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1.
N C Med J ; 81(1): 14-22, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31908326

RESUMO

BACKGROUND The Zika virus (ZIKV) epidemic that began in 2015 presented a risk for ZIKV infection among persons who traveled to ZIKV-affected countries. Latinas in North Carolina and their sexual partners may be exposed to ZIKV when traveling to these regions.METHODS We administered a cross-sectional survey, measuring ZIKV risk and knowledge, to a convenience sample of 262 reproductive-age Latinas attending a Federally Qualified Health Center in rural North Carolina. We described ZIKV risk and knowledge in the sample, and compared responses between those who were pregnant or recently pregnant, and those who were not pregnant. We further identified factors associated with 1) awareness of ZIKV and 2) high knowledge of ZIKV sequelae and prevention among those who were aware of ZIKV, using log-binomial regression.RESULTS Two-thirds of participants had ever heard of ZIKV, which was positively associated with educational attainment. Most participants aware of ZIKV had moderate/high knowledge of ZIKV transmission (92.5%) and symptoms (73.2%), but knowledge of preventing sexual and congenital transmission was limited. Travel was infrequent among pregnant or recently pregnant participants (5.4%) and their partners (7.1%). Despite low risk for ZIKV infection, participants were willing to practice ZIKV prevention.LIMITATIONS Our study is limited by a lack of generalizability to Latinas in other regions of the country, self-reporting bias, and lack of survey validation as an indicator of English language proficiency.CONCLUSIONS Providers should identify patients likely to become pregnant and travel to high-risk areas, inquire about partner travel history, and offer culturally appropriate ZIKV risk counseling.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde/etnologia , Hispano-Americanos/psicologia , Doença Relacionada a Viagens , Infecção por Zika virus/etnologia , Estudos Transversais , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , North Carolina , Gravidez , Fatores de Risco , Serviços de Saúde Rural
2.
Int J Infect Dis ; 78: 39-43, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30368020

RESUMO

BACKGROUND: The incidence rate of Zika virus (ZIKV) infection in travellers from non-endemic areas to the Americas during the ZIKV outbreak in 2016 is unknown. METHODS: Belgian adults who planned to travel to South America, Central America, and the Caribbean were recruited prospectively to study the incidence and characteristics of ZIKV. Demographic data and sera were collected at baseline. Participants were trained to collect capillary blood on filter paper (BFP). When ill during travel, the participants completed a questionnaire and they sampled BFP for post-hoc analysis. All symptomatic participants were screened for ZIKV using ZIKV-specific RT-PCR on serum or urine, or BFP, and antibody detection assays (ELISA). Follow-up sera of asymptomatic travellers, obtained at least 20 days post travel, were tested by ZIKV ELISA only. All positive ELISA results were subject to confirmation by virus neutralization testing (VNT). RESULTS: Forty-nine participants completed follow-up: 38 women and 11 men, with a median age of 32 years (range 19-64 years). Travel destinations were countries in South America (n=20), Central America (n=24), and the Caribbean (n=5). The total travel duration was 67.8 person-months. Illness was reported by 24 participants (49.0%). ZIKV infection was confirmed in nine cases, by RT-PCR (n=5) and by VNT (n=4). Only one of nine ZIKV cases (11.1%) was asymptomatic. The ZIKV incidence rate was 17.0% (95% confidence interval 7.8-32.2%) per month of travel. CONCLUSIONS: The ZIKV incidence rate in adult travellers from non-endemic countries to the epidemic territories during the 2016 outbreak was high. Asymptomatic ZIKV infection was rare in this population.


Assuntos
Surtos de Doenças , Viagem , Infecção por Zika virus/etnologia , Adulto , Américas/epidemiologia , Bélgica/etnologia , Transmissão de Doença Infecciosa , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doença Relacionada a Viagens , Adulto Jovem , Zika virus/isolamento & purificação
3.
Med Anthropol ; 37(6): 458-471, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30004260

RESUMO

In this article, we draw on two cases-one of the reproductive justice movements in the wake of the Latin American Zika epidemic, and one of an environmental justice movements spurred by an epidemic of chronic kidney disease among sugarcane workers-to argue for social justice as an "elastic" technology of epidemic control. In its compressed form, social justice simply refers to the fair distribution of medical goods. In its expanded form, it emphasizes the recognition and representation not just of medical problems, but of entangled histories of racial, gendered, and economic inequity.


Assuntos
Epidemias/prevenção & controle , Comunicação em Saúde , Justiça Social , Antropologia Médica , Humanos , América Latina/etnologia , Insuficiência Renal Crônica/etnologia , Insuficiência Renal Crônica/prevenção & controle , Infecção por Zika virus/etnologia , Infecção por Zika virus/prevenção & controle
4.
Public Health Rep ; 133(4): 461-471, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29920225

RESUMO

OBJECTIVES: We assessed sociodemographic and health care factors of mothers and newborns during a 2015-2016 outbreak of microcephaly in Recife, Brazil, and we analyzed the spatial distribution and incidence risk of newborns with microcephaly in relation to socio-environmental indicators. METHODS: We collected data from August 2015 through May 2016 from Brazil's Live Birth Information System and Bulletin of Microcephaly Notification, and we geocoded the data by maternal residence. We constructed thematic maps of districts, according to socio-environmental and vector indicators. We identified spatial aggregates of newborns with microcephaly by using the Bernoulli model. We performed logistic regression analyses to compare the incidence risk of microcephaly within socio-environmental indicator groups. RESULTS: We geocoded 17 990 of 19 554 (92.0%) live births in Recife, of which 202 (1.1%) newborns were classified as having microcephaly, based on a head circumference of ≥2 standard deviations below the mean. Larger proportions of newborns with microcephaly (compared with newborns without microcephaly) were born to mothers who delivered in a public hospital, did not attend college, were aged ≤19, or were black or mixed race. A higher risk of microcephaly (incidence rate ratio [IRR] = 3.90; 95% confidence interval [CI], 1.88-8.06) occurred in districts with the lowest (vs highest) Municipal Human Development Index (ie, an index that assesses longevity, education, and income). The risk of microcephaly was significantly higher where rates of larvae density (IRR = 2.31; 95% CI, 1.19-4.50) and larvae detection (IRR = 2.04; 95% CI, 1.05-4.00) were higher and rates of sewage system (IRR = 2.20; 95% CI, 1.16-4.18) and garbage collection (IRR = 1.96; 95% CI, 0.99-3.88) were lower. Newborns with microcephaly lived predominantly in the poorest areas and in a high-risk cluster (relative risk = 1.89, P = .01) in the north. CONCLUSIONS: The disproportionate incidence of microcephaly in newborns in poor areas of Recife reinforces the need for government and public health authorities to formulate policies that promote social equity and support for families and their children with microcephaly.


Assuntos
Meio Ambiente , Geografia , Microcefalia/epidemiologia , Pobreza , Infecção por Zika virus/epidemiologia , Adolescente , Adulto , Brasil/epidemiologia , Feminino , Humanos , Recém-Nascido , Microcefalia/etnologia , Mães/estatística & dados numéricos , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/etnologia , Zika virus/isolamento & purificação , Infecção por Zika virus/etnologia
5.
Pediatrics ; 140(6)2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29093135

RESUMO

BACKGROUND AND OBJECTIVE: In July 2016, local transmission of Zika virus (ZIKV) was announced in Miami-Dade County, Florida. In this report, we describe the epidemiology of pediatric ZIKV infections in locally acquired and travel-associated cases. METHODS: All children aged 1 to 17 years tested for ZIKV between October 1, 2015, and March 29, 2017, were included. SAS 9.4 was used to analyze age, sex, race and/or ethnicity, origin of exposure, onset date, affiliation with a household cluster, clinical symptoms, hospitalizations, viremia, viruria, and antibody detection in specimens. RESULTS: Among 478 confirmed ZIKV cases in Miami-Dade County, 33 (6.9%) occurred in children (1-17 years). Twenty-seven (82.3%) cases were travel-associated. The median age of a pediatric Zika case patient was 11 years. Seventeen (51.5%) case patients were boys, and 23 (69.9%) were Hispanic. Among 31 symptomatic cases, all reported having rash, 25 (80.6%) reported fever, 9 (29.0%) reported conjunctivitis, and 7 (22.6%) reported arthralgia. Sixteen (48.5%) cases reported 2 of 4 and 8 (24.2%) reported 3 of 4 main symptoms. CONCLUSIONS: This report found that the majority of children identified during the 2016 ZIKV outbreak only presented with 2 of the 4 main symptoms. In addition, pediatric ZIKV cases were frequently associated with symptomatic household members.


Assuntos
Surtos de Doenças , Grupos Étnicos , Medição de Risco/métodos , Infecção por Zika virus/etnologia , Adolescente , Fatores Etários , Anticorpos Antivirais/análise , Criança , Pré-Escolar , DNA Viral/análise , Feminino , Florida/epidemiologia , Humanos , Lactente , Masculino , Morbidade/tendências , Estudos Retrospectivos , Fatores Sexuais , Zika virus/genética , Zika virus/imunologia , Infecção por Zika virus/diagnóstico , Infecção por Zika virus/virologia
6.
Int J Infect Dis ; 65: 116-118, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29081369

RESUMO

French Polynesia and the French Territories of the Americas (FTAs) have experienced outbreaks of Zika virus (ZIKV) infection. These territories used similar sentinel syndromic surveillance to follow the epidemics. However, the surveillance system only takes into account consulting patients diagnosed with ZIKV disease, while non-consulting cases, as well as asymptomatic cases, are not taken into account. In the French territories under study, the ratio of consulting to non-consulting patients was found to likely be as low as 1/3 to 1/4, and rough estimates of the ZIKV asymptomatic infections indicated a lower rate than previously reported (i.e., not more than half).


Assuntos
Infecção por Zika virus/epidemiologia , Surtos de Doenças , França/epidemiologia , França/etnologia , Guadalupe/epidemiologia , Humanos , Martinica/epidemiologia , Polinésia/epidemiologia , Vigilância de Evento Sentinela , Zika virus , Infecção por Zika virus/etnologia
7.
J Perinat Neonatal Nurs ; 31(3): 216-224, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28590945

RESUMO

Escalating evidence for the fetal impact of Zika virus infection required a change in care by all prenatal providers. This article describes an effective model of rapid implementation of universal prenatal screening at one hospital and its network of community health centers for a large and diverse immigrant population exploring the challenges, experiences, and lessons learned. Implementation of national recommendations required a workflow change, challenging a system with a heterogeneity of settings and providers. Using a physician clinical champion and advanced practice nurses in the roles of logistical coordinator and liaison to the network, Zika screening was embedded into prenatal intake visits at both the hospital and community health centers. Challenges addressed include varied medical record systems, acceptance by patients, providers, and community health center leadership, as well as culturally appropriate outreach to diverse ethnic and linguistic communities. In 6 months, the prenatal screening rates increased from 20% to 88%, which resulted in the identification of more than 300 pregnant patients at risk of exposure to Zika virus. This model offers key lessons for emergency preparedness in heterogeneous, safety net hospital settings.


Assuntos
Centros Comunitários de Saúde , Assistência à Saúde Culturalmente Competente , Hospitais , Cuidado Pré-Natal , Diagnóstico Pré-Natal , Infecção por Zika virus , Adulto , Assistência à Saúde Culturalmente Competente/métodos , Assistência à Saúde Culturalmente Competente/organização & administração , Emigrantes e Imigrantes , Feminino , Humanos , Relações Interprofissionais , Massachusetts , Modelos Organizacionais , Gravidez , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/organização & administração , Diagnóstico Pré-Natal/métodos , Diagnóstico Pré-Natal/enfermagem , Infecção por Zika virus/diagnóstico , Infecção por Zika virus/etnologia
8.
Transfusion ; 57(3pt2): 770-778, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28229475

RESUMO

BACKGROUND: Zika virus (ZIKV) is transmitted by Aedes mosquitos and can result in severe congenital and adult neurologic abnormalities. ZIKV has rapidly spread northward through Central America and the Caribbean and autochthonous cases have been identified in the continental United States. High rates of ZIKA RNA positivity were detected in blood donors during previous epidemics. ZIKV transmission by transfused blood from healthy donor components has been a growing concern. STUDY DESIGN AND METHODS: Individual-donation aliquots of plasma from volunteer blood donors were tested individually with an investigational Procleix ZIKV assay. Initially reactive samples were tested for ZIKV RNA in plasma and red blood cells (RBCs) and for ZIKV-specific antibodies in serum. A confirmed positive classification required confirmation of RNA and/or detection of ZIKV antibodies in index and/or follow-up samples. RESULTS: Between September 19 and November 30, 2016, a total of 466,834 donations were screened for ZIKV RNA. Five donors (one in approx. 93,000) were reactive for ZIKV RNA by both the Procleix ZIKV assay and supplemental testing. The donations were collected outside areas considered as having active transmission, and all five donors had travel exposures. A lookback case demonstrated no infection despite transfusion of a Zika IgG-positive platelet (PLT) component with probable low levels of ZIKV RNA. CONCLUSIONS: This report describes the first ZIKV-positive donors detected outside areas with active transmission. These donors most likely represent travel-acquired "tail-end infections" with prolonged RBC-associated ZIKV RNA. The lack of transmission to the recipient of an apheresis PLT may suggest that these units are not infectious.


Assuntos
Doadores de Sangue , RNA Viral/sangue , Infecção por Zika virus , Zika virus , Adulto , Região do Caribe/epidemiologia , América Central/epidemiologia , Feminino , Humanos , Masculino , Infecção por Zika virus/sangue , Infecção por Zika virus/etnologia , Infecção por Zika virus/transmissão
9.
Ophthalmic Surg Lasers Imaging Retina ; 47(10): 952-955, 2016 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-27759862

RESUMO

A 6-day-old female baby with known diagnosis of congenital Zika infection was referred for ophthalmologic examination. The mother (37 years old) was referred for a pruritic rash, conjunctival hyperemia, and malaise at 12 weeks of gestation while still living in Venezuela. Upon arrival to Miami, Zika virus (ZIKV) exposure was confirmed during prenatal screening. At birth, due to the known exposure, a complete congenital ZIKV workup was performed, including brain ultrasound and MRI, which disclosed calcifications in the frontal lobe. Fundus examination revealed a hypopigmented retinal lesion in the left eye that was documented with retinal imaging. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:952-955.].


Assuntos
Encéfalo/diagnóstico por imagem , Nervo Óptico/diagnóstico por imagem , Viagem , Infecção por Zika virus/congênito , Zika virus , Adulto , Feminino , Florida/epidemiologia , Humanos , Recém-Nascido , Imagem por Ressonância Magnética , Microcefalia , Síndrome , Venezuela/etnologia , Infecção por Zika virus/diagnóstico , Infecção por Zika virus/etnologia
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