Robson Bruniera de Oliveira

Is pregnancy associated with severe dengue? A review of data from the Rio de Janeiro surveillance information system.

Background Dengue is a reportable disease in Brazil; however, pregnancy has been included in the application form of the Brazilian notification information system only after 2006. To estimate the severity of maternal dengue infection, the available data that were compiled from January 2007 to December 2008 by the official surveillance information system of the city of Rio de Janeiro were reviewed. Methods and Principal Findings During the study period, 151,604 cases of suspected dengue infection were reported. Five hundred sixty-one women in their reproductive age (15–49 years) presented with dengue infection; 99 (18.1%) pregnant and 447 (81.9%) non-pregnant women were analyzed. Dengue cases were categorized using the 1997 WHO classification system, and DHF/DSS were considered severe disease. The Mann-Whitney test was used to compare maternal age, according to gestational period, and severity of disease. A chi-square test was utilized to evaluate the differences in the proportion of dengue severity between pregnant and non-pregnant women. Univariate analysis was performed to compare outcome variables (severe dengue and non-severe dengue) and explanatory variables (pregnancy, gestational age and trimester) using the Wald test. A multivariate analysis was performed to assess the independence of statistically significant variables in the univariate analysis. A p-value<0.05 was considered statistically significant. A higher percentage of severe dengue infection among pregnant women was found, p = 0.0001. Final analysis demonstrated that pregnant women are 3.4 times more prone to developing severe dengue (OR: 3.38; CI: 2.10–5.42). Mortality among pregnant women was superior to non-pregnant women. Conclusion Pregnant women have an increased risk of developing severe dengue infection and dying of dengue.

A systematic review and meta-analysis of the factors associated with Leishmania infantum infection in dogs in Brazil

The risk factors associated with canine visceral leishmaniosis (CVL) in Brazil are unclear and controversial. The objectives of this systematic review and meta-analysis were to identify the best evidence available in this field and to determine the gaps in existing knowledge. Literature searches were carried out using four databases, the reference lists within articles, and references provided by experts in the field. Theoretical discussions or separate and independent meta-analyses of p-values or of effect sizes were used to pool information about each variable. Thirty-six articles were selected for detailed review, including 31 cross-sectional, two ecological and three cohort studies. The variables showing significant association with CVL were short hair, purebred, peri-domestic restricted (as compared with domestic-restricted dogs), and presence of green areas adjacent to home. The occurrence of CVL was also associated with the presence of domestic fowl in the home environment, with free dogs (as compared with restrained dogs), with male gender and with dogs >1 or 2 years of age, although these associations were not statistically significant. Due to the small number of publications, consistent results could not be obtained concerning the role of other factors. Most studies did not describe the criteria of eligibility and the process of selection of participants in sufficient detail and employed only one diagnostic test as proof of infection. Few studies controlled for confounding variables. No statistical evidence of publication bias was detected, but a great deal of information contained in the primary articles was lost because the results were not adequately described. The results of this review contribute to a better understanding of CVL and should assist in optimizing the development and implementation of control policies. Continuous actions, prioritizing dogs at higher risk and areas with higher abundance of green vegetation, together with policies to promote responsible dog ownership are mandatory. Problems concerning study design and data analysis described in the present study need to be taken into consideration in future studies. These must follow clear procedures to select participants and utilize standardized, valid and reliable diagnostic methods. The development of multivariate models and the use of the STROBE statement for description of the results should also be encouraged. Further research should investigate the patterns identified and prioritize CVL-related factors that have not been fully recognized or elucidated. Finally, ecological and cohort studies of CVL and investigations in other countries of Latin America are urgently required.

Leishmania infection in a population of dogs: an epidemiological investigation relating to visceral leishmaniasis control.

Identification of factors associated with Leishmania infection in dogs is essential for targeting visceral leishmaniasis control actions. Thus, the present study analyzed some of these factors in a population of dogs in a Brazilian municipality, along with the limitations of control strategies implemented there. The association between the exposure variables and occurrences of infection was analyzed through logistic regression models. The disease control interventions were treated qualitatively. Out of the 755 animals examined, 13.6% (103/755) were seropositive. Of these, 23.3% (24/103) were asymptomatic and 76.7% (79/103) presented at least one clinical sign possibly associated with visceral leishmaniasis. With weak associations, purebred, shorthaired, over 5 years of age, male and large dogs were more prone to infection. The latter two variables formed the final regression model and the association with dog size was statistically significant. The control strategies developed presented limitations and a great number of seronegative dogs was culled. The data presented contribute towards better understanding of the dynamics of infection in canine visceral leishmaniasis and indicate that actions aimed towards adequate implementation of Visceral Leishmaniasis control program in Brazilian endemic areas should be prioritized.

Fatores associados à ocorrência de parasitoses intestinais em uma população de crianças e adolescentes

OBJETIVOS: Analizar la prevalencia de infecciones por parasitas intestinales en ninos y adolescentes matriculados en escuelas de ensenanza primaria en el municipio de Sao Joao del-Rei, Minas Gerais (Brasil), y los factores asociados a la infeccion. METODOS: Estudio epidemiologico seccional, realizado entre marzo/2008 y julio/2009. Se realizaron examenes coproscopicos por sedimentacion espontanea y Kato-Katz en 1.172 escolares. Se ajustaron modelos de regresion logistica multiple para el estudio de los factores asociados a las infecciones en general y, separadamente, por helmintos y protozoos. RESULTADOS: La prevalencia de infecciones fue de 29%, habiendo una variacion de 7 a 83%, respectivamente, entre las escuelas de menor y mayor ocurrencia. La presencia de instalacion sanitaria en el domicilio fue asociada a una ocurrencia menor de helmintos; el aumento en la edad de los escolares se asocio a una mayor ocurrencia de protozoos y de parasitas en general; mientras que la presencia de filtro de agua y la ubicacion del domicilio en area urbana se mostraron asociadas a una ocurrencia menor de los tres desenlaces analizados. En todas las regiones, se registro el consumo de medicacion preventiva contra helmintos. CONCLUSIONES: Desigualdades en las condiciones de vida convirtieron las prevalencias diferenciadas entre las regiones del estudio. El estudio subraya la necesidad de promover el uso de filtros de agua en las residencias de areas epidemicas y de evaluar el consumo preventivo de medicamentos anti-helminticos en la dinamica de las infecciones y en la salud de los individuos. Medidas de control que tengan en cuenta los factores descritos deben ser prioritarias en nivel de Salud Publica.

Factors associated with intestinal parasitosis in a population of children and adolescents

OBJETIVOS: Analizar la prevalencia de infecciones por parasitas intestinales en ninos y adolescentes matriculados en escuelas de ensenanza primaria en el municipio de Sao Joao del-Rei, Minas Gerais (Brasil), y los factores asociados a la infeccion. METODOS: Estudio epidemiologico seccional, realizado entre marzo/2008 y julio/2009. Se realizaron examenes coproscopicos por sedimentacion espontanea y Kato-Katz en 1.172 escolares. Se ajustaron modelos de regresion logistica multiple para el estudio de los factores asociados a las infecciones en general y, separadamente, por helmintos y protozoos. RESULTADOS: La prevalencia de infecciones fue de 29%, habiendo una variacion de 7 a 83%, respectivamente, entre las escuelas de menor y mayor ocurrencia. La presencia de instalacion sanitaria en el domicilio fue asociada a una ocurrencia menor de helmintos; el aumento en la edad de los escolares se asocio a una mayor ocurrencia de protozoos y de parasitas en general; mientras que la presencia de filtro de agua y la ubicacion del domicilio en area urbana se mostraron asociadas a una ocurrencia menor de los tres desenlaces analizados. En todas las regiones, se registro el consumo de medicacion preventiva contra helmintos. CONCLUSIONES: Desigualdades en las condiciones de vida convirtieron las prevalencias diferenciadas entre las regiones del estudio. El estudio subraya la necesidad de promover el uso de filtros de agua en las residencias de areas epidemicas y de evaluar el consumo preventivo de medicamentos anti-helminticos en la dinamica de las infecciones y en la salud de los individuos. Medidas de control que tengan en cuenta los factores descritos deben ser prioritarias en nivel de Salud Publica.

Avaliação da vigilância epidemiológica ampliada do rotavírus

Objective: To assess the practices of Rotavirus surveillance, identifying the positive aspects and the difficulties found through the evaluation model from the Enhanced Surveillance of Rotavirus Diarrheal Diseases. Method: This is an evaluative and qualitative research performed in two different Brazilian states between March and November 2010. Participated in the evaluation 14 subjects in total (from central, state and municipal level), which were submitted to tape-recorded interviews using semi-structured questionnaires, along with conduction of document analysis and direct observation of routine service within their respective units. This information allowed to feed a judgment matrix, thus highlighting the various aspects comprising the system operation. Results: Positive aspects were observed (the sensitivity to capture cases, the system acceptability by the technicians involved, the proper physical structure and the training and updating of technicians), and operational difficulties when conducting surveillance activities (the shortage of human and financial resources and the low opportunity of the information system). Conclusion: The results suggest the low effectiveness of the monitoring system adopted, indicating that the sentinel type of surveillance may not be the most appropriate for the health system in the studied states. doi:10.5020/18061230.2014.p140

Os efeitos do crescimento urbano sobre a dengue

Objective: To analyze the spatial and temporal dynamics of dengue in Coronel Fabriciano, Minas Gerais State, Brazil, and to associate cases to the growth of urban areas and loss of natural areas in recent years. Methods: This is a descriptive, exploratory study, with a quantitative approach. Dengue cases of 2009 were obtained from the Health Municipal Secretariat, including the suspected and confirmed cases. Shape files were obtained, containing information about the municipal boundary, boundary of the urban area, census tracts, areas with buildings and natural areas. Based on the distribution of dengue cases, the Kernel estimator was used to measure data dispersion. Results: Dengue cases reported were georeferenced in GIS (Geographic Information System) environment. The landscape showed changes in the units of urban area and pasture, as an urban growth over the pasture matrix. No changes were observed in the areas of remaining forest and eucalyptus. There are cases spatially spread with a tendency to form clusters. Conclusion: Cases of dengue were observed spatially clustered in the northern region of the city, where new neighborhoods have emerged in recent years, following the population growth without proper structure of urbanization and urban planning. In addition, urban growth have reduced the margin of watercourses providing a bare soil, suitable for accumulation of trash and formation of breeding sites for mosquitoes. Efficient public policies and appropriate urban planning might reduce the impact of dengue in endemic regions. doi: http://dx.doi.org/10.5020/18061230.2013.p539

Factores asociados a la ocurrencia de parasitosis intestinales en una población de niños y adolescentes

OBJETIVOS: Analizar la prevalencia de infecciones por parasitas intestinales en ninos y adolescentes matriculados en escuelas de ensenanza primaria en el municipio de Sao Joao del-Rei, Minas Gerais (Brasil), y los factores asociados a la infeccion. METODOS: Estudio epidemiologico seccional, realizado entre marzo/2008 y julio/2009. Se realizaron examenes coproscopicos por sedimentacion espontanea y Kato-Katz en 1.172 escolares. Se ajustaron modelos de regresion logistica multiple para el estudio de los factores asociados a las infecciones en general y, separadamente, por helmintos y protozoos. RESULTADOS: La prevalencia de infecciones fue de 29%, habiendo una variacion de 7 a 83%, respectivamente, entre las escuelas de menor y mayor ocurrencia. La presencia de instalacion sanitaria en el domicilio fue asociada a una ocurrencia menor de helmintos; el aumento en la edad de los escolares se asocio a una mayor ocurrencia de protozoos y de parasitas en general; mientras que la presencia de filtro de agua y la ubicacion del domicilio en area urbana se mostraron asociadas a una ocurrencia menor de los tres desenlaces analizados. En todas las regiones, se registro el consumo de medicacion preventiva contra helmintos. CONCLUSIONES: Desigualdades en las condiciones de vida convirtieron las prevalencias diferenciadas entre las regiones del estudio. El estudio subraya la necesidad de promover el uso de filtros de agua en las residencias de areas epidemicas y de evaluar el consumo preventivo de medicamentos anti-helminticos en la dinamica de las infecciones y en la salud de los individuos. Medidas de control que tengan en cuenta los factores descritos deben ser prioritarias en nivel de Salud Publica.