Dengue 4 in Ceará, Brazil: characterisation of epidemiological and laboratorial aspects and causes of death during the first epidemic in the state.

BACKGROUND The first dengue cases in Brazil with laboratory confirmation occurred in the northern region of the country, with the isolation of two serotypes, dengue virus 1 (DENV-1) and DENV-4. In Ceará, the introduction of DENV-4 was reported during a DENV-1 epidemic in 2011, with only two isolations. OBJECTIVES The aim of this study was to characterise the first DENV-4 epidemic in the state of Ceará, Brazil. METHODS The study population was composed of patients with suspected dengue that were reported to health care units from January to December 2012. The laboratory confirmation of infection was made by viral isolation, reverse transcription polymerase chain reaction (RT-PCR), AgNS1, immunohistochemistry and IgM enzyme-linked immunosorbent assay (ELISA). MAIN CONCLUSIONS In the study year, 72,211 suspected dengue cases were reported and 51,865 of these cases (71.8%) were confirmed to be positive. Co-circulation of three serotypes, DENV-1, DENV-3 and DENV-4, was detected with a predominance of DENV-4 (95.3%). Most cases were not severe, but there were 44 fatal outcomes. DENV-4 Genotype II was identified for the first time in Ceará.

Coinfection with influenza A(H1N1)pdm09 and dengue virus in fatal cases.

We report on four patients with fatal influenza A(H1N1)pdm09 and dengue virus coinfections. Clinical, necropsy and histopathologic findings presented in all cases were characteristic of influenza-dengue coinfections, and all were laboratory-confirmed for both infections. The possibility of influenza and dengue coinfection should be considered in locations where these two viruses' epidemic periods coincide to avoid fatal outcomes. Dengue is a mosquito-borne viral infection caused by one of the four dengue viruses (DENV-1 to 4). Each of these viruses is capable of causing nonspecific febrile illnesses, classic dengue fever and dengue haemorrhagic fever (Gubler 1998). As a result, dengue is often difficult to diagnose clinically, especially because peak dengue season often coincides with that of other common febrile illnesses in tropical regions (Chacon et al. 2015). In April 2009, a new virus, influenza A/H1N1/pandemic (FluA/H1N1/09pdm), caused a severe outbreak in Mexico. The virus quickly spread throughout the world, and in June 2009, the World Health Organization declared a pandemic (WHO 2010). In Brazil, the first laboratory confirmed case of FluA/H1N1/09pdm was in July 2009 (Pires Neto et al. 2013). The state of Ceará, in Northeast Brazil, is a dengue endemic area. In this state, the virus influenza A(H1N1)pdm09 has circulated since 2009, and through the first half of 2012, 11 deaths caused by the virus were confirmed (Pires Neto et al. 2013). The influenza and dengue seasons in Ceará overlap, which led to diagnostic difficulties. We report four cases of laboratory-confirmed coinfection of deadly influenza A(H1N1)pdm09 with DENV, which occurred during the dengue and influenza season in 2012 and 2013 in Ceará.

Seroprevalence and factors associated with SARS-CoV-2 infection among education workers after the first wave: the first cross-sectional study in Brazil.

BACKGROUND: The school community was heavily impacted by the Covid-19 pandemic, especially with the long time of school closures. This study aimed to analyze the seroprevalence of SARS-CoV-2 antibodies and possible factors associated with seropositivity for COVID-19 in teachers and other school staff, and to estimate the fraction of asymptomatic individuals by sex and age group. METHODS: We conducted a serological survey of SARS-CoV-2 infections. An analytical cross-sectional study was conducted in Fortaleza, Brazil. Teachers and other staff members from pre-schools to universities of higher education to were investigated. RESULTS: A total of 1,901 professionals participated in the study, of which 1,021 were staff and 880 were teachers. The seroprevalence of SARS-CoV-2 was 8.0% (152/1901). In the seropositive group, 48.3% were asymptomatic. There was a predominance of women (68.4%); and, 47.1% of the participants were between 31 and 45 years old. There was an increase in prevalence with increasing age. An inverse relationship was found for education level: more professionals with less education tested positive for COVID-19. The presence of an infected person living in the same household was significantly associated with positive results for COVID-19 among the professionals. CONCLUSIONS: This is the first study to report the seroprevalence of IgG against SARS-CoV-2 in Brazilian educational staff after the first wave of the disease. In this study, the seroprevalence was much lower than that in the general population. During school reopening, a small fraction of school workers showed serologically detectable signs of SARS-CoV-2 exposure.

Seroprevalence and factors associated with SARS-CoV-2 infection among education workers after the first wave: the first cross-sectional study in Brazil

ABSTRACT Background: The school community was heavily impacted by the Covid-19 pandemic, especially with the long time of school closures. This study aimed to analyze the seroprevalence of SARS-CoV-2 antibodies and possible factors associated with seropositivity for COVID-19 in teachers and other school staff, and to estimate the fraction of asymptomatic individuals by sex and age group. Methods: We conducted a serological survey of SARS-CoV-2 infections. An analytical cross-sectional study was conducted in Fortaleza, Brazil. Teachers and other staff members from pre-schools to universities of higher education to were investigated. Results: A total of 1,901 professionals participated in the study, of which 1,021 were staff and 880 were teachers. The seroprevalence of SARS-CoV-2 was 8.0% (152/1901). In the seropositive group, 48.3% were asymptomatic. There was a predominance of women (68.4%); and, 47.1% of the participants were between 31 and 45 years old. There was an increase in prevalence with increasing age. An inverse relationship was found for education level: more professionals with less education tested positive for COVID-19. The presence of an infected person living in the same household was significantly associated with positive results for COVID-19 among the professionals. Conclusions: This is the first study to report the seroprevalence of IgG against SARS-CoV-2 in Brazilian educational staff after the first wave of the disease. In this study, the seroprevalence was much lower than that in the general population. During school reopening, a small fraction of school workers showed serologically detectable signs of SARS-CoV-2 exposure.

OSCE 3D: a virtual clinical skills assessment tool for coronavirus pandemic times / OSCE 3D: uma ferramenta virtual de avaliação de habilidades clínicas para tempos de pandemia de coronavírus

Abstract: Introduction: In pandemic times, in which the "lockdown strategy" has been adopted, the use of innovations using technological resources such as the creation of instruments that can replace traditional teaching-learning methods in the training of health professionals is essential. Objective: the aim of this study was to develop and evaluate the usability of a realistic interactive simulation computer system using three-dimensional imaging technology and virtual reality with free-access computational tools available on the web. Methods: the development of a prototype (OSCE 3D) was based on the steps used for the construction of a "Serious Game" simulation software. The free-access version of the Unity Editor 3D platform (Unity Technologies, version 2018), used for developing educational games, the software GNU Image Manipulation Program (GIMP, version 2.10.12), Blender (version 2.79) and MakeHuman (version 1.1.1) were utilized for creating textures and building models of the 3D environments. An experimental phase was carried out to assess usability, through a questionnaire based on the System Usability Scale. The study was approved by the Research Ethics Committee of the institution and all participants signed the Informed Consent Form. Results: a total of 39 undergraduate medical students attending the 6th semester of a private university center of northeastern Brazil voluntarily participated in the evaluation of the OSCE 3D. The usability evaluation resulted in a mean score of 75.4 with a margin of error of 3.2, which is considered a good usability score according to the literature. Conclusions: this study allowed the development of a low-cost prototype, using a three-dimension realistic simulation system for clinical skills assessment. This product, even in the prototype phase, showed good usability.

Resumo: Introdução: Em tempos de pandemia em que a "estratégia de bloqueio" tem sido adotada, é imprescindível a utilização de inovações utilizando recursos tecnológicos como a criação de instrumentos que possam substituir os métodos tradicionais de ensino-aprendizagem na formação dos profissionais de saúde. Objetivo: o objetivo deste estudo foi desenvolver e avaliar a usabilidade de um sistema computacional de simulação interativa realista utilizando tecnologia de imagem tridimensional e realidade virtual com ferramentas computacionais de acesso livre disponíveis na web. Métodos: o desenvolvimento de um protótipo (OSCE 3D) baseou-se nas etapas utilizadas para a construção de um software de simulação de um "Serious Game". Foi utilizada a versão de acesso livre da plataforma Unity Editor 3D (Unity Technologies, versão 2018) para o desenvolvimento de jogos educacionais, software GNU Image Manipulation Program (GIMP, versão 2.10.12), Blender (versão 2.79) e MakeHuman (versão 1.1 .1) para criar texturas e modelos de construção de ambientes 3D. Uma fase experimental para avaliação da usabilidade foi realizada por meio de um questionário baseado na Escala de Usabilidade de Sistema. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da instituição e todos os participantes assinaram o Termo de Consentimento Livre e Esclarecido. Resultados: um total de 39 alunos de graduação do 6º semestre de uma universidade privada do Nordeste do Brasil participaram voluntariamente da avaliação do OSCE 3D. A avaliação de usabilidade resultou em pontuação média de 75,4 com margem de erro de 3,2, sendo esta considerada uma boa usabilidade de acordo com a literatura. Conclusões: este trabalho permitiu o desenvolvimento de um protótipo de baixo custo, utilizando um sistema de simulação realista tridimensional para avaliação de habilidades clínicas. Este produto, ainda em fase de protótipo, apresentou boa usabilidade.

Dengue 4 in Ceará, Brazil: characterisation of epidemiological and laboratorial aspects and causes of death during the first epidemic in the state

BACKGROUND The first dengue cases in Brazil with laboratory confirmation occurred in the northern region of the country, with the isolation of two serotypes, dengue virus 1 (DENV-1) and DENV-4. In Ceará, the introduction of DENV-4 was reported during a DENV-1 epidemic in 2011, with only two isolations. OBJECTIVES The aim of this study was to characterise the first DENV-4 epidemic in the state of Ceará, Brazil. METHODS The study population was composed of patients with suspected dengue that were reported to health care units from January to December 2012. The laboratory confirmation of infection was made by viral isolation, reverse transcription polymerase chain reaction (RT-PCR), AgNS1, immunohistochemistry and IgM enzyme-linked immunosorbent assay (ELISA). MAIN CONCLUSIONS In the study year, 72,211 suspected dengue cases were reported and 51,865 of these cases (71.8%) were confirmed to be positive. Co-circulation of three serotypes, DENV-1, DENV-3 and DENV-4, was detected with a predominance of DENV-4 (95.3%). Most cases were not severe, but there were 44 fatal outcomes. DENV-4 Genotype II was identified for the first time in Ceará.