Risk factors associated with severe dengue in Latin America: A systematic review and meta-analysis.

OBJECTIVE: Severe dengue is a significant health problem in Latin America, with children being the most affected. Understanding risk factors for severe dengue is crucial for enhancing patient care. Therefore, this study aims to systematically review the literature to identify the risk factors associated with severe dengue in Latin America through systematic review and meta-analysis. METHODS: PubMed, SciELO, LILACS and EMBASE databases were used to search for eligible scientific articles for the review. The outcomes considered were symptoms of severe dengue, hospitalisation and death. The Joanna Briggs Institute Critical Appraisal Checklist was used to assess the quality of the studies. Data analysis was performed using STATA v 13.0 software. The degree of heterogeneity between studies was quantified using the I2 measure, and statistically significant results were defined as those with p values <0.05. RESULTS: Of the 1876 articles screened, 47 articles were included in the systematic review and 45 articles were analysed through meta-analysis. Identified risk factors associated with severe dengue included secondary dengue infection, female sex, white or Caucasian ethnicity and specific signs and symptoms such as headache, myalgia and/or arthralgia, vomiting/nausea, abdominal pain or tenderness, diarrhoea, prostration, lethargy, fatigue or similar. For the death outcome, respiratory symptoms and age <18 years were identified as risk factors. On the other hand, in women, the diagnosis of positive tourniquet test, platelet count <100,000 per µL and symptoms of capillary fragility were associated with a lower probability of death. These data highlight the importance of early screening of patients, to identify possible haemorrhagic signs and reduce deaths from dengue. This study has limitations, including possible publication bias, heterogeneity of results and study design biases. CONCLUSION: These findings are significant for shaping strategies, management approaches and identifying high-risk groups, which will help establish future guidelines.

High Incidence of Congenital Syphilis after Implementation of the Brazilian Ministry of Health Ordinances Related to Maternal Diagnostics.

The increasing rates of maternal and congenital syphilis (CS) infections are public health concerns and need further investigation in order to provide better assistance in epidemiological surveillance and new strategies for the assistance and prevention of CS. In December 2011, the Brazilian Ministry of Health (BMH) implemented ordinance number 3.242, reinforced in 2012 by ordinance number 77, aiming to improve the quality of the syphilis diagnosis system using rapid tests. Here, we evaluate the incidence, lethality, and possible factors associated with CS in Salvador, Bahia, in the pre-resolution period (2007 to 2011) and post-resolution (2012 to 2016). An observational, ecological time-series study is conducted using secondary data collected from the National Notifiable Diseases Information System (SINAN). Linear regression analysis to estimate increases or reductions in the mean incidence over time is also performed. A total of 5470 CS cases are analyzed. The incidence ranges from 2.1 cases per 1000 live births in 2007 to 17.1 cases per 1000 live births in 2019, showing a progressive increase in incidence over the years and reduction of lethality in the post-resolution period. The number of CS cases reported prior to the implementation of the ordinances (2007-2011) does not reveal a significant increase in the incidence. However, in the post-ordinances period (2012-2019), there is an average increase of the number of CS cases by three times over the years, with an average increase of 1.8 new cases annually. Our findings highlight the importance of diagnosis and support information in strategies for CS prevention. Furthermore, these data show a positive impact of resolutions on the diagnosis and evolution of the disease.

Clinical and epidemiological features of pertussis in Salvador, Brazil, 2011-2016.

Pertussis, a severe respiratory infection caused by Bordetella pertussis, is distributed globally. Vaccination has been crucial to annual reductions in the number of cases. However, disease reemergence has occurred over the last decade in several countries, including Brazil. Here we describe the clinical and epidemiological aspects of suspected pertussis cases in Salvador, Brazil, and evaluate factors associated with case confirmation. This descriptive and retrospective study was conducted in the five hospitals in Salvador that reported the highest number of pertussis cases between 2011-2016. Demographic and clinical data were recorded for each patient. Bivariate analysis was performed to evaluate differences between groups (confirmed vs. unconfirmed cases) using Pearson's Chi-square test or Fisher's exact test. Results: Of 529 suspected pertussis cases, 29.7% (157/529) were confirmed by clinical, clinical-epidemiological or laboratory criteria, with clinical criteria most frequently applied (63.7%; 100/157). Unvaccinated individuals (43.3%; 68/157) were the most affected, followed by age groups 2-3 months (37.6%; 59/157) and <2 months (31.2%; 49/157). Overall, ≤50% of the confirmed cases presented a complete vaccination schedule. All investigated cases presented cough in association with one or more symptoms, especially paroxysmal cough (66.9%; 105/529) (p = 0.001) or cyanosis (66.2%; 104/529) (p<0.001). Our results indicate that pertussis occurred mainly in infants and unvaccinated individuals in Salvador, Brazil. The predominance of clinical criteria used to confirm suspected cases highlights the need for improvement in the laboratory tools used to perform rapid diagnosis. Fluctuations in infection prevalence demonstrate the importance of vaccination strategies in improving the control and prevention of pertussis.

Maternal common mental disorder over time and asthma control: The role of social support.

BACKGROUND: Despite therapeutic advances, asthma prevalence remains high. Psychosocial factors, including maternal mental disorders, may be involved. This study aims to evaluate the association of maternal common mental disorders (CMDs) and their change over time with asthma morbidity in the child and to observe the effect of social support on this association. METHODS: This prospective study involved 189 dyads of mothers and their asthmatic children aged between 2 and 14 years, assisted in specialized outpatient clinics. We measured the association of maternal CMD evolution (absent, maintained, or improved over time) with asthma control and visits to the emergency department (ED) due to asthma attacks through Poisson regression analysis. We further stratified the sample according to social support levels to identify a possible effect of this variable on the association of maternal psychological symptoms with asthma morbidity. RESULTS: Compared with mothers who maintained CMD over time, maternal CMD absence had a protective effect on the occurrence of visits to the ED (RR: 0.45; 95% CI: 0.26-0.79) and maternal CMD improvement was associated with lower risk of uncontrolled asthma in the child (RR: 0.60; 95% CI: 0.37-0.97). There was a stronger association of maternal CMD improvement with asthma control in the child only for the stratum of mothers with high social support in its three dimensions (affective-social interaction, emotional-informational, and material dimensions). CONCLUSIONS: Maternal CMD absence and improvement over the study period were protective factors for uncontrolled asthma in the child, mainly in the presence of high social support.

Meningococcal carriage in young adults six years after meningococcal C conjugate (MCC) vaccine catch-up campaign in Salvador, Brazil.

Meningococcal carriage studies are important to improve the knowledge of disease epidemiology as well as to support appropriate vaccination strategies. We conducted a cross-sectional study to determine the prevalence and genotypic characteristics of meningococci collected from young adults in Salvador, Brazil six years after a meningococcal C conjugate vaccine catch-up campaign. From August through November 2016, oropharyngeal swabs were collected from 407 students aged 1824 years attending a private college in Salvador, Brazil. Neisseria meningitidis was identified by standard microbiology methods and real time PCR. Genetic characteristics of meningococci were assessed by rt-PCR and/or whole genome sequencing. We also investigated potential factors associated with carriage. N. meningitidis was detectable in 50 students, 39 by both culture and rt-PCR, 7 by culture alone and 4 by rt-PCR alone, resulting in an overall meningococcal carriage prevalence of 12.3% (50/407). Carriage was independently associated with male sex (adjusted PR: 1.97; 95% CI: 1.12-3.46; p = 0.018) and attending bars or parties at least once per month (aPR: 3.31; 95% CI: 1.49-7.38; p = 0.003). Molecular tests identified 92% (46/50) N. meningitidis as non-groupable, of which 63% (29/46) had the capsule null genotype; 14 NG isolates contained disrupted capsule backbones and belonged to the following genogroups: 7 B, 3 Z, 3 E and 1 W. One isolate belonged to genogroup C tested only by PCR; 3 isolates contained a complete B capsule backbones, 2 of which were determined to be NG by slide agglutination serogrouping. While most meningococcal carriage isolates were non-groupable, there was a high degree of genetic diversity present in the collection, as evidenced by 25 unique STs being detected. The carriage prevalence of meningococcal serogroup C was low among young adults. Continuous vaccination is important to maintain reduced meningococcal carriage and transmission, inducing herd protection.

Carriage prevalence of Neisseria meningitidis in the Americas in the 21st century: a systematic review

Abstract Neisseria meningitidis is a bacterium that colonizes the human nasopharynx and is transmitted by respiratory droplets from asymptomatic or symptomatic carriers. Occasionally, the pathogen invades the mucosa and enters the bloodstream, causing invasive meningococcal disease, a life-threatening infection. While meningococcal colonization is the first step in the development of invasive disease, the risk factors that predict progression from asymptomatic to symptomatic status are not well-known. The present report aimed to describe the prevalence of N. meningitidis carriers throughout the Americas, emphasizing the risk factors associated with carrier status, as well as the most prevalent serogroups in each studied population. We conducted a systematic review by searching for original studies in the MEDLINE/PubMed, Embase, LILACS and SciELO databases, published between 2001 and 2018. Exclusion criteria were articles published in a review format, case studies, case control studies, investigations involving animal models, and techniques or publications that did not address the prevalence of asymptomatic carriers in an American country. A total of 784 articles were identified, of which 23 were selected. The results indicate that the highest prevalence rates are concentrated in Cuba (31.9%), the United States (24%), and Brazil (21.5%), with increased prevalence found among adolescents and young adults, specifically university students and males. The present systematic review was designed to support epidemiological surveillance and prevention measures to aid in the formulation of strategies designed to control the transmission of meningococci in a variety of populations and countries throughout the Americas.

Carriage prevalence of Neisseria meningitidis in the Americas in the 21st century: a systematic review.

Neisseria meningitidis is a bacterium that colonizes the human nasopharynx and is transmitted by respiratory droplets from asymptomatic or symptomatic carriers. Occasionally, the pathogen invades the mucosa and enters the bloodstream, causing invasive meningococcal disease, a life-threatening infection. While meningococcal colonization is the first step in the development of invasive disease, the risk factors that predict progression from asymptomatic to symptomatic status are not well-known. The present report aimed to describe the prevalence of N. meningitidis carriers throughout the Americas, emphasizing the risk factors associated with carrier status, as well as the most prevalent serogroups in each studied population. We conducted a systematic review by searching for original studies in the MEDLINE/PubMed, Embase, LILACS and SciELO databases, published between 2001 and 2018. Exclusion criteria were articles published in a review format, case studies, case control studies, investigations involving animal models, and techniques or publications that did not address the prevalence of asymptomatic carriers in an American country. A total of 784 articles were identified, of which 23 were selected. The results indicate that the highest prevalence rates are concentrated in Cuba (31.9%), the United States (24%), and Brazil (21.5%), with increased prevalence found among adolescents and young adults, specifically university students and males. The present systematic review was designed to support epidemiological surveillance and prevention measures to aid in the formulation of strategies designed to control the transmission of meningococci in a variety of populations and countries throughout the Americas.

Impact of meningococcal C conjugate vaccination programs with and without catch-up campaigns in adolescents: Lessons learned from Bahia, Brazil.

The significant increase in the incidence rates and ongoing outbreaks of serogroup C meningococcal (MenC) disease, associated with the sequence type-103 complex, motivated the incorporation of the meningococcal C conjugate (MCC) vaccine in the routine immunization program in the State of Bahia, Brazil in early 2010, targeting children younger than 5 years of age. In its capital, Salvador, the program also included a catch-up campaign for individuals 10-24 years of age. We performed an observational, ecological study, analyzing data collected from 2007 to 2015, to compare the impact of these two immunization strategies on meningococcal disease incidence and mortality rates. In Salvador, following the vaccination program, a dramatic early impact on MenC disease and mortality rates could be observed, with significant reductions in incidence rates of MenC disease in all age groups, including individuals that were too old to have been vaccinated, indicating the presence of herd protection. Compared to the pre-vaccine period, a virtual disappearance of MenC disease was observed in 2015. However, in the state of Bahia (excluding the city of Salvador), no herd protection could be observed, with significant impact only among vaccine-eligible children within 5 years of introduction of the MCC vaccination program. These results highlight the importance of catch-up campaigns, including adolescents and young adults, to induce herd protection compared to immunization strategies restricted to infants and young children. This information is crucial for identifying optimal immunization policies and future strategies, focused on adolescents, to optimize the impact of MCC vaccination programs.

Correction: Factors Associated with Anemia in the Institutionalized Elderly.

[This corrects the article DOI: 10.1371/journal.pone.0162240.].

Factors Associated with Anemia in the Institutionalized Elderly.

As a common problem in long-term care facilities (LTCFs), anemia affects 25-63% of the elderly. The aim of the present study was to describe the prevalence and characteristics of anemia and its associated factors in the institutionalized elderly. The cross-sectional study was carried out with three hundred thirteen individuals aged ≥ 60 years, of both genders, living in long-term care facilities for the elderly in Salvador, Bahia, Brazil. Poisson regression (PR) with robust variance estimates was used to assess the factors related to anemia. The prevalence of anemia was 38%. Mild anemia was predominant in both genders (male: 26.8%; female: 21.1%), as normocytic and normochromic anemia, with no anisocytosis (69.75%). Anemia was associated with thinness (PR: 1.68; 95% CI: 1.04-2.72) and with moderate (PR: 1.98; 95% CI: 1.07-3.63) and total (PR: 2.61; 95% CI: 1.34-5.07) dependence in the final model. Severe dependence exhibited borderline significance (PR: 1.94; 95% CI: 1.00-3.77). The prevalence of anemia was high in the institutionalized elderly in both genders, with characteristics suggesting chronic diseases as the causal factor, and the frequency of occurrence was higher in thinness elderly with moderate to total dependence.

Community violence and childhood asthma prevalence in peripheral neighborhoods in Salvador, Bahia State, Brazil.

This study aimed to identify degrees of exposure to community violence reported by parents and guardians of children from four to 12 years of age and the association with childhood asthma symptoms. A cross-sectional study was conducted with 1,232 parents/guardians in 24 peripheral neighborhoods in Salvador, the capital of Bahia State, Brazil. The authors investigated asthma symptoms in children and acts of violence in the community. More than 75% of parents/guardians had been exposed to community violence in the previous year, with 20% reporting high levels of exposure. Children that were more exposed to violence showed higher asthma prevalence (28.4%) as compared to non-exposed children (16.4%). Children exposed to maximum levels of violence were nearly twice as likely to present asthma symptoms (adjusted OR = 1.94; 95%CI: 1.12-3.36). The study highlighted the relevance of community violence as a risk factor for asthma and the need for further research to elucidate methodological issues.

Community violence and childhood asthma prevalence in peripheral neighborhoods in Salvador, Bahia State, Brazil / Violência comunitária e prevalência de asma em crianças na periferia de Salvador, Bahia, Brasil

This study aimed to identify degrees of exposure to community violence reported by parents and guardians of children from four to 12 years of age and the association with childhood asthma symptoms. A cross-sectional study was conducted with 1,232 parents/guardians in 24 peripheral neighborhoods in Salvador, the capital of Bahia State, Brazil. The authors investigated asthma symptoms in children and acts of violence in the community. More than 75 percent of parents/guardians had been exposed to community violence in the previous year, with 20 percent reporting high levels of exposure. Children that were more exposed to violence showed higher asthma prevalence (28.4 percent) as compared to non-exposed children (16.4 percent). Children exposed to maximum levels of violence were nearly twice as likely to present asthma symptoms (adjusted OR = 1.94; 95 percentCI: 1.12-3.36). The study highlighted the relevance of community violence as a risk factor for asthma and the need for further research to elucidate methodological issues.

O objetivo deste artigo foi identificar o grau de violência comunitária relatado por cuidadores de crianças entre quatro e 12 anos, além da influência dessa exposição na ocorrência de sintomas de asma nas crianças. Realizou-se um estudo transversal com 1.232 cuidadores residentes na cidade de Salvador, Bahia, Brasil. Investigaram-se sintomas de asma nas crianças e atos violentos na comunidade. Aproximadamente 75 por cento dos cuidadores foram vítimas de violência comunitária no último ano, com 20 por cento convivendo com graus elevados deste fenômeno. Encontrou-se prevalência de 28,4 por cento de sintomas asmáticos entre crianças expostas ao grau máximo de violência, e 16,4 por cento entre as não expostas. Encontrou-se associação estatisticamente significante entre exposição ao nível máximo de violência e ocorrência de sintomas asmáticos (OR ajustada = 1,94; IC95 por cento: 1,12-3,36). Nossos achados sugerem a importância da violência comunitária como um dos fatores de risco associados com asma, sendo fundamental o desenvolvimento de novas pesquisas para esclarecer as limitações do presente estudo.