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1.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-47889

RESUMO

Edição número 26/2020 do SBP AmamentAÇÃO – informativo anual da Sociedade Brasileira de Pediatria (SBP) – disponível para leitura no site instituição e traz um resumo das ações da SBP e suas filiadas em prol da promoção, proteção e apoio ao aleitamento materno durante a Semana Mundial de Aleitamento Materno (SMAM) e Agosto Dourado. O editorial aborda a manutenção da amamentação em tempos de pandemia de Covid-19. No texto, ela esclarece a dúvida comum entre as mães que testam positivo para a doença e se há risco de contaminação da criança pelo leite materno. Na sessão, Pergunte ao Especialista, profissionais da SBP esclarecem dúvidas frequentes sobre o aleitamento materno.


Assuntos
Aleitamento Materno , Promoção da Saúde , Infecções por Coronavirus/transmissão , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Leite Humano
2.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-47831

RESUMO

Uma revisão sistemática das evidências científicas disponíveis feita pela Organização Pan-Americana da Saúde (OPAS) e pela Organização Mundial da Saúde (OMS) revela que as recomendações sobre o contato mãe-bebê e aleitamento materno devem se basear em uma consideração ampla, não apenas nos riscos potenciais da COVID-19 para o bebê, mas também dos riscos de morbidade e mortalidade associados ao não aleitamento e uso inapropriado de fórmulas infantis.


Assuntos
Aleitamento Materno , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Infecções por Coronavirus , Betacoronavirus , Promoção da Saúde
3.
Am J Perinatol ; 37(S 02): S46-S53, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32898882

RESUMO

OBJECTIVE: We aimed at reviewing the currently available guidelines and scientific recommendations regarding the neonatal in-hospital management and feeding in the light of the coronavirus disease 2019 (COVID-19) pandemic. STUDY DESIGN: We systematically searched the guideline databases, Medline, Embase, and nationale/international neonatal societies websites as of June 19, 2020, for guidelines on neonatal management and feeding during the COVID-19 pandemic, at the same time assessing the methodological quality using the Appraisal of Guidelines for Research and Evaluation II tool. RESULTS: Eleven guidelines were included. The Chinese and American recommendations suggest separation of the mother and her neonate, whereas in French, Italian, UK, Canadian, and World Health Organization consensus documents the rooming-in is suggested, with Centers for Disease Control and Prevention guidelines suggesting to decide on a case-by-case basis. All the guidelines recommend breastfeeding or feeding with expressed maternal milk; the only exception is the Chinese recommendations, these last suggesting to avoid breastfeeding. CONCLUSION: This review may provide a useful tool for clinicians and organizers, highlighting differences and similarities of the existing guidelines on the management and feeding strategies in the light of the COVID-19 pandemic. KEY POINTS: · This study compares guidelines on management and nutrition of a newborn born to a mother with SARS-CoV-2 infection.. · Existing guidelines on neonatal management and nutrition during the SARS-CoV-2 pandemic show many differences.. · The majority of recommendations are mainly based on experts' opinion and are not evidence-based..


Assuntos
Aleitamento Materno/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Fenômenos Fisiológicos da Nutrição do Lactente , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Feminino , Humanos , Recém-Nascido , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Leite Humano , Pandemias , Organização Mundial da Saúde
4.
Rev Bras Ginecol Obstet ; 42(9): 562-568, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32992359

RESUMO

OBJECTIVE: The present comprehensive review aims to show the full extent of what is known to date and provide a more thorough view on the effects of SARS-CoV2 in pregnancy. METHODS: Between March 29 and May, 2020, the words COVID-19, SARS-CoV2, COVID-19 and pregnancy, SARS-CoV2 and pregnancy, and SARS and pregnancy were searched in the PubMed and Google Scholar databases; the guidelines from well-known societies and institutions (Royal College of Obstetricians and Gynaecologists [RCOG], American College of Obstetricians and Gynecologists [ACOG], International Society of Ultrasound in Obstetrics & Gynecology [ISUOG], Centers for Disease Control and Prevention [CDC], International Federation of Gynecology and Obstetrics [FIGO]) were also included. CONCLUSION: The COVID-19 outbreak resulted in a pandemic with > 3.3 million cases and 230 thousand deaths until May 2nd. It is caused by the SARS-CoV2 virus and may lead to severe pulmonary infection and multi-organ failure. Past experiences show that unique characteristics in pregnancy make pregnant women more susceptible to complications from viral infections. Yet, this has not been reported with this new virus. There are risk factors that seem to increase morbidity in pregnancy, such as obesity (body mass index [BMI] > 35), asthma and cardiovascular disease. Current reports describe an increased rate of preterm birth and C-section. Vertical transmission is still a possibility, due to a few reported cases of neonatal positive real-time polymerase chain reaction (RT-PCR) in nasal swab, amniotic fluid, and positive immunoglobulin M (IgM) in neonatal blood. Treatments must be weighed in with caution due to the lack of quality trials that prove their effectiveness and safety during pregnancy. Medical staff must use personal protective equipment in handling SARS-CoV2 suspected or positive patients and be alert for respiratory decompensations.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Complicações Infecciosas na Gravidez , Betacoronavirus/isolamento & purificação , Cesárea/estatística & dados numéricos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Infecções por Coronavirus/transmissão , Feminino , Saúde Global , Humanos , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Assistência Perinatal/métodos , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Pneumonia Viral/transmissão , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/terapia , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/virologia , Fatores de Risco
5.
Medicine (Baltimore) ; 99(39): e22352, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991450

RESUMO

BACKGROUND: Antiretroviral therapy for HIV in sub-Saharan Africa has transformed the highly infectious virus to a stable chronic condition, with the advent of Highly active antiretroviral therapy (HAART). The longterm effects of HAART on the oral health of children are understudied. OBJECTIVE: To compare the effect of lopinavir-ritonavir and lamivudine on oral health indicators (dental caries, gingivitis, tooth eruption, and oral health related quality of life) in 5 to 7 year old HIV-1 exposed uninfected children from the ANRS 12174 trial. METHODS: This study used data collected in 2017 among children aged 5 to 7 years from the Ugandan site of the ANRS 12174 randomized trial (ClinicalTrials.gov no: NCT00640263) implemented between 2009 and 2012 in Mbale district, Eastern Uganda. The intervention was lopinavir-ritonavir or lamuvudine treatment to prevent vertical HIV-1 transmission. One hundred thirty-seven and 139 children were randomized to receive lopinavir-ritonavir or lamivudine treatment at day 7 postpartum to compare efficacy of prevention of vertical HIV-1 transmission. At follow up, the children underwent oral examination using the World Health Organization methods for field conditions. The oral health related quality of life was assessed using the early childhood oral health impact scale. Negative binomial and logistic regression were used for the analysis of data. MAIN OUTCOME MEASURES: Dental caries, gingivitis, tooth eruption, and oral health related quality of life) in 5 to 7 year old HIV-1 exposed uninfected children. RESULTS: The prevalence of dental caries was 48% in the study sample: 49% in the lopinavir-ritonavir arm and 48% in the lamivudine treatment group. The corresponding mean decayed missing filled teeth and standard deviation was 1.7 (2.4) and 2.3 (3.7) The mean number (standard deviation) of erupted permanent teeth was 3.8 (3.7) and 4.6 (3.9) teeth in the lopinavir- and lamivudine group, respectively. The prevalence of reported impacts on oral health was 7% in the lopinavir-ritonavir and 18% in the lamivudine group. Gingivitis had a prevalence of 7% in the lopinavir-ritonavir and 14% lamivudine treatment group. The regression analysis revealed 70% less reported impacts on oral health in lopinavir-ritonavir group than the lamivudine treatment group with an incidence rate ratio of 0.3 (95% confidence interval: 0.1-0.9). CONCLUSIONS: HIV exposed uninfected infants in the lopinavir-ritonavir group reported less impacts on oral health than the lamivudine treatment group. Dental caries, gingivitis, and tooth eruption were not significantly affected by the treatment lopinavir-ritonavir or lamivudine. TRIAL REGISTRATION CLINICALTRIALS. GOV IDENTIFIER: NCT00640263.


Assuntos
Antirretrovirais/uso terapêutico , Terapia Antirretroviral de Alta Atividade/métodos , Infecções por HIV/tratamento farmacológico , Saúde Bucal/estatística & dados numéricos , Fármacos Anti-HIV/farmacologia , Fármacos Anti-HIV/uso terapêutico , Estudos de Casos e Controles , Criança , Pré-Escolar , Cárie Dentária/tratamento farmacológico , Cárie Dentária/epidemiologia , Quimioterapia Combinada , Feminino , Gengivite/tratamento farmacológico , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , HIV-1/efeitos dos fármacos , Humanos , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Lamivudina/farmacologia , Lamivudina/uso terapêutico , Lopinavir/farmacologia , Lopinavir/uso terapêutico , Masculino , Avaliação de Resultados em Cuidados de Saúde , Prevalência , Qualidade de Vida , Ritonavir/farmacologia , Ritonavir/uso terapêutico , Erupção Dentária/efeitos dos fármacos , Uganda/epidemiologia
6.
BMC Infect Dis ; 20(1): 684, 2020 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-32948128

RESUMO

BACKGROUND: Untreated male partners are a critical source of maternal re-infection. Contact tracing is a good way to identify infection among partners and reduce risk of mother-to-child transmission related to maternal re-infection. This study aimed to analyze the current situation and related factors of contact tracing of syphilis-seropositive pregnant women and syphilis-infection among their male partners. METHOD: Data of syphilis-seropositive pregnant women and their male partners attending clinic for syphilis-screening were obtained from the Shenzhen Program for Prevention of Congenital Syphilis. Contact tracing rate of syphilis-seropositive pregnant women and syphilis prevalence among male partners were counted, and related factors were also analyzed using a random-effects logistic regression model. RESULT: Of the 1299 syphilis-seropositive pregnant women, 74.1% (963/1299) had their male partners receiving syphilis-screening and 19.1% (184/963) of male partners were syphilis-infected. For pregnant women, being divorced (adjusted odds ratio [AOR] =0.39; 95%CI: 0.17-0.87), seeking for emergency services at their first antenatal clinics visits (AOR = 0.58; 95%CI: 0.44-0.77), reporting willingness to notify partner(AOR = 7.65; 95%CI: 4.69-12.49), multi-partners (AOR = 1.38; 95%CI:1.03-1.86) and having a history of drug abuse (AOR = 0.37; 95%CI: 0.14-1.00)were independently associated with successful contact tracing. For male partners, of minority ethnicity (AOR = 4.15; 95%CI: 1.66-10.34), age at first sex>20(AOR = 0.57; 95%CI: 0.37-0.87), reporting multi-partners (AOR = 1.60; 95%CI: 1.04-2.46), having a history of drug abuse (AOR = 4.07; 95%CI: 1.31-12.64) were independently associated with syphilis-infection. In addition, pregnant women with TRUST titer ≥1:8 (AOR = 2.81; 95%CI: 1.87-4.21), having a history of adverse pregnancy outcomes (AOR = 1.70; 95%CI: 1.14-2.53), reporting multi-partners (AOR = 0.43; 95%CI: 0.29-0.64) and reporting the current partner as the source of syphilis (AOR = 5.05; 95%CI: 2.82-9.03) were independently associated with partners' syphilis-infection. CONCLUSION: Contact tracing is feasible and effective in identifying syphilis-infected partners among syphilis-seropositive pregnant women. Contact tracing is associated with many factors such as women's marital status, services at their first antenatal clinics visit and willingness of partner notification. Partners' ethnicity, age at first sex, multi-partners and history of drug abuse as well as women's levels of TRUST titer were associated with partners' syphilis-infection.


Assuntos
Busca de Comunicante , Complicações Infecciosas na Gravidez/epidemiologia , Sífilis/transmissão , Adolescente , Adulto , Instituições de Assistência Ambulatorial , China/epidemiologia , Feminino , Humanos , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Modelos Logísticos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Razão de Chances , Gravidez , Resultado da Gravidez , Gestantes , Prevalência , Parceiros Sexuais , Sífilis/epidemiologia , Sífilis Congênita/prevenção & controle , Sífilis Congênita/transmissão , Adulto Jovem
7.
BMJ Case Rep ; 13(9)2020 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-32878840

RESUMO

The COVID-19 outbreak has spread across the globe at an alarming rate. As the pandemic escalates, experience of COVID-19 in pregnant women is accumulating. We present a case of COVID-19 pneumonia in a 28-week pregnant woman with a known low lying placenta. The patient had deranged liver function tests at presentation, along with elevated bile acids. We discuss the differential diagnosis of these findings, and the possible mechanisms of hepatic injury in COVID-19. The low lying placenta in this patient meant that we had to carefully consider the application of recommendations for thromboprophylaxis in pregnant COVID-19 patients. With supportive management, this patient improved enough to be discharged, and has gone on to deliver a healthy neonate at term.


Assuntos
Colestase/diagnóstico , Infecções por Coronavirus/diagnóstico , Pneumonia Viral/diagnóstico , Complicações Infecciosas na Gravidez/diagnóstico , Terceiro Trimestre da Gravidez , Adulto , Colestase/complicações , Infecções por Coronavirus/complicações , Feminino , Humanos , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Pandemias , Pneumonia Viral/complicações , Gravidez , Resultado da Gravidez
8.
Lancet ; 396(10253): 779-785, 2020 09 12.
Artigo em Inglês | MEDLINE | ID: mdl-32919517

RESUMO

BACKGROUND: Cytomegalovirus is a common congenital infection, with high morbidity after an early primary maternal infection. No effective means exist to prevent viral transmission to the fetus. We aimed to investigate whether valaciclovir can prevent vertical transmission of cytomegalovirus to the fetus in pregnant women with a primary infection acquired early in pregnancy. METHODS: This prospective, randomised, double-blind, placebo-controlled trial was done at the Infectious Feto-Maternal Clinic of Rabin Medical Center (Petach Tikvah, Israel). Pregnant women aged 18 years or older, with serological evidence of a primary cytomegalovirus infection acquired either periconceptionally or during the first trimester of pregnancy, were randomly assigned to oral valaciclovir (8 g per day, twice daily) or placebo from enrolment until amniocentesis at 21 or 22 gestational weeks. Randomisation was done separately for participants infected periconceptionally or during the first trimester and was done in blocks of four. Patients and researchers were masked to participant allocation throughout the entire study period. The primary endpoint was the rate of vertical transmission of cytomegalovirus. Statistical analyses were done according to per-protocol principles. The study was registered at ClinicalTrials.gov, NCT02351102. FINDINGS: Between Nov 15, 2015, and Oct 8, 2018, we enrolled and randomly assigned 100 patients to receive valaciclovir or placebo. Ten patients were excluded, five from each study group; therefore, the final analysis included 45 patients (all singletons) in the valaciclovir group and 45 patients (43 singletons and two sets of twins) in the placebo group. In the valaciclovir group, including both first trimester and periconceptional infections, five (11%) of 45 amniocenteses were positive for cytomegalovirus, compared with 14 (30%) of 47 amniocenteses in the placebo group (p=0·027; odds ratio 0·29, 95% CI 0·09-0·90 for vertical cytomegalovirus transmission). Among participants with a primary cytomegalovirus infection during the first trimester, a positive amniocentesis for cytomegalovirus was significantly less likely in the valaciclovir group (two [11%] of 19 amniocenteses) compared with the placebo group (11 [48%] of 23 amniocenteses; p=0·020. No clinically significant adverse events were reported. INTERPRETATION: Valaciclovir is effective in reducing the rate of fetal cytomegalovirus infection after maternal primary infection acquired early in pregnancy. Early treatment of pregnant women with primary infection might prevent termination of pregnancies or delivery of infants with congenital cytomegalovirus. FUNDING: None.


Assuntos
Antivirais/uso terapêutico , Infecções por Citomegalovirus/transmissão , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Valaciclovir/uso terapêutico , Adulto , Antivirais/efeitos adversos , Método Duplo-Cego , Feminino , Humanos , Adesão à Medicação , Gravidez , Primeiro Trimestre da Gravidez , Estudos Prospectivos , Tempo para o Tratamento , Valaciclovir/efeitos adversos
9.
New Jersey; BMJ Best Practice; Ago. 6, 2020. 194 p.
Monografia em Inglês | BIGG | ID: biblio-1116708

RESUMO

A potentially severe acute respiratory infection caused by the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).[1] The clinical presentation is generally that of a respiratory infection with a symptom severity ranging from a mild common cold-like illness, to a severe viral pneumonia leading to acute respiratory distress syndrome that is potentially fatal. Characteristic symptoms include fever, cough, and dyspnea, although some patients may be asymptomatic. Complications of severe disease include, but are not limited to, multi-organ failure, septic shock, and blood clots.


Assuntos
Humanos , Masculino , Feminino , Gravidez , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Pneumonia Viral/complicações , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/diagnóstico por imagem , Grupos de Risco , Portador Sadio/transmissão , Pessoal de Saúde/organização & administração , Infecções por Coronavirus/complicações , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/diagnóstico por imagem , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Pandemias/estatística & dados numéricos , Exacerbação dos Sintomas , Betacoronavirus/patogenicidade , Pneumonia Associada a Assistência à Saúde/diagnóstico , China/epidemiologia
11.
Dan Med J ; 67(9)2020 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-32829745

RESUMO

INTRODUCTION: The coronavirus disease 19 (COVID-19) pandemic, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), progresses globally, and means to reduce the transmission are needed. In the community, the use of face masks is increasing world-wide, but documentation for the efficacy of this remedy is lacking. This trial investigates whether the use of face masks in the community will reduce wearers' risk of SARS-CoV-2 infection. METHODS: This study will be a two-arm, unblinded, randomised controlled trial. We will include adults (>18 years of age) without prior confirmed COVID-19 or symptoms suggestive of COVID-19, who spend more than three hours per day outside the home with exposure to other people. A total of 6,000 participants are randomly assigned 1:1 to use face masks or not for a 30-day period during the pandemic. Participants will perform self-testing; quick test for SARS-CoV-2 antibodies (immunoglobulin M (IgM) and immunoglobulin G (IgG)) (the Livzon lateral flow test) and oropharyngeal/nasal swabs for viral detection using polymerase chain reaction (PCR). The primary endpoint following the 30-day study period is the difference in the number of SARS-CoV-2-infected individuals between the two study groups as assessed by a positive nasopharyngeal swap, a positive antibody test or a hospital-based diagnosis of SARS-CoV-2 infection. CONCLUSIONS: We will study whether a face mask protects the wearer of the mask against SARS-CoV-2 infection. The findings are expected to apply to the present pandemic and to future viral outbreaks and to provide evidence for authority recommendations across the world. FUNDING: This study was funded by Salling Fondene. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04337541.


Assuntos
Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/prevenção & controle , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Máscaras/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Saúde Pública , Adulto , Idoso , Dinamarca , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevenção Primária/instrumentação , Prevenção Primária/métodos , Medição de Risco , Organização Mundial da Saúde
12.
Ginekol Pol ; 91(7): 417-423, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32779163

RESUMO

The pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has become the reason of the global health crisis. Since the first case of diagnosed COVID-19 pneumonia was reported in Wuhan, Hubei Province, China, in December 2019, the infection has spread rapidly to all over the world. The knowledge gained from previous human coronavirus infection outbreaks suggests that pregnant women and their foetuses represent a high-risk population during infectious disease epidemics. Moreover, a pregnancy, due to the physiological changes involving immune and cardiopulmonary systems, is a state predisposing women to respiratory complications of viral infection. The constantly increasing number of publications regarding the course of COVID-19 infection in pregnant women has been published, however, the available data remains limited and many questions remain unanswered. The aim of this review was to summarize the literature data and adjusted to current recommendations regarding pregnancy care, delivery and postpartum period. An extremely important issue is the need to register all the cases of COVID-19 affected women and the course of these pregnancies to local, regional, or international registries, which will be helpful to answer many clinical and scientific questions and to create guidelines ensuring an adequate level of care for women affected by COVID-19 infection during pregnancy, delivery and during postpartum period, as well as their newborns.


Assuntos
Infecções por Coronavirus , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Pandemias , Pneumonia Viral , Complicações Infecciosas na Gravidez , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Feminino , Humanos , Administração dos Cuidados ao Paciente/métodos , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/fisiopatologia , Complicações Infecciosas na Gravidez/terapia , Resultado da Gravidez/epidemiologia
13.
Lancet HIV ; 7(8): e582-e592, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32763221

RESUMO

Pregnancy is a high-risk period for HIV acquisition in African women, and pregnant women who become acutely infected with HIV account for up to a third of vertical HIV transmission cases in African settings. To protect women and eliminate vertical transmission, WHO recommends offering oral pre-exposure prophylaxis (PrEP) based on tenofovir to HIV-negative pregnant and post-partum women with a substantial risk of HIV acquisition. PrEP implementation for pregnant and post-partum women lags behind implementation for other high-risk populations. Unique considerations for PrEP implementation arise during pregnancy and post partum, including the integration of provider training with clinical delivery and monitoring of PrEP exposure and outcomes within existing maternal health systems, yet scarce implementation data are available to generate evidence in this context.


Assuntos
Fármacos Anti-HIV/administração & dosagem , Infecções por HIV/prevenção & controle , Profilaxia Pré-Exposição , Fármacos Anti-HIV/uso terapêutico , Feminino , Implementação de Plano de Saúde , Humanos , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Masculino , Cuidado Pós-Natal , Gravidez
14.
Public Health Rep ; 135(1_suppl): 182S-188S, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32735204

RESUMO

OBJECTIVES: We evaluated the impact of a 2014 New York City health code change requiring laboratories to indicate if a patient is pregnant or probably pregnant in the electronic laboratory report (ELR) when reporting syphilis and hepatitis B virus (HBV) cases to the New York City Department of Health and Mental Hygiene (DOHMH). METHODS: We calculated the number of pregnant persons with syphilis or HBV infection reported to DOHMH from January 1, 2013, through June 30, 2018. We compared the proportion in which the first report to DOHMH was an ELR with pregnancy indicated before and after the policy change. We calculated time between first ELR with pregnancy indicated and subsequent reporting by a method other than ELR and the proportion of cases in which ELR with pregnancy indicated was the only report source. RESULTS: A total of 552 new syphilis and 8414 HBV-infected cases were reported to DOHMH. From January 2013-June 2014 (pre-change) to January 2017-June 2018 (post-change), the proportion of cases in which ELR with pregnancy indicated was the first report to DOHMH increased significantly (14.7% [23/156] to 46.2% [80/173] for syphilis; 8.0% [200/2498] to 45.3% [851/1879] for HBV infection [P < .001]). Median time between first ELR with pregnancy indicated and subsequent reporting by a method other than ELR was 9.0 days for syphilis and 51.0 days for HBV infection. ELR with pregnancy indicated was the only report for 43.1% (238/552) of syphilis cases and 23.4% (1452/6200) of HBV cases during the study period. CONCLUSION: Including pregnancy status with ELR can increase the ability of public health departments to conduct timely interventions to prevent mother-to-child transmission.


Assuntos
Hepatite B/diagnóstico , Complicações Infecciosas na Gravidez/diagnóstico , Vigilância em Saúde Pública/métodos , Sífilis/diagnóstico , Adolescente , Adulto , Feminino , Humanos , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Cidade de Nova Iorque , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controle , Adulto Jovem
16.
PLoS One ; 15(8): e0237525, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32776972

RESUMO

Hepatitis B is a global epidemic that requires carefully orchestrated vaccination initiatives in geographical regions of medium to high endemicity to reach the World Health Organization's elimination targets by 2030. This study compares two widely-used deterministic hepatitis B models-the Imperial HBV model and the CDA Foundation's PRoGReSs-based on their predicted outcomes in four countries. The impact of scaling up of the timely birth dose of the hepatitis B vaccine is also investigated. The two models predicted largely similar outcomes for the impact of vaccination programmes on the projected numbers of new cases and deaths under high levels of the infant hepatitis B vaccine series. However, scenarios for the scaling up of the infant hepatitis B vaccine series had a larger impact in the PRoGReSs model than in the Imperial model due to the infant vaccine series directly leading to the reduction of perinatal transmission in the PRoGReSs model, but not in the Imperial model. Meanwhile, scaling up of the timely birth dose vaccine had a greater impact on the outcomes of the Imperial hepatitis B model than in the PRoGReSs model due to the greater protection that the birth dose vaccine confers to infants in the Imperial model compared to the PRoGReSs model. These differences underlie the differences in projections made by the models under some circumstances. Both sets of assumptions are consistent with available data and reveal a structural uncertainty that was not apparent in either model in isolation. Those relying on projections from models should consider outputs from both models and this analysis provides further evidence of the benefits of systematic model comparison for enhancing modelling analyses.


Assuntos
Vacinas contra Hepatite B/administração & dosagem , Vírus da Hepatite B/efeitos dos fármacos , Hepatite B/prevenção & controle , Programas de Imunização/estatística & dados numéricos , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Modelos Estatísticos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Saúde Global , Hepatite B/epidemiologia , Hepatite B/virologia , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Gravidez , Organização Mundial da Saúde , Adulto Jovem
19.
Lancet HIV ; 7(9): e629-e640, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32771089

RESUMO

BACKGROUND: The COVID-19 pandemic could lead to disruptions to provision of HIV services for people living with HIV and those at risk of acquiring HIV in sub-Saharan Africa, where UNAIDS estimated that more than two-thirds of the approximately 38 million people living with HIV resided in 2018. We aimed to predict the potential effects of such disruptions on HIV-related deaths and new infections in sub-Saharan Africa. METHODS: In this modelling study, we used five well described models of HIV epidemics (Goals, Optima HIV, HIV Synthesis, an Imperial College London model, and Epidemiological MODeling software [EMOD]) to estimate the effect of various potential disruptions to HIV prevention, testing, and treatment services on HIV-related deaths and new infections in sub-Saharan Africa lasting 6 months over 1 year from April 1, 2020. We considered scenarios in which disruptions affected 20%, 50%, and 100% of the population. FINDINGS: A 6-month interruption of supply of antiretroviral therapy (ART) drugs across 50% of the population of people living with HIV who are on treatment would be expected to lead to a 1·63 times (median across models; range 1·39-1·87) increase in HIV-related deaths over a 1-year period compared with no disruption. In sub-Saharan Africa, this increase amounts to a median excess of HIV deaths, across all model estimates, of 296 000 (range 229 023-420 000) if such a high level of disruption occurred. Interruption of ART would increase mother-to-child transmission of HIV by approximately 1·6 times. Although an interruption in the supply of ART drugs would have the largest impact of any potential disruptions, effects of poorer clinical care due to overstretched health facilities, interruptions of supply of other drugs such as co-trimoxazole, and suspension of HIV testing would all have a substantial effect on population-level mortality (up to a 1·06 times increase in HIV-related deaths over a 1-year period due to disruptions affecting 50% of the population compared with no disruption). Interruption to condom supplies and peer education would make populations more susceptible to increases in HIV incidence, although physical distancing measures could lead to reductions in risky sexual behaviour (up to 1·19 times increase in new HIV infections over a 1-year period if 50% of people are affected). INTERPRETATION: During the COVID-19 pandemic, the primary priority for governments, donors, suppliers, and communities should focus on maintaining uninterrupted supply of ART drugs for people with HIV to avoid additional HIV-related deaths. The provision of other HIV prevention measures is also important to prevent any increase in HIV incidence. FUNDING: Bill & Melinda Gates Foundation.


Assuntos
Fármacos Anti-HIV/provisão & distribução , Betacoronavirus/patogenicidade , Infecções por Coronavirus/epidemiologia , Infecções por HIV/epidemiologia , Modelos Estatísticos , Pandemias , Pneumonia Viral/epidemiologia , África ao Sul do Saara/epidemiologia , Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade , Preservativos/provisão & distribução , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/transmissão , Infecções por Coronavirus/virologia , Feminino , Saúde Global/tendências , Infecções por HIV/mortalidade , Infecções por HIV/transmissão , Infecções por HIV/virologia , HIV-1/efeitos dos fármacos , HIV-1/crescimento & desenvolvimento , Humanos , Incidência , Recém-Nascido , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Transmissão Vertical de Doença Infecciosa/estatística & dados numéricos , Masculino , Pneumonia Viral/mortalidade , Pneumonia Viral/transmissão , Pneumonia Viral/virologia , Comportamento Sexual/psicologia , Comportamento Sexual/estatística & dados numéricos , Análise de Sobrevida
20.
Z Geburtshilfe Neonatol ; 224(4): 181-186, 2020 08.
Artigo em Alemão | MEDLINE | ID: mdl-32838447

RESUMO

The novel coronavirus SARS-CoV-2 has developed into a pandemic, yet still has many unknowns. The modalities of transmission, different symptoms and manifestations as well as concomitant circumstances of the disease are insufficiently characterized. Especially patient groups in special situations like pregnant women and newborns have to be considered separately. The current knowledge about pregnancy, labor and the first days of life is characterized by particular uncertainty due to the scarce data available. However, there is currently no evidence of significant unfavorable maternal and perinatal outcome. Many pregnant women with SARS-CoV-2 infection remain asymptomatic. The possibility of vertical transmission to the child cannot be excluded with certainty. However, indications of vertical transmission were detected only in individual cases. Newborn infections are also rather rare, unspecific and usually mild, with respiratory symptoms dominating. In this article, the data available to date are examined in order to provide better information, advice and treatment for pregnant women and newborns with SARS-CoV-2 and to provide suggestions for future research.


Assuntos
Infecções por Coronavirus/prevenção & controle , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Pandemias , Assistência Perinatal , Pneumonia Viral/prevenção & controle , Complicações Infecciosas na Gravidez/virologia , Betacoronavirus , Criança , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Recém-Nascido , Pneumonia Viral/epidemiologia , Gravidez
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