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Adelino TÉR, Santos SC, Lima MT, da Costa AVB, Guimarães NR, Tomé LMR, Silva MVF, Pereira AM, Luiz KCM, Lamounier LO, Gomes Júnior AC, Ribeiro AA, Alvarez P, Arruda MB, Kroon EG, Guerra-Duarte C, Iani FCDM. Differential diagnosis of exanthematous viruses during the 2022 Mpox outbreak in Minas Gerais, Brazil. J Clin Microbiol 2024; 62:e0010324. [PMID: 38785446 PMCID: PMC11237812 DOI: 10.1128/jcm.00103-24] [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: 01/23/2024] [Accepted: 04/24/2024] [Indexed: 05/25/2024] Open
Abstract
The monkeypox virus (MPXV) outbreak, primarily endemic to Africa, has spread globally, with Brazil reporting the second-highest number of cases. The emergence of MPXV in non-endemic areas has raised concerns, particularly due to the co-circulation of other exanthematous viruses such as varicella-zoster virus (VZV) and molluscum contagiosum virus (MOCV). To perform an accurate differential diagnosis of MPXV during the ongoing outbreak in Minas Gerais, Brazil, a 5PLEX qPCR assay targeting orthopoxviruses (OPV), VZV, and MOCV was used to retrospectively analyze all clinical samples that tested negative for MPXV in the initial screening conducted at Funed. In summary, our study analyzed 1,175 clinical samples received from patients suspected of MPXV infection and found a positivity rate of 33.8% (397 samples) for MPXV using the non-variola qPCR assay. Testing the 778 MPXV-negative clinical samples using the 5PLEX qPCR assay revealed that 174 clinical samples (22.36%) tested positive for VZV. MOCV DNA was detected in 13 and other OPV in 3 clinical samples. The sequencing of randomly selected amplified clinical samples confirmed the initial molecular diagnosis. Analysis of patient profiles revealed a significant difference in the median age between groups testing positive for MPXV and VZV and a male predominance in MPXV cases. The geographic distribution of positive cases was concentrated in the most populous mesoregions of Minas Gerais state. This study highlights the challenges posed by emerging infectious diseases. It emphasizes the importance of epidemiological surveillance and accurate diagnosis in enabling timely responses for public health policies and appropriate medical care. IMPORTANCE Brazil ranks second in the number of cases during the global monkeypox epidemic. The study, conducted in Minas Gerais, the second most populous state in Brazil with over 20 million inhabitants, utilized differential diagnostics, revealing a significant number of positive cases for other exanthematous viruses and emphasizing the need for accurate diagnoses. During the study, we were able to assess the co-circulation of other viruses alongside monkeypox, including varicella-zoster virus, molluscum contagiosum virus, and other orthopoxviruses. The significance of the research is underscored by the concentration of positive cases in populous areas, highlighting the challenges posed by emerging infectious diseases. This demographic context further amplifies the importance of the research in guiding public health policies and medical interventions, given the substantial population at risk. The study not only addresses a global concern but also holds critical implications for a state with such a large population and geographic expanse within Brazil. Overall, the study emphasizes the pivotal role of surveillance and precise diagnosis in guiding effective public health responses and ensuring appropriate medical interventions.
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Affiliation(s)
- Talita Émile Ribeiro Adelino
- Diretoria do Instituto Octávio Magalhães, Fundação Ezequiel Dias (Funed), Belo Horizonte, Minas Gerais, Brazil
- Instituto René Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
| | - Sara Cândida Santos
- Diretoria do Instituto Octávio Magalhães, Fundação Ezequiel Dias (Funed), Belo Horizonte, Minas Gerais, Brazil
| | - Maurício Teixeira Lima
- Diretoria do Instituto Octávio Magalhães, Fundação Ezequiel Dias (Funed), Belo Horizonte, Minas Gerais, Brazil
- Departamento de Microbiologia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | | | - Natália Rocha Guimarães
- Diretoria do Instituto Octávio Magalhães, Fundação Ezequiel Dias (Funed), Belo Horizonte, Minas Gerais, Brazil
- Instituto René Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
| | - Luiz Marcelo Ribeiro Tomé
- Diretoria do Instituto Octávio Magalhães, Fundação Ezequiel Dias (Funed), Belo Horizonte, Minas Gerais, Brazil
- Instituto René Rachou, Fundação Oswaldo Cruz (FIOCRUZ), Belo Horizonte, Minas Gerais, Brazil
- Laboratório de Biologia Molecular e Computacional de Fungos, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | | | - Amanda Matos Pereira
- Diretoria do Instituto Octávio Magalhães, Fundação Ezequiel Dias (Funed), Belo Horizonte, Minas Gerais, Brazil
| | | | - Ludmila Oliveira Lamounier
- Diretoria do Instituto Octávio Magalhães, Fundação Ezequiel Dias (Funed), Belo Horizonte, Minas Gerais, Brazil
| | - Antônio Carlos Gomes Júnior
- Diretoria do Instituto Octávio Magalhães, Fundação Ezequiel Dias (Funed), Belo Horizonte, Minas Gerais, Brazil
| | - Adriana Aparecida Ribeiro
- Diretoria do Instituto Octávio Magalhães, Fundação Ezequiel Dias (Funed), Belo Horizonte, Minas Gerais, Brazil
| | - Patrícia Alvarez
- Laboratório de Tecnologia Diagnóstica (LATED), Instituto de Tecnologia de Imunobiológicos (Bio-Manguinhos), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Mônica Barcellos Arruda
- Laboratório de Tecnologia Diagnóstica (LATED), Instituto de Tecnologia de Imunobiológicos (Bio-Manguinhos), Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Erna Geessien Kroon
- Departamento de Microbiologia, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Minas Gerais, Brazil
| | - Clara Guerra-Duarte
- Diretoria de Pesquisa e Desenvolvimento, Fundação Ezequiel Dias (Funed), Belo Horizonte, Minas Gerais, Brazil
| | - Felipe Campos de Melo Iani
- Diretoria do Instituto Octávio Magalhães, Fundação Ezequiel Dias (Funed), Belo Horizonte, Minas Gerais, Brazil
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Enore RMB, Freitas BHBMD, Silva RAD, Gaíva MAM. Vaccination coverage and abandonment among children under two years old in Brazil: a time-series study. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2024; 42:e2023116. [PMID: 38836806 DOI: 10.1590/1984-0462/2024/42/2023116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 02/18/2024] [Indexed: 06/06/2024]
Abstract
OBJECTIVE To analyze the vaccination coverage and abandonment rates among children under two years old in Brazil, from 2015 to 2021. METHODS A time-series ecological study. The dependent variables of the research were "vaccination coverage" and "abandonment rate", both assessed by Brazilian region. The data were extracted in July 2022 from the Information System of the National Immunization Program. The Prais-Winsten technique was used for the trend analysis, with the aid of the STATA 16.0 software. RESULTS The mean vaccination coverage in Brazil was 76.96%, with a decreasing trend during the period (Annual Percent Change=-5.12; confidence interval - CI95% -7.81; -2.34); in 2015, the rate was 88.85% and it dropped to 62.35% in 2021. In turn, the overall abandonment rate was 24.00% in 2015 and 9.01% in 2021, with a mean of 10.48% and a stationary trend (Annual Percentage Change=-9.54; CI95% -22.92; 6.12). In 2021, all the vaccines presented coverage values below 74.00% in the country. CONCLUSIONS The vaccination coverage rate trend among children under two years old was stationary or decreasing for all the immunobiologicals in all Brazilian regions, with the exception of yellow fever in the South and Southeast regions. There was an increase in the abandonment rate trend for the Meningococcal C vaccine in the country and, specifically in relation to the regions, for BCG in the North, Northeast, and Midwest and for Meningococcal C in the North and Northeast.
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Abreu E Silva HBD, Corrêa HP, Ribeiro IA, Nascimento VAM, Greco CM, Pinto ICT, Teixeira DC, Diniz LMO, Ribeiro JGL. Impact of six years of routine varicella vaccination on the disease-related hospitalizations at Minas Gerais, Brazil. Vaccine 2021; 40:390-395. [PMID: 34507860 DOI: 10.1016/j.vaccine.2021.08.008] [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: 04/13/2021] [Revised: 07/07/2021] [Accepted: 08/01/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The varicella vaccine was first introduced into the Brazilian immunization schedule in September 2013 as a single dose for children aged 15 months. In 2018, a second dose was recommended for individuals between 4 and 6 years old. This study aims to assess the impact of routine varicella vaccination on the number and profile of hospitalized varicella patients during the single dose period, as well as in the first two years after the adoption of the second dose. METHODS An observational retrospective study was conducted in an infectious disease pediatric hospital, in Minas Gerais, Brazil. Clinical as well as epidemiological data from patients hospitalized due to varicella between 2010 and 2019 were collected. Patients were split into groups based on the vaccine introduction: pre-vaccine period, single dose and two-dose period. They were compared by age, sex, reason for admission, illness-related complications and clinical outcome. RESULTS There were 1193 admissions due to varicella during the studied period. When compared with the pre-vaccine period, the number of hospitalizations decreased in 61.5% during the single-dose regime, reaching 95.2% in the two-dose period. Hospitalization rates decreased in all age groups, including non-vaccinated individuals such as those younger than 12 months (92.1%). As for reasons of admission, secondary bacterial skin infections were perceived to be the most common cause (>70%). A reduction was also seen in admission of immunocompromised or HIV positive patients (84.8%). CONCLUSION The collected data shows a significant impact in the number of hospital admissions due to varicella after six years of the implementation of the vaccine, positively affecting both vaccinated and non-vaccinated individuals. Further reduction was seen after the second dose was initiated, but its true impact will only be understood fully after a longer period of continuous vaccination.
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Vitale F, Amodio E. Evaluation of varicella vaccine effectiveness as public health tool for increasing scientific evidence and improving vaccination programs. J Pediatr (Rio J) 2020; 96:670-672. [PMID: 32619409 PMCID: PMC9432120 DOI: 10.1016/j.jped.2020.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Francesco Vitale
- University of Palermo, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Palermo, Italy.
| | - Emanuele Amodio
- University of Palermo, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Palermo, Italy
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