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1.
Risk Anal ; 2020 Feb 17.
Artículo en Inglés | MEDLINE | ID: mdl-32067244

RESUMEN

This study draws on the Planned Risk Information Seeking Model (PRISM) to assess Zika virus information seeking and systematic processing, paying particular attention to the relationship between perceived knowledge and knowledge insufficiency. Novel risks, such as Zika, provide an interesting context for examining whether information-seeking models, such as PRISM, are able to predict information seeking when available information is limited or scarce. A cross-sectional, online study of men and women of childbearing age (N = 494) residing in the state of Florida was conducted. Our results provide some support for the PRISM for predicting Zika information seeking intention, as well as systematic processing of information. We also found that individuals with high levels of perceived knowledge were more likely to report high level of knowledge insufficiency, illustrating that contextual factors may impact the fit of risk information seeking models.

2.
J Emerg Manag ; 18(1): 7-14, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32031668

RESUMEN

In our increasingly interconnected world, the potential for emerging infectious diseases (EIDs) to spread globally is of paramount concern. Travel bans-herein defined as the complete restriction of travel from at least one geographic region to at least one other international geographic region-are a potential policy solution to control the global spread of disease. The social, economic, and health-related consequences of travel bans, as well as the available evidence on the effectiveness of travel restrictions in preventing the global spread of influenza, have been previously described. However, the effectiveness of travel bans in reducing the spread of noninfluenza EIDs, characterized by different rates and modes of transmission, is less well understood. This study employs an integrative review approach to summarize the minimal evidence on effectiveness of travel bans to decrease the spread of severe acute respiratory syndrome (SARS), Middle Eastern respiratory syndrome (MERS), Ebola virus disease (EVD), and Zika virus disease (ZVD). We describe and qualify the evidence presented in six modeling studies that assess the effectiveness of travel bans in controlling these noninfluenza EID events. We conclude that there is an urgent need for additional research to inform policy decisions on the use of travel bans and other control measures to control noninfluenza EIDs in advance of the next outbreak.

3.
Cell Rep ; 2020 Feb 12.
Artículo en Inglés | MEDLINE | ID: mdl-32075736

RESUMEN

Zika virus (ZIKV) has caused an explosive epidemic linked to severe clinical outcomes in the Americas. As of June 2018, 4,929 ZIKV suspected infections and 46 congenital syndrome cases had been reported in Manaus, Amazonas, Brazil. Although Manaus is a key demographic hub in the Amazon region, little is known about the ZIKV epidemic there, in terms of both transmission and viral genetic diversity. Using portable virus genome sequencing, we generated 59 ZIKV genomes in Manaus. Phylogenetic analyses indicated multiple introductions of ZIKV from northeastern Brazil to Manaus. Spatial genomic analysis of virus movement among six areas in Manaus suggested that populous northern neighborhoods acted as sources of virus transmission to other neighborhoods. Our study revealed how the ZIKV epidemic was ignited and maintained within the largest urban metropolis in the Amazon. These results might contribute to improving the public health response to outbreaks in Brazil.

4.
Sci Rep ; 10(1): 1752, 2020 Feb 04.
Artículo en Inglés | MEDLINE | ID: mdl-32019953

RESUMEN

Despite all the research done on the first Zika virus (ZIKV) epidemics, it was only after the Brazilian epidemic that the Congenital Zika Syndrome was described. This was made possible due to the large number of babies born with microcephaly in the Northeast region (NE) in a narrow time. We hypothesize that the fivefold difference in the rate of microcephalic neonates between the NE and other regions is partially an effect of the population prior immunity against Dengue viruses (DENV), that cross-react with ZIKV. In this ecological study, we analysed the interaction between dengue fever epidemics from 2001 to 2014 and the 2015/2016 microcephaly epidemic in 400 microregions in Brazil using random-effects models under a Bayesian approach. The estimated effect of the time lag between the most recent large dengue epidemic (>400/100,000 inhabitants) and the microcephaly epidemic ranged from protection (up to 6 years prior) to an increased risk (from 7 to 12 years). This sustained window of protection, larger than described in previous longitudinal studies, is possibly an effect of herd immunity and of multiple exposures to DENV that could boost immunity.

5.
Reprod Health ; 17(1): 22, 2020 Feb 06.
Artículo en Inglés | MEDLINE | ID: mdl-32028969

RESUMEN

BACKGROUND: In 2016, the World Health Organization declared a Public Health Emergency of International Concern due to Zika's association with microcephaly and other neurological disorders. Brazil was the epicenter of this epidemic and the most affected region has the lowest Human Development Index and the highest rates of adolescent pregnancy. Despite the end of the epidemic, Brazil continues to be the epicenter of Zika illness. This study examined the barriers faced by young women who seek sexual and reproductive health (SRH) care services living in affected areas and their attitudes towards SRH needs and the available services. METHODS: Individual semi-structured interviews were conducted with 22 young women, aged 14-24 years in three Zika affected municipalities in the Brazilian Northeast. This qualitative research used thematic analysis for data analysis. RESULTS: Almost half (n = 10) of the participants had their first pregnancy during adolescence (from 12 to 19), all of which were unintended. Lack of information and barriers to access family planning were found to contribute to the unmet need for contraception. Participants reported knowledge gaps about contraception. Zika was not considered a health concern and participants were unaware of the possibility of Zika's sexual transmission. CONCLUSIONS: The young women's knowledge and attitudes towards their SRH needs highlight the barriers to access care. It also implies that comprehensive, biopsychosocial and political, understanding is necessary in order to adequately provide SRH to this population and meet their needs. The government should place women at the center of any public health response to an emergency affecting women of reproductive age and focus on improving access to information and family planning services in a culturally and age appropriate manner.

6.
Cad Saude Publica ; 36Suppl 1(Suppl 1): e00190518, 2020.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-32049123

RESUMEN

The objective of this study was to analyze the national press coverage of abortion in cases of Zika infection and examine whether it reinforced discourses already associated with the practice or broadened and qualified the discussion of the subject. It is a qualitative study based on the analysis of 43 news stories on Zika/microcephaly/abortion published in the newspapers O Globo and Folha de S.Paulo between November 2015 and December 2016. Based on concepts from Journalism and Discourse Analysis, we identified the sources present in the coverage and analyzed the arguments they used in order to justify their positions, in addition to the strategies, types of knowledge and values they mobilized in the argumentation. We found that both newspapers privileged specialized sources - physicians in Folha de S.Paulo and lawyers and legal scholars in O Globo - and silenced the voices of women directly affected by the epidemic. As for the argumentation, sources that were favorable to the right to have an abortion in cases of Zika infection mainly denounced social injustices, while those who oppose it used a defense-of-life discourse. We observed the predominance of knowledge derived from beliefs and moral values in the discursive arena we analyzed, which was further marked by analogies loaded with negative meaning on both sides of the debate. Comparing our data with those from other studies on abortion in the media, we consider that the media coverage of Zika/microcephaly/abortion played a relevant role in reconfiguring the media discourse on the subject, characterized by a more technical focus, by a plurality of voices and positions and by a greater attention afforded to favorable arguments based on constitutional principles.

7.
Artículo en Inglés | MEDLINE | ID: mdl-32049261

RESUMEN

Aedes aegypti is associated with epidemic diseases in Brazil, such as urban yellow fever, dengue, and more recently, chikungunya and Zika viruses infections. More information about Ae. aegypti infestation is fundamental to virological surveillance in order to ensure the effectiveness of control measures in use. Thus, the present study aims to identify and compare infestation and infectivity of Ae. aegypti females in Macapa city, Amapa State (Amazon region), Brazil, between the epidemiological weeks 2017/02 and 2018/20. A total number of 303 Ae. aegypti females were collected at 21 fixed collection points, 171 at the 10 collection points in the Marabaixo neighborhood and 132 at the 11 collection points in the Central neighborhood. Among the collected samples, only two were positive for dengue virus, with a 2.08% (2/96 pools) infectivity rate for Marabaixo. The difference between the medians of Ae. aegypti females captured in Central and Marabaixo sites was not statistically significant. The findings indicate similar mosquito infestation levels between the neighborhoods, and a low-level of mosquito infectivity, although dengue virus was found only in Marabaixo. Virological surveillance of Ae. aegypti was important to identify sites of infection and determine possible routes of transmission to enable health surveillance teams to adopt preventive strategies where infected mosquitoes are present and act faster.

8.
Emerg Infect Dis ; 26(4)2020 Apr 17.
Artículo en Inglés | MEDLINE | ID: mdl-32043959

RESUMEN

Zika virus is transitioning to become a long-term public health challenge, and countries should remain informed of the risk for emergence. We developed a stochastic epidemiologic model to profile risk for Zika virus emergence, including trimester-specific fetal risk across time, in all 3,208 counties in the United States, including Puerto Rico. Validation against known transmission in North America demonstrated accuracy to predict epidemic dynamics and absolute case counts across scales (R2 = 0.98). We found that, although sporadic single transmission events could occur in most US counties, outbreaks will likely be restricted to the Gulf Coast region and to late spring through autumn. Seasonal fluctuations in birth rates will confer natural population-level protection against early-trimester infections. Overall, outbreak control will be more effective and efficient than prevention, and vaccination will be most effective at >70% coverage. Our county-level risk profiles should serve as a critical resource for resource allocation.

10.
Artículo en Inglés | MEDLINE | ID: mdl-32011597

RESUMEN

INTRODUCTION: In 2016, Puerto Rico became the focal point of the Zika epidemic, with more than 36 000 laboratory-confirmed cases before August. The Puerto Rico Department of Health (PRDH) responded by providing tests to symptomatic and asymptomatic pregnant women. The increased demand for Zika testing placed unprecedented strain on the laboratory capacity and information management processes used within the PRDH. The PRDH recognized the need to have an updated informatics system that securely manages, stores, and transmits digital data. The Centers for Disease Control and Prevention funded the Public Health Informatics Institute to collaborate with the PRDH to assess and improve the informatics capability to respond to the ongoing Zika virus transmission in Puerto Rico. APPROACH: The team employed a 4-component approach to assess the informatics system and improve the information management processes for laboratory testing and reporting of arboviral diseases (Zika, chikungunya, and dengue). The method consisted of a (1) needs assessment, (2) business process analysis and requirements definition, (3) vendor analysis, and (4) solution implementation. RESULTS: The needs assessment determined that the PRDH's procedures for arbovirus testing and reporting were highly complex and paper-based and thus did not maximize the use of existing technology. The solution was to build a Web portal. The business process analysis yielded information to create a map of the flow of specimens, an arbovirus context diagram, and more than 200 requirements. The requirements identified in this process guided the design and creation of the Web portal. DISCUSSION: This report describes the process to build a Web portal to enhance laboratory testing and electronic reporting of Zika cases during the 2016 epidemic in Puerto Rico. We demonstrate the utility of applying the Collaborative Requirements Development Methodology, a proven informatics method, to the development of a Web portal for managing arboviruses in a health department.

11.
Sci Adv ; 6(5): eaaw7449, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32064329

RESUMEN

Disease epidemics and outbreaks often generate conspiracy theories and misperceptions that mislead people about the risks they face and how best to protect themselves. We investigate the effectiveness of interventions aimed at combating false and unsupported information about the Zika epidemic and subsequent yellow fever outbreak in Brazil. Results from a nationally representative survey show that conspiracy theories and other misperceptions about Zika are widely believed. Moreover, results from three preregistered survey experiments suggest that efforts to counter misperceptions about diseases during epidemics and outbreaks may not always be effective. We find that corrective information not only fails to reduce targeted Zika misperceptions but also reduces the accuracy of other beliefs about the disease. In addition, although corrective information about the better-known threat from yellow fever was more effective, none of these corrections affected support for vector control policies or intentions to engage in preventive behavior.

12.
Int J Dev Neurosci ; 2020 Feb 17.
Artículo en Inglés | MEDLINE | ID: mdl-32065434

RESUMEN

OBJECTIVE: to characterize the spectrum of brain damages presented in children affected by Congenital Zika Syndrome (CZS), verify the existence of a co-occurrence pattern of these damages and discuss possible implications for the neuropsychological development. METHODS: descriptive, quantitative, individualized and cross-sectional study using secondary sources. We selected 136 children with CZS from the database of the Center of Strategic Information on Health Vigilance of the Municipal Office of Salvador, Brazil. We conducted descriptive and multiple correspondence analyses. RESULTS: Among the set of analyzed variables, microcephaly (51.5%), ventriculomegaly (57.4%) and brain calcifications (77.2%) were identified as the most frequent. The multiple correspondence analysis showed that the combination of these three variables (32.4%) was what better represented the spectrum of brain damages in the Central Nervous System. INTERPRETATION: Damage in the sensory-motor, cognitive and language development, as well as neurodevelopmental disorders, are described in the literature as impairments associated, either isolated or combined, with these damages, and it is worth highlighting that, in combined brain damages, impairments tend to be more severe. The findings of this study may contribute to understanding the repercussions of CZS on the neuropsychological development of children affected by the epidemic.

13.
Epilepsia ; 2020 Feb 17.
Artículo en Inglés | MEDLINE | ID: mdl-32065676

RESUMEN

OBJECTIVE: To estimate the incidence of epilepsy in children with Zika-related microcephaly in the first 24 months of life; to characterize the associated clinical and electrographic findings; and to summarize the treatment responses. METHODS: We followed a cohort of children, born during the 2015-2016 Zika virus (ZIKV) epidemic in Brazil, with congenital microcephaly and evidence of congenital ZIKV infection on neuroimaging and/or laboratory testing. Neurological assessments were performed at ≤3, 6, 12, 15, 18, 21, and 24 months of life. Serial electroencephalograms were performed over the first 24 months. RESULTS: We evaluated 91 children, of whom 48 were female. In this study sample, the cumulative incidence of epilepsy was 71.4% in the first 24 months, and the main type of seizure was infantile spasms (83.1%). The highest incidence of seizures occurred between 3 and 9 months of age, and the risk remained high until 15 months of age. The incidence of infantile spasms peaked between 4 and 7 months and was followed by an increased incidence of focal epilepsy cases after 12 months of age. Neuroimaging results were available for all children, and 100% were abnormal. Cortical abnormalities were identified in 78.4% of the 74 children evaluated by computed tomography and 100% of the 53 children evaluated by magnetic resonance imaging. Overall, only 46.1% of the 65 children with epilepsy responded to treatment. The most commonly used medication was sodium valproate with or without benzodiazepines, levetiracetam, phenobarbital, and vigabatrin. SIGNIFICANCE: Zika-related microcephaly was associated with high risk of early epilepsy. Seizures typically began after the third month of life, usually as infantile spasms, with atypical electroencephalographic abnormalities. The seizure control rate was low. The onset of seizures in the second year was less frequent and, when it occurred, presented as focal epilepsy.

14.
Clin Exp Dermatol ; 2020 Jan 09.
Artículo en Inglés | MEDLINE | ID: mdl-31916616

RESUMEN

Skin disorders are frequent in travellers, but data vary between different studies. The objectives of the current study were to describe imported dermatoses in the Bordeaux GeoSentinel prospective database between August 2015 and March 2018. During the study period, 1025 travellers were seen in the clinic, 201 of them with dermatoses. Patients with skin disorders were more likely to be aged > 60 years (OR = 1.88, 95% CI 1.22-2.89), to be tourists (OR 3.04, 95% CI 2.03-4.55) and to have travelled to South America (OR = 2.18, 95% CI 1.29-3.67), and less likely to have sought pretravel advice (OR = 0.53, 95% CI 0.31-0.91). Skin bacterial infections (19.4%) and Zika virus infections (18.4%) were the most common dermatoses. Dengue fever and bacterial skin infections were the leading causes of hospitalization. The contribution of tropical diseases to imported dermatoses remains important. Lack of pretravel advice puts tourists at risk of significant diseases such as dengue fever, Zika virus and bacterial infections.

15.
Infect Genet Evol ; 80: 104180, 2020 Jan 07.
Artículo en Inglés | MEDLINE | ID: mdl-31918041

RESUMEN

Zika virus (ZIKV) is a negative sense RNA virus from the Flaviviridae family, which was relatively unknown until the first human epidemic in Micronesia, in 2007. Since then, it spread to French Polynesia and the Americas. Recife, the capital of Pernambuco state and epicenter of the Zika epidemic in Brazil, experienced a large number of microcephaly cases and other congenital abnormalities associated to the ZIKV infection from, 2015 to 16. Evidences suggest that both Aedes aegypti and Culex quinquefasciatus mosquitoes from Recife are capable of replicating and transmitting the virus. Here, we conducted high throughput sequencing of ZIKV genomes directly from Ae. aegypti and Cx. quinquefasciatus mosquitoes collected during the ZIKV epidemics in Recife, in order to investigate the variability and evolution of the virus. We obtained 11 draft ZIKV genomes derived from 5 pools from each Ae. aegypti and Cx. quinquefasciatus species. Genome coverage breadth ranged from 16 to 100% and average depth from 45 to 46,584×. Two of these genomes were obtained from pools of Cx. quinquefasciatus females with no sign of blood in the abdomen. Amino acid substitutions found here were not species-specific. In addition, molecular clock dating estimated that ZIKV draft genomes obtained here were co-circulating in other regions of the country during the epidemics. Overall results highlight that viral mutations and even minor variants can be detected in genomes directly sequenced from mosquito samples and insights about natural viral genomic variability and viral evolution can be useful when designing tools for mosquito control programs.

16.
Emerg Infect Dis ; 26(2): 315-319, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31967538

RESUMEN

We queried hospital patients about international travel in the previous 30 days to assess potential importation of emerging infections. We used 12 months of deidentified data to analyze patient demographics, travel destinations, and diagnoses for exposure to Zika virus. Our approach could be used to analyze potential infectious disease exposures.

17.
J Med Chem ; 63(3): 1313-1327, 2020 Feb 13.
Artículo en Inglés | MEDLINE | ID: mdl-31972088

RESUMEN

Emerging and resurging mosquito-borne flaviviruses are an important public health challenge. The increased prevalence of dengue virus (DENV) infection has had a significant socioeconomic impact on epidemic countries. The recent outbreak of Zika virus (ZIKV) has created an international public health emergency because ZIKV infection has been linked to congenital defects and Guillain-Barré syndrome. To develop potentially prophylactic antiviral drugs for combating these acute infectious diseases, we have targeted the host calcium/calmodulin-dependent kinase II (CaMKII) for inhibition. By using CaMKII structure-guided inhibitor design, we generated four families of benzenesulfonamide (BSA) derivatives for SAR analysis. Among these substances, N-(4-cycloheptyl-4-oxobutyl)-4-methoxy-N-phenylbenzenesulfonamide (9) showed superior properties as a lead CaMKII inhibitor and antiviral agent. BSA 9 inhibited CaMKII activity with an IC50 value of 0.79 µM and displayed EC50 values of 1.52 µM and 1.91 µM against DENV and ZIKV infections of human neuronal BE(2)C cells, respectively. Notably, 9 significantly reduced the viremia level and increased animal survival time in mouse-challenge models.

18.
Travel Med Infect Dis ; : 101562, 2020 Jan 26.
Artículo en Inglés | MEDLINE | ID: mdl-31996323

RESUMEN

BACKGROUND: No large-scale Zika epidemic has been observed to date in Southeast Asia following the 2015-16 Latin American and the Caribbean epidemic. One hypothesis is Southeast Asian populations' partial immunity to Zika. METHOD: We estimated the two conditions for a Zika outbreak emergence in Southeast Asia: (i) the risk of Zika introduction from Latin America and the Caribbean and, (ii) the risk of autochthonous transmission under varying assumptions on population immunity. We also validated the model used to estimate the risk of introduction by comparing the estimated number of Zika seeds introduced into the United States with case counts reported by the Centers for Disease Control and Prevention (CDC). RESULTS: There was good agreement between our estimates and case counts reported by the CDC. We thus applied the model to Southeast Asia and estimated that, on average, 1-10 seeds were introduced into Indonesia, Malaysia, the Philippines, Singapore, Thailand and Vietnam. We also found increasing population immunity levels from 0 to 90% reduced probability of autochthonous transmission by 40% and increasing individual variation in transmission further reduced the outbreak probability. CONCLUSIONS: Population immunity, combined with heterogeneity in transmission, can explain why no large-scale outbreak was observed in Southeast Asia during the 2015-16 epidemic.

19.
Bioorg Med Chem Lett ; 30(5): 126965, 2020 Mar 01.
Artículo en Inglés | MEDLINE | ID: mdl-31980339

RESUMEN

In recent years, the Zika virus has emerged from a neglected flavivirus to a health-threatening pathogen that causes epidemic outbreaks associated with neurological disorders and congenital malformations. In addition to vaccine development, the discovery of specific antiviral agents has been pursued intensely. The Zika virus protease NS2B-NS3 catalyses the processing of the viral precursor polyprotein as an essential step during viral replication. Since the epidemic Zika virus outbreak in the Americas, several inhibitors of this protease have been reported. Substrate-derived peptides revealed important structural information about the active site, whilst more drug-like small molecules have been discovered as allosteric inhibitors.

20.
Int J Gynaecol Obstet ; 148 Suppl 2: 9-14, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31975394

RESUMEN

OBJECTIVE: To identify newborns with congenital Zika infection (CZI) at a maternity hospital in Salvador, Brazil, during the 2016 microcephaly outbreak. METHODS: A prospective study enrolled microcephalic and normocephalic newborns with suspected CZI between January and December 2016. Serology (immunoglobulins IgM and IgG) and quantitative reverse transcriptase polymerase chain reaction (RT-qPCR) for the Zika virus were performed. Demographic and clinical characteristics of newborns with and without microcephaly were compared. RESULTS: Of the 151 newborns enrolled, 32 (21.2%) were classified as microcephalic. The majority of these cases were born between January and May 2016. IgM and IgG Zika virus antibodies were detected in 5 (23.8%) and 17 (80.9%) microcephalic newborn blood samples, respectively. Six (24%) microcephalic newborns tested positive for Zika virus by RT-qPCR in urine or placenta samples. Thirteen (11.8%) normocephalic newborns also tested positive for Zika virus by PCR in urine, plasma, or placenta samples, while IgM antibodies against Zika were detected in 4 (4.2%) others. CONCLUSIONS: Identification of 17 normocephalic CZI cases, confirmed by IgM serology or RT-qPCR for Zika virus, provides evidence that CZI can present asymptomatically at birth. This finding highlights the need for prenatal and neonatal screening for Zika virus in endemic regions.

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