André Reynaldo Santos Périssé

Characteristics of children hospitalized with dengue fever in an outbreak in Rio de Janeiro, Brazil

During a dengue epidemic in Rio de Janeiro in 2007-2008 the Instituto de Puericultura e Pediatria Martagão Gesteira Hospital was a reference for admitted children. The World Health Organization (WHO) considered several manifestations as warning signs of severe dengue This is a retrospective cohort study of all children admitted with dengue fever. Clinical variables considered warning signs by WHO were evaluated in the multivariate analysis, to investigate if they were independently associated with severe dengue. One hundred and eighty one children were admitted, aged from 4 months to 15 years; 30 were classified as severe dengue. Abdominal pain (OR=2.63, 95% CI 1.06-6.53) and lethargy (OR=3.40, 95% CI 1.45-7.99) were independently associated with severe dengue.

Acceptability of self-conducted home-based HIV testing among men who have sex with men in Brazil: data from an on-line survey

The Brazilian HIV/AIDS epidemic is concentrated among men who have sex with men (MSM), however HIV testing rates among MSM are not commensurate with their risk. Strategies to expand early diagnosis may include use of self-conducted home-based testing kits, which are now available for purchase in the US. In April 2011 we conducted a survey with Brazilian MSM using Facebook to assess HIV testing preferences and acceptability of home-based testing. Among 356 previously tested, HIV-negative MSM, 47% reported a preference for home-based testing, 27% preferred clinic-based testing, and 26% had no preference. Less frequent testers and those who had considered testing but failed to test were more likely to prefer home-based testing. Close to 90% reported that they would use self-test kits; 62% and 54% said they would use home-based testing to make choices about unprotected sex with regular and new partners, respectively. Concerns included difficulty to understand the tests (32%) and receiving results alone (23%). Overall, home-based testing may appeal to MSM and result in increased testing frequency. Research on feasibility and utilization of self-tests in practice is needed.

Incidência de episódios hipotônicos-hiporresponsivos associados à vacina combinada DTP/Hib usada no Programa Nacional de Imunizações

OBJECTIVE:To evaluate the safety of a combined diphtheria-tetanus-whole cell pertussis-Haemophilus influenzae type b vaccine used on the Brazilian National Immunizations Program, chiefly the incidence of hypotonic-hyporesponsive episodes. METHOD: Follow-up of a cohort of 21,064 infants (20,925 or 99.7% adhered to the study protocol), within 48 hours of vaccination with diphtheria-tetanus-whole cell pertussis-Haemophilus influenzae type b vaccine in health care units in the City of Rio de Janeiro, to ascertain and investigate spontaneous and solicited severe adverse events. Each child was followed-up for one dose only. RESULTS: The rate of hypotonic-hyporesponsive episodes was 1/1,744 doses (confirmed cases) and 1/1,495 doses (confirmed plus suspect cases). The rate of convulsions was 1/5,231 doses. No cases of apnea were detected. These results are comparable to those found in the literature with diphtheria-tetanus-whole cell pertussis vaccine. CONCLUSION: The diphtheria-tetanus-whole cell pertussis-Haemophilus influenzae type b vaccine under study can be safely used in the National Immunizations Program, according to the current precautions and contraindications.

Molecular characterization of uropathogenic and diarrheagenic Escherichia coli pathotypes

In this study diarrheagenic and uropathogenic Escherichia coli (UPEC) strains were comparatively characterized according to serotype, hemolytic activity, protein polymorphism among housekeeping enzymes, phylogenetic group and urovirulence genes. Intra‐serogroup/serotype variations were observed. Hemolytic activity was detected in 100%, 93%, 67% and 39% of UPEC, EAEC, EPEC and ETEC strains, respectively. The alpha‐hemolytic phenotype was observed in all pathogenic groups while beta‐hemolytic phenotype was less frequent. PCR phylotyping revealed higher prevalence of diarrheagenic E. coli in groups A and D while uropathogenic strains were mainly found in subgroup B2. Amplification assays revealed that 74%, 45% and 22% of UPEC, EAEC and EPEC strains, respectively, carried at least one of the urovirulence sequences. The molecular typing system revealed a pathotype‐specific clonal group distribution and showed a closer relationship between the EAEC and UPEC. Additionally, the occurrence of urovirulence traits, especially those related to iron acquisition, was more frequent among EAEC and UPEC than among the other E. coli pathotypes. This observation is of special value considering that the EAEC pathotype constitutes an emerging group of enteropathogens, particularly, in developing countries, and information on their pathogenic and phylogenetic characteristics is still scarce. (© 2010 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)

Incidence of hypotonic-hyporesponsive episodes associated to the combined DTP/Hib vaccine used in Brazilian National Immunizations Program

OBJECTIVE To evaluate the safety of a combined diphtheria-tetanus-whole cell pertussis-Haemophilus influenzae type b vaccine used on the Brazilian National Immunizations Program, chiefly the incidence of hypotonic-hyporesponsive episodes. METHOD Follow-up of a cohort of 21,064 infants (20,925 or 99.7% adhered to the study protocol), within 48 hours of vaccination with diphtheria-tetanus-whole cell pertussis-Haemophilus influenzae type b vaccine in health care units in the City of Rio de Janeiro, to ascertain and investigate spontaneous and solicited severe adverse events. Each child was followed-up for one dose only. RESULTS The rate of hypotonic-hyporesponsive episodes was 1/1,744 doses (confirmed cases) and 1/1,495 doses (confirmed plus suspect cases). The rate of convulsions was 1/5,231 doses. No cases of apnea were detected. These results are comparable to those found in the literature with diphtheria-tetanus-whole cell pertussis vaccine. CONCLUSION The diphtheria-tetanus-whole cell pertussis-Haemophilus influenzae type b vaccine under study can be safely used in the National Immunizations Program, according to the current precautions and contraindications.

CANINE VISCERAL LEISHMANIASIS CASE INVESTIGATION IN THE JACARE REGION OF NITEROI, RIO DE JANEIRO, BRAZIL

SUMMARY American visceral leishmaniasis is a vector-borne zoonosis in expansion in Brazil. Dogs are the main urban reservoir. Departing from a case of canine visceral leishmaniasis (CVL) in Jacaré, Niterói, Rio de Janeiro State, an epidemiological canine and entomological study was performed to assess the extension of the disease at the location. Sample was collected around the case and the dogs identified by serological tests (rapid double platform immunochromatographic exams, immunoenzymatic assay/ELISA, indirect immunofluorescence/IFAT). The parasitological diagnosis was performed in animals positive in at least one of these tests. The entomological study was carried out by using light traps and manual collection. The associations between canine variables and outcome (ELISA and IFAT reagents) were assessed by the chi-square test and adjusted by multivariate logistic regression for those associations with p < 0.1 in the bivariate analysis. Seventeen cases of CVL were detected among 110 evaluated dogs (prevalence of 15.5%). Presence of ectoparasites (OR 6.5; 95% CI 1.1-37.4), animals with clinical signs (OR 9.5; 95% CI 1.2-76.6), and previous cases of CVL in the same house (OR 17.9; 95% CI 2.2-147.1) were associated with the outcome. Lutzomyia longipalpiswas not detected. Our results are indicative of an ongoing transmission in the area.

Outcomes among HIV-1 Infected Individuals First Starting Antiretroviral Therapy with Concurrent Active TB or Other AIDS-Defining Disease

Background Tuberculosis (TB) is common among HIV-infected individuals in many resource-limited countries and has been associated with poor survival. We evaluated morbidity and mortality among individuals first starting antiretroviral therapy (ART) with concurrent active TB or other AIDS-defining disease using data from the “Prospective Evaluation of Antiretrovirals in Resource-Limited Settings” (PEARLS) study. Methods Participants were categorized retrospectively into three groups according to presence of active confirmed or presumptive disease at ART initiation: those with pulmonary and/or extrapulmonary TB (“TB” group), those with other non-TB AIDS-defining disease (“other disease”), or those without concurrent TB or other AIDS-defining disease (“no disease”). Primary outcome was time to the first of virologic failure, HIV disease progression or death. Since the groups differed in characteristics, proportional hazard models were used to compare the hazard of the primary outcome among study groups, adjusting for age, sex, country, screening CD4 count, baseline viral load and ART regimen. Results 31 of 102 participants (30%) in the “TB” group, 11 of 56 (20%) in the “other disease” group, and 287 of 1413 (20%) in the “no disease” group experienced a primary outcome event (p = 0.042). This difference reflected higher mortality in the TB group: 15 (15%), 0 (0%) and 41 (3%) participants died, respectively (p<0.001). The adjusted hazard ratio comparing the “TB” and “no disease” groups was 1.39 (95% confidence interval: 0.93–2.10; p = 0.11) for the primary outcome and 3.41 (1.72–6.75; p<0.001) for death. Conclusions Active TB at ART initiation was associated with increased risk of mortality in HIV-1 infected patients.

Detection of clusters of leprosy cases among Guarani Indians in the Southern region of the State of Rio de Janeiro, Brazil

1. Laboratório de Hanseníase, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ. 2. Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ. 3. Secretaria Especial de Saúde Indígena, Ministério da Saúde, Brasília, DF. 4. Departamento de Ciências Biológicas, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, RJ. Address to: Dr. André Reynaldo Santos Périssé. Depto Ciências Biológicas/ENSP/ FIOCRUZ. R. Leopoldo Bulhões 1480, 21041-210 Manguinhos, Rio de Janeiro, RJ, Brasil. Phone: 55 21 2598-2584 e-mail: aperisse@ensp.fiocruz.br Received in 28/09/2011 Accepted in 16/05/2012 Detection of clusters of leprosy cases among Guarani Indians in the southern region of the state of Rio de Janeiro, Brazil

Challenges and Prospects for Integrating the Assessment of Health Impacts in the Licensing Process of Large Capital Project in Brazil

Brazil was one of the first countries in Latin America to institutionalize a National Environmental Policy in 1981, including the environmental impact assessment (EIA) process of economic activities with anticipated impacts on the environment. Today, EIA practice in Brazil comes with a number of limitations: it is constrained by its environmental advocacy role; application is strongly oriented towards large capital projects; and social responsibility considerations are only partially included. Consequently, EIA studies mainly address issues connected to localised and direct environmental impacts, largely ignoring any socio-economic and health impacts. This perspective paper highlights limitations of current EIA practice in Brazil with a focus on health considerations in impact assessment. While recognizing the positive impact to municipalities where large capital projects are being developed and operated, adverse impacts on health are a reality with measurable evidence in Brazil. Therefore, we argue that specificities on how to systematically assess and monitor potential health impacts cannot remain invisible in the Brazilian legislation, as currently seen in the reformulation of the licensing process in the country. The process of better integrating the assessment of health impacts in the licensing process of large capital project in Brazil must, however, not be based on the imposition of an external model but should be promoted by internal stakeholders from the environmental and health sector, incorporating the experiences gained in various case studies from all over the country.

HIV Vertical transmission in Rio de Janeiro, Brazil – does the distance matter?

ABSTRACT Mother-to-child transmission (MTCT) is the main route of transmission for HIV among under 5 children in Brazil. National data indicate that missed opportunities for HIV prevention of MTCT are still common in antenatal care (ANC). We studied variables related to target process indicators in a cohort of HIV exposed children. We used data from 1996 to 2013 related to HIV exposed uninfected and HIV-infected children attended in an HIV reference hospital in Rio de Janeiro, Brazil. Data were collected from baseline questionnaires applied to all children followed-up in the hospital. Gestational and perinatal history were extracted from the mother’s ANC card. Infants were categorized according to dates of first HIV care at the unit (1996–2000, 2001–2006 and 2007–2013). Distances between recorded addresses and the nearest maternity/hospital were measured by Euclidean distance, the shortest car route calculated in Google Maps and the route of the available bus line. Of the 599 children who fulfilled the inclusion criteria, 178 (29.7%) were HIV-infected. Approximately 70% of infants exposed to the virus from 1996–2000 were infected, dropping to 15.2% from 2001–2006 and rebounding to 30.1% from 2007–2013. Birth cohort was associated with ANC, and mothers from 2007–2013 had a lower chance of attending ANC (OR = 0.16; 95%CI 0.08–0.30). In addition, when the distance home-birthplace was higher than 9.5 km, there was a lower chance that the mother had attended ANC (OR = 0.35; 95%CI 0.18–0.68). Birth cohort was associated to HIV and ANC, and our data showed that a reduction of ANC might be related to rebound in HIV cases. There seems to have an association between larger distances from home to the birthplace and absence of ANC, which suggests that ANC was being performed in the tertiary units instead of in the primary care facilities as recommended.