COVID-19 Vaccine Acceptance and Hesitancy among People Living with HIV: Review and Meta-Analysis.

This study aims to estimate the COVID-19 vaccine acceptance and hesitancy among people living with HIV (PLWHA). A search for observational studies was conducted in five databases and preprinted literature. Summary estimates were pooled using a random effects model and meta-regression. Of 150 identified studies, 31 were eligible (18,550 PLWHA). The weighted prevalence of COVID-19 vaccine hesitancy overall was 29.07% among PLWHA (95%CI = 24.33-34.32; I² = 98%,) and that of vaccine acceptance was 68.66% (95%CI = 62.25-74.43; I² = 98%). Higher hesitancy prevalence was identified in low/lower-middle income countries (35.05; 95% CI = 19.38-54.78). The heterogeneity was explained by the risk of bias, region, and year of data collection. The findings conclude that the COVID-19 vaccine hesitancy rate remains high, especially in low-income countries. Evidence-informed interventions aimed at increasing COVID-19 vaccine acceptance at the national and individual levels ought to be designed to increase COVID-19 vaccine acceptance among PLWHA.

Previous BCG vaccination is associated with less severe clinical progression of COVID-19.

BACKGROUND: BCG vaccination, originally used to prevent tuberculosis, is known to "train" the immune system to improve defence against viral respiratory infections. We investigated whether a previous BCG vaccination is associated with less severe clinical progression of COVID-19 METHODS: A case-control study comparing the proportion with a BCG vaccine scar (indicating previous vaccination) in cases and controls presenting with COVID-19 to health units in Brazil. Cases were subjects with severe COVID-19 (O2 saturation < 90%, severe respiratory effort, severe pneumonia, severe acute respiratory syndrome, sepsis, and septic shock). Controls had COVID-19 not meeting the definition of "severe" above. Unconditional regression was used to estimate vaccine protection against clinical progression to severe disease, with strict control for age, comorbidity, sex, educational level, race/colour, and municipality. Internal matching and conditional regression were used for sensitivity analysis. RESULTS: BCG was associated with high protection against COVID-19 clinical progression, over 87% (95% CI 74-93%) in subjects aged 60 or less and 35% (95% CI - 44-71%) in older subjects. CONCLUSIONS: This protection may be relevant for public health in settings where COVID-19 vaccine coverage is still low and may have implications for research to identify vaccine candidates for COVID-19 that are broadly protective against mortality from future variants. Further research into the immunomodulatory effects of BCG may inform COVID-19 therapeutic research.

The need for fast-track, high-quality and low-cost studies about the role of the BCG vaccine in the fight against COVID-19.

Bacillus Calmette-Guérin (BCG) vaccination is routine and near-universal in many low- and middle-income countries (LMIC). It has been suggested that BCG can have a protective effect on COVID-19 morbidity and mortality. This commentary discusses the limitations of the evidence around BCG and COVID-19. We argue that higher-quality evidence is necessary to understand the protective effect of the BCG vaccine from existing, secondary data, while we await results from clinical trials currently conducted in different settings.

Cross-sectional study of the anthropometric characteristics of children with congenital Zika syndrome up to 12 months of life.

BACKGROUND: Little is known about physical development of children with Congenital Zika Syndrome (CZS). This study aims to evaluate the anthropometric characteristics of children with CZS up to 12 months. METHODS: This is a cross-sectional study developed with 46 children with CZS living in Bahia. We used the Public Health Events Register, Live Births Information System and Childcare Records of Primary Health Care Services. Descriptive analysis was performed by distributing absolute and relative frequencies and median and interquartile range. The Weight/Age (W/A), Length/Age (L/A), Weight/Length (W/L) and Head Circumference/Age (HC/A) indexes were calculated for each month and expressed in z-score values, and the results were evaluated individually and by group average. Values between ≥ - 2 and ≤ 2 standard deviations were used as reference. T-Student and Spearman's Correlation Tests were applied to verify the existence of any relationship between maternal and children's variables with the anthropometric indexes weight/age and height/age at birth and at 3, 6 and 12 months of age. RESULTS: The studied children had high proportions of low birth weight (23.9%), dysphagia (56.8%) and seizures (53.5%). The mean z-score for the HC/A index at birth was - 3.20 and remained below - 3 z-scores throughout the assessed period. The analysis of the indices equivalent to every single child's anthropometric measurement showed a deficit in 20.4% of the W/A, 39.1% of the L/A, 9.2% of the W/L and 85.7% of the HC/A measurements. Distribution of the mean values of these anthropometric indices revealed a risk of delayed stature growth (L/A < -1 z-score). There was a statistically significant association between L/A at 12 months and dysphagia (p = 0.0148) and a positive correlation between breastfeeding time and W/A. No statistically significant correlation was found between any other tested variables. CONCLUSIONS: We observed a deficit in the HC/A index, which is a common feature in CZS, but also a high proportion of W/A and L/A deficit. The average group z-score highlighted the risk of delay in stature growth for age, which calls attention to the need for health interventions, as this condition exposes them to a higher risk of morbidity and mortality.

Seroprevalence of Chikungunya Virus after Its Emergence in Brazil.

Chikungunya has had a substantial impact on public health because of the magnitude of its epidemics and its highly debilitating symptoms. We estimated the seroprevalence, proportion of symptomatic cases, and proportion of chronic form of disease after introduction of chikungunya virus (CHIKV) in 2 cities in Brazil. We conducted the population-based study through household interviews and serologic surveys during October-December 2015. In Feira de Santana, we conducted a serologic survey of 385 persons; 57.1% were CHIKV-positive. Among them, 32.7% reported symptoms, and 68.1% contracted chronic chikungunya disease. A similar survey in Riachão do Jacuípe included 446 persons; 45.7% were CHIKV-positive, 41.2% reported symptoms, and 75.0% contracted the chronic form. Our data confirm intense CHIKV transmission during the continuing epidemic. Chronic pain developed in a high proportion of patients. We recommend training health professionals in management of chronic pain, which will improve the quality of life of chikungunya-affected persons.

History, Epidemiology, and Clinical Manifestations of Zika: A Systematic Review.

OBJECTIVES: To describe salient epidemiological characteristics of Zika virus outbreaks across the world and to examine the clinical presentations, complications, and atypical manifestations related to their occurrence in recent history. METHODS: We conducted a systematic review of the literature by searching through MEDLINE, Embase, and Global Health Library, as well as the epidemiological bulletins and alerts from the World Health Organization, the Pan American Health Organization, and the European Centre for Disease Prevention and Control over the period 1954 to 2016. RESULTS: The search yielded 547 records. We retained 333 for further analysis, to which we added 11 epidemiological bulletins from various sources. Of these, we systematically reviewed 52 articles and reports, revealing some epidemiological features and patterns of spread of the Zika virus worldwide, as well as pathological outcomes suspected to be linked to Zika outbreaks. Neurologic disorders among zika patients were similar in Brazil and French Polynesia but a causal link is not established. Incidence of zika infection in pregnant women is not known. In Brazil, during the zika outbreak the incidence of microcephaly increased more than 20 times. Among 35 infants with microcephaly, born from women suspected to have Zika infection during pregnancy in northeast Brazil, 74% of the mothers reported rash during the first and second trimester. CONCLUSIONS: On February 1, 2016, The World Health Organization declared the ongoing Zika crisis an emergency and that, although not yet scientifically proven, the link between the virus and growing numbers of microcephaly cases was "strongly suspected." However, the causal relationship between zika and microcephaly is not universally accepted. Public Health Implications. The current situation with regard to Zika is not encouraging, because there is no vaccine, no treatment, and no good serological test, and vector control remains a challenge.

The spatiotemporal trajectory of a dengue epidemic in a medium-sized city.

Understanding the transmission dynamics of infectious diseases is important to allow for improvements of control measures. To investigate the spatiotemporal pattern of an epidemic dengue occurred at a medium-sized city in the Northeast Region of Brazil in 2009, we conducted an ecological study of the notified dengue cases georeferenced according to epidemiological week (EW) and home address. Kernel density estimation and space-time interaction were analysed using the Knox method. The evolution of the epidemic was analysed using an animated projection technique. The dengue incidence was 6.918.7/100,000 inhabitants; the peak of the epidemic occurred from 8 February-1 March, EWs 6-9 (828.7/100,000 inhabitants). There were cases throughout the city and was identified space-time interaction. Three epicenters were responsible for spreading the disease in an expansion and relocation diffusion pattern. If the health services could detect in real time the epicenters and apply nimbly control measures, may possibly reduce the magnitude of dengue epidemics.

Chikungunya seroprevalence in population-based studies: a systematic review and meta-analysis.

BACKGROUND: Seroprevalence studies about chikungunya infection are usually conducted after epidemics to estimate the magnitude of the attack. This study aimed to estimate the seroprevalence of CHIKV by WHO region, considering the periods of introduction of the virus in these regions and its potential to lead to epidemics. METHODS: We systematically reviewed Medline/Pubmed, Embase, Lilacs, Scopus and Web of Science for original articles published up to 2020. Cohort, case-control and cross-sectional studies were eligible for inclusion, based on the results of laboratory diagnosis of previous or previous and recent infection. Those conducted with symptomatic individuals were excluded. RESULTS: 596 articles were identified, 197 full-text were reviewed and 64 were included, resulting in 71 seroprevalences. Most were cross-sectional studies (92%), between 2001 and 2020 (92%), with population of all ages (55%), conducted in Kenya (10.9%), Brazil (9.4%) and French Polynesia (7.8%). The pooled estimates were 24% (95%CI 19-29; I2 = 99.7%; p < 0.00), being 21% (95%CI 13-30; I2 = 99.5%; p < 0.00) for adults, 7% (95%CI 0-23; I2 = 99.7%; p < 0.00) for children and 30% (95%CI 23-38; I2 = 99.7%; p < 0.00) for all ages. The higher seroprevalences were found in African, the Americas and South-East Asian Regions. CONCLUSIONS: The great heterogeneity of seroprevalences points to the persistence of viral circulation. Even where the seroprevalence is high, the population replacement and the absence of vaccines mean that the risk of virus spread and epidemics remains. REGISTRATION: PROSPERO CRD42020166227.

Evolution of the Bacillus Calmette-Guérin scar Russia and Moreau strains in newborns: A brazilian cohort.

Background: In Brazil, in 1925, the Moreau strain was introduced, and since its implementation, it has been the routine vaccine for health services. Since 2013, many countries, including Brazil, have been experiencing problems with the production of vaccines. As of January 2018, the country started to use the BCG vaccine with Russia strain, developed by the Serum Institute India. Objective: To describe the evolution of the vaccine scar in neonates vaccinated by BCG-Russia compared to BCG-Moreau. Methods: This was a cohort study was conducted in Salvador city, northeast Brazil. The study population consisted of newborns from the reference maternity hospital, who were vaccinated with BCG-ID strains Moreau or Russia, followed up to assess vaccine lesion evolution. Results: It was observed that regardless of the vaccine strains, the evolution of the lesion was the same: wheal, reddish macula, induration, pustule, ulcer, and scar. The proportion of vaccine scar in the group vaccinated with BCG Russia was lower than that of BCG Moreau, 62.5 % and 90.9 %, respectively, with a statistically significant difference. Conclusion: The evolution of the scar by BCG-Russia was similar to the Moreau scar, however different proportions were observed in different stages of lesion between the groups.

Risk factors for the incidence of dengue virus infection in preschool children.

OBJECTIVE: To estimate the seroincidence of dengue in children living in Salvador, Bahia, Brazil and to evaluate the factors associated. METHODS: A prospective serological survey was carried out in a sample of children 0-3 years of age. A multilevel logistic model was used to identify the determinants of seroincidence. RESULTS: The seroprevalence of dengue was 26.6% in the 625 children evaluated. A second survey detected an incidence of 33.2%. Multilevel logistic regression showed a statistically significant association between the seroincidence of dengue and age and the premises index. CONCLUSION: In Salvador, the dengue virus is in active circulation during early childhood; consequently, children have heterotypic antibodies and run a high risk of developing dengue haemorrhagic fever, because the sequence and intensity of the three dengue virus serotypes currently circulating in this city are very similar to those that were circulating in Rio de Janeiro, Brazil, in 2008. Therefore, the authors strongly recommend that the health authorities in cities with a similar epidemiological scenario be aware of this risk and implement improvements in health care, particularly targeting the paediatric age groups. In addition, information should be provided to the population and actions should be implemented to combat this vector.

Seroprevalence of Chikungunya virus and living conditions in Feira de Santana, Bahia-Brazil.

BACKGROUND: Chikungunya is an arbovirus, transmitted by Aedes mosquitoes, which emerged in the Americas in 2013 and spread rapidly to almost every country on this continent. In Brazil, where the first cases were detected in 2014, it currently has reached all regions of this country and more than 900,000 cases were reported. The clinical spectrum of chikungunya ranges from an acute self-limiting form to disabling chronic forms. The purpose of this study was to estimate the seroprevalence of chikungunya infection in a large Brazilian city and investigate the association between viral circulation and living condition. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a population-based ecological study in selected Sentinel Areas (SA) through household interviews and a serologic survey in 2016/2017. The sample was of 1,981 individuals randomly selected. The CHIKV seroprevalence was 22.1% (17.1 IgG, 2.3 IgM, and 1.4 IgG and IgM) and varied between SA from 2.0% to 70.5%. The seroprevalence was significantly lower in SA with high living conditions compared to SA with low living condition. There was a positive association between CHIKV seroprevalence and population density (r = 0.2389; p = 0.02033). CONCLUSIONS/SIGNIFICANCE: The seroprevalence in this city was 2.6 times lower than the 57% observed in a study conducted in the epicentre of the CHIKV epidemic of this same urban centre. So, the herd immunity in this general population, after four years of circulation of this agent is relatively low. It indicates that CHIKV transmission may persist in that city, either in endemic form or in the form of a new epidemic, because the vector infestation is persistent. Besides, the significantly lower seroprevalences in SA of higher Living Condition suggest that beyond the surveillance of the disease, vector control and specific actions of basic sanitation, the reduction of the incidence of this infection also depends on the improvement of the general living conditions of the population.

Repercussions of Zika virus emergency on the health of the population of Tocantins state, Brazil, 2015 and 2016: a descriptive study. / Repercussões da emergência do vírus Zika na saúde da população do estado do Tocantins, 2015 e 2016: estudo descritivo.

Objective To describe the occurrence of Zika virus disease and its complications in the state of Tocantins and in its capital, the city of Palmas. Methods This was a descriptive study using data from health information systems. Results Incidence of reported Zika virus disease cases in 2015 and 2016 was 295.2/100,000 inhabitants and 411.1/100,000 inhab. in the general population, and 5.9/1,000 and 27.8/1,000 live births, respectively. Higher risks occurred in women, the 20-39 year age group, municipalities in the central and northwestern regions of the state and in hotter months (February and March). Incidence of Zika-related microcephaly during pregnancy was 0.06/1,000 live births. One case of Guillain-Barré Syndrome resulting from Zika virus infection was confirmed. Conclusion Zika virus disease hit Tocantins intensely, although its adverse outcomes were less frequent than in other states.

Congenital syphilis distribution in the State of Tocantins, Brazil, 2007-2015. / Distribuição da sífilis congênita no estado do Tocantins, 2007-2015.

OBJECTIVE: to describe the epidemiological profile of congenital syphilis (CS) in Tocantins, from 2007 to 2015. METHODS: this was a cross-sectional descriptive study conducted with data from the Notifiable Health Conditions Information System (SINAN) and the Live Birth Information System (SINASC). RESULTS: 1,029 CS cases were reported; mean CS incidence was 4.6/1,000 Live Births (LB), increasing from 3.1/1,000 LB in 2007 to 9.8/1,000 LB in 2015 (increase of 216.1%); municipalities located in the central and northern regions of the state had the highest rates; the majority of mothers of newborn babies were 15-24 years old, had elementary school education, started prenatal care in the third trimester of pregnancy, and received inadequate prenatal care. CONCLUSION: high occurrence of congenital syphilis in Tocantins requires immediate intensification of CS surveillance and improved prenatal care quality, especially in municipalities with higher incidence.

Case Fatality Rate Related to Microcephaly Congenital Zika Syndrome and Associated Factors: A Nationwide Retrospective Study in Brazil †.

BACKGROUND: The clinical manifestations of microcephaly/congenital Zika syndrome (microcephaly/CZS) have harmful consequences on the child's health, increasing vulnerability to childhood morbidity and mortality. This study analyzes the case fatality rate and child-maternal characteristics of cases and deaths related to microcephaly/CZS in Brazil, 2015-2017. METHODS: Population-based study developed by linkage of three information systems. We estimate frequencies of cases, deaths, case fatality rate related to microcephaly/CZS according to child and maternal characteristics and causes of death. Multivariate logistic regression models were applied. RESULTS: The microcephaly/CZS case fatality rate was 10% (95% CI 9.2-10.7). Death related to microcephaly/CZS was associated to moderate (OR = 2.15; 95% CI 1.63-2.83), and very low birth weight (OR = 3.77; 95% CI 2.20-6.46); late preterm births (OR = 1.65; 95% CI 1.21-2.23), Apgar < 7 at 1st (OR = 5.98; 95% CI 4.46-8.02) and 5th minutes (OR = 4.13; 95% CI 2.78-6.13), among others. CONCLUSIONS: A high microcephaly/CZS case fatality rate and important factors associated with deaths related to this syndrome were observed. These results can alert health teams to these problems and increase awareness about the factors that may be associated with worse outcomes.

Congenital Zika Syndrome: Prevalence of low birth weight and associated factors. Bahia, 2015-2017.

OBJECTIVE: The clinical manifestations of Congenital Zika Syndrome (CZS) are not fully known, for example its effect on birth weight. This study estimated the prevalence of low birth weight (LBW) among children with CZS, and identified associated factors. METHODS: Cross-sectional study involving 393 children with CZS living in Bahia, Brazil, in 2015-2017. Official Information Systems were the data sources. We calculated LBW prevalence and applied Logistic Regression to assess associated factors. RESULTS: Prevalence of LBW among children with CZS was 37.2%. Excluding pre-term births the proportion was 29.9%. This prevalence was 81.0% and 28.0% among children born pre-term and term/post term, respectively. There was a higher proportion (53.2%) in female children, and in those delivered by cesarean section (51.4%). Most mothers were single/separated (62.1%) and had a low level of schooling (70.0%). In the model adjusted for type of delivery, preterm births presented a 10.8 times greater chance of presenting LBW than term/post-term ones. However, the Confidence Interval was very wide. Adjusting for gestation duration, children born by cesarean section had a 1.63 higher probability of presenting LBW than those born by vaginal delivery (OR=1,63; CI95% 1.01, 2.63). CONCLUSIONS: The prevalence of LBW among children with CZS was very elevated, both preterm and term/post-term live births. This can contribute to increasing their risk for morbimortality. The association of LBW with prematurity and cesarean deliveries is known, but in children with CZS, it has not been clarified whether or not this is related to pathological conditions caused by fetal infection by the Zika virus.

Spread pattern of the first dengue epidemic in the city of Salvador, Brazil.

BACKGROUND: The explosive epidemics of dengue that have been occurring in various countries have stimulated investigation into new approaches to improve understanding of the problem and to develop new strategies for controlling the disease. The objective of this study was to evaluate the characteristics of diffusion of the first dengue epidemic that occurred in the city of Salvador in 1995. METHODS: The epidemiological charts and records of notified cases of dengue in Salvador in 1995 constituted the source of data. The cases of the disease were georeferenced according to census areas (spatial units) and epidemiological weeks (temporal unit). Kernel density estimation was used to identify the pattern of spatial diffusion using the R-Project computer software program. RESULTS: Of the 2,006 census areas in the city, 1,400 (70%) registered cases of dengue in 1995 and the spatial distribution of these records revealed that by the end of 1995 practically the entire city had been affected by the virus, with the largest concentration of cases occurring in the western region, composed of census areas with a high population density and predominantly horizontal residences compared to the eastern region of the city, where there is a predominance of vertical residential buildings. CONCLUSION: The pattern found in this study shows the characteristics of the classic process of spreading by contagion that is common to most infectious diseases. It was possible to identify the epicenter of the epidemic from which centrifugal waves of the disease emanated. Our results suggest that, if a more agile control instrument existed that would be capable of rapidly reducing the vector population within a few days or of raising the group immunity of the population by means of a vaccine, it would theoretically be possible to adopt control actions around the epicenter of the epidemic and consequently reduce the incidence of the disease in the city. This finding emphasizes the need for further research to improve the technology available for the prevention of this disease.

Trend in mortality due to ill-defined causes in the state of Tocantins and in its capital Palmas, Brazil, 1998-2014. / Tendência da mortalidade por causas mal definidas no estado do Tocantins e na sua capital Palmas, 1998-2014.

OBJECTIVE: to evaluate the time trend of proportional mortality due to ill-defined causes, in Tocantins and Palmas, Brazil, 1998-2014. METHODS: this was a time trend study using data from the Mortality Information System (SIM) and the Death Verification Service (SVO); we evaluated the time trend of this type of this mortality using Joinpoint Regression. RESULTS: between 1998 and 2014, proportional mortality from ill-defined causes fell 88.5% in Tocantins and 88.1% in Palmas; the trend test indicated statistically significant inflection points in 1998-2004 (-4.14; p=0.001) for Tocantins and in 1998-2000 (-7.92; p<0.005) for Palmas; a certain degree of stability was observed with effect from 2004. CONCLUSION: there was a significant decline in proportional mortality due to ill-defined causes in Tocantins; however, it is still necessary to intensify actions aimed at improving the quality of information on mortality in some municipalities.

The achievements of the SUS in tackling the communicable diseases. / Conquistas do SUS no enfrentamento das doenças transmissíveis.

This article presents the development of the epidemiological situation of some of the major communicable diseases (CD) in Brazil, with emphasis on the interventions by the SUS and other social policies. The data and information were collected from Datasus, epidemiological newsletters from the Brazilian Ministry of Health, and scientific articles on the issue. The universalization, decentralization and expansion of the surveillance, control and prevention of CD has produced an impact on the morbidity and mortality of these diseases, mainly those which are vaccine-preventable. The emergence and re-emergence of three arboviruses, for which there are no effective control instruments, interrupted the downward trend in the morbidity profile of CD in Brazil. Other social and economic programs, which are geared to the needier sectors of the Brazilian population, have also contributed to the improvement of the analyzed health indicators. However, the universalization of access to healthcare services, as well as improvements in the scope of the surveillance of diseases and health risks, has played a key role in improving the health and quality of life of the population, as well as contributing to the process of the democratization of Brazil.

Apresenta-se a evolução da situação epidemiológica de algumas das principais Doenças transmissíveis (DT) no Brasil, assinalando as intervenções proporcionadas pelo SUS e outras políticas sociais. Dados e informações foram levantados do Datasus e Boletins epidemiológicos do Ministério da Saúde e de artigos científicos sobre o tema. A universalização, a descentralização e a ampliação das ações de vigilância, controle e prevenção de DT produziram impacto sobre a morbimortalidade dessas doenças, principalmente das imunopreveníveis. A emergência e reemergência de três arboviroses, para as quais não se dispõe de instrumentos de controle efetivos, interromperam a evolução decrescente no perfil de morbidade das DT no Brasil. Outros programas sociais e econômicos, voltados para a população brasileira mais carente, também contribuíram para a melhoria dos indicadores de saúde analisados. Contudo, a universalização do acesso aos serviços de atenção à saúde, ao lado do aperfeiçoamento do escopo de atuação da vigilância sobre doenças e riscos à saúde, vem desempenhando papel fundamental na melhoria das condições de saúde e qualidade de vida da população, bem como contribuindo para o processo de democratização do país.

Chikungunya chronic disease: a systematic review and meta-analysis.

Background: Chikungunya is a mosquito-borne disease caused by an arthritogenic alphavirus, with four genotypes: East Central South African (ECSA), West African, ECSA-diverged or Indian Ocean Lineage (IOL) and Asian lineage. Overall, the disease is self-limited; however, in some patients, joint pain and other non-specific symptoms can last for months or years. This systematic review and meta-analysis aims to estimate the proportion of people that self-report chikungunya-related chronic non-specific symptoms. Methods: Medline, EMBASE, Global Health Library and Scopus were searched for articles published before March 2017. Case-control, cohort, cross-sectional, clinical trials studies and outcome-independent case series were eligible. It was estimated that the proportion of patients who did not recover, by virus genotype, and by the time between disease onset and assessment of chronic symptoms. Results: A total of 38 studies were included in the review and 34 in the meta-analysis. Of 6532 chikungunya patients, 3157 did not recover fully after 3 months. The overall no recovery rate associated with chikungunya was 43% (95% CI, 35-52%); Inter-genotype group heterogeneity was observed, the highest prevalence in the ECSA-diverged genotype: 50% (95% CI; 40-60%), followed by the Asian lineage genotype: 36% (95% CI; 20-52%). After 12 months follow-up, the overall no-recovery rate was 21% (95% CI; 19-22%). Conclusion: The evidence suggests that the prevalence of chronic discomfort associated with chikungunya illness varies by virus lineage. The proportion of people that do not fully recovered after chikungunya was high and, therefore, health authorities must prepare to treat patients with symptoms of long-lasting chikungunya adequately addressing the physical, psychological and social needs.

Relevance of transportation to correlations among criticality, physical means of propagation, and distribution of dengue fever cases in the state of Bahia.

Dengue infection is a public health problem with a complex distribution. The physical means of propagation and the dynamics of diffusion of the disease between municipalities need to be analysed to direct efficient public policies to prevent dengue infection. The present study presents correlations of occurrences of reported cases of dengue infection among municipalities, self-organized criticality (SOC), and transportation between areas, identifying the municipalities that play an important role in the diffusion of dengue across the state of Bahia, Brazil. The significant correlation found between the correlation network and the SOC demonstrates that the pattern of intramunicipal diffusion of dengue is coupled to the pattern of synchronisation between the municipalities. Transportation emerges as influential in the dynamics of diffusion of epidemics by acting on the aforementioned variables.