High prevalence of hepatitis B virus and low vaccine response in children and adolescents in Northeastern Brazil.

Children have an increased likelihood of becoming carriers of the chronic hepatitis B virus. A total of 1,381 children and adolescents were assessed in five municipalities of Maranhao State, Brazil, for detection of anti-HBc, HBsAg and anti-HBs serologic markers and sociodemographic and behavioral features. Among those who were HBsAg negative and anti-HBc negative, the proportion of anti-HBs positives was calculated after the individuals had completed the vaccination schedule. The robust variance of the Poisson's regression model was used in order to have adjusted tables and calculate the prevalence ratio. Multivariate analysis was performed to identify the factors associated with the prevalence of anti-HBc with or without HBsAg and the vaccine response. It was observed that 163 children were anti-HBc positive and nine individuals were HBsAg positive. The factors associated with the infection were: municipality of residence (residing in Morros municipality or Humberto de Campos municipality), residence in a rural area, aged between 13 and 15 years old, and illicit drug use. The percentage of individuals who were anti-HBc negative and received all three doses of the vaccine was 48.5%. Among these, only 276 (38.9%) had antibodies at protective concentrations. In an adjusted analysis, Morros municipality presented an increased positivity of vaccine response (p < 0.001), and the age ranging between 6 and 10 years old presented a reduced frequency of response. This study reveals a high prevalence of current and past HBV infection within the targeted age group which, in addition to the low vaccination coverage and serological responses, raises concerns about the management of prevention measures, especially the quality of vaccination in these locations.

Assistência de enfermagem no pré-natal da gestante adolescente: uma revisão integrativa / Prenatal nursing care for adolescent pregnant women: an integrative review / Atención de enfermería prenatal a adolescentes embarazadas: una revisión integradora

A gravidez na adolescência é um problema de saúde pública devido aos riscos relacionados à sua ocorrência. Logo, a assistência de enfermagem torna-se essencial para o início precoce e acompanhamento do pré-natal, com intuito de alcançar resultados favoráveis no ciclo gravídico-puerperal. O objetivo deste trabalho foi analisar, na literatura, a assistência de enfermagem no pré-natal e a percepção da gestante adolescente sobre a assistência recebida. Trata-se de uma revisão integrativa da literatura, cujas buscas foram realizadas em junho de 2022, nas bases de dados SCOPUS, Web of Science, LILACS, MEDLINE (PubMed) e BDENF. Foram selecionados 12 artigos para compor a amostra deste estudo. Observou-se que as adolescentes apontaram situações positivas durante a assistência pré-natal, como: relacionamento e tratamento respeitoso, participação em grupos de gestantes adolescentes, abordagens diferenciadas para orientações de educação em saúde, promoção do autocuidado, conscientização sobre importância do pré-natal e inserção familiar. Entretanto também relataram situações negativas, como: deficiências nas orientações, falta de habilidades dos profissionais em se relacionar com adolescentes, preconceito, atitudes de desencorajamento, comprometimento da privacidade e confidencialidade, assim como interrupção na continuidade do cuidado. Os achados desta revisão demonstraram que a assistência de enfermagem em sua maioria é respeitosa e acolhedora, entretanto a percepção das adolescentes grávidas variou entre experiências negativas e positivas, influenciando no seguimento do pré-natal, por isso é necessário aprimoramento dos enfermeiros para atendimento da gestante adolescente.

Teenage pregnancy is a public health problem due to the risks related to its occurrence. Therefore, nursing care becomes essential for the early initiation and monitoring of prenatal care, with the aim of achieving favorable results in the pregnancy- puerperal cycle. The objective of this study was to analyze, in the literature, nursing care in prenatal care and the perception of pregnant teenagers about the care received. This is an integrative literature review, whose searches were carried out in June 2022, in the SCOPUS, Web of Science, LILACS, MEDLINE (PubMed) and BDENF databases. Twelve articles were selected to compose the sample of this study. It was observed that the adolescents pointed out positive situations during prenatal care, such as: respectful relationship and treatment, participation in groups of pregnant teenagers, different approaches to health education guidelines, promotion of self-care, awareness of the importance of prenatal care and family insertion. However, they also reported negative situations, such as: deficiencies in the guidelines, lack of skills of professionals in relating to adolescents, prejudice, attitudes of discouragement, compromise of privacy and confidentiality, as well as interruption in the continuity of care. The findings of this review demonstrated that nursing care is mostly respectful and welcoming, however, the perception of pregnant adolescents varied between negative and positive experiences, influencing the prenatal follow-up, which is why it is necessary to improve nurses to care for pregnant women adolescent.

El embarazo adolescente es un problema de salud pública debido a los riesgos relacionados con su ocurrencia. Por lo tanto, el cuidado de enfermería se vuelve fundamental para el inicio temprano y seguimiento de la atención prenatal, con el objetivo de lograr resultados favorables en el ciclo embarazo-puerperio. El objetivo de este estudio fue analizar, en la literatura, el cuidado de enfermería en el prenatal y la percepción de las adolescentes embarazadas sobre el cuidado recibido. Se trata de una revisión integrativa de la literatura, cuyas búsquedas se realizaron en junio de 2022, en las bases de datos SCOPUS, Web of Science, LILACS, MEDLINE (PubMed) y BDENF. Doce artículos fueron seleccionados para componer la muestra de este estudio. Se observó que las adolescentes señalaron situaciones positivas durante el prenatal, tales como: relación y trato respetuoso, participación en grupos de adolescentes embarazadas, diferentes abordajes de las pautas de educación en salud, promoción del autocuidado, conciencia de la importancia del prenatal y inserción familiar. Sin embargo, también relataron situaciones negativas, como: deficiencias en las orientaciones, falta de competencia de los profesionales en el relacionamiento con los adolescentes, prejuicios, actitudes de desánimo, compromiso de la privacidad y confidencialidad, así como interrupción en la continuidad del cuidado. Los hallazgos de esta revisión demostraron que la atención de enfermería es en su mayoría respetuosa y acogedora, sin embargo, la percepción de las adolescentes embarazadas varió entre experiencias negativas y positivas, influyendo en el seguimiento prenatal, por lo que es necesario perfeccionar a las enfermeras para el cuidado de las gestantes. adolescente.

High prevalence of hepatitis B virus and low vaccine response in children and adolescents in Northeastern Brazil

ABSTRACT Children have an increased likelihood of becoming carriers of the chronic hepatitis B virus. A total of 1,381 children and adolescents were assessed in five municipalities of Maranhao State, Brazil, for detection of anti-HBc, HBsAg and anti-HBs serologic markers and sociodemographic and behavioral features. Among those who were HBsAg negative and anti-HBc negative, the proportion of anti-HBs positives was calculated after the individuals had completed the vaccination schedule. The robust variance of the Poisson's regression model was used in order to have adjusted tables and calculate the prevalence ratio. Multivariate analysis was performed to identify the factors associated with the prevalence of anti-HBc with or without HBsAg and the vaccine response. It was observed that 163 children were anti-HBc positive and nine individuals were HBsAg positive. The factors associated with the infection were: municipality of residence (residing in Morros municipality or Humberto de Campos municipality), residence in a rural area, aged between 13 and 15 years old, and illicit drug use. The percentage of individuals who were anti-HBc negative and received all three doses of the vaccine was 48.5%. Among these, only 276 (38.9%) had antibodies at protective concentrations. In an adjusted analysis, Morros municipality presented an increased positivity of vaccine response (p < 0.001), and the age ranging between 6 and 10 years old presented a reduced frequency of response. This study reveals a high prevalence of current and past HBV infection within the targeted age group which, in addition to the low vaccination coverage and serological responses, raises concerns about the management of prevention measures, especially the quality of vaccination in these locations.

Aspectos éticos relacionados ao processo de comunicação efetiva durante pandemia COVID-19: revisão integrativa / Ethical aspects related to the effective communication process during pandemic COVID-19: integrative review

Objetivo: Investigar a produção de literatura sobre a comunicação da equipe de saúde com pacientes e familiares durante a pandemia da COVID-19. Método: Trata-se de uma revisão integrativa realizada nas bases de dados BVS, PubMed e Scopus, utilizando os descritores em ciências da saúde (DeCS): Coronavirus, Bioética e Comunicação. Resultados: Obtiveram-se 139 artigos, sendo selecionados 6 artigos para análise dessa revisão. Os achados mais comuns foram: os desafios no processo de comunicação, principalmente entre populações mais vulneráveis, como a oncologia, cuidados paliativos e pacientes de unidades de terapia intensiva; na outra ponta estratégias que visam mitigar esse agravante, como métodos alternativos de comunicação, que inclue um componente de vídeo. Conclusão: A comunicação efetiva ficou comprometida durante a pandemia da COVID-19, sendo necessário a criação de protocolos com base em parâmetros éticos e bioéticos conforme os valores de cada sociedade.(AU)

Objective: Investigate the production of literature on the communication of the health team with patients and families during the COVID-19 pandemic. Method: This is an integrative review carried out in the VHL, PubMed and Scopus databases, using the health science descriptors (DeCS): Coronavirus, Bioethics and Communication. Results: 139 articles were obtained, with 6 articles selected for analysis of this review. The most common findings were: challenges in the communication process, especially among the most vulnerable populations, such as oncology, palliative care and intensive care unit patients; at the other end, strategies aimed at mitigating this problem, such as alternative methods of communication, which include a video component. Conclusion: Effective communication was compromised during the COVID-19 pandemic, requiring the creation of protocols based on ethical and bioethical parameters according to the values of each society.(AU)

Objetivo: Investigar la producción de literatura sobre la comunicación del equipo de salud con pacientes y familiares durante la pandemia COVID-19. Método: Se trata de una revisión integradora realizada en las bases de datos BVS, PubMed y Scopus, utilizando los descriptores de ciencias de la salud (DeCS): Coronavirus, Bioética y Comunicación. Resultados: Se obtuvieron 139 artículos, con 6 artículos seleccionados para el análisis de esta revisión. Los hallazgos más comunes fueron: desafíos en el proceso de comunicación, especialmente entre las poblaciones más vulnerables, como pacientes de oncología, cuidados paliativos y unidad de cuidados intensivos; en el otro extremo, estrategias destinadas a mitigar este problema, como los métodos alternativos de comunicación, que incluyen un componente de video. Conclusión: La comunicación efectiva se vio comprometida durante la pandemia de COVID-19, requiriendo la creación de protocolos basados en parámetros éticos y bioéticos acordes a los valores de cada sociedad.(AU)

Cartão da gestante como instrumento para continuidade da assistência à saúde: revisão integrativa da literatura / The card of the pregnant woman as an instrument for continuity of health care: integrative review of the literature

Resumo Objetivo: Analisar as evidências científicas acerca da utilização do cartão da gestante na prática clínica. Método: Trata-se de uma revisão integrativa da literatura, cuja busca das produções ocorreu em abril de 2019, por meio da Biblioteca Virtual em Saúde. Os critérios de inclusão foram: artigos originais, disponíveis na íntegra e nos idiomas português, inglês ou espanhol. A busca resultou em um total de 416 artigos, dos quais 8 foram selecionados para análise. Resultados: Os artigos selecionados foram publicados entre 2004 e 2017. Todos apresentaram abordagem quantitativa, foram publicados no idioma português, em revistas eletrônicas nas áreas de Saúde Pública, Ginecologia e Obstetrícia, Enfermagem e Ciências da Saúde. Da análise dos artigos emergiram três seções: qualidade dos registros no cartão da gestante; concordância entre registros no cartão da gestante, prontuário e recordatório materno; e uso do cartão pelas gestantes. Conclusão: Constatou-se que o cartão da gestante vem sendo utilizado de maneira insatisfatória, tendo em vista a incompletude e/ou ilegibilidade dos registros.

Abstract Objective: Analyze the scientific evidence about the use of the pregnant woman's card in clinical practice. Method: This is an integrative review, whose literature search took place in April 2019, through the Virtual Health Library. The inclusion criteria were: original articles, available in full and in Portuguese, English or Spanish. The search resulted in a total of 416 articles, of which 8 were selected for analysis. Results: The selected articles were published between 2004 and 2017. All presented a quantitative approach, were published in Portuguese, in electronic journals in the areas of Public Health, Gynecology and Obstetrics, Nursing and Health Sciences. From the analysis of the articles, three thematic axes emerged: quality of the records on the pregnant woman's card; agreement between records on the pregnant woman's card, medical record and maternal recall; and use of the card by pregnant women. Conclusion: It was found that the pregnant woman's card has been used in an unsatisfactory way, in view of the incompleteness and/or illegibility of the records.

Resumen Objetivo: Analizar la evidencia científica sobre el uso de la tarjeta de gestante en la práctica clínica. Método: Esta es una revisión integradora, cuya búsqueda en la literatura tuvo lugar en abril de 2019, a través de la Biblioteca Virtual en Salud. Los criterios de inclusión fueron: artículos originales, disponibles íntegramente y en portugués, inglés o español. La búsqueda resultó en un total de 416 artículos, de los cuales 8 fueron seleccionados para análisis. Resultados: Los artículos seleccionados se publicaron entre 2004 y 2017. Todos presentaron un enfoque cuantitativo, se publicaron en portugués, en revistas electrónicas en las áreas de Salud Pública, Ginecología y Obstetricia, Enfermería y Ciencias de la Salud. Del análisis de los artículos surgieron tres ejes temáticos: calidad de los registros en la tarjeta de la mujer embarazada; acuerdo entre los registros en la tarjeta de la mujer embarazada, el registro médico y la memoria materna; y uso de la tarjeta por mujeres embarazadas. Conclusión: Se constató que la tarjeta de la mujer embarazada se ha utilizado de manera insatisfactoria, en vista de la incompletitud y/o ilegibilidad de los registros.

Unexpected findings of hepatitis B and delta infection in northeastern Brazil: A public health alert.

INTRODUCTION AND OBJECTIVES: Research has shown that hepatitis B (HBV) and Delta virus (HDV) are a worldwide public health problem. This study aims to estimate the prevalence rates of HBV and HDV infection in five municipalities of Maranhão, Northeastern Brazil. MATERIALS AND METHODS: A total sample between 3856 and 4000 individuals. Questionnaires were used to register sociodemographic characteristics and factors associated with transmission. Patients were tested for hepatitis B virus surface antigen (HBsAg), anti-hepatitis B core antigen (anti-HBc), and antibodies against hepatitis Delta virus (anti-HDV). Factors associated with HBV were detected by means of multivariate Poisson regression. RESULTS: Overall, 3983 subjects were included. Ninety-two of the participants were HBsAg-positive (2.30%, 95% CI 1.80-2.80), and anti-HBc was detected in 1535 (38.50%, 95% CI 37-40). The factors associated with the presence of anti-HBc were: (1) Municipality (P<0.001); Age (P<0.001); School education (P<0.001); Illicit drug use (P=0.001); non-HBV vaccine (P=0.041). Among the HBsAg carriers, eight were anti-HDV-positive (8.69%, 95% CI 2.90-14.40). The most frequent HBV genotype was D4. The only HDV genotype was HDV-8. CONCLUSION: HBV exhibited intermediate endemicity in the studied region. Traditional factors were associated with exposure to the virus. The presence of the HDV was confirmed. The most frequent HBV and HDV genotypes were unlike the ones currently described in Brazil.

Qualidade dos registros da assistência pré-natal na caderneta da gestante / Calidad de los recordados de cuidado prenatal en el cuaderno de la mujer pregnant / Quality of the prenatal care records in the pregnant women's booklet

Objetivo avaliar a qualidade dos registros na caderneta da gestante averiguando a legibilidade e completude dos registros da assistência pré-natal de risco habitual. Método estudo avaliativo, descritivo e quantitativo, realizado em nove unidades de saúde da atenção básica em São Luís, Maranhão, Brasil, no período de maio de 2017 a setembro de 2018. Os registros foram avaliados quanto à legibilidade e completude. Resultados 92,4% das cadernetas foram consideradas com registros legíveis. A avaliação da completude evidenciou que 72,4% apresentaram completude ruim. Nenhuma caderneta foi classificada com registro bom ou excelente. A avaliação por seções demonstrou que a seção de Exames Complementares de Rotina apresentou os melhores resultados, enquanto a seção de Atividades Complementares apresentou os menores níveis de completude. Conclusão os registros nas cadernetas da gestante foram predominantemente ruins, denotando uma desvalorização desse instrumento e um provável descumprimento das recomendações do Ministério da Saúde para uma assistência de qualidade.

Objetivo evaluar la calidad de los registros en la cartilla de las mujeres embarazadas, evaluando la legibilidad y la integridad de los registros de control prenatal de riesgo habitual. Método estudio evaluativo, descriptivo y cuantitativo, realizado en nueve unidades de atención básica en salud en São Luís, Maranhão, Brasil, en el período de mayo de 2017 a septiembre de 2018. Los registros fueron evaluados en cuanto a la legibilidad y la integridad. Resultados el 92,4% de las cartillas fueron consideradas con registros legibles. La evaluación de la integridad mostró que el 72,4% tenía mala integridad. Ningún registro de la cartilla fue clasificado como bueno o excelente. La evaluación por secciones mostró que la sección de Exámenes Complementarios de Rutina obtuvo los mejores resultados, mientras que la sección de Actividades Complementarias obtuvo los niveles más bajos de la integridad. Conclusión los registros de la cartilla de mujeres embarazadas eran, en su mayoría, pobres, denotando una devaluación de este instrumento y un probable incumplimiento de las recomendaciones del Ministerio de Salud para una asistencia de calidad.

Objective to evaluate the quality of the records in the pregnant women's booklet, assessing the legibility and completeness of usual-risk pre-natal records. Method evaluative, descriptive and quantitative study, conducted in nine basic health care units in São Luís, Maranhão, Brazil, in the period from May 2017 to September 2018. The records were evaluated according to legibility and completeness. Results 92.4% of the booklets were considered with legible records. The assessment of the completeness showed that 72.4% had bad completeness. No record booklet was classified as good or excellent. The assessment by sections showed that the Routine Complementary Test section showed the best results, whereas the Complementary Activities section showed the lowest levels of completeness. Conclusion the records in the pregnant women's booklet were predominantly bad, denoting a devaluation of this instrument and a probable noncompliance with the recommendations of the Ministry of Health for a quality assistance.

Pré-natal da gestante de risco habitual: potencialidades e fragilidades / Prenatal care of habitual- risk pregnant women: potentialities and weaknesses / Prenatal de la gestante de riesgo habitual: potencialidades y fragilidades

"\"\\\"[{\\\\\\\"text\\\\\\\": \\\\\\\"Objetivo: conhecer as potencialidades e fragilidades na consulta pré-natal de risco habitual. Método:\\\\\\\\r\\\\\\\\nestudo qualitativo, desenvolvido com vinte gestantes que realizaram o pré-natal na Atenção Primária à Saúde do\\\\\\\\r\\\\\\\\nmunicípio de São Luís, no ano de 2017. Para análise dos dados utilizou-se a Análise Temática com base nos\\\\\\\\r\\\\\\\\nparâmetros preconizados pelo Ministério da Saúde. Resultados: o acolhimento, o fácil acesso, a realização de\\\\\\\\r\\\\\\\\nexames e os grupos de gestantes configuram-se como potencialidades do pré-natal. A falta de organização das\\\\\\\\r\\\\\\\\nunidades, de medicamentos de uso essencial, de recursos materiais, o tempo prolongado para início das consultas e para as realizações dos exames consistiram em fragilidades. Conclusões: a avaliação da assistência pré-natal a partir da percepção das usuárias trouxe contribuições para intervenções nas fragilidades dos serviços de saúde às gestantes, e o atendimento de acordo com o que está preconizado pelo Ministério da Saúde.\\\\\\\", \\\\\\\"_i\\\\\\\": \\\\\\\"pt\\\\\\\"}, {\\\\\\\"text\\\\\\\": \\\\\\\"Objective: to know the potentialities and weaknesses in the prenatal consultation of habitual risk.\\\\\\\\r\\\\\\\\nMethods: qualitative study, developed with twenty pregnant women who underwent prenatal care at Primary\\\\\\\\r\\\\\\\\nHealth Care in the city of São Luís in 2017. Data analysis used the Thematic Analysis based on the parameters recommended by the Ministry of Health. Results: the reception, the easy access, the examinations and the groups of pregnant women are configured as prenatal potentialities. The lack of organization of the units, of essential drugs, of material resources, the long time to start consultations and the accomplishment of the examinations constituted weaknesses. Conclusions: the assessment of prenatal care from the users' perceptions brought contributions to interventions in the weaknesses of health services to pregnant women, according to the recommendations of the Ministry of Health.\\\\\\\", \\\\\\\"_i\\\\\\\": \\\\\\\"en\\\\\\\"}, {\\\\\\\"text\\\\\\\": \\\\\\\"Objetivo: conocer las potencialidades y fragilidades en la consulta prenatal de riesgo habitual.\\\\\\\\r\\\\\\\\nMétodos: estudio cualitativo, desarrollado con veinte gestantes, que realizaron el prenatal en la Atención Primaria a la Salud, del municipio de São Luís, en el año 2017. Para análisis de los datos, se utilizó el Análisis Temático, con base en los parámetros determinados por el Ministerio de Salud. Resultados: la acogida, el fácil acceso, la realización de exámenes y los grupos de gestantes se configuran como potencialidades del prenatal. La falta de organización de las unidades, de medicamentos de uso básico, de recursos materiales, el tiempo prolongado para el inicio de las consultas y para la realización de los exámenes consistieron en fragilidades. Conclusión: la evaluación de la asistencia prenatal, a partir de la percepción de las usuarias, aportó contribuciones para intervenciones en las fragilidades de los servicios de salud a las gestantes y para garantizar la atención de acuerdo con lo que está determinado por el Ministerio de Salud.\\\\\\\", \\\\\\\"_i\\\\\\\": \\\\\\\"es\\\\\\\"}]\\\"\""

Contribuições do enfermeiro no pré-natal para a conquista do empoderamento da gestante / The nurse's contributions in prenatal care towards achieving the pregnant women empowerment / Contribuciones de enfermería prenatal para conquista de habilitación de la embarazada

Objetivo: Compreender as contribuições do enfermeiro no pré-natal para o incentivo ao empoderamento feminino no processo de parturição natural, sob a ótica da gestante. Métodos: Estudo descritivo exploratório com abordagem qualitativa, desenvolvido em uma Unidade de Saúde da Família, em São Luís/MA, com gestantes que realizavam o pré-natal. Para análise dos depoimentos utilizou-se o referencial teórico Empowerment. Resultados: As orientações fornecidas pelos enfermeiros fazem alusão a muitos aspectos da gravidez, porém não evidencia que as gestantes se utilizaram das informações para alcançar o empoderamento no parto. Ademais, não se identificou a realização de ações educativas que visem à obtenção do empoderamento. Conclusão: As estratégias utilizadas pelo enfermeiro para o incentivo ao empoderamento caracterizam-se como práticas fragmentadas, refletindo ausência de diálogo entre gestante e profissional e não oferecendo o conhecimento suficiente para o preparo do exercício da autonomia feminina

Objective: The study's purpose has been to further understand the nurse's contributions in prenatal care in order to encourage female empowerment during the process of natural parturition by taking the pregnant woman perspective. Methods: It is a descriptive-exploratory study with a qualitative approach, which was carried out in a Family Health Unit at São Luís city, Maranhão State, Brazil, and having pregnant women who performed prenatal care as participants. For the testimonies' analysis, the Content Analysis Technique was used. Results: The nurses provided guidelines allude to many aspects of pregnancy, but it does not show that pregnant women have used the information in order to achieve empowerment during childbirth. Furthermore, it was not identified the accomplishment of educational actions aiming to obtain this empowerment. Conclusions: The strategies used by the nurses to encourage empowerment are considered as fragmented practices, thus reflecting the absence of dialogue between the pregnant women and the professionals, and also not offering sufficient knowledge to arrange the female autonomy implementation

Objetivo: La comprensión de las contribuciones de las enfermeras en el cuidado prenatal para fomentar la autonomía de la mujer en el proceso del parto natural desde la perspectiva de la mujer embarazada. Métodos: Estudio exploratorio descriptivo con un enfoque cualitativo, desarrollado en una Unidad de Salud de la Familia en São Luis/MA, con las mujeres embarazadas que realizaron allí prenatal. Para el análisis de los informes se utilizó la técnica de análisis de contenido. Resultados: Las directrices proporcionadas por enfermeras aluden a muchos aspectos del embarazo, pero no hay evidencia de que las mujeres embarazadas se utilizaron la información para lograr la potenciación en el parto. Por otra parte, no se identifica la realización de actividades educativas dirigidas a la consecución de este empoderamiento. Conclusión: Las estrategias utilizadas por las enfermeras para fomentar la potenciación se caracterizan por prácticas fragmentadas, lo que refleja la ausencia de diálogo entre la madre y profesional y no proporcionar suficiente conocimiento para preparar el ejercicio de la autonomía de la mujer

Sífilis em gestantes e sífilis congênita no Maranhão / Syphilis in pregnant women and congenital syphilis in Maranhão

Introdução: segundo estimativa da Organização Mundial da Saúde, aproximadamente 1,5 milhão de mulheres grávidas no mundo são infectadas com sífilis anualmente e metade delas terão filhos com consequências adversas. A sífilis na gestação e a sífilis congênita constituem problemas de saúde pública, tornando-se imperioso conhecer a dimensão da doença em nível local.Objetivo: descrever as características da sífilis na gestação e da sífilis congênita no Maranhão entre 2009 e 2013. Material e Métodos: estudo descritivo, retrospectivo e quantitativo, utilizando dados de domínio público e acesso irrestrito, cujo levantamento ocorreu por meio do aplicativo TABNET do Departamento de Informática do SUS, em janeiro de 2017. Resultados: no período foram confirmados 1.033 casos de sífilis em gestantes e notificados 679 casos de sífilis congênita. O município de São Luís, seguido por Imperatriz, apresentou o maior número de casos. As taxas de detecção de sífilis em gestantes e de incidência de sífilis congênita foram de 1,7 e 1,1 casos para cada 1.000 nascidos vivos, respectivamente. O maior número de casos de sífilis ocorreu em gestantes de 20 a 39 anos (69,5%), com ensino fundamental incompleto (51,1%), teste não treponêmico reativo (88,7%) e classificação da sífilis como primária (55,4%). A identificação dos casos de sífilis materna foi realizada principalmente no momento do parto (53,2%). A maioria dos casos de sífilis congênita foi na faixa etária de até 6 dias (94,3%) e teve evolução com criança viva (93,2%). Adicionalmente, a taxa de mortalidade infantil por sífilis congênita correspondeu a 2,0 óbitos por 100.000 nascidos vivos. Conclusão: a taxa de incidência da sífilis congênita permaneceu acima do desejado. A realização do teste não treponêmico encontrou-se aquém do preconizado. O diagnóstico da sífilis em gestantes foi realizado tardiamente na maioria dos casos. Houve maior ocorrência de sífilis primária, o que aumenta a possibilidade de infecção fetal.

Introduction:according to the World Health Organization estimate, roughly 1.5 million pregnant women are infected with syphilis annually and half of them will have children with adverse consequences. Gestational syphilis and congenital syphilis constitute public health problems, making it imperative to know the extent of the disease at the local level. Objective: to describe the characteristics of syphilis in pregnancy and congenital syphilis in Maranhão state between 2009 and 2013. Material andMethods: this is a descriptive, retrospective and quantitative study, using data from the public domain and unrestricted access, whose survey took place through the application TABNET, in January 2017. Results: 1,033 cases of syphilis were confirmed in pregnant women and 679 cases of congenital syphilis were notified. The city of São Luís, followed by Imperatriz, presented the highest number of cases. The rates of detection of syphilis in pregnant women and incidence of congenital syphilis were 1.7 and 1.1 cases per 1,000 live births, respectively. A greater number of syphilis cases were identified among pregnant women aged 20 to 39 years (69.5%), incomplete primary education (51.1%), reactive non-treponemic test (88.7%) and syphilis classification as primary (55.4%). The identification of cases of maternal syphilis was performed mainly at the time of delivery (53.2%). There was a greater number of cases of congenital syphilis in the age group of up to 6 days (94.3%) and most cases of syphilis congenital evolved with live child (93.2%). In addition, the infant mortality rate for congenital syphilis corresponded to 2.0 deaths per 100,000 live births. Conclusion: the incidence rate of congenital syphilis remained higher than desired. The non-treponemal test was less than recommended. The diagnosis of syphilis in pregnant women was performed late in most cases. There was a higher occurrence of primary syphilis, which increases the possibility of fetal infection.

Mutation in the S gene a determinant of the hepatitis B virus associated with concomitant HBsAg and anti-HBs in a population in Northeastern Brazil.

Mutations in the a determinant of S gene may develop co-existence of hepatitis B surface antigen (HBsAg) and antibodies to HBsAg (anti-HBs) in the serum of infected hepatitis B virus (HBV) individuals. Mutations in this region may change the antigenicity of HBsAg, which in turn, lead to escape of neutralizing action of anti-HBs antibodies. This study identified individuals with concomitant HBsAg and anti-HBs serological markers in individuals of Maranhão, Northeastern Brazil. Samples from a population-based study were evaluated for HBsAg, anti-HBs, and anti-HBc, and those that tested positive for simultaneous HBsAg and anti-HBs were submitted to HBV DNA quantification and S gene characterization by Sanger sequencing. Mutations were investigated in the a determinant located in major hydrophilic region (MHR) of the S gene. Among 3,984 samples analyzed, 92 (2.3%) were positive for HBsAg and three had the atypical HBsAg and anti-HBs-positive profile (3.26%). The frequency of HBsAg and anti-HBs co-existence was similar to previous studies. Only one individual harbored mutation in the S gene a determinant associated with this profile. Little is known about this phenomenon; however, studies as ours may contribute for future enlightenment of this important issue. J. Med. Virol. 89:458-462, 2017. © 2016 Wiley Periodicals, Inc.

Prevalence of hepatitis B among pregnant women assisted at the public maternity hospitals of São Luís, Maranhão, Brazil

INTRODUCTION: Hepatitis B virus (HBV) infection is an important worldwide public health problem. In Brazil, the Ministry of Health estimates that 15% of the population has had contact with HBV, and that the mean rate of chronic carriers in Northeastern Brazil is around 0.5%. OBJECTIVE: The aim of this study was to assess the prevalence of HBV markers in pregnant women receiving prenatal care at the public maternity hospitals of São Luís. Methods: Demographical and epidemiological data were collected from 541 pregnant women according to the research protocol. Blood samples were collected, and the anti-HBc test was performed first. If positive, the sample was subsequently tested for HBsAg and anti-HBs. All HBsAg and/or anti-HBc positive samples were additionally tested for HBV-DNA. RESULTS: 40 (7.4%) pregnant women turned out positive for anti-HBc. Of those, five (0.9%) were HBsAg positive, four (0.7%) were anti-HBc positive with negative HBsAg and anti-HBs, and 31 (5.7%) were positive for anti-HBc and anti-HBs. Anti-HBc positivity was associated with family history of hepatitis and education level below 11 years of schooling. HBV-DNA was positive in only one HBsAg-positive sample. There was no HBV-DNA positivity among HBsAg negative samples. CONCLUSIONS: The prevalence of HBsAg in pregnant women in this study confirmed that São Luís is a low endemicity area. Occult hepatitis B was not detected in these samples.

Prevalence of hepatitis B among pregnant women assisted at the public maternity hospitals of São Luís, Maranhão, Brazil.

INTRODUCTION: Hepatitis B virus (HBV) infection is an important worldwide public health problem. In Brazil, the Ministry of Health estimates that 15% of the population has had contact with HBV, and that the mean rate of chronic carriers in Northeastern Brazil is around 0.5%. OBJECTIVE: The aim of this study was to assess the prevalence of HBV markers in pregnant women receiving prenatal care at the public maternity hospitals of São Luís. METHODS: Demographical and epidemiological data were collected from 541 pregnant women according to the research protocol. Blood samples were collected, and the anti-HBc test was performed first. If positive, the sample was subsequently tested for HBsAg and anti-HBs. All HBsAg and/or anti-HBc positive samples were additionally tested for HBV-DNA. RESULTS: 40 (7.4%) pregnant women turned out positive for anti-HBc. Of those, five (0.9%) were HBsAg positive, four (0.7%) were anti-HBc positive with negative HBsAg and anti-HBs, and 31 (5.7%) were positive for anti-HBc and anti-HBs. Anti-HBc positivity was associated with family history of hepatitis and education level below 11 years of schooling. HBV-DNA was positive in only one HBsAg-positive sample. There was no HBV-DNA positivity among HBsAg negative samples. CONCLUSIONS: The prevalence of HBsAg in pregnant women in this study confirmed that São Luís is a low endemicity area. Occult hepatitis B was not detected in these samples.