Victor Santana Santos

Incidence of Rotavirus and Circulating Genotypes in Northeast Brazil during 7 Years of National Rotavirus Vaccination

Background and Aims Rotavirus causes severe diarrhoea and Brazil introduced the Rotarix G1P[8] vaccine in 2006. We aimed to describe changes in rotavirus incidence and diarrhoea epidemiology before and after vaccine introduction. Methods Design: (i) hospital-based survey of children with diarrhoea (2006–2012); (ii) diarrhea-mortality and hospitalization surveillance (1999–2012). Setting (i) Aracaju and (ii) state and national level. Results 1841 children were enrolled and 231 (12.5%) had rotavirus. Rotavirus was less frequent from January-June than from July-December (9.4% versus 20.9%, p<0.01), but the seasonal variation was less defined after 2009. Very few rotavirus cases (8–3.9%) were detected in 2011, with an increase in 2012 (13–18.5%). In 2006, unvaccinated children were more likely to have rotavirus, but thereafter unvaccinated and vaccinated children had equally low incidence. Older children and those with rotavirus were more likely to have severe diarrhea episodes. The most frequent genotype from 2006 to 2010 was G2P[4]; except in 2009, when most cases were G1P[8]. Very few G2P[4] were detected from 2011 and 50% cases in 2012 were G8P[4]. Diarrhoea-hospitalizations decreased nationally from 89,934 (2003) to 53,705 (2012; 40.3% reduction) and in the state from 1729 to 748 (56.7% reduction). Diarrhoea-deaths decreased nationally from 4368 in 1999 to 697 in 2012 (84% reduction, p<0.001) and in the state from 132 to 18 (86% reduction). These changes were much larger after vaccine introduction. Conclusions The vaccine was associated with substantial reductions in rotavirus incidence and diarrhoea-hospitalizations and deaths. The G2P[4] genotype predominance disappeared over time and may be replaced by other heterotypic genotypes.

Maternal risk factors for HIV infection in infants in northeastern Brazil

INTRODUCTION While the rate of vertically transmitted HIV infection has fallen in most regions of Brazil, there have been no similar decreases in northern and northeastern Brazil. OBJECTIVE The objective of this study was to evaluate the risk factors associated with vertical transmission in the state of Sergipe in northeastern Brazil. METHODS This was a retrospective cohort study. We recorded clinic and registry data for all HIV-infected pregnant women and exposed children diagnosed in Sergipe from 1990 to 2011. RESULTS We identified 538 deliveries and 561 HIV-exposed infants (23 sets of twins). One hundred one (18.9%) infants were HIV-infected. In the multivariate analysis, infant antiretroviral prophylaxis was a significant protective factor (adjusted odds ratio (aOR) 0.07, 95% confidence interval (CI) 0.01-0.41, p=0.003). Breastfeeding was marginally associated with an increased odds of perinatal transmission (aOR 4.52, 95% CI 0.78-26.17, p = 0.092). The attributable risk percentage for breastfeeding over the study period was 91.0%. Transmission decreased from 91 per 100 live births before 1997 to 2 per 100 in 2011 following the adoption of the prevention protocol. CONCLUSION Transmission declined over the study period. The screening of pregnant women and timely initiation of prophylaxis and therapy are issues that require further attention.

Inequalities in health: living conditions and infant mortality in Northeastern Brazil

OBJECTIVE To analyze the variation of infant mortality as per condition of life in the urban setting. METHODS Ecological study performed with data regarding registered deaths of children under the age of one who resided in Aracaju, SE, Northeastern Brazil, from 2001 to 2010. Infant mortality inequalities were assessed based on the spatial distribution of the Living Conditions Index for each neighborhood, classified into four strata. The average mortality rates of 2001-2005 and 2006-2010 were compared using the Student’s t-test. RESULTS Average infant mortality rates decreased from 25.3 during 2001-2005 to 17.7 deaths per 1,000 live births in 2006-2010. Despite the decrease in the rates in all the strata during that decade, inequality of infant mortality risks increased in neighborhoods with worse living conditions compared with that in areas with better living conditions. CONCLUSIONS Infant mortality rates in Aracaju showed a decline, but with important differences among neighborhoods. The assessment based on a living condition perspective can explain the differences in the risks of infant mortality rates in urban areas, highlighting health inequalities in infant mortality as a multidimensional issue.

Evaluation of agreement between clinical and histopathological data for classifying leprosy

BACKGROUND The diversity of clinical manifestations of leprosy has given rise to different classification systems. However, there are important differences in the sensitivity and specificity of these classifications. The objective of this study was to evaluate the agreement between clinical and histopathological data for classifying leprosy. METHODS A total of 1265 patient reports containing clinical and histopathological data relating to the diagnosis and classification of leprosy were included in this study. The diagnostic concordance between the clinical form (Madrid classification) and the histopathological type, as well as the initial and final classifications, was calculated by dividing the number of concordant cases by the total number of patients. RESULTS The overall agreement between the World Health Organization operational classification and the results of direct smear examination of the lesion for acid-fast bacilli was 84.8% (1073/1265). The clinical-histopathological agreement was 58.1% (735/1265). The indeterminate and lepromatous forms were those that showed the highest percentages of agreement: 72.1% (186/258) and 71.0% (142/200), respectively. CONCLUSION Although classifications based on clinical characteristics have an important role in the control of leprosy, they present flaws that can influence the adequacy of treatment. Therefore, a histopathological examination is important for appropriate treatment.

Mortality from oral cancer in Aracaju/SE, Brazil: 2000-2009

INTRODUCTION: The incidence of oral cancer varies widely in the world, with two thirds of cases diagnosed in developing countries. OBJECTIVE: To investigate the epidemiology of deaths from oral cancer and the spatial distribution in the city of Aracaju in the state of Sergipe between 2000 and 2009. MATERIAL AND METHOD: Data were collected using the Mortality Information System (MIS) of Aracaju/SE at the DATASUS website and were tabulated using the software TABWIN 3.4. The geographic distribution of deaths by neighborhoods of that city was visualized. RESULT: Of the 78 deaths, 61 (78.2%) were male. The mean age was 64.23 years. Individuals of mixed ethnicity had a higher death frequency (34.6%). Regarding education, the majority of death certificates recorded the option ignored, followed by individuals with 1 to 3 years of study. The anatomical sites most affected were unspecified parts of the mouth (43.6%). The spatial distribution analysis indicated that neighborhoods such as Santos Dumont, Luzia, Atalaia, Santa Maria, Cidade Nova and Industrial had the highest death frequencies. CONCLUSION: Males between the fifth and sixth decades of life of mixed ethnicity, low education and in neighborhoods with low and very low standards of living constitute the epidemiological profile for deaths from oral cancer.

Anxiety, depression, and quality of life in mothers of newborns with microcephaly and presumed congenital Zika virus infection

Dear Editor, In Brazil, an unusual increase of newborns withmicrocephaly has been reported since August 2015 (França et al. 2016), with a strong evidence of association with congenital Zika virus (ZIKV) infection (Martines et al. 2016). In February 2016, the World Health Organization declared the clusters of microcephaly and other neonatal malformations reported in Brazil a Public Health Emergency of International Concern (WHO 2016). In June 2016, the Brazilian Ministry of Health confirmed 1410 cases of microcephaly in the Northeast region, out of which 111 (7.9 %) cases in the Sergipe state, the smallest state of the Brazilian Federation, with ∼2 million population (BRAZIL 2016). Studies have shown an increased risk of microcephaly when mothers are infected with ZIKV during the first trimester of pregnancy (Cauchemez et al. 2016; Johansson et al. 2016). Unfortunately, there is currently no vaccine or medication to prevent ZIKV infection, which may be asymptomatic in an estimate of 80% of cases (Duffy et al. 2009). Recently, in Colombia, four infants with microcephaly had laboratory evidence of congenital ZIKVwhose mothers had asymptomatic infection during pregnancy (Pacheco et al. 2016). Because of growing evidence, experts have suggested safety measures to avoid ZIKV infection during pregnancy, especially in areas where the virus has been circulating. Brazilian newborns with microcephaly have demonstrated severe abnormalities in the central nervous system including brain dysgenesis and intracranial calcifications consistent with an intrauterine infection (Microcephaly Epidemic Research Group 2016). The expectancy of microcephaly diagnosis may lead to higher levels of parental stress because of the uncertainty regarding the developmental outcome of their children. To the best of our knowledge, there have been no previous studies evaluation anxiety, depression, and quality of life in mothers of newborns with microcephaly and presumed congenital ZIKV infection. We evaluated nine consecutive mothers of babies with microcephaly born in a public maternity in Sergipe state, Brazil, from November 2015 to June 2016. The newborns with microcephaly presented typical alterations indicating congenital infection including intracranial calcifications, cerebral ventricles dilation, or changes in the posterior fossa and other clinical signs found by any image diagnostic method or ZIKV identification in laboratory tests (BRAZIL 2016).We compared data regarding anxiety, depression, and quality of life with those from a concurrent control group of 20 mothers of healthy newborns. Psychometric evaluation of anxiety and depression was performed using the State-Trait Anxiety Inventory and the Beck Depression Inventory, respectively. Quality of life was assessed using the World Health Organization Questionnaire—short version (WHOQOL-BREF). Differences between the groups were compared using the Mann-Whitney test with a significance level of 5 %. All participants signed the informed consent. Data were collected during the first 24 h after birth. The mothers’ age of newborns with microcephaly ranged from 18 to 39 years. Only three mothers were married and all * Paulo Ricardo Saquete Martins-Filho martins-filho@ufs.br

Clinical variables associated with disability in leprosy cases in northeast Brazil

INTRODUCTION The clinical outcomes of leprosy include complications such as physical disabilities and deformities that vary according to the degree of impairment of nerve trunks. Knowledge of the factors that lead to the development of these complications is important for disability prevention programs. This study aimed to evaluate clinical factors associated with the occurrence of physical disability in leprosy cases. METHODOLOGY This was a retrospective study of 2,358 cases of leprosy in Aracaju, northeast Brazil, between 2001 and 2011. Analysis was done using the Chi-square test and logistic regression model. RESULTS Significant factors associated with disability were found to be male gender, having more than two affected nerves, multibacillary leprosy classification, leprosy reaction, and lepromatous leprosy. The multivariate analysis revealed that the associated factors included having more than two affected nerves, leprosy reaction (adjusted odds ratio [aOR]: 2.02, 95% confidence interval [CI]: 1.36 to 3.01), the multibacillary form (aOR: 2.74, 95% CI: 1.84 to 4.08), and lepromatous leprosy (aOR: 4.87, 95% CI: 2.86 to 16.08). CONCLUSIONS The number of affected nerves, leprosy reaction, operational classification, and clinical presentation were identified as the main factors associated with the development of disability in leprosy patients.

Leprosy and Disability in Children Younger Than 15 Years in an Endemic Area of Northeast Brazil

Background: Leprosy in children is still a frequent but sometimes unrecognized public health problem and an important cause of disability. Establishing the risk factors that lead to the development of disability is important for the development of suitable prevention programs. We describe the incidence of leprosy and the prevalence and degree of associated disabilities in children <15 years of age at the time of first presentation to the health services in Aracaju, Sergipe, Northeast Brazil. Methods: A retrospective case series of 266 cases of leprosy in children under 15 years old of Aracaju from 2001 to 2012. Logistic regressions were performed to identify factors for disability. Results: The average detection rate was 16.5/100,000 children under 15 years old per year over the study period. Physical disability was associated with the presence of affected nerves and multibacillary leprosy. Conclusions: The detection rate of leprosy in children is still high in Aracaju, Northeast Brazil. Having affected nerves and multibacillary leprosy are associated with the development of disability in children.

Functional Activity Limitation and Quality of Life of Leprosy Cases in an Endemic Area in Northeastern Brazil

Background Few studies have evaluated the association between quality of life (QoL) and functional activity limitations (FAL) of leprosy patients as determined by the Screening of Activity Limitation and Safety Awareness scale (SALSA). Aim To identify the association between FALs and the QoL of patients during and post leprosy treatment. Materials and Methods Cross-sectional survey of 104 patients with leprosy followed in specialist reference centres in Sergipe, Brazil, between June and October 2014. QoL was evaluated using the World Health Organization-QoL-BREF (WHOQoL-BREF) questionnaire. The SALSA scale was used to measure FALs. Results Low SALSA scores were present in 76% of patients. QoL scores were lower for the physical and environmental domains, with median (interquartile range (IQR)) scores of 53.6 (32.1–67.9) and 53.1 (46.9–64.8), respectively. There was a statistical association between increasing SALSA scores and lower QoL as measured by the WHOQoL-BREF. Conclusion Functional limitations are associated with lower QoL in leprosy patients, especially in the physical and environmental WHOQoL-BREF domains.

Similarities and differences between WHO criteria and two other approaches for maternal near miss diagnosis.

To evaluate the similarities, differences and diagnostic aspects between World Health Organization (WHO) criteria and two other maternal near miss (MNM) diagnostic tools.