chikungunya virus (CHIKV) in 2 cities in Brazil. We conducted the population-based study through household interviews and serologic surveys during October-December 2015. In Feira de Santana, we conducted a serologic survey of 385 persons; 57.1% were CHIKV-positive. Among them, 32.7% reported symptoms, and 68.1% contracted chronic chikungunya disease. A similar survey in Riachão do Jacuípe included 446 persons; 45.7% were CHIKV-positive, 41.2% reported symptoms, and 75.0% contracted the chronic form. Our data confirm intense CHIKV transmission during the continuing epidemic. Chronic pain developed in a high proportion of patients. We recommend training health professionals in management of chronic pain, which will improve the quality of life of chikungunya-affected persons.

High Zika Virus Seroprevalence in Salvador, Northeastern Brazil Limits the Potential for Further Outbreaks.

During 2015 to 2016, Brazil reported more Zika virus (ZIKV) cases than any other country, yet population exposure remains unknown. Serological studies of ZIKV are hampered by cross-reactive immune responses against heterologous viruses. We conducted serosurveys for ZIKV, dengue virus (DENV), and Chikungunya virus (CHIKV) in 633 individuals prospectively sampled during 2015 to 2016, including microcephaly and non-microcephaly pregnancies, HIV-infected patients, tuberculosis patients, and university staff in Salvador in northeastern Brazil using enzyme-linked immunosorbent assays (ELISAs) and plaque reduction neutralization tests. Sera sampled retrospectively during 2013 to 2015 from 277 HIV-infected patients were used to assess the spread of ZIKV over time. Individuals were georeferenced, and sociodemographic indicators were compared between ZIKV-positive and -negative areas and areas with and without microcephaly cases. Epidemiological key parameters were modeled in a Bayesian framework. ZIKV seroprevalence increased rapidly during 2015 to 2016, reaching 63.3% by 2016 (95% confidence interval [CI], 59.4 to 66.8%), comparable to the seroprevalence of DENV (75.7%; CI, 69.4 to 81.1%) and higher than that of CHIKV (7.4%; CI, 5.6 to 9.8%). Of 19 microcephaly pregnancies, 94.7% showed ZIKV IgG antibodies, compared to 69.3% of 257 non-microcephaly pregnancies (P = 0.017). Analyses of sociodemographic data revealed a higher ZIKV burden in low socioeconomic status (SES) areas. High seroprevalence, combined with case data dynamics allowed estimates of the basic reproduction number R0 of 2.1 (CI, 1.8 to 2.5) at the onset of the outbreak and an effective reproductive number Reff of <1 in subsequent years. Our data corroborate ZIKV-associated congenital disease and an association of low SES and ZIKV infection and suggest that population immunity caused cessation of the outbreak. Similar studies from other areas will be required to determine the fate of the American ZIKV outbreak.IMPORTANCE The ongoing American Zika virus (ZIKV) outbreak involves millions of cases and has a major impact on maternal and child health. Knowledge of infection rates is crucial to project future epidemic patterns and determine the absolute risk of microcephaly upon maternal ZIKV infection during pregnancy. For unknown reasons, the vast majority of ZIKV-associated microcephaly cases are concentrated in northeastern Brazil. We analyzed different subpopulations from Salvador, a Brazilian metropolis representing one of the most affected areas during the American ZIKV outbreak. We demonstrate rapid spread of ZIKV in Salvador, Brazil, and infection rates exceeding 60%. We provide evidence for the link between ZIKV and microcephaly, report that ZIKV predominantly affects geographic areas with low socioeconomic status, and show that population immunity likely caused cessation of the outbreak. Our results enable stakeholders to identify target populations for vaccination and for trials on vaccine efficacy and allow refocusing of research efforts and intervention strategies.

INTERNAÇÕES POR FRATURAS DE FÊMUR EM SALVADOR, BAHIA / HOSPITALIZATION FOR FEMORAL FRACTURES IN SALVADOR, BAHIA / HOSPITALIZACIONES PARA LAS FRACTURAS FEMORALES EN SALVADOR, BAHIA

As fraturas de fêmur são causadas, principalmente, por traumas de alta energia em indivíduos jovens e adultos e por quedas entre os idosos. Mulheres idosas são mais susceptíveis, devido ao maior risco de osteoporose, já os homens jovens são mais expostos por causa de acidentes. Mediante o quadro exposto, o objetivo da pesquisa foi descrever o perfil epidemiológico dos internados com fraturas de fêmur em Salvador, Bahia, no período de 2003 a 2012. Para tanto, utilizou-se como método um estudo descritivo, retrospectivo, usando dados secundários do Sistema de Internações Hospitalares do Sistema Único de Saúde, tendo como local a cidade de Salvador, Bahia, analisando o período de 2003 a 2012. Os resultados indicaram que ocorreram 10.721 internações, predominando no terceiro trimestre do ano, e 195 óbitos hospitalares. Foram mais acometidos os indivíduos de 20-49 anos e maiores de 70 anos, do sexo masculino, com maior mortalidade hospitalar entre as mulheres. O tempo médio de permanência foi 12,2 dias, com valor médio da Autorizações de Internamento Hospitalar de R$ 1.901,18. Assim, concluiu-se que predominam as internações em jovens e adultos do sexo masculino. Os acidentes de trânsito e o consumo de álcool provavelmente contribuem para esse perfil. Não foi possível estabelecer uma relação entre tempo e taxa de internação por fratura de fêmur, porém a mortalidade hospitalar tende ao crescimento com o passar dos anos.

Femur fractures are mainly caused by high energy trauma in young adults, and falls among the elderly. Old women are more susceptible due to the increased risk of osteoporosis, and men are more exposed to accidents. The objective of this research was to describe the epidemiology profile of patients hospitalized for fractures in Salvador, Bahia, during the period from 2003 to 2012. For this purpose, a descriptive, retrospective study using data from System of Hospitalizations of the Unified Health System was used as method, with the city of Salvador, Bahia as locus for the research, analyzing the period from 2003 to 2012. Results indicate 10,721 admissions were recorded, predominantly in the third quarter of the year, and 195 deaths. Individuals aged between 20 and 49 years and over 70 years old, male were more affected, with higher hospital mortality among women. The average length of stay was 12.2 days, with an average cost of AIH of R$ 1,901.18. In conclusion, hospitalizations in young adult males predominate. Traffic accidents and alcohol probably contribute to this profile. It was not possible to establish a relationship between time and rate of hospitalization for femoral fracture, but the mortality rate tends to grow over the years.

Las fracturas de fémur son causadas, principalmente, por traumas de alta energía en adultos jóvenes, y las caídas entre los ancianos. Las mujeres mayores tienen más probabilidades debido al aumento del riesgo de osteoporosis, y los hombres están más expuestos a los accidentes. El objetivo de esta investigación fue describir la epidemiología de los hospitalizados con fracturas en Salvador, Bahia, en el período desde 2003 hasta 2012. Por lo tanto, el método adoptado fue un estudio descriptivo, retrospectivo con datos del Sistema de Internaciones Hospitalarias del Sistema Único de Salud, teniendo como local la ciudad de Salvador, Bahia, analizando el período desde 2003 hasta 2012. Los resultados puntan que ocurrieron 10.721 admisiones, sobre todo en el tercer trimestre del año, y 195 muertes. Los individuos más afectados tenían edad entre 20 y 49 años y más de 70 años, sexo masculino, con una mayor mortalidad hospitalaria entre mujeres. La permanencia media fue de 12,2 días, con un valor promedio de R$ 1,901.18. Así, se concluyó que las hospitalizaciones de hombres adultos jóvenes predominan. Accidentes de tráfico y el alcohol probablemente contribuyen a este perfil. No se pudo establecer una relación entre el tiempo y la tasa de hospitalización por fractura de fémur, pero la tasa de mortalidad tiende a crecer con el pasar de los años.

First Detection of Chikungunya Virus in Breast Milk.

Chikungunya virus (CHIKV) has never been detected in human breast milk. This is a brief report of CHIKV infection in a breastfeeding woman of a 3-month-old baby. The mother's CHIKV-RT PCR was positive in serum, urine and milk. The baby's CHIKV serology and reverse transcription polimerase chain reaction (RT-PCR) were negative. The detection of CHIKV in milk raises clinical and epidemiologic questions.

Tuberculosis incidence in a cohort of individuals infected with human T-lymphotropic virus type 1 (HTLV-1) in Salvador, Brazil.

BACKGROUND: Few reports have investigated the association between human T-lymphotropic virus type 1 (HTLV-1) and tuberculosis (TB) in countries where both infections are endemic. This study estimates the incidence of TB in a cohort infected with HTLV-1, compared with non-infected individuals, over a ten-year period. METHODS: Retrospective cohort study involving the cross-matching of records of individuals for whom a HTLV serology was performed at a referral center for HTLV (CHTLV) with a database of TB cases from Sinan-the Information System on Diseases of Compulsory Declaration between 2002 and 2012. RESULTS: From a cohort of 6,495 individuals, 1,711 were infected with HTLV-1. A total of 73 TB cases occurred during the study period: 33 HTLV-1-infected patients and 40 uninfected individuals. The incidence density for TB in the HTLV-1 infected group was 3.3 person-years per 1,000 individuals and 1.1 person-years per 1,000 individuals in the group HTLV-1 uninfected group. The relative risk of developing TB in the group of patients infected with HTLV-1 was 2.6 (CI 95 % 1.6-4.2) in comparison with HTLV-1 uninfected group. Compared to individuals with isolated TB, those in the HTLV-1 infected group who had TB were older (p = 0.005) and had lower education levels (p = 0.02). No differences were observed with respect to the clinical/radiological presentation, nor in the outcome of TB and prevalence of HIV infection, when comparing among the HTLV-1-infected and uninfected groups. CONCLUSIONS: Patients infected with HTLV-1 are more susceptible to TB. The epidemiological characteristics of HTLV-1/TB subjects and those infected with TB overlap.

Arterial hypertension and skin allergy are risk factors for progression from dengue to dengue hemorrhagic fever: a case control study.

BACKGROUND: Currently, knowledge does not allow early prediction of which cases of dengue fever (DF) will progress to dengue hemorrhagic fever (DHF), to allow early intervention to prevent progression or to limit severity. The objective of this study is to investigate the hypothesis that some specific comorbidities increase the likelihood of a DF case progressing to DHF. METHODS: A concurrent case-control study, conducted during dengue epidemics, from 2009 to 2012. Cases were patients with dengue fever that progressed to DHF, and controls were patients of dengue fever who did not progress to DHF. Logistic regression was used to estimate the association between DHF and comorbidities. RESULTS: There were 490 cases of DHF and 1,316 controls. Among adults, progression to DHF was associated with self-reported hypertension (OR = 1.6; 95% CI 1.1-2.1) and skin allergy (OR = 1.8; 95% CI 1.1-3.2) with DHF after adjusting for ethnicity and socio-economic variables. There was no statistically significant association between any chronic disease and progression to DHF in those younger than 15 years. CONCLUSIONS: Physicians attending patients with dengue fever should keep those with hypertension or skin allergies in health units to monitor progression for early intervention. This would reduce mortality by dengue.

Completeness of tuberculosis reporting forms in five Brazilian capitals with a high incidence of the disease.

The aim of this study was to evaluate the completeness of tuberculosis reporting forms in the greater metropolitan areas of five Brazilian capitals where the incidence of tuberculosis was high in 2010 - Salvador, Rio de Janeiro, Cuiabá, Porto Alegre, and Belém - using tabulations obtained from the Sistema Nacional de Informação de Agravos de Notificação (National Case Registry Database). The degree of completeness was highest in Porto Alegre and Cuiabá, whereas it was lowest in Rio de Janeiro, where there are more reported cases of tuberculosis than in any other Brazilian capital. A low degree of completeness of these forms can affect the quality of the Brazilian National Tuberculosis Control Program, which will have negative consequences for health care and decision-making processes.

Conhecimento dos estudantes de medicina de uma faculdade do nordeste brasileiro sobre o Sistema Único de Saúde / The knowledge of undergraduate students from a college in the northeastern brazil about the unified health system / Conocimiento de los estudiantes de medicina de una universidad en el noreste de brasil sobre el sistema único de salud

Os estudantes de medicina têm sido alvo de pesquisas nos últimos anos, devido à importância que esses futuros profissionais apresentam no processo de aprimoramento do Sistema Único de Saúde (SUS). O objetivo deste trabalho é identificar o nível de conhecimento desses alunos sobre os Princípios/Doutrinas/Diretrizes do SUS. Para isso, foi definida umaamostra representativa composta por 224 estudantes de uma escola médica do nordeste brasileiro distribuídos igualitariamente entre os 12 semestres do curso. Os dados foram obtidos mediante a aplicação de um questionário confeccionado pelos próprios autores, aplicado aosalunos no período de abril a agosto de 2011. Os resultados mostram que 59,8por cento dos estudantes entrevistados não apresentam conhecimentos consolidados sobre o tema; os melhores resultados estavam relacionados com o sexo feminino; idade menor que 20 anos; renda familiarmenor que 20 salários mínimos; desejo de trabalhar no setor público; e o fato de o aluno estar cursando os primeiros semestres. Conclui-se que são necessárias reformas no ensino médico, por meio de projetos pedagógicos, curriculares e extracurriculares, que favoreçam a formaçãode indivíduos mais éticos e comprometidos com a Saúde Pública.

Medical students have been the targets of research in the last years due to the importance of these future professionals in the improvement process of the Unified Health System (SUS). The objective of this study was to identify the level of knowledge of these students about the SUS Principles/Doctrines/Guidelines. In order to do this, there was defined a representative sample composed by 224 students from a medical school in the northeastern Brazil, distributed among the 12 semesters of the course. The data were obtained using a questionnaire made bythe authors themselves, which was conducted with the students from April to August 2011. The results showed that the 59.8percent of the students don?t have consolidated knowledge about SUS and the best results were obtained from the female students whose age was less than 20 years old, their family income was less than 20 minimum wages, they showed desire to work in the public sector and were mostly in the beginning of the course. It can be concluded that reforms are needed in medical education through educational programs, curricular and extracurricular, that promote the formation of more ethical and committed individuals to Public Health.

Los estudiantes de medicina han sido objeto de investigación en los últimos años, debido a la importancia que tienen estos futuros profesionales en el proceso de mejora del Sistema Único de Salud (SUS). El objetivo de este trabajo es identificar el nivel de conocimiento de los estudiantes sobre los Principios/Directrices/Doctrinas del SUS. Paraello, se definió una muestra representativa compuesta por 224 estudiantes de una escuela de medicina en el noreste de Brasil distribuidos igualmente entre los 12 semestres del curso. Los datos se obtuvieron mediante un cuestionario realizado por los mismos autores, aplicados en los alumnos entre abril y agosto de 2011. Los resultados mostraron que el 59,8por ciento de los estudiantes no tienen conocimiento consolidado sobre el tema; los mejores resultados se relacionaron con el sexo femenino; edad inferior a 20 años; ingreso familiar inferior a 20sueldos bases; deseo de trabajar en el sector público; y el hecho de que el estudiante está empezando el curso. Se concluye sobre la necesidad de reformas en la educación médica, a través de proyectos educativos, curriculares y extracurriculares, que favorezcan la formaciónde personas más éticas y comprometidas con la Salud Pública.

Hantavirus pulmonary syndrome: prognostic factors for death in reported cases in Brazil.

Hantavirus pulmonary syndrome (HPS) was described for the first time in Brazil in 1993 and has occurred endemically throughout the country. This study analysed clinical and laboratory aspects as well as death-related factors for HPS cases in Brazil from 1993 to 2006. The investigation comprised a descriptive and exploratory study of the history of cases as well as an analytical retrospective cohort survey to identify prognostic factors for death due to HPS. A total of 855 Brazilian HPS cases were assessed. The majority of cases occurred during spring (33.5%) and winter (27.6%), mainly among young male adults working in rural areas. The global case fatality rate was 39.3%. The mean interval between the onset of symptoms and hospitalisation was 4 days and that between hospitalisation and death was 1 day. In the multiple regression analysis, adult respiratory distress syndrome and mechanical respiratory support were associated with risk of death; when these two variables were excluded from the model, dyspnoea and haemoconcentration were associated with a higher risk of death.

Caracterización fenotípica y molecular de neisseria meningitidis del serogrupo C asociada con un brote en Bahia, Brasil / Phenotypic and molecular characterization of serogroup C Neisseria meningitidis associated with an outbreak in Bahia, Brazil

Objetivo Caracterizar las cepas de Neisseria meningitidis (Nm) aisladas de cinco pacientes con Enfermedad Meningocócica (EM) asociada a un brote epidémico en Trancoso - BA, que ocurrió en octubre del 2009, luego de una fiesta en zona rural y en la que participaron 1000 jóvenes .Todos los casos fueron secundarios al caso primario a excepción de un paciente varón de 39 años. Materiales y métodos El Servicio de Vigilancia Epidemiológica del Estado de Bahia realizó la investigación epidemiológica y las cepas de Nm se caracterizaron en el Laboratorio Nacional de Referencia para Meningitis, Instituto Adolfo Lutz - São Paulo mediante métodos convencionales (sero - subtipificación y prueba de sensibilidad a los antimicrobianos) y métodos moleculares (electroforesis en gel de campo pulsado- PFGE y Multilocus Sequence Typing - MLST).Resultados La PFGE mostró dos perfiles de restricción estrechamente relacionados designados como PFGE tipos A y A1 con 92% de relación entre sí. Ambos tipos fueron clasificados como ST-3780 mediante MLST, y pertenecientes al complejo clonal ST-103. Todos los aislados mostraron el fenotipo C: 23: P1.5 y eran susceptibles a todos los antibióticos testados. Conclusiones Este es el primer brote de EM reportado asociado a cepas de Nm serogrupo C del complejo clonal ST-103 y relacionado con el consumo de drogas en Brasil (AU)

Objective To characterize meningococcal strains isolated from five cases of meningococcal disease (MD) associated with an outbreak in Trancoso - BA, occurred in October 2009. All cases, with the exception of a 39-year-old male, attended a dance party with approximately 1000 youngsters in a rural site. Materials and methods The epidemiological investigation was conducted by the Epidemiological Surveillance Service of Bahia State. Meningococcal strains were characterized at Adolfo Lutz Institute, the Brazilian National Reference Laboratory for Bacterial Meningitis by conventional techniques (serotype, serosubtype and antimicrobial susceptibility test) and by molecular methods (Pulsed-field gel electrophoresis - PFGE and Multilocus Sequence Typing - MLST).Results The PFGE showed 2 closely related restriction profiles, designated as PFGE types A and A1, having 92% relatedness to each other. MLST characterization showed both A and A1 clones were ST-3780, which belongs to the ST-103 complex. All isolates displayed the phenotype C:23:P1.5 and were susceptible to all antibiotics tested. Conclusions This is the first reported MD outbreak associated with serogroup C ST-103 complex in Brazil, as well as the party and illicit drug-use associated outbreak (AU)

Phenotypic and molecular characterization of serogroup C Neisseria meningitidis associated with an outbreak in Bahia, Brazil.

OBJECTIVE: To characterize meningococcal strains isolated from five cases of meningococcal disease (MD) associated with an outbreak in Trancoso - BA, occurred in October 2009. All cases, with the exception of a 39-year-old male, attended a dance party with approximately 1000 youngsters in a rural site. MATERIALS AND METHODS: The epidemiological investigation was conducted by the Epidemiological Surveillance Service of Bahia State. Meningococcal strains were characterized at Adolfo Lutz Institute, the Brazilian National Reference Laboratory for Bacterial Meningitis by conventional techniques (serotype, serosubtype and antimicrobial susceptibility test) and by molecular methods (Pulsed-field gel electrophoresis - PFGE and Multilocus Sequence Typing - MLST). RESULTS: The PFGE showed 2 closely related restriction profiles, designated as PFGE types A and A1, having 92% relatedness to each other. MLST characterization showed both A and A1 clones were ST-3780, which belongs to the ST-103 complex. All isolates displayed the phenotype C:23:P1.5 and were susceptible to all antibiotics tested. CONCLUSIONS: This is the first reported MD outbreak associated with serogroup C ST-103 complex in Brazil, as well as the party and illicit drug-use associated outbreak.

[Yersinia pestis infection in the State of Bahia: effective control or epidemiological silence?]. / Infecção por Yersinia pestis, no Estado da Bahia: controle efetivo ou silêncio epidemiológico?

INTRODUCTION: From an epidemiological point of view, the plague is still being considered of great importance, because of its high epidemic potential. Despite the absence of cases of human plague in Brazil, its etiologic agent, the bacteria Yersinia pestis, is still deep rooted in its natural environment. The occurrence of positive serology for plague in domestic carnivores in plague areas in Bahia in the past few years implies the need for a more rigorous evaluation in order to verify whether the bacillus of the plague is still active in these areas. METHODS: In this study, the presence of infection caused by Y. pestis was analyzed by seroprevalence tests on humans, dogs and rodents and by the detection of the bacteria in rodents and fleas. A structured questionnaire was used to analyze the association between environmental, socioeconomic and biological factors and seroprevalence in humans. RESULTS: Of the 630 serum samples examined (88 from humans, 480 from dogs and 62 from rodents), all were nonreactive for plague and bacteriological analyses performed on 14 rodents and 2 flea lots showed no signs of the bacteria. CONCLUSIONS: These results cannot confirm the eradication of the disease in the entire State, since the cyclic nature of the plague indicates that it can go silent for long periods and then resurge, affecting large numbers of people. Thus, maintenance of active, permanent surveillance is required for early detection and the development of adequate control measures.

Infecção por Yersinia pestis, no Estado da Bahia: controle efetivo ou silêncio epidemiológico? / Yersinia pestis infection in the State of Bahia: effective control or epidemiological silence?

INTRODUÇÃO: A peste, doença infectocontagiosa milenar, continua sendo considerada da maior importância do ponto de vista epidemiológico devido ao alto potencial epidêmico, estando inclusive sujeita ao Regulamento Sanitário Internacional. Apesar da ausência de casos humanos da doença no Brasil, seu agente etiológico, a bactéria Yersinia pestis, permanece firmemente arraigado em seus focos naturais. A ocorrência de sorologia positiva em carnívoros domésticos de regiões pestígenas da Bahia, nos últimos anos, objetivou a realização deste estudo, que se propõe a verificar a existência de circulação do agente no estado, tendo em vista que fatores condicionantes para a doença são mantidos, oferecendo riscos à população. MÉTODOS: Trata-se de um estudo para verificação da presença de infecção por Y. pestis através do inquérito de soroprevalência em humanos, cães e roedores; e pesquisa da bactéria em roedores e pulgas. Utilizou-se de questionário estruturado para avaliação da associação existente entre fatores ambientais, sócioeconômicos e biológicos e a soroprevalência da infecção em humanos. RESULTADOS: Os 630 soros examinados (88 de humanos, 480 de cães, 62 de roedores) apresentaram-se não reagentes para peste e as análises bacteriológicas realizadas em 14 roedores e dois lotes de pulgas não identificaram a bactéria. CONCLUSÕES: Os resultados não configuram erradicação da doença no estado, pois sua natureza cíclica indica que pode passar longos períodos silente e depois ressurgir acometendo um grande número de pessoas. Portanto, a manutenção da vigilância ativa e permanente se faz necessária para a detecção precoce da doença e desenvolvimento oportuno das medidas de controle pertinentes.

INTRODUCTION: From an epidemiological point of view, the plague is still being considered of great importance, because of its high epidemic potential. Despite the absence of cases of human plague in Brazil, its etiologic agent, the bacteria Yersinia pestis, is still deep rooted in its natural environment. The occurrence of positive serology for plague in domestic carnivores in plague areas in Bahia in the past few years implies the need for a more rigorous evaluation in order to verify whether the bacillus of the plague is still active in these areas. METHODS: In this study, the presence of infection caused by Y. pestis was analyzed by seroprevalence tests on humans, dogs and rodents and by the detection of the bacteria in rodents and fleas. A structured questionnaire was used to analyze the association between environmental, socioeconomic and biological factors and seroprevalence in humans. RESULTS: Of the 630 serum samples examined (88 from humans, 480 from dogs and 62 from rodents), all were nonreactive for plague and bacteriological analyses performed on 14 rodents and 2 flea lots showed no signs of the bacteria. CONCLUSIONS: These results cannot confirm the eradication of the disease in the entire State, since the cyclic nature of the plague indicates that it can go silent for long periods and then resurge, affecting large numbers of people. Thus, maintenance of active, permanent surveillance is required for early detection and the development of adequate control measures.

Perfil epidemiológico da dengue no Município de Itabuna (BA), 2000 jun. 2009 / Epidemic profile of dengue in the municipal district of Itabuna (BA), 2000 Jun. 2009 / Perfil epidemiologico de la dengue en el municipio de Itabuna (BA), 2000 Jun. 2009

A dengue é uma doença infecciosa viral aguda de transmissão vetorial. No Brasil e em Itabuna tem apresentado elevado grau de morbidade e mortalidade e provocado graves epidemias nos últimos anos. O objetivo deste artigo é descrever o perfil epidemiológico dos casos de dengue em Itabuna entre 2000 e junho de 2009. Os dados foram obtidos do Sistema de Informação de Agravos de Notificação, Programa de Febre Amarela e Dengue e Centro de Pesquisas do Cacau. Foram analisadas as variáveis sexo, faixa etária, bairro de residência e ano de ocorrência. No município, no período estudado, foram notificados 31.290 casos, 8,5por cento do total da Bahia. Observou-se, uma alça epidêmica da doença em 2003, com taxa de incidência oito vezes superior à do Estado e outra em 2009, quase doze vezes maior que a da Bahia. A maioria dos casos ocorreu entre janeiro e abril, meses com as maiores médias de precipitações pluviométricas. No bairro de Fátima, o sexo feminino e indivíduos de 20-39 anos foram os mais acometidos. As formas graves da dengue atingiram 92 pessoas em 2009, a maioria entre 5-14 anos. Concluiu-se que a dengue é um importante problema de saúde em Itabuna, cuja situação agrava-se pela circulação concomitante de três sorotipos e pelos elevados níveis de infestação vetorial.

Dengue is an acute infectious viral disease of vector transmission. In Brazil and in Itabuna, it has shown a high morbidity and mortality rate and has caused severe epidemics in recent years. The aim of this article is to describe the epidemic profile of the dengue cases in Itabuna between 2000 to 2009. The data was collected from the Sistema de Informação de Agravos de Notificação, Programa de Febre Amarela e Dengue and Centro de Pesquisas do Cacau. Gender, age group, neighborhood of residence and year of occurrence were the analyzed variables. It was observed, an epidemic loop of the disease in 2003, with Rate of Incidence eight times superior to the one of the State and another in 2009, almost twelve times bigger than that of Bahia. Most cases happened between January and April, months with the largest averages of rain precipitations. In the Fátima neighborhood, women and 20-39 year-old individuals were the most affected. The serious forms of dengue affected 92 people in 2009, the majority between5-14 years old. Dengue is a serious health problem in Itabuna, the situation of which becomes worse for the concomitant circulation of three serotypes and for the high levels of vectorial infestation.

La dengue es una enfermedad infecciosa viral aguda de transmisión vectorial. En Brasil y, en el municipio de Itabuna, ha presentado elevada tasa de morbidad y mortalidad, provocando en los últimos años graves epidemias. El objetivo de este artículo es describir el perfil epidemiológico de los casos de dengue en Itabuna entre 2000 y 2009. Los datos se obtuvieron en el Sistema de Información de Agravos de Notificación, Programa de Fiebre Amarilla y Dengue y Centro de investigaciones del Cacao. Fueron analizadas las variables sexo, edad, barrio y año del registro. En el municipio fueron notificados 31.290 casos, 8,5 por ciento del total del estado de la Bahia. En 2003 se observo una alta epidémica de la enfermedad, con una tasa de incidencia ocho veces superior a la del Estado y otra, en 2009, casi doce veces mayor que el estado de la Bahia. La mayoría de los casos se registró entre enero y abril, meses con el mayor índice pluviométrico. En el barrio de Fátima, el sexo femenino y los individuos de 20 a 30 años fueron los más afectados. En 2009, las formas graves de la dengue acometieron 92 personas, la mayoría entre 5 y 14 años. Se concluye que en Itabuna, la dengue es importante problema de salud, cuya situación se agrava en función de la circulación concomitante de tres sorotipos y por los elevados niveles de infección vectorial.

Dengue hemorrhagic fever is associated with polymorphisms in JAK1.

To identify genes associated with the clinical presentation of dengue, 50 cases of probable or possible dengue hemorrhagic fever (DHF), 236 dengue fever (DF), and 236 asymptomatic infections were genotyped for 593 single-nucleotide polymorphisms (SNPs) in 56 genes across the type 1 interferon (IFN) response pathway as well as other important candidate genes. By single locus analysis comparing DHF with DF, 11 of the 51 markers with P<0.05 were in the JAK1 gene. Five markers were significantly associated by false discovery rate criteria (q<0.20 when P<6 × 10(-4)). The JAK1 SNPs showed differential distribution by ethnicity and ancestry consistent with epidemiologic observations in the Americas. The association remained significant after controlling for ancestry and income. No association was observed with markers in the gene encoding CD209 (DC-SIGN). An association between DHF and JAK1 polymorphisms is in agreement with expression profiles showing generalized decreased type 1 IFN-stimulated gene expression in these patients.

Clinical outcomes of thirteen patients with acute chagas disease acquired through oral transmission from two urban outbreaks in northeastern Brazil.

BACKGROUND: Outbreaks of orally transmitted Trypanosoma cruzi continue to be reported in Brazil and are associated with a high mortality rate, mainly due to myocarditis. METHODS: This study is a detailed report on the disease progression of acute Chagas disease in 13 patients who were infected during two micro-outbreaks in two northeastern Brazilian towns. Clinical outcomes as well as EKG and ECHO results are described, both before and after benznidazole treatment. RESULTS: Fever and dyspnea were the most frequent symptoms observed. Other clinical findings included myalgia, periorbital edema, headache and systolic murmur. Two patients died of cardiac failure before receiving benznidazole treatment. EKG and ECHO findings frequently showed a disturbance in ventricular repolarization and pericardial effusion. Ventricular dysfunction (ejection fraction <55%) was present in 27.3% of patients. After treatment, EKG readings normalized in 91.7% of patients. Ventricular repolarization abnormalities persisted in 50% of the patients, while sinus bradycardia was observed in 18%. The systolic ejection fraction normalized in two out of three patients with initially depressed ventricular function, while pericardial effusion disappeared. CONCLUSIONS: Myocarditis is frequently found and potentially severe in patients with acute Chagas disease. Benznidazole treatment may improve clinical symptoms, as well as EKG and ECHO findings.

HTLV-1 infection in blood donors from the Western Brazilian Amazon region: seroprevalence and molecular study of viral isolates.

To determine the seroprevalence of HTLV-1 in Brazil, and to review the virus molecular epidemiology in this Amazon population (Rio Branco-Acre), 219 blood donors were screened for HTLV-1. Only one case of infection (0.46% seroprevalence) was detected during July 2004 screening at the Acre Hospital Foundation (FUNDACRE). Neighbor-joining and Maximum Likelihood phylogenetic analyses of two (n = 2) complete LTR region sequences were performed with the PAUP* software. Since the HTLV-1 envelope surface (gp46) and transmembrane (gp21) glycoproteins are important for virus fitness, three envelope glycoproteins sequences (n = 3) were analyzed using the Prosite tool to determinate potential protein sites. Phylogenetic analysis demonstrated that the new isolate described in this study, and the unpublished LTR strain described in a previous report belong to the Transcontinental subgroup of the Cosmopolitan subtype, inside the Latin American cluster. A similar result was obtained when submitting, to the Automated Genotyping System, three LTR partial sequences from a previous study of the seroprevalence of HTLV-1 in the same Amazon population. In all analyzed env sequences, the potential protein site was found: two PKC phosphorylation sites at amino acid (aa) positions 310-312 and 342-344, one CK2 phosphorylation site at 194-197aa, three N-glycosylation sites at 222-225aa, 244-247aa and 272-275aa, and a single N-myristylation site at 327-338aa. In conclusion, potential protein sites described in HTLV-1 gp46 and gp21 confirm the presence of conserved sites in the HTLV-1 envelope proteins, likewise phylogenetic analysis suggests a possible recent introduction of the virus into North Brazil.