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Foo SS, Chen W, Azamor T, Jung KL, Cambou MC, Familiar-Macedo D, Salem GM, Melano I, Sim MS, Moreira ME, Brasil P, Vasconcelos Z, Nielsen-Saines K, Jung JU. Sustained chronic inflammation and altered childhood vaccine responses in children exposed to Zika virus. EBioMedicine 2024; 106:105249. [PMID: 39024898 PMCID: PMC11304698 DOI: 10.1016/j.ebiom.2024.105249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 06/27/2024] [Accepted: 07/02/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND Congenital Zika virus (ZIKV) infection leads to severe newborn abnormalities, but its long-term impact on childhood immunity is not well understood. This study aims to investigate the serum proteomics in children exposed to ZIKV during pregnancy to understand potential immunological consequences during early childhood. METHODS The study included ZIKV-exposed infants (ZEI) at birth (n = 42) and children exposed to ZIKV (ZEC) at two years of age (n = 20) exposed to ZIKV during pregnancy, as well as healthy controls. Serum proteomic analysis was performed on these groups to assess inflammation and immune profiles. Additionally, antibody titres against two common childhood vaccines, DTaP and MMR, were measured in healthy controls (n = 50) and ZEC (n = 92) to evaluate vaccine-induced immunity. FINDINGS Results showed elevated inflammation in ZEI with birth abnormalities. Among ZEC, despite most having normal clinical outcomes at two years, their serum proteomics indicated a bias towards Th1-mediated immune responses. Notably, ZEC displayed reduced anti-Diphtheria toxin and anti-Clostridium tetani IgG levels against DTaP and MMR vaccines. They also exhibited lower antibody titres particularly against Th2-biased DTaP vaccines, but not Th1-biased MMR vaccines. INTERPRETATION In conclusion, the study highlights the long-term immunological consequences of congenital ZIKV exposure. Heightened inflammation was observed in ZEI with abnormalities at birth, while ZEC maintained a chronic Th1-biased immune profile. The impaired response to Th2-biased vaccines raises concerns about lasting effects of ZIKV exposure on immune responses. Consequently, there is a need for continued longitudinal clinical monitoring to identify potential immune-related complications arising from prenatal exposure to ZIKV. FUNDING This work was partially funded by the National Institute of Allergy and Infectious Diseases (NIAID) and National Institute of Dental and Craniofacial Research (NIDCR).
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Affiliation(s)
- Suan-Sin Foo
- Department of Infection Biology and Global Centre for Pathogen Research and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Weiqiang Chen
- Department of Infection Biology and Global Centre for Pathogen Research and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tamiris Azamor
- Department of Infection Biology and Global Centre for Pathogen Research and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kyle L Jung
- Department of Infection Biology and Global Centre for Pathogen Research and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mary Catherine Cambou
- Department of Medicine, Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Débora Familiar-Macedo
- Department of Infection Biology and Global Centre for Pathogen Research and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Gielenny M Salem
- Department of Infection Biology and Global Centre for Pathogen Research and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ivonne Melano
- Department of Infection Biology and Global Centre for Pathogen Research and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Myung-Shin Sim
- Department of Medicine, Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | | | | | - Zilton Vasconcelos
- Department of Medicine, Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA; Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Karin Nielsen-Saines
- Fundação Oswaldo Cruz, Rio de Janeiro, Brazil; Department of Paediatrics, Division of Infectious Diseases, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jae U Jung
- Department of Infection Biology and Global Centre for Pathogen Research and Human Health, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
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de Freitas DA, Wakimoto MD, Dias S, Souza-Santos R. High-Risk Areas for Congenital Zika Syndrome in Rio de Janeiro: Spatial Cluster Detection. Trop Med Infect Dis 2024; 9:105. [PMID: 38787038 PMCID: PMC11125739 DOI: 10.3390/tropicalmed9050105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 05/25/2024] Open
Abstract
Brazil reported 18,282 suspected congenital Zika syndrome (CZS) cases up to 2018 and accounts for 61.4% of the total reported Zika cases in the Americas in the period. To detect high-risk areas for children with CZS in the city of Rio de Janeiro, we used cluster detection and thematic maps. We analyzed data using a Poisson model in Satscan 10.1.3 software. We also analyzed the records of children with CZS from 2015 to 2016 to describe the clinical and epidemiological maternal and child profile, as well as live births in 2016 and the social development index (SDI) by neighborhood. In 2015 and 2016, the incidence rates of CZS were 8.84 and 46.96 per 100,000 live births in the city, respectively. Severe congenital findings such as microcephaly and brain damage, osteoarticular impairment, ocular abnormalities, and hearing loss were observed in 47 children. The spatial distribution of CZS was concentrated in the north and west zones in heterogeneous neighborhoods. The neighborhoods with the highest occurrence of CZS cases were found to have the worst SDIs. Stascan detected three spatial clusters in the north zone, where the SDI is lower. The clusters presented high relative risks for CZS (7.86, 1.46, and 2.08), although they were not statistically significant. Our findings highlight a higher occurrence of CZS in areas with less favorable socioeconomic conditions.
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Affiliation(s)
- Danielle Amaral de Freitas
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rua Leopoldo Bulhões, Rio de Janeiro 1480, RJ, Brazil;
| | - Mayumi Duarte Wakimoto
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil, Rio de Janeiro 4365, RJ, Brazil;
| | - Sónia Dias
- National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center (CHRC), REAL, NOVA University of Lisbon, Avenida Padre Cruz, 1600-560 Lisboa, Portugal;
| | - Reinaldo Souza-Santos
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rua Leopoldo Bulhões, Rio de Janeiro 1480, RJ, Brazil;
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de Amorin Vilharba BL, Yamamura M, de Azevedo MV, Fernandes WDS, Santos-Pinto CDB, de Oliveira EF. Disease burden of congenital Zika virus syndrome in Brazil and its association with socioeconomic data. Sci Rep 2023; 13:11882. [PMID: 37482558 PMCID: PMC10363536 DOI: 10.1038/s41598-023-38553-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023] Open
Abstract
Zika virus (ZIKV) infection became a global public health concern, causing an epidemic in Latin America from 2015 to 2016, when a sudden increase in cases of microcephaly and other congenital anomalies was observed. In 2016, the Centers for Disease Control and Prevention and the World Health Organization defined congenital Zika-associated syndrome (CZS) as a set of congenital anomalies seen in children born to mothers with a history of gestational Zika fever, who have microcephaly as the most prevalent clinical sign. In order to describe the magnitude of CZS in Brazil, this study estimated the burden of disease due to CZS in Brazil using the disability-adjusted life years (DALY) indicator and other frequency measures, such as incidence and mortality rate, during the years 2015-2020. The association of these indicators with socioeconomic variables was also evaluated using Spearman's correlation coefficient. Choropleth maps were used to evaluate the spatial distribution of the indicators evaluated and the spatial autocorrelation was verified by the Bivariate Moran Local Index. From 2015 to 2020, 3,591 cases of CZS were confirmed in Brazil, with an incidence of 44.03 cases per 1000 live births, and a specific mortality of 12.35 deaths per 1000 live births. A global loss of 30,027.44 DALYs was estimated from 2015 to 2020. The Northeast region had the highest values for all health indicators assessed. Spatial correlation and autocorrelation analyses showed significant associations between health and socioeconomic indicators, such as per capita income, Gini index, illiteracy rate and basic sanitation. The study allowed us to have access to all reported cases of CZS, showing us the possible situation of the disease in Brazil; therefore, we believe that our results can help in the understanding of future studies.
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Affiliation(s)
- Bruna Luiza de Amorin Vilharba
- Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brasil
| | - Mellina Yamamura
- Departamento de Enfermagem, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | | | - Wagner de Souza Fernandes
- Universidade Federal de Mato Grosso do Sul, Hospital Universitário Maria Aparecida Pedrossian-HUMAP-EBSERH, Campo Grande, MS, Brasil
| | | | - Everton Falcão de Oliveira
- Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brasil.
- Faculdade de Medicina, Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brasil.
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Whitfield B, Marteleto L. Women's Attitudes Towards Abortion in Response to the Zika and COVID-19 Outbreaks in Brazil. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2023:1-17. [PMID: 37363355 PMCID: PMC10185939 DOI: 10.1007/s13178-023-00813-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/29/2023] [Indexed: 06/28/2023]
Abstract
Introduction Abortion attitudes are influenced by people's socioeconomic and demographic circumstances and can be volatile during times of crisis. Brazil is an interesting case for examining abortion attitudes because of its strict abortion policies, changing religious landscape, high income inequality, and extreme uncertainty generated by the back-to-back Zika and COVID-19 crises. This study seeks to assess Brazilian women's attitudes toward abortion and whether religion and income explain these attitudes in the context of novel infectious disease epidemics. Methods We used data from a population-based sample of 3996 women ages 18-34 in Pernambuco, Brazil, collected during the onset of the COVID-19 pandemic (May-September 2020). We conducted paired t-tests and multivariate-adjusted logistic regression models with adjusted Odds Ratios (aORs) and 95% CIs to assess differences in support for abortion in the case of fetal congenital Zika syndrome (CZS), maternal Zika infection during pregnancy, and maternal COVID-19 infection during pregnancy. Results Significantly more women support the right to abortion in the case of fetal CZS (50%) than in the case of maternal Zika infection (40%) and maternal COVID-19 infection (31%). Support for abortion varies by income and religion. Controlling for other demographic characteristics, high-income women have higher odds of supporting abortion in the case of fetal CZS (aOR = 1.92; 95% CI: 1.25-2.94) and maternal Zika infection (aOR = 2.07; 95% CI: 1.33-3.21) than low-income women. Evangelical women have lower odds of supporting abortion in the case of maternal Zika infection (aOR = 0.65; 95% CI: 0.45-0.93) and marginally lower odds of supporting the right to abortion in the case of maternal COVID-19 infection (aOR = 0.69; 95% CI: 0.47-1.00) than women of other religious affiliations. Conclusions and Policy Implications With increasingly conservative religious groups gaining size in Brazil, we expect to see increasing abortion restrictions. However, this research finds that a sizable portion of women across all incomes and religious affiliations support abortion, particularly in the case of fetal anomalies associated with Zika.
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Affiliation(s)
- Brooke Whitfield
- Population Research Center, University of Texas at Austin, 305 E 23rd St. G1800, Austin, TX 78712 USA
| | - Leticia Marteleto
- Population Research Center, University of Texas at Austin, 305 E 23rd St. G1800, Austin, TX 78712 USA
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Rosado LEP, de Aquino EC, Brickley EB, França DDDS, Silva FPA, da Silva VL, Lopes AF, Turchi MD. Socioeconomic disparities associated with symptomatic Zika virus infections in pregnancy and congenital microcephaly: A spatiotemporal analysis from Goiânia, Brazil (2016 to 2020). PLoS Negl Trop Dis 2022; 16:e0010457. [PMID: 35714146 PMCID: PMC9246127 DOI: 10.1371/journal.pntd.0010457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 06/30/2022] [Accepted: 04/30/2022] [Indexed: 11/18/2022] Open
Abstract
The Zika virus (ZIKV) epidemic, which was followed by an unprecedented outbreak of congenital microcephaly, emerged in Brazil unevenly, with apparent pockets of susceptibility. The present study aimed to detect high-risk areas for ZIKV infection and microcephaly in Goiania, a large city of 1.5 million inhabitants in Central-West Brazil. Using geocoded surveillance data from the Brazilian Information System for Notifiable Diseases (SINAN) and from the Public Health Event Registry (RESP-microcefalia), we analyzed the spatiotemporal distribution and socioeconomic indicators of laboratory confirmed (RT-PCR and/or anti-ZIKV IgM ELISA) symptomatic ZIKV infections among pregnant women and clinically confirmed microcephaly in neonates, from 2016 to 2020. We investigated temporal patterns by estimating the risk of symptomatic maternal ZIKV infections and microcephaly per 1000 live births per month. We examined the spatial distribution of maternal ZIKV infections and microcephaly cases across the 63 subdistricts of Goiania by manually plotting the geographical coordinates. We used spatial scan statistics estimated by discrete Poisson models to detect high clusters of maternal ZIKV infection and microcephaly and compared the distributions by socioeconomic indicators measured at the subdistrict level. In total, 382 lab-confirmed cases of maternal ZIKV infections, and 31 cases of microcephaly were registered in the city of Goiania. More than 90% of maternal cases were reported between 2016 and 2017. The highest incidence of ZIKV cases among pregnant women occurred between February and April 2016. A similar pattern was observed in the following year, although with a lower number of cases, indicating seasonality for ZIKV infection, during the local rainy season. Most congenital microcephaly cases occurred with a time-lag of 6 to 7 months after the peak of maternal ZIKV infection. The highest estimated incidence of maternal ZIKV infections and microcephaly were 39.3 and 2.5 cases per 1000 livebirths, respectively. Districts with better socioeconomic indicators and with higher proportions of self-identified white inhabitants were associated with lower risks of maternal ZIKV infection. Overall, the findings indicate heterogeneity in the spatiotemporal patterns of maternal ZIKV infections and microcephaly, which were correlated with seasonality and included a high-risk geographic cluster. Our findings identified geographically and socio-economically underprivileged groups that would benefit from targeted interventions to reduce exposure to vector-borne infections. The first wave of Zika virus (ZIKV) epidemic and its Congenital Zika Syndrome, has vanished. However, the consequences have remained for the affected children and families ever since. In Brazil, the first cases of microcephaly, detected in the end of 2015 in the Northeast region, especially in coastal cities, quickly spread to other regions and cities in countryside of Brazil. Understanding the temporal and spatial dynamics of cases distribution is essential to identify areas of greater risk and enable preparedness for a future wave of cases. In this study, we analyzed the spatiotemporal distribution of cases of ZIKV infection in pregnant women and cases of microcephaly in newborns by district, over a five-year period, in a large city in Midwest Brazil. Additionally, cases of microcephaly were correlated with the socioeconomic and structural conditions at the local level. Our findings indicate heterogeneity in the spatiotemporal patterns of maternal ZIKV infections and microcephaly, which were correlated with seasonality and included a persistent high-risk geographic location (cluster) in the city of Goiania. We could identify geographically and socio-economically underprivileged groups, with higher risk for ZIKV infection, that would benefit from targeted interventions to reduce exposure to new vector borne infections.
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Affiliation(s)
- Luiza Emylce Pela Rosado
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil
- Department of Obstetrics, of Maternal Children’s Hospital, Goiania, Brazil
- * E-mail:
| | | | - Elizabeth Bailey Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | | | | | - Marilia Dalva Turchi
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil
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6
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Falcão Neto PADO, Branco MDRFC, Costa SDSB, Câmara APB, Marques TMNF, Araujo AS, Loureiro FHF, Dias Júnior JDJ, Silva MDSD, Queiroz RCDS, Ribeiro MRC, Kulkarni MA, Silva AAMD, Santos AMD. Análise espacial da taxa de detecção de casos suspeitos de síndrome congênita pelo vírus Zika, Maranhão, 2015 a 2018. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2022; 25:e220002. [DOI: 10.1590/1980-549720220002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/03/2021] [Indexed: 11/21/2022] Open
Abstract
RESUMO: Objetivo: Identificar padrões espaciais em casos de lactentes com alterações de crescimento e desenvolvimento relacionadas à infecção pelo vírus Zika e outras etiologias infecciosas (neste trabalho denominado de síndrome congênita pelo vírus Zika), notificados no Maranhão de 2015 a 2018 e sua relação com variáveis socioeconômicas e demográficas. Métodos: Estudo ecológico de casos suspeitos notificados de síndrome congênita pelo vírus Zika nos 217 municípios do Maranhão, Brasil. Calculou-se a autocorrelação espacial pelos índices de Moran local e global (I) univariado e bivariado da taxa de detecção de casos suspeitos de síndrome congênita pelo vírus Zika com índice de desenvolvimento humano municipal, densidade demográfica, índice de Gini e tempo de emancipação político-administrativa dos municípios. O índice de Moran local foi calculado para localizar clusters com autocorrelação espacial significativa. Resultados: Houve autocorrelação espacial na análise univariada da taxa municipal de detecção de casos suspeitos de síndrome congênita pelo vírus Zika (I=0,494; p=0,001) e, na análise bivariada, correlação positiva da taxa de detecção de casos suspeitos com índice de desenvolvimento humano municipal (I=0,252; p=0,001), densidade demográfica (I=0,338; p=0,001) e tempo de emancipação dos municípios (I=0,134; p=0,001). Não houve correlação significativa da taxa de detecção de casos suspeitos com o índice de Gini (I= -0,033; p=0,131). Cinco clusters de alta detecção de casos suspeitos foram encontrados em áreas distintas do estado. Conclusões: Os municípios com maior índice de desenvolvimento humano municipal, maior densidade demográfica e mais tempo de emancipação político-administrativa tiveram mais casos suspeitos notificados de síndrome congênita pelo vírus Zika.
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Lobkowicz L, Power GM, De Souza WV, Montarroyos UR, Martelli CMT, de Araùjo TVB, Bezerra LCA, Dhalia R, Marques ETA, Miranda-Filho DDB, Brickley EB, Ximenes RADA. Neighbourhood-level income and Zika virus infection during pregnancy in Recife, Pernambuco, Brazil: an ecological perspective, 2015-2017. BMJ Glob Health 2021; 6:bmjgh-2021-006811. [PMID: 34857522 PMCID: PMC8640636 DOI: 10.1136/bmjgh-2021-006811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 10/28/2021] [Indexed: 11/24/2022] Open
Abstract
Zika virus (ZIKV) infections during pregnancy can lead to adverse neurodevelopmental and clinical outcomes in congenitally infected offspring. As the city of Recife in Pernambuco State, Brazil—the epicentre of the Brazilian microcephaly epidemic—has considerable disparities in living conditions, this study used an ecological approach to investigate the association between income at the neighbourhood level and the risk of ZIKV infections in pregnant individuals between December 2015 and April 2017. The spatial distribution of pregnant individuals with ZIKV infection was plotted on a map of Recife stratified into four categories based on mean monthly income of household heads. Additionally, a Poisson regression model with robust variance was fitted to compare proportions of ZIKV infections among pregnant individuals in relation to the mean monthly income of household heads, based on the 2010 census data, across 94 neighbourhoods in Recife. The results provide evidence that the risk of ZIKV infection to pregnant individuals was higher among those residing in lower-income neighbourhoods: relative to neighbourhoods that had a mean monthly income of ≥5 times minimum wage, neighbourhoods with <1 and 1 to <2 times minimum wage had more than four times the risk (incidence rate ratio, 95% CI 4.08, 1.88 to 8.85 and 4.30, 2.00 to 9.20, respectively). This study provides evidence of a strong association between neighbourhood-level income and ZIKV infection risks in the pregnant population of Recife. In settings prone to arboviral outbreaks, locally targeted interventions to improve living conditions, sanitation, and mosquito control should be a key focus of governmental interventions to reduce risks associated with ZIKV infections during pregnancy.
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Affiliation(s)
- Ludmila Lobkowicz
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Grace M Power
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.,Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK.,MRC Integrative Epidemiology Unit, Department of Population Health Sciences, Bristol Medical School, Bristol, UK
| | | | | | | | | | | | - Rafael Dhalia
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brasil
| | - Ernesto T A Marques
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz, Recife, PE, Brasil.,Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Elizabeth B Brickley
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ricardo Arraes de Alencar Ximenes
- Departamento de Medicina Interna, Universidade de Pernambuco, Recife, PE, Brasil.,Departamento de Medicina Tropical, Universidade Federal de Pernambuco, Recife, PE, Brasil
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8
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Pinto M, Moreira MEL, Barros LBDP, Costa ACCD, Fernandes S, Kuper H. [Catastrophic expenditure on congenital Zika syndrome: results of a cross-sectional study of caregivers of children in Rio de Janeiro, Brazil]. CAD SAUDE PUBLICA 2021; 37:e00007021. [PMID: 34816948 DOI: 10.1590/0102-311x00007021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/01/2021] [Indexed: 01/07/2023] Open
Abstract
In 2015, there was an increase in cases of congenital malformations in newborns in Brazil, associated with maternal Zika virus infection, having serious social and economic repercussions for the families. The study aimed to estimate the prevalence of catastrophic expenditure by families of children with severe or mild/moderate congenital Zika syndrome (CZS) in comparison to families of children without a diagnosis of CZS in the state of Rio de Janeiro. Catastrophic expenditure occurs when spending exceeds a given proportion of the family income due to a disease. Family caregivers of children with severe CZS were younger and had less schooling and lower income. Prevalence of catastrophic expenditure was higher in families of children with CZS. Among caregivers of children with severe CZS, the prevalence of catastrophic expenditure was higher in those with severe or very severe depression, anxiety, and stress. Low social support among caregivers was also a determinant factor for increased prevalence of catastrophic expenditure. The burden on caregivers of children with severe CZS exacerbates a situation of vulnerability that requires the expansion of mechanisms for financial and social protection, through linkage of various policies capable of effectively reaching this group.
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Affiliation(s)
- Márcia Pinto
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Maria Elisabeth Lopes Moreira
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Letícia Baptista de Paula Barros
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Ana Carolina Carioca da Costa
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Silke Fernandes
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, U.K
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, U.K
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9
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Maciel ELN, Jabor PM, Macedo LR, Almada GL, Zanotti RL, Cerutti Junior C, Gomes CC, Alencar FECD, Reuter T, Andrade VLGD, Cardoso OA, Medeiros Junior NFD, Bastos WM, Bertolani MN, Silva LT, Zandonade E. Living conditions, seroprevalence and symptoms of COVID-19 in slums in the Metropolitan Region of Vitória (Espírito Santo). REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2021; 24:e210048. [PMID: 34730710 DOI: 10.1590/1980-549720210048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/05/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to estimate the prevalence of SARS-CoV-2 infection in residents of the Greater Vitória region living in subnormal and non-subnormal agglomerates, and to compare sociodemographic and clinical characteristics of total residents (infected and not infected with SARS-CoV-2) between them. METHODS Population-based prevalence study conducted by serological testing in 2020, with a study unit in households in Greater Vitória, grouped into census tracts classified as sub-normal agglomerates and non-sub-normal agglomerates. The two groups were compared in terms of prevalence and associated factors. The significance level adopted was 5%. RESULTS The prevalence found in the sub-normal clusters was 12.05% (95%CI 9.59-14.50), and in the non-sub-normal clusters 10.23% (95%CI 7.97-12.50) this difference was not statistically significant (p = 0.273). Comparing the sociodemographic characteristics, more people who declare themselves to be of mixed race were found in the sub-normal clusters, a higher percentage of illiterates and people with only elementary education, greater number of residents per household, longer stay in public transportation, sharing a bathroom with another household, fewer bedrooms per residence and higher frequency of irregular water supply when compared to non-sub-normal clusters (p < 0.05). CONCLUSIONS The epidemiological characteristics of sub-normal clusters' residents show the social inequalities that can hinder control measures in a pandemic situation.
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Affiliation(s)
- Ethel Leonor Noia Maciel
- Biomedical Center, Department of Nursing, Universidade Federal do Espírito Santo - Vitória (ES), Brazil.,Epidemiology Laboratory, Universidade Federal do Espírito Santo - Vitória (ES), Brazil
| | | | - Laylla Ribeiro Macedo
- Epidemiology Laboratory, Universidade Federal do Espírito Santo - Vitória (ES), Brazil
| | | | | | | | | | | | - Tania Reuter
- Universitary hospital Cassiano Antonio de Moraes - Vitória (ES), Brazil
| | | | | | | | | | | | | | - Eliana Zandonade
- Center for Exact Sciences, Universidade Federal do Espírito Santo - Vitória (ES), Brazil
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Nunes PS, Guimarães RA, Martelli CMT, de Souza WV, Turchi MD. Zika virus infection and microcephaly: spatial analysis and socio-environmental determinants in a region of high Aedes aegypti infestation in the Central-West Region of Brazil. BMC Infect Dis 2021; 21:1107. [PMID: 34706662 PMCID: PMC8549329 DOI: 10.1186/s12879-021-06805-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 10/19/2021] [Indexed: 11/25/2022] Open
Abstract
Background More than 5 years after the Zika virus (ZIKV) epidemic, Zika infection remains a major concern in regions with high Aedes infestation. The objectives of this study were (i) to identify clusters of ZIKV infection and microcephaly, and/or central nervous system (CNS) alterations associated with congenital infection during the epidemic peak in 2016 and subsequently, in 2017 and 2018; (ii) to measure the non-spatial correlation between ZIKV infection and microcephaly and/or CNS alterations associated with congenital infection; and (iii) to analyse the sociodemographic/economic, health, and environmental determinants associated with the incidence of ZIKV in a region of high infestation by Aedes aegypti in the Central-West Region of Brazil. Methods This ecological study analysed 246 municipalities in the state of Goiás (6.9 million inhabitants). The data were obtained from the Information System for Notifiable Diseases (ZIKV cases) and the Public Health Event Registry (microcephaly and/or CNS alterations associated with congenital infection). Incidence rates and prevalence of ZIKA infection were smoothed by an empirical Bayesian estimator (LEbayes), producing the local empirical Bayesian rate (LEBR). In the spatial analysis, ZIKV infection and microcephaly cases were georeferenced by the municipality of residence for 2016 and grouped for 2017 and 2018. Global Moran's I and the Hot Spot Analysis tool (Getis-Ord Gi* statistics) were used to analyse the spatial autocorrelation and clusters of ZIKV infection and microcephaly, respectively. A generalised linear model from the Poisson family was used to assess the association between ecological determinants and the smoothing incidence rate of ZIKV infection. Results A total of 9892 cases of acute ZIKV infection and 121 cases of microcephaly were confirmed. The mean LEBR of the ZIKV infection in the 246 municipalities was 22.3 cases/100,000 inhabitants in 2016, and 10.3 cases/100,000 inhabitants in 2017 and 2018. The LEBR of the prevalence rate of microcephaly and/or CNS alterations associated with congenital infection was 7 cases/10,000 live births in 2016 and 2 cases/10,000 live births during 2017–2018. Hotspots of ZIKV infection and microcephaly cases were identified in the capital and neighbouring municipalities in 2016, with new clusters in the following years. In a multiple regression Poisson analysis, ZIKV infection was associated with higher population density, the incidence of dengue, Aedes larvae infestation index, and average rainfall. The important determinant of ZIKV infection incidence reduction was the increase in households attended by endemic disease control agents. Conclusions Our analyses were able to capture, in a more granular way, aspects that make it possible to inform public managers of the sentinel areas identified in the post-epidemic hotspots. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06805-1.
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Affiliation(s)
- Patrícia Silva Nunes
- Federal Institute of Education, Science and Technology of Goiás, Goiânia, Brazil. .,Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil.
| | - Rafael Alves Guimarães
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil.,Faculty of Nursing, Federal University of Goiás, Goiânia, Brazil
| | | | | | - Marília Dalva Turchi
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil.
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Social determinants associated with Zika virus infection in pregnant women. PLoS Negl Trop Dis 2021; 15:e0009612. [PMID: 34329305 PMCID: PMC8323902 DOI: 10.1371/journal.pntd.0009612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/01/2021] [Indexed: 11/23/2022] Open
Abstract
This study aims to describe the sociodemographic determinants associated with exposure to Zika Virus (ZIKV) in pregnant women during the 2015–2016 epidemic in Salvador, Brazil. The Zika virus (ZIKV) epidemic in Brazil has intensified global concern about congenital defects associated with intrauterine exposure. Social determinants are factors that reinforce and contribute to the transmission and spread of ZIKV as well as other arboviruses like Dengue. We performed a cross-sectional study to describe the prevalence of ZIKV and the contribution of social determinants to transmission among pregnant women during the 2015–2016 ZIKV epidemic in Salvador, Brazil. We found that 61% of pregnant women were ZIKV seropositive. We also found that lower education level, food insecurity and lower maternal age were associated with higher ZIKV infection risk. These findings contribute to understanding the role of social determinants in ZIKV transmission, providing key social factors that can be combined with pre-existing tactics (vector control and environmental improvement) to create policies and interventions which reduce social inequalities and risk of infection in vulnerable populations like pregnant women.
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Teixeira GA, Silva AND, Miranda LSMVD, Silva MPMD, Cavalcante EFDO, Enders BC. Theoretical care model for children with congenital Zika virus syndrome in the family context. Rev Lat Am Enfermagem 2021; 29:e3458. [PMID: 34190948 PMCID: PMC8253351 DOI: 10.1590/1518-8345.4057.3458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 12/07/2020] [Indexed: 11/23/2022] Open
Abstract
Objective: to develop a theoretical model about the care of children with Congenital
Zika Virus Syndrome in the family context. Method: the Straussian Grounded Theory and the theoretical/philosophical framework of
Callista Roy and Leonardo Boff were used. It was carried out in northeastern
Brazil, with 19 participants, in four sample groups. The data were collected
and analyzed simultaneously, using the constant comparison method. Results: the theoretical model comprising the mother’s care for the child with
Congenital Zika Virus Syndrome in the family context is formed by five
categories: revealing family care, centered on the mother, to the child with
the syndrome; identifying the maternal bond that determines the care for
children with the syndrome in the family context; identifying the factors
that hinder the mother’s care for the child with the syndrome; recognizing
the evolution of the child with the syndrome in the face of early
stimulation care; and recognizing harms due to the absence of early stimulus
to children with the syndrome. Conclusion: the phenomenon runs through the care of the child with Congenital Zika Virus
Syndrome, in the family context and centered on the mother, and is faced
with the need for shared responsibility among the family members.
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Affiliation(s)
| | - Aylla Nauana da Silva
- Universidade Federal do Rio Grande do Norte, Departamento de Enfermagem, Natal, RN, Brazil
| | | | | | | | - Bertha Cruz Enders
- Universidade Federal do Rio Grande do Norte, Departamento de Enfermagem, Natal, RN, Brazil
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Raymundo CE, de Andrade Medronho R. Association between socio-environmental factors, coverage by family health teams, and rainfall in the spatial distribution of Zika virus infection in the city of Rio de Janeiro, Brazil, in 2015 and 2016. BMC Public Health 2021; 21:1199. [PMID: 34162338 PMCID: PMC8220830 DOI: 10.1186/s12889-021-11249-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 06/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Zika virus (ZIKV) infection caused outbreak in Brazil, in 2015 and 2016. Disorganized urban growth, facilitates the concentration of numerous susceptible and infected individuals. It is useful to understand the mechanisms that can favor the increase in ZIKV incidence, such as areas with wide socioeconomic and environmental diversity. Therefore, the study analyzed the spatial distribution of ZIKV in the city of Rio de Janeiro, Brazil, in 2015 and 2016, and associations between the incidence per 1000 inhabitants and socio-environmental factors. METHODS The census tracts were used as the analytical units reported ZIKV cases among the city's inhabitants. Local Empirical Bayesian method was used to control the incidence rates' instability effect. The spatial autocorrelation was verified with Moran's Index and local indicators of spatial association (LISA). Spearman correlation matrix was used to indicate possible collinearity. The Ordinary Least Squares (OLS), Spatial Lag Model (SAR), and Spatial Error Model (CAR) were used to analyze the relationship between ZIKV and socio-environmental factors. RESULTS The SAR model exhibited the best parameters: R2 = 0.44, Log-likelihood = - 7482, Akaike Information Criterion (AIC) = 14,980. In this model, mean income between 1 and 2 minimum wages was possible risk factors for Zika occurrence in the localities. Household conditions related to adequate water supply and the existence of public sewage disposal were associated with lower ZIKV cumulative incidence, suggesting possible protective factors against the occurrence of ZIKV in the localities. The presence of the Family Health Strategy in the census tracts was positively associated with the ZIKV cumulative incidence. However, the results show that mean income less than 1 minimum wage were negatively associated with higher ZIKV cumulative incidence. CONCLUSION The results demonstrate the importance of socio-environmental variables in the dynamics of ZIKV transmission and the relevance for the development of control strategies.
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Affiliation(s)
- Carlos Eduardo Raymundo
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, State of Rio de Janeiro, Brazil.
- Present address: s/n - Próximo a Prefeitura Universitária da UFRJ Rio de Janeiro, Avenida Horácio Macedo, Rio de Janeiro, State of Rio de Janeiro, 21941598, Brazil.
| | - Roberto de Andrade Medronho
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, State of Rio de Janeiro, Brazil
- Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, State of Rio de Janeiro, Brazil
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A spatio-temporal analysis of dengue spread in a Brazilian dry climate region. Sci Rep 2021; 11:11892. [PMID: 34088931 PMCID: PMC8178350 DOI: 10.1038/s41598-021-91306-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 05/24/2021] [Indexed: 11/13/2022] Open
Abstract
We investigated the relation between the spread, time scale, and spatial arrangement of dengue in Bahia, a Brazilian dry climate region, for the period 2000 to 2009. The degree of cross-correlation is calculated for 15 economic regions. We propose a multiscale statistical analysis to datasets of dengue cases in order to verify the effect of infection dispersal on the economic regions from the metropolitan region of Salvador. Our empirical results support a significant and persistent cross-correlation between most regions, reinforcing the idea that economic regions or climatic conditions are non-statistically significant in the spread of dengue in the State of Bahia. Our main contribution lies in the cross-correlation results revealing multiple aspects related to the propagation of dengue in dry climate regions.
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Morgan J, Strode C, Salcedo-Sora JE. Climatic and socio-economic factors supporting the co-circulation of dengue, Zika and chikungunya in three different ecosystems in Colombia. PLoS Negl Trop Dis 2021; 15:e0009259. [PMID: 33705409 PMCID: PMC7987142 DOI: 10.1371/journal.pntd.0009259] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 03/23/2021] [Accepted: 02/20/2021] [Indexed: 02/06/2023] Open
Abstract
Dengue, Zika and chikungunya are diseases of global health significance caused by arboviruses and transmitted by the mosquito Aedes aegypti, which is of worldwide circulation. The arrival of the Zika and chikungunya viruses to South America increased the complexity of transmission and morbidity caused by these viruses co-circulating in the same vector mosquito species. Here we present an integrated analysis of the reported arbovirus cases between 2007 and 2017 and local climate and socio-economic profiles of three distinct Colombian municipalities (Bello, Cúcuta and Moniquirá). These locations were confirmed as three different ecosystems given their contrasted geographic, climatic and socio-economic profiles. Correlational analyses were conducted with both generalised linear models and generalised additive models for the geographical data. Average temperature, minimum temperature and wind speed were strongly correlated with disease incidence. The transmission of Zika during the 2016 epidemic appeared to decrease circulation of dengue in Cúcuta, an area of sustained high incidence of dengue. Socio-economic factors such as barriers to health and childhood services, inadequate sanitation and poor water supply suggested an unfavourable impact on the transmission of dengue, Zika and chikungunya in all three ecosystems. Socio-demographic influencers were also discussed including the influx of people to Cúcuta, fleeing political and economic instability from neighbouring Venezuela. Aedes aegypti is expanding its range and increasing the global threat of these diseases. It is therefore vital that we learn from the epidemiology of these arboviruses and translate it into an actionable local knowledge base. This is even more acute given the recent historical high of dengue cases in the Americas in 2019, preceding the COVID-19 pandemic, which is itself hampering mosquito control efforts.
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Affiliation(s)
- Jasmine Morgan
- Department of Biology, Edge Hill University, Lancashire, United Kingdom
| | - Clare Strode
- Department of Biology, Edge Hill University, Lancashire, United Kingdom
- * E-mail: (CS); (JES-S)
| | - J. Enrique Salcedo-Sora
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- * E-mail: (CS); (JES-S)
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Thorson A, Aslanyan G, Brizuela V, Perez F, Gómez Ponce de León R, Reeder JC, Serruya SJ, Espinal M, Askew I. Research and research capacity strengthening in the context of an emerging epidemic: Zika virus in Latin America. Int J Gynaecol Obstet 2020; 148 Suppl 2:1-3. [PMID: 31975399 DOI: 10.1002/ijgo.13040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Anna Thorson
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Garry Aslanyan
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Vanessa Brizuela
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Freddy Perez
- Communicable Diseases and Environmental Determinants of Health Department, Pan American Health Organization (PAHO), Washington, DC, USA
| | | | - John C Reeder
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
| | - Suzanne J Serruya
- Center for Perinatology, Women's Health, and Reproduction (CLAP/PAHO), Montevideo, Uruguay
| | - Marcos Espinal
- Communicable Diseases and Environmental Determinants of Health Department, Pan American Health Organization (PAHO), Washington, DC, USA
| | - Ian Askew
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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