Ricardo Queiroz Gurgel

Predominance of Rotavirus P(4)G2 in a Vaccinated Population, Brazil

We identified 21 rotaviruses in 129 patients with diarrhea in a Brazilian city with high rotavirus vaccine coverage. All rotaviruses were genotype P[4]G2 with 1 mixed infection with P[NT]G9. Although virus predominance could have occurred randomly, the vaccine may be less protective against P[4]G2. Prospective surveillance is urgently needed.

Human Metapneumovirus and Respiratory Syncytial Virus, Brazil

We describe the epidemiologic and clinical characteristics of 111 children attending clinics and hospitals in Aracaju, northeast Brazil, with acute respiratory infections attributable to human metapneumovirus (HMPV), respiratory syncytial virus (RSV), or both in May and June 2002. Fifty-three (48%) children were infected with RSV alone, 19 (17%) with HMPV alone, and 8 (7%) had RSV/HMPV co-infections.

Anemia and intestinal parasitic infections in primary school students in Aracaju, Sergipe, Brazil.

Anemia is estimated to affect half the school-age children and adolescents in developing countries. The main causes are parasitic infections, malaria, and low iron intake. This study aimed to describe the prevalence of anemia, parasitic infections, and nutritional status of children attending public primary schools in Aracaju, Northeast Brazil. Of 360 students, 26.7% were anemic, and prevalence was higher in children under 8 and over 15 years of age. Overall prevalence of intestinal parasites was 42%, with Ascaris lumbricoides (28.7%), Trichuris trichiura (15.6%), and hookworm (1. 7%) most frequently found. There was an association between parasitic infections and poor sanitary conditions, but there was no association between anemia and presence of intestinal parasites. Height-for-age Z scores were lower than the NCHS standard, and prevalence of stunting was 5.4%. Although intestinal parasites were not associated with anemia, children with parasites had lower nutritional indices (weight- and height-for-age Z scores) than those without parasites.

An evaluation of the RIDASCREEN and IDEIA enzyme immunoassays and the RIDAQUICK immunochromatographic test for the detection of norovirus in faecal specimens.

BACKGROUND The detection of norovirus by ELISA and immunochromatographic methods may facilitate epidemiological studies into the global disease burden associated with norovirus gastroenteritis and provide a quick method of testing for norovirus infection. OBJECTIVES To evaluate the new RIDASCREEN norovirus ELISA (3rd generation) and RIDAQUICK norovirus immunochromatographic test on a collection of samples from Brazilian children with acute gastroenteritis, and compare them against the established 2nd generation IDEIA norovirus assay. STUDY DESIGN Reverse transcriptase PCR, the study reference standard, was used to test 726 specimens for the presence of norovirus. All 96 norovirus positive samples and a systematic selection of negative samples were tested by RIDASCREEN, RIDAQUICK and IDEIA norovirus tests. RESULTS The sensitivity of RIDASCREEN for the detection of norovirus was 63% (95% CI: 53-72%) and RIDAQUICK 69% (95% CI: 58-78%); both were >98% specific. The IDEIA had a sensitivity of 45% (95% CI: 35-55%), significantly lower than RIDASCREEN and RIDAQUICK (p≤0.01). The sensitivity of RIDASCREEN and RIDAQUICK in detecting GII.4 noroviruses, the principal norovirus strain identified in community and nosocomial infection globally, was 78% and 88% respectively. CONCLUSION The norovirus RIDASCREEN test may be useful in epidemiological studies of norovirus infection and the norovirus RIDAQUICK test offers an accurate and rapid method of detecting norovirus infection.

Zinc supplementation in Brazilian children with acute diarrhoea

Abstract Although oral rehydration therapy greatly reduces mortality from diarrhoeal diseases, it has little effect on stool frequency. However, there is mounting evidence that zinc is an effective adjunct to the treatment of diarrhoea, although few studies have examined its efficacy in Latin America. This study assessed the efficacy of zinc supplementation in children with acute diarrhoea in Brazil. The study was a double-blind, placebo-controlled, randomised, clinical trial in children <5 years of age attending emergency services in Sergipe, Brazil. Subjects received zinc or vitamin C as placebo. There was a marked reduction in the duration of the diarrhoea (1.1 vs 2.6 days) and of watery stools in the zinc-supplemented group. The efficacy of zinc was independent of the presence of viral enteropathogens in the stools. It is concluded that, similar to studies in India and Bangladesh, zinc could be an important adjunct for treating acute diarrhoea in Brazilian children.

Risk factors for inadequate prenatal care use in the metropolitan area of Aracaju, Northeast Brazil.

BackgroundThe aim of prenatal care is to promote good maternal and foetal health and to identify risk factors for adverse pregnancy outcomes in an attempt to promptly manage and solve them. Although high prenatal care attendance is reported in most areas in Brazil, perinatal and neonatal mortalities are disproportionally high, raising doubts about the quality and performance of the care provided. The objective of the present study was to evaluate the adequacy of prenatal care use and the risk factors involved in inadequate prenatal care utilization in the metropolitan area of Aracaju, Northeast Brazil.MethodsA survey was carried out with puerperal women who delivered singleton liveborns in all four maternity hospitals of Aracaju. A total of 4552 singleton liveborns were studied. The Adequacy of Prenatal Care Utilization Index, modified according to the guidelines of the Prenatal Care and Birth Humanization Programme, was applied. Socioeconomic, demographic, biological, life style and health service factors were evaluated by multiple logistic regression. Results: Prenatal care coverage in Aracaju was high (98.3%), with a mean number of 6.24 visits. Prenatal care was considered to be adequate or intensive in 66.1% of cases, while 33.9% were considered to have inadequate usage. Age < 18 to 34 years at delivery, low maternal schooling, low family income, two or more previous deliveries, maternal smoking during pregnancy, having no partner and prenatal care obtained outside Aracaju were associated with inadequate prenatal care use. In contrast, private service attendance protected from inadequate prenatal care use.ConclusionPrenatal care coverage was high. However, a significant number of women still had inadequate prenatal care use. Socioeconomic inequalities, demographic factors and behavioural risk factors are still important factors associated with inadequate prenatal care use.

Impact of rotavirus vaccination on diarrhoea mortality and hospital admissions in Brazil

Objective  To analyse the data reported by the national surveillance system of Brazil, including data on diarrhoea mortality and hospital admissions before and after rotavirus vaccine introduction, and evaluate the impact of its widespread use under operational conditions.

Soroprevalência de anticorpos para toxoplasmose, rubéola, citomegalovírus, sífilis e HIV em gestantes sergipanas

The seroprevalence of antibodies for HIV, syphilis, toxoplasmosis, cytomegalovirosis and rubella and its association with age and origin was investigated among pregnant women in Sergipe, northeastern Brazil. A total of 9,550 pregnant women (2,112 from the state capital and 7,438 from other municipalities) were enrolled in the study and consecutively tested during their first antenatal care visit in 2007. The following serum prevalences were found: syphilis (0.9%; 95% CI 0.7%-1.6%), HIV (0.14%; 95% CI 0.08%-0.2%), toxoplasmosis (IgG 69.3%; 95% CI 68.3%-70.2%; IgM 0.4%, 95% CI 0.3%-0.6%), cytomegalovirosis (IgG 76.6%, 95% CI 75.7%-77.5%; IgM 0.2%, 95% CI 0.09%-0.3%) and rubella (IgG 71.6%, 95% CI 70.7%-72.6%; IgM 0.1%, 95% CI 0.04%-0.2%). Toxoplasmosis seropositivity increased with age. The prevalences of IgG antibodies for toxoplasmosis, cytomegalovirus and rubella were higher in Aracaju (state capital) than in other municipalities in the State of Sergipe. The results showed that a large proportion of the pregnant women, particularly in municipalities other than the state capital, were susceptible to toxoplasmosis, rubella and cytomegalovirus, with a risk for their infants.

Interferon gamma, interferon-gamma-induced-protein 10, and tuberculin responses of children at high risk of tuberculosis infection.

Background: Children in contact with adults with pulmonary tuberculosis (TB) are at risk for infection and disease progression, and chemoprophylaxis may reduce this risk. The identification of infection is based on the tuberculin skin test (TST) and interferon-γ (INF-γ) release assays. Other biomarkers such as interferon-γ-induced-protein 10 (IP-10) may have potential for the diagnosis of latent TB infections. Objectives: To describe IP-10 concentrations and their association to TST and INF-γ responses in children recently exposed to adults with smear-positive TB in Brazil and Nepal. Methods: Two surveys using the same design were undertaken to describe TST, INF-γ, and IP-10 responses in 146 children in Nepal and 113 children in Brazil. Results: The concordance of TST and QuantiFERON-TB gold in-tube (QFT-IT) was high (&kgr; 0.73 in Brazil and 0.80 in Nepal). IP-10 responses were higher in children with both positive TST and positive QFT-IT (medians 1434 pg/mL in Brazil and 1402 pg/mL in Nepal) and lowest in children with both negative TST and negative QFT-IT (medians 206 pg/mL in Brazil and 81 pg/mL in Nepal). Children with negative TST and positive QFT-IT had higher IP-10 concentrations than children with positive TST but negative QFT-IT. Conclusions: IP-10 is a potential marker to identify latent TB infections that is expressed in large quantities and with good agreement with QFT-IT. The reasons for the discrepant results observed are discussed.

Prevalência da infecção por HIV em parturientes de maternidades vinculadas ao SUS

OBJETIVO: avaliar a prevalencia do HIV nas parturientes de maternidades vinculadas ao SUS, pela utilizacao do teste rapido. METODOS: estudo transversal realizado em maternidades conveniadas ao SUS no Estado de Sergipe, apos treinamento realizado com os profissionais de saude dessas maternidades. As parturientes foram submetidas ao teste rapido imunocromatografico para HIV, independente de ja o terem realizado no pre-natal, apos aconselhamento e assinatura do termo de consentimento livre e esclarecido. O teste utilizado foi DetermineTM - Abbott Laboratorios do Brasil. Utilizou-se o esquema de profilaxia da transmissao vertical para todos os casos, segundo o protocolo recomendado pelo Ministerio da Saude. Foi criado banco de dados no Epi-Info 2002 e calculada a prevalencia em relacao a todos os testes realizados no periodo de janeiro de 2003 a marco de 2004, por meio de analise estatistica descritiva. RESULTADO: apos realizacao de 9.215 testes rapidos, foram detectadas 39 (0,42%) soropositivas para HIV, das quais 23 (59%) nao conheciam a sua soropositividade. Duas gestantes que ja eram sabidamente HIV positivas nao relataram aos profissionais sua condicao no momento da admissao. O numero de parturientes que referiram ter frequentado o servico de pre-natal foi alto (89%), mas somente 32,5% destas foram submetidas ao teste para HIV na gestacao. CONCLUSAO: a prevalencia detectada (0,42%) neste estudo e semelhante a nacional. E alta a prevalencia de parturientes que desconhecem sua soropositividade para HIV, o que indica inadequado funcionamento de cuidados pre-natais dispensados. Na situacao atual e necessaria a triagem no momento do parto, para garantia de intervencoes adequadas neste momento crucial da transmissao do HIV.