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Park C, Richardson DB, Tchetgen Tchetgen EJ. Single proxy control. Biometrics 2024; 80:ujae027. [PMID: 38646999 PMCID: PMC11033710 DOI: 10.1093/biomtc/ujae027] [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: 03/16/2023] [Revised: 12/08/2023] [Accepted: 03/27/2024] [Indexed: 04/25/2024]
Abstract
Negative control variables are sometimes used in nonexperimental studies to detect the presence of confounding by hidden factors. A negative control outcome (NCO) is an outcome that is influenced by unobserved confounders of the exposure effects on the outcome in view, but is not causally impacted by the exposure. Tchetgen Tchetgen (2013) introduced the Control Outcome Calibration Approach (COCA) as a formal NCO counterfactual method to detect and correct for residual confounding bias. For identification, COCA treats the NCO as an error-prone proxy of the treatment-free counterfactual outcome of interest, and involves regressing the NCO on the treatment-free counterfactual, together with a rank-preserving structural model, which assumes a constant individual-level causal effect. In this work, we establish nonparametric COCA identification for the average causal effect for the treated, without requiring rank-preservation, therefore accommodating unrestricted effect heterogeneity across units. This nonparametric identification result has important practical implications, as it provides single-proxy confounding control, in contrast to recently proposed proximal causal inference, which relies for identification on a pair of confounding proxies. For COCA estimation we propose 3 separate strategies: (i) an extended propensity score approach, (ii) an outcome bridge function approach, and (iii) a doubly-robust approach. Finally, we illustrate the proposed methods in an application evaluating the causal impact of a Zika virus outbreak on birth rate in Brazil.
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Affiliation(s)
- Chan Park
- Department of Statistics and Data Science, University of Pennsylvania, Philadelphia, PA 19104, United States
| | - David B Richardson
- Department of Environmental & Occupational Health, University of California Irvine, Irvine, CA 92697, United States
| | - Eric J Tchetgen Tchetgen
- Department of Statistics and Data Science, University of Pennsylvania, Philadelphia, PA 19104, United States
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Terra AP, Rohweder R, Herber S, Friedrich L, Sanseverino MTV, Favreto C, Maria FS, Athayde EDJ, Cardoso-Júnior LM, Marinho ACP, Marinho AP, Zarpelon T, Schuler-Faccini L. Microcephaly in South Brazil: Are cases of Congenital Zika Syndrome increasing in recent years? Genet Mol Biol 2024; 46:e20230191. [PMID: 38252061 PMCID: PMC10802226 DOI: 10.1590/1678-4685-gmb-2023-0191] [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: 06/26/2023] [Accepted: 12/04/2023] [Indexed: 01/23/2024] Open
Abstract
Northeast Brazil was the first region to detect a significant increase in babies born with microcephaly associated with prenatal zika virus infection in 2015. Rio Grande do Sul (RS) state was less impacted due to the temperate climate preventing the spread of the vector. This study investigated the prevalence and etiology of congenital microcephaly in RS in two different periods. This cross-sectional descriptive study included all live births with congenital microcephaly in RS from 2015 to 2022. Cases were divided into two groups: P1 "outbreak" (2015-16); and P2 "endemic" (2017-22). There were 58 cases of microcephaly (3.8/10,000) in P1 and 148 (1.97/10,000) in P2. Congenital Zika Virus infection was the etiology in 5.2% (n=3) in P1 and 6.7% (n=10) in P2. In conclusion, although the ZIKV outbreak in Brazil has receded, RS remains an area of concern, with a possible slight increase of live births with microcephaly secondary to ZIKV prenatal infection relative to the number of cases due to congenital infections. The broader distribution of the vector Aedes aegypti with warmer temperatures in our state might be linked to the increase in recent years. This study can be an alert to other regions of temperate or subtropical climates.
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Affiliation(s)
- Anna Pires Terra
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Genética e Biologia Molecular (PPGBM), Porto Alegre, RS, Brazil
- Hospital de Clínicas de Porto Alegre, Serviço de Genética Médica, Sistema de Informação sobre Agentes Teratogênicos (SIAT), Porto Alegre, RS, Brazil
- Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Neonatologia, Porto Alegre, RS, Brazil
| | - Ricardo Rohweder
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Genética e Biologia Molecular (PPGBM), Porto Alegre, RS, Brazil
- Hospital de Clínicas de Porto Alegre, Serviço de Genética Médica, Sistema de Informação sobre Agentes Teratogênicos (SIAT), Porto Alegre, RS, Brazil
| | - Silvani Herber
- Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Neonatologia, Porto Alegre, RS, Brazil
- Universidade Federal de Ciências da Saúde de Porto Alegre(UFCSPA), Departamento de Enfermagem, Porto Alegre, RS, Brazil
| | - Luciana Friedrich
- Hospital de Clínicas de Porto Alegre (HCPA), Serviço de Neonatologia, Porto Alegre, RS, Brazil
- Universidade Federal do Rio Grande do Sul, Faculdade de Medicina, Porto Alegre, RS, Brazil
| | - Maria Teresa Vieira Sanseverino
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Genética e Biologia Molecular (PPGBM), Porto Alegre, RS, Brazil
- Hospital de Clínicas de Porto Alegre, Serviço de Genética Médica, Sistema de Informação sobre Agentes Teratogênicos (SIAT), Porto Alegre, RS, Brazil
| | - Catia Favreto
- Secretaria de Saúde do Estado do Rio Grande do Sul (SES/RS), Centro Estadual de Vigilância em Saúde (CEVS), Porto Alegre, RS, Brazil
| | - Fernanda Santa Maria
- Hospital de Clínicas de Porto Alegre, Serviço de Genética Médica, Sistema de Informação sobre Agentes Teratogênicos (SIAT), Porto Alegre, RS, Brazil
| | - Emilly de Jesus Athayde
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Genética e Biologia Molecular (PPGBM), Porto Alegre, RS, Brazil
- Hospital de Clínicas de Porto Alegre, Serviço de Genética Médica, Sistema de Informação sobre Agentes Teratogênicos (SIAT), Porto Alegre, RS, Brazil
| | - Laércio Moreira Cardoso-Júnior
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Genética e Biologia Molecular (PPGBM), Porto Alegre, RS, Brazil
- Hospital de Clínicas de Porto Alegre, Serviço de Genética Médica, Sistema de Informação sobre Agentes Teratogênicos (SIAT), Porto Alegre, RS, Brazil
| | | | | | - Tailine Zarpelon
- Universidade Federal do Rio Grande do Sul, Faculdade de Odontologia, Porto Alegre, RS, Brazil
| | - Lavínia Schuler-Faccini
- Universidade Federal do Rio Grande do Sul (UFRGS), Programa de Pós-Graduação em Genética e Biologia Molecular (PPGBM), Porto Alegre, RS, Brazil
- Hospital de Clínicas de Porto Alegre, Serviço de Genética Médica, Sistema de Informação sobre Agentes Teratogênicos (SIAT), Porto Alegre, RS, Brazil
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Tchetgen Tchetgen EJ, Park C, Richardson DB. Universal Difference-in-Differences for Causal Inference in Epidemiology. Epidemiology 2024; 35:16-22. [PMID: 38032801 PMCID: PMC10683972 DOI: 10.1097/ede.0000000000001676] [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: 02/01/2023] [Accepted: 09/21/2023] [Indexed: 12/02/2023]
Abstract
Difference-in-differences is undoubtedly one of the most widely used methods for evaluating the causal effect of an intervention in observational (i.e., nonrandomized) settings. The approach is typically used when pre- and postexposure outcome measurements are available, and one can reasonably assume that the association of the unobserved confounder with the outcome has the same absolute magnitude in the two exposure arms and is constant over time; a so-called parallel trends assumption. The parallel trends assumption may not be credible in many practical settings, for example, if the outcome is binary, a count, or polytomous, as well as when an uncontrolled confounder exhibits nonadditive effects on the distribution of the outcome, even if such effects are constant over time. We introduce an alternative approach that replaces the parallel trends assumption with an odds ratio equi-confounding assumption under which an association between treatment and the potential outcome under no treatment is identified with a well-specified generalized linear model relating the pre-exposure outcome and the exposure. Because the proposed method identifies any causal effect that is conceivably identified in the absence of confounding bias, including nonlinear effects such as quantile treatment effects, the approach is aptly called universal difference-in-differences. We describe and illustrate both fully parametric and more robust semiparametric universal difference-in-differences estimators in a real-world application concerning the causal effects of a Zika virus outbreak on birth rate in Brazil. A supplementary digital video is available at: http://links.lww.com/EDE/C90.
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Affiliation(s)
| | - Chan Park
- From the Department of Statistics and Data Science, University of Pennsylvania, Philadelphia, PA
| | - David B. Richardson
- Department of Environmental & Occupational Health, University of California, Irvine, CA
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Moreno-Louzada L, Menezes-Filho N. The relationship between staying at home during the pandemic and the number of conceptions: A national panel data analysis. PLoS One 2023; 18:e0289604. [PMID: 37566617 PMCID: PMC10420359 DOI: 10.1371/journal.pone.0289604] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
hether the COVID-19 pandemic has changed fertility patterns is still an open question, as social isolation for long periods can impact the number of conceptions in many ways. We combine administrative data on all recent births in Brazil with daily data on individual location to estimate the relationship between the share of individuals staying close to their homes in each week and the number of conceptions in that same week, comparing municipalities with different social isolation patterns during the first semester of 2020. We find that conceptions unequivocally decline when social isolation increases. The effect is stronger for women who are between 21 and 25 years old and more educated, as well as for richer, larger, and more urban municipalities. COVID-19 is likely to change fertility across countries depending on the behavior of the population and on the lock-down measures implemented to fight the pandemic.
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Lee DS, Batyra E, Castro A, Wilde J. Human fertility after a disaster: a systematic literature review. Proc Biol Sci 2023; 290:20230211. [PMID: 37161332 PMCID: PMC10170212 DOI: 10.1098/rspb.2023.0211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
Fertility is a key demographic parameter influenced by disaster. With the growing risk of disasters, interest in the fertility response to a disaster is increasing among the public, policy makers and researchers alike. However, a systematic literature review on how disaster affects live birth counts does not yet exist. We reviewed 50 studies retrieved from a systematic search based on a pre-registered protocol. We found an overall negative impact of disasters on fertility. If any, increases in fertility were mostly linked with weather-related physical disasters. We also identified 13 distinct mechanisms which researchers have considered as underlying the fertility effects of disaster. By contrast to the common belief that disasters are more likely to increase fertility in contexts with already high fertility, we found little evidence to suggest that the total fertility rate of the studied populations was an important predictor of the direction, timing or size of fertility impacts. While this may be because no relationship exists, it may also be due to biases we observed in the literature towards studying high-income countries or high-cost disasters. We summarize the methodological limitations identified from the reviewed studies into six practical recommendations for future research. Our findings inform both the theories behind the fertility effects of disasters and the methods for studying them.
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Affiliation(s)
- D Susie Lee
- Centre for Demographic Studies (CED), Barcelona, 08193, Spain
| | - Ewa Batyra
- Fertility and Well-being, Max-Planck-Institute for Demographic Research, 18057 Rostock, Mecklenburg-Vorpommern, Germany
- Centre for Demographic Studies (CED), Barcelona, 08193, Spain
| | - Andres Castro
- Fertility and Well-being, Max-Planck-Institute for Demographic Research, 18057 Rostock, Mecklenburg-Vorpommern, Germany
- Centre for Demographic Studies (CED), Barcelona, 08193, Spain
| | - Joshua Wilde
- Fertility and Well-being, Max-Planck-Institute for Demographic Research, 18057 Rostock, Mecklenburg-Vorpommern, Germany
- Institute of Labor Economics (IZA), 53113 Bonn, Germany
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Souza MPA, da Natividade MS, Werneck GL, Dos Santos DN. Congenital Zika syndrome and living conditions in the largest city of northeastern Brazil. BMC Public Health 2022; 22:1231. [PMID: 35725427 PMCID: PMC9208747 DOI: 10.1186/s12889-022-13614-x] [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: 09/25/2021] [Accepted: 06/09/2022] [Indexed: 12/01/2022] Open
Abstract
Background The Zika virus (ZIKV) epidemic hit Brazil in 2015 and resulted in a generation of children at risk of congenital Zika syndrome (CZS). The social vulnerability of certain segments of the population contributed to the disproportional occurrence of CZS in the Brazilian Northeast, the poorest region in the country. Living conditions are essential factors in understanding the social determination of CZS, which is embedded in a complex interaction between biological, environmental, and social factors. Salvador, the biggest city in the region, played a central role in the context of the epidemic and was a pioneer in reporting the ZIKV infection and registering a high number of cases of CZS. The aim of the study was identifying the incidence and spatial distribution pattern of children with CZS in the municipality of Salvador, according to living conditions. Methods This is an ecological study that uses the reported cases of ZIKV and CZS registered in the epidemiological surveillance database of the Municipal Secretariat of Health of the city of Salvador between August of 2015 and July of 2016. The neighborhoods formed the analysis units and the thematic maps were built based on the reported cases. Associations between CZS and living conditions were assessed using the Kernel ratio and a spatial autoregressive linear regression model. Results Seven hundred twenty-six live births were reported, of which 236 (32.5%) were confirmed for CZS. Despite the reports of ZIKV infection being widely distributed, the cases of CZS were concentrated in poor areas of the city. A positive spatial association was observed between living in places with poorer living conditions and births of children with CZS. Conclusions This study shows the role of living conditions in the occurrence of births of children with CZS and indicates the need for approaches that recognize the part played by social inequalities in determining CZS and in caring for the children affected.
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Affiliation(s)
- Marcos Paulo Almeida Souza
- Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Bahia, Brazil. .,Department of Surgery, University Hospital of Lagarto, Federal University of Sergipe, Lagarto, Sergipe, Brazil.
| | | | - Guilherme Loureiro Werneck
- Instituto de Estudos em Saúde Coletiva, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Instituto de Medicina Social, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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Da Costa HVV, Vieira do Bonfim C, Fusco W, Moreira MDM, Maciano de Paula Neto F. Impact of the COVID-19 pandemic on the number of births in Pernambuco Brazil. GEOSPATIAL HEALTH 2022; 17. [PMID: 35735943 DOI: 10.4081/gh.2022.1069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 04/14/2022] [Indexed: 06/15/2023]
Abstract
This study aimed at analysing the potential effects of the COVID-19 pandemic on the time series and spatial patterns of live births in the state of Pernambuco, Brazil, from 2010 to 2021. This is an ecological study that applied intervention analysis in time series, with the goal to identify how projected data behaved in relation to observed data in the months December 2020 to November 2021, i.e. months representing conceptions from March2020 to April 2021. For the state of Pernambuco, a discrepancy up to +5.7% was found between the observed and projected data, while the respective difference for the São Francisco mesoregion showed the opposite trend with maximum discrepancy of -9%. The results did not indicate a clear change in the number of live births but supported the expected continuation of the downward trend of the previous years. Considering the importance of the number of live births in the context of demography, economy and public health, monitoring must be maintained to analyse the possible future impact of the COVID-19 pandemic on live birth projections.
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Affiliation(s)
| | - Cristine Vieira do Bonfim
- Joaquim Nabuco Foundation, Recife, Pernambuco; Postgraduate Program in Collective Health, Federal University of Pernambuco, Recife, Pernambuco.
| | - Wilson Fusco
- Joaquim Nabuco Foundation, Recife, Pernambuco; Postgraduate Program in Demographics, Federal University of Rio Grande do Norte (UFRN), Lagoa Nova, Natal.
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Bigoni A, Malik AM, Tasca R, Carrera MBM, Schiesari LMC, Gambardella DD, Massuda A. Brazil's health system functionality amidst of the COVID-19 pandemic: An analysis of resilience. LANCET REGIONAL HEALTH. AMERICAS 2022; 10:100222. [PMID: 35284904 PMCID: PMC8896985 DOI: 10.1016/j.lana.2022.100222] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background As of December 31, 2020, Brazil had the second-highest burden of COVID-19 worldwide. Given the absence of federal government coordination, it was up to the local governments to maintain healthcare provision for non-COVID health issues. In this descriptive study, we aimed to discuss the SUS functionality and resilience, describing the impact of the pandemic on non-COVID health services delivery while considering the regional inequalities of the allocation of financing health system, health infrastructure and health workforce. Methods We used input-output framework based on the World Health Organization (WHO) Health System Building Blocks to estimate health system functionality and resilience. An ecological assessment was designed to calculated mean relative changes to compare the first year of the pandemic in Brazil with the previous one. All data used in this study were anonymized and made available by the Brazilian Ministry of Health. Input indicators were categorized in health system financing (federal funding received as well as expenditure of both state and city governments), health system's infrastructure (hospital beds) and health workforce (healthcare workers positions). Output indicators were categorized into nine different groups of service delivery procedures. To explore the relationship between the variation in procedures with socioeconomic conditions, we used the Socioeconomic Vulnerability Index (SVI). Findings State governments had a 38·6% increase in federal transfers, while municipal governments had a 33·9% increase. The increase of ICU beds reached its peak in the third quarter of 2020, averaging 72·1% by the end of the year. The country also saw an increase in jobs for registered nurses (13·6%), nurse assistants (8·5%), physiotherapists (7·9%), and medical doctors (4·9%). All procedures underwent expressive reduction: Screenings (−42·6%); Diagnostic procedures (−28·9%); Physician appointments (−42·5%); Low and medium complexity surgeries (−59·7%); High complexity surgeries (−27·9%); Transplants (−44·7%); Treatments and clinical procedures due to injuries of external causes (−19·1%); Irrepressible procedures (−8·5%); and Childbirths (−12·6%). The most significant drop in procedures happened in the first quarter of the pandemic, followed by progressive increase; most regions had not yet recovered by the end of 2020. State-level changes in numbers of procedures point towards a negative trend with SVI. Interpretation The Brazilian Government did not consider that socioeconomically vulnerable states were at a higher risk of being impacted by the overburden of the health system caused by the COVID-19, which resulted in poorer health system functionality for those vulnerable states. The lack of proper planning to improve health system resilience resulted in the decrease of a quarter of the amount of healthcare procedures increasing the already existing health disparities in the country. Funding MCTIC/CNPQ/FNDCT/MS/SCTIE/DECIT No 07/2020.
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Affiliation(s)
- Alessandro Bigoni
- São Paulo School of Business Administration, Fundação Getulio Vargas, Avenida Dr Arnaldo 715, São Paulo, SP CEP-01246-904, Brazil
- School of Public Health – University of São Paulo, São Paulo, SP, Brazil
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Corresponding author at: School of Public Health - University of São Paulo, Avenida Dr Arnaldo 715, São Paulo, SP CEP-01246-904, Brazil.
| | - Ana Maria Malik
- São Paulo School of Business Administration, Fundação Getulio Vargas, Avenida Dr Arnaldo 715, São Paulo, SP CEP-01246-904, Brazil
| | - Renato Tasca
- São Paulo School of Business Administration, Fundação Getulio Vargas, Avenida Dr Arnaldo 715, São Paulo, SP CEP-01246-904, Brazil
| | - Mariana Baleeiro Martins Carrera
- São Paulo School of Business Administration, Fundação Getulio Vargas, Avenida Dr Arnaldo 715, São Paulo, SP CEP-01246-904, Brazil
| | - Laura Maria Cesar Schiesari
- São Paulo School of Business Administration, Fundação Getulio Vargas, Avenida Dr Arnaldo 715, São Paulo, SP CEP-01246-904, Brazil
| | - Dante Dianezi Gambardella
- São Paulo School of Business Administration, Fundação Getulio Vargas, Avenida Dr Arnaldo 715, São Paulo, SP CEP-01246-904, Brazil
- Real e Benemérita Associação Portuguesa de Beneficência, São Paulo, SP, Brazil
| | - Adriano Massuda
- São Paulo School of Business Administration, Fundação Getulio Vargas, Avenida Dr Arnaldo 715, São Paulo, SP CEP-01246-904, Brazil
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Fertility decision-making during the Zika virus epidemic in Brazil: Where is the decision? SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 32:100722. [PMID: 35381437 DOI: 10.1016/j.srhc.2022.100722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 02/28/2022] [Accepted: 03/27/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND In 2016, a Public Health Emergency of International Concern (PHEIC) was declared in response to the rise of microcephaly cases among newborns in Northeastern Brazil. A common reactionary measure by public health authorities was to recommend women postpone pregnancy to avoid the possible perinatal transmission of Zika virus (ZIKV). METHODS The purpose of this study was to assess how women in Fortaleza, Brazil conceptualize pregnancy; experience facilitators and barriers to pregnancy avoidance; perceive the authorities' recommendation to postpone pregnancy due to the ZIKV outbreak; and recall their experiences during the ZIKV epidemic. Qualitative methods, specifically a Rapid Anthropological Assessment (RAA), were utilized in this study. Data collection included semi-structured interviews, triangulated with observations and informal interviews with community members. RESULTS The sample included 35 women (18-39 years old) who exclusively utilized the national public health care system. Findings indicated that all participants perceived the ZIKV pregnancy-postponement recommendation to be counter-cultural to Brazilian social norms. Overall women's self-perceived agency to prevent pregnancy was low due to social expectations and lack of trust for contraceptives. ZIKV prevention was not seen as a reason to utilize contraceptives. Interestingly, only women who self-perceived as more affluent were willing to attempt pregnancy prevention for educational, occupational, or financial opportunity. CONCLUSION Pregnancy postponement as a response to a ZIKV epidemic ignores gaps in reproductive agency and defies social norms, making it unrealistic and counter-cultural. Future ZIKV health recommendations must be culturally aligned with the population, and address barriers and motivators for family planning.
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Zanatta-Coutinho R, Branco-Simão A. Abortion in the times of Zika: the perspective of women in two Brazilian municipalities. PAPELES DE POBLACION 2021; 27:33-57. [PMID: 36447797 PMCID: PMC9703644 DOI: 10.22185/24487147.2021.109.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
In Brazil, abortion is considered a crime under the Criminal Code since 1940. After the Zika virus epidemic (2015-2017) and the consequent appearance of microcephaly in newborns struck South America, the debate on the decriminalization of abortion in the Brazilian society was reignited. Using data obtained from focus groups comprising women of reproductive age across different socioeconomic strata and two Brazilian cities, we investigated the perceptions of the participants on abortion, especially its use during the Zika epidemic. Although legally criminalized, abortion is prevalent among women, as a way to fulfill their reproductive desire. Criminalization puts the health and lives of women at risk, particularly those with less economic and cultural capital. We also discover the role of friends in women's decision to utilize the procedure. The strong asymmetry of power between men and women contributes to the greater vulnerability of women. The results suggest an urgent need to review the legislation on abortion concerning its criminalization and the option of safer abortion within the scope of the public health service.
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Affiliation(s)
- Raquel Zanatta-Coutinho
- Departamento de Demografia e Centro de Desenvolvimento e Planejamento Regional (Cedeplar), Universidade Federal de Minas Gerais, Brazil
| | - Andréa Branco-Simão
- Departamento de Demografia e Centro de Desenvolvimento e Planejamento Regional (Cedeplar), Universidade Federal de Minas Gerais, Brazil
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Rackimuthu S, Hunain R, Islam Z, Natoli V, Costa ACDS, Ahmad S, Essar MY. Zika virus amid COVID-19 in India: A rising concern. Int J Health Plann Manage 2021; 37:556-560. [PMID: 34549467 DOI: 10.1002/hpm.3336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - Reem Hunain
- Kasturba Medical College, Manipal, Karnataka, India
| | - Zarmina Islam
- Dow University of Health Sciences, Karachi, Pakistan
| | - Valentino Natoli
- Department of Dentistry, School of Biomedical and Health Sciences, European University of Madrid, Madrid, Spain
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Scoping Review on the Impact of Outbreaks on Sexual and Reproductive Health Services: Proposed Frameworks for Pre-, Intra-, and Postoutbreak Situations. BIOMED RESEARCH INTERNATIONAL 2021; 2021:9989478. [PMID: 34541003 PMCID: PMC8443356 DOI: 10.1155/2021/9989478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/16/2021] [Indexed: 11/17/2022]
Abstract
Introduction Recent experiences from global outbreaks have highlighted the severe disruptions in sexual and reproductive health services that expose women and girls to preventable health risks. Yet, to date, there is no review studying the possible impact of outbreaks on sexual and reproductive health (SRH). Methodology. Studies reporting outbreaks impacting sexual and reproductive health and pregnancy outcomes were identified using MEDLINE, Embase, and ISI-WoS. Reported impacts were reviewed at systems, community, and legislative levels. Results The initial run listed 4423 studies; the 37 studies that met all inclusion criteria were mainly from Latin America and Africa. Studies on outbreaks of diseases like Zika and Ebola have documented declines in facility-based deliveries, contraceptive use, and antenatal and institutional care due to burdened healthcare system. Service usage was also impacted by a lack of trust in the healthcare system and system shocks, including workforce capacity and availability. At the community level, poverty and lack of awareness were critical contributors to poor access to SRH services. Assessing the target population's knowledge, attitude, beliefs, and behavior and using health literacy principles for communication were fundamental for designing service delivery. Online resources for SRH services were an acceptable medium of information among young adults. In outbreak situations, SRH and pregnancy outcomes were improved by implementing laboratory surveillance, free-of-cost contraceptive services, improved screening through professional training, and quality of care. In addition, mobile health clinics were reported to be effective in remote areas. Knowledge Contribution. In outbreaks, the interventions are categorized into preoutbreak, during, and postoutbreak periods. The proposed steps can help to improve and do course correction in emergencies. Though conducted before the COVID-19 crisis, the authors believe that lessons can be drawn from the paper to understand and mitigate the impact of the pandemic on sexual and reproductive health services.
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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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Santos-Pinto CB, Osorio-De-Castro CS, Ferreira LM, Miranda ES. The role of primary care pharmacists in the response to the Zika epidemic. Pharm Pract (Granada) 2021; 19:2290. [PMID: 34221195 PMCID: PMC8234616 DOI: 10.18549/pharmpract.2021.2.2290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 06/13/2021] [Indexed: 11/14/2022] Open
Abstract
Background: Zika virus (ZIKV) infection emerged in Brazil in 2015, leading to the
declaration of a national public health emergency, mainly due to its
consequences for pregnant women and newborn babies. The Zika epidemic
demanded major efforts from the public health system to address the full
range of disease consequences. Objective: The objective of this study was to investigate the role of Primary Health
Care pharmacists working in the city of Campo Grande in the State of Mato
Grosso do Sul. Methods: A qualitative cross-sectional interview-based study with pharmacists working
in municipal Primary Health Care services was carried out to investigate
knowledge about the disease and involvement in the response to the health
emergency. Informed consent was obtained. After coding, the corpus underwent
thematic analysis. Results: The data show that few professionals had received specific training in public
health. Knowledge largely encompassed disease transmission by the mosquito
and collective and individual preventive measures. Findings highlight
knowledge gaps relating to signs and symptoms, diagnosis, consequences of
infection, and the role of epidemiological surveillance. Most professionals
mentioned at least one of the recommendations on the use of medicines in
symptom management protocols. The practical implications surrounding
knowledge gaps and misconceptions were reflected in pharmacists´ role
in response, restricted to counselling on preventive measures. Few
respondents participated in institutional groups and committees or in
multiprofessional teams involving case management. Conclusions: The study identified important knowledge gaps and showed that the involvement
of pharmacy professionals in the response to the Zika epidemic was timid or
inadequate. The results also suggest that pharmacists failed to recognize
their role in interventions related to the ZIKV epidemic. Findings highlight
the need to increase the involvement of primary care pharmacists in
community-based actions, for communication and reduction of health risks,
and emergency preparedness and response.
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Affiliation(s)
- Cláudia B Santos-Pinto
- ScD, MSc. Adjunct Professor. Integrated Health Institute (INISA), Federal University of Mato Grosso do Sul . Campo Grande ( Brazil ).
| | - Claudia S Osorio-De-Castro
- ScD, MSc, Senior Researcher. Sergio Arouca National School of Public Health (ENSP), Oswaldo Cruz Foundation (FIOCRUZ) . Rio de Janeiro ( Brazil ).
| | - Larissa M Ferreira
- Faculty of Pharmacy, Fluminense Federal University . Niterói ( Brazil ).
| | - Elaine S Miranda
- ScD, MSc, Adjunct Professor. Faculty of Pharmacy, Fluminense Federal University . Niterói ( Brazil ).
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Sié A, Hanefeld J, Chaponda M, Chico RM, LeDoare K, Mayaud P, Drexler JF, Jaenisch T. Congenital malformations in sub-Saharan Africa-warnings of a silent epidemic? THE LANCET. INFECTIOUS DISEASES 2021; 21:594-596. [PMID: 33773619 PMCID: PMC9760594 DOI: 10.1016/s1473-3099(21)00061-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 01/27/2021] [Indexed: 01/25/2023]
Affiliation(s)
- Ali Sié
- National Institute of Public Health, Burkina Faso
| | - Johanna Hanefeld
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK,Zentrum Internationaler Gesundheitsschutz, Robert Koch Institute, Berlin 14195, Germany
| | | | - R Matthew Chico
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Kirsty LeDoare
- Paediatric Infectious Diseases Research Group, St George's Medical School, London, UK
| | - Philippe Mayaud
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Jan Felix Drexler
- Charité-Universitätsmedizin Berlin Universität Berlin, Humbolt-Universität zu Berlin, Berlin, Germany,Institute of Virology, Berlin, Germany
| | - Thomas Jaenisch
- Heidelberg Institute of Global Health (HIGH), Heidelberg University Hospital, Heidelberg, Germany,Center for Global Health, Colorado School of Public Health, Aurora, CO, USA
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16
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Diniz D, Medeiros M, Madeiro A. Abortion after the Zika virus epidemic in Northeast Brazil. Rev Saude Publica 2021; 55:6. [PMID: 33825799 PMCID: PMC8009316 DOI: 10.11606/s1518-8787.2021055003053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 08/25/2020] [Indexed: 11/18/2022] Open
Affiliation(s)
- Debora Diniz
- Universidade de Brasília. Faculdade de Direito. Brasília, DF, Brasil
| | - Marcelo Medeiros
- Princeton University. Program of Latin American Studies. Princeton. New Jersey, USA
| | - Alberto Madeiro
- Universidade Estadual do Piauí. Núcleo de Pesquisa e Extensão em Saúde da Mulher. Teresina, PI, Brasil
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17
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Almeida LFB, Kattah M, Ventura LO, Gois AL, Rocha C, Andrade CG, Mendonza-Santiesteban C, Ventura CV. Pattern-Reversal Visual Evoked Potential in Children With Congenital Zika Syndrome. J Pediatr Ophthalmol Strabismus 2021; 58:78-83. [PMID: 34038265 DOI: 10.3928/01913913-20201110-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To objectively evaluate the visual function in children with congenital Zika syndrome using pattern-reversal visual evoked potential (PR-VEP). METHODS This was a cross-sectional study composed of two patient groups: children aged between 18 and 24 months who were positive for the Zika virus (congenital Zika syndrome group) and age-matched healthy children (control group). All patients underwent a comprehensive ophthalmologic examination and PR-VEP was performed binocularly in a room with constant dim illumination. The P100 peak time in the 60' arc stimuli was used, and the results were correlated with visual acuity, cephalic perimeter at birth, and funduscopic findings. RESULTS Thirty-seven children were included in the congenital Zika syndrome group and 15 in the control group. The mean age was 18.5 ± 0.9 months (range: 17 to 20 months) in the congenital Zika syndrome group and 24.3 ± 1.6 months (range: 21 to 28 months) in the control group. The P100 response was normal in 7 patients (18.9%) with congenital Zika syndrome, borderline in 2 (5.4%), abnormal with prolonged latency in 18 (48.6%), and abnormal with no response in 10 (27.0%). A significant correlation between the visual acuity and P100 peak time was observed (P < .001). The P100 values were not correlated significantly with the cephalic perimeter at birth (P = .412) or the funduscopic findings (P = .510). PR-VEP in children with congenital Zika syndrome and no funduscopic findings was significantly worse than in the control group (P = .001). CONCLUSIONS Children with congenital Zika syndrome have characteristically abnormal PR-VEPs regardless of the funduscopic findings and severe microcephaly. The PR-VEP findings supported the diagnosis of cortical visual impairment in these children. [J Pediatr Ophthalmol Strabismus. 2021;58(2):78-83.].
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18
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Marteleto LJ, Dondero M. Navigating women's reproductive health and childbearing during public health crises: Covid-19 and Zika in Brazil. WORLD DEVELOPMENT 2021; 139:105305. [PMID: 35495087 PMCID: PMC9053522 DOI: 10.1016/j.worlddev.2020.105305] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Affiliation(s)
| | - Molly Dondero
- Population Research Center, University of Texas at Austin, United States
- Department of Sociology, American University, United States
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19
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Lima FMDS, Iriart JAB. [Meanings, risk perceptions, and prevention strategies for pregnant women since the emergence of the Zika virus in Brazil]. CAD SAUDE PUBLICA 2021; 37:e00145819. [PMID: 33624694 DOI: 10.1590/0102-311x00145819] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 07/06/2020] [Indexed: 11/22/2022] Open
Abstract
This study aimed to understand the meanings, risk perceptions, and strategies to prevent infection with the Zika virus developed by pregnant women with different socioeconomic conditions seen at public and private health services in the city of Salvador, Bahia State, Brazil, as well the contribution by their male partners in dealing with the risk of infection since the emergence of this virus in Brazil. A qualitative study was performed with 18 semi-structured interviews, nine each with pregnant women seen in the public and private health systems, respectively. The resulting data revealed insufficient knowledge in pregnant women concerning important aspects of Zika virus infection. The pregnant women's socioenvironmental situation was an important factor for risk perception and preventive strategies. Women interviewed in the public health system felt more vulnerable to the risk of infection than women interviewed in the private health system, with a major impact on their psychosocial well-being. According to the women, their partners placed huge demands on them to adopt preventive measures, but the male partners themselves failed to take the same precautions, e.g., ignoring the risk of sexual transmission of the Zika virus. In conclusion, three years since the outbreak reached Brazil, the Zika virus still has a major impact on the lives of pregnant women. It is crucial to strengthen health communications activities to guarantee the availability of information on the disease that responds adequately to the population's needs.
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20
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Coutinho RZ, Montalvo AV, Weitzman A, Marteleto LJ. Zika virus public health crisis and the perpetuation of gender inequality in Brazil. Reprod Health 2021; 18:40. [PMID: 33588891 PMCID: PMC7883759 DOI: 10.1186/s12978-021-01067-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 01/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2015-2017, the Americas experienced a highly consequential epidemics for pregnancy and childbearing. Mainly transmitted by the mosquito Aedes aegypti, but also through sexual intercourse, the Zika virus poses the risk of congenital Zika syndrome to fetus, which includes microcephaly and other child development complications. When a public health crisis taps directly into reproductive health, typically a feminine realm, responses to the emergency may exacerbate deeply-rooted gender norms. This paper investigates the role of gender in two relational contexts: (a) the government-led response to the pandemic in terms of communication campaigns aimed at preventing Zika infections; and (b) an individual level of response to the emergency, concerning women's negotiation with their sexual partners with regard to the prevention of Zika as well as pregnancies. METHODS We conducted content analysis of 94 unique pieces from public health communication campaigns produced by governmental agencies with the goal of promoting Zika awareness. Print and online materials were collected from May 2016 to August 2017, and included TV ads, Internet Pop-ups, and pamphlets. We also analyzed transcripts from 16 focus groups conducted with reproductive-aged women (18-40) in Belo Horizonte and Recife, two large cities differently affected by the Zika outbreak. Women answered open-ended questions connected to the epidemic, in areas such as personal knowledge and experiences with the Zika virus, experiences of their friends and acquaintances, their primary information sources, their perceptions of public health efforts toward containing the outbreak, as well as women's contraceptive use. RESULTS Campaign pieces handling pregnancy and microcephaly were largely gendered. Pieces targeted women, placing on their shoulders the responsibility for protecting a potential fetus from the disease. Importantly, campaigns neglected addressing male's participation on Zika prevention and contraceptive management, while failing to take into account Brazil's large proportion of unplanned pregnancies. Women were placed in a double bind by being expected to prevent both pregnancy and Zika, in a context where gendered power imbalances often translate in women having little power/means for condom negotiation/avoiding unprotected sexual intercourse. CONCLUSION Government and individual responses to the epidemics reinforced gender roles, situating pregnant women as responsible for averting mosquito bites and microcephaly. Further, prevention campaigns largely excluded men. Since low-socioeconomic status women possessed fewer resources to preclude infection, we also found that beyond the gender divide, this subgroup faced more pronounced Zika prevention challenges as they found it harder to negotiate condom use with their sexual partners and often could not access other types of contraceptives resulting in unplanned pregnancies.
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Affiliation(s)
- Raquel Zanatta Coutinho
- Faculdade de Ciências Econômicas, Universidade Federal de Minas Gerais and Center for Development and Regional Planning (Cedeplar), Av. Pres. Antônio Carlos, 6627-Pampulha, Belo Horizonte, MG, 31270-901, Brazil.
| | - Aida Villanueva Montalvo
- Department of Sociology, University of Massachusetts-Amherst, 910 Thompson Hall, Amherst, MA, 01003, USA
| | - Abigail Weitzman
- The College of Liberal Arts, University of Texas at Austin and Population Research Center, 116 Inner Campus Dr Stop G6000, Austin, TX, 78712, USA
| | - Letícia Junqueira Marteleto
- The College of Liberal Arts, University of Texas at Austin and Population Research Center, 116 Inner Campus Dr Stop G6000, Austin, TX, 78712, USA
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21
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Majee P, Pattnaik A, Sahoo BR, Shankar U, Pattnaik AK, Kumar A, Nayak D. Inhibition of Zika virus replication by G-quadruplex-binding ligands. MOLECULAR THERAPY. NUCLEIC ACIDS 2021; 23:691-701. [PMID: 33575115 PMCID: PMC7851496 DOI: 10.1016/j.omtn.2020.12.030] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 12/30/2020] [Indexed: 01/05/2023]
Abstract
Zika virus (ZIKV), a mosquito-transmitted Flavivirus, emerged in the last decade causing serious diseases and affecting human health globally. Currently, no licensed vaccines or antivirals are available to combat ZIKV, although several vaccine candidates are in the pipeline. In recent years, the presence of non-canonical G-quadruplex (GQ) secondary structures in viral genomes has ignited significant attention as potential targets for antiviral strategy. In this study, we identified several novel conserved potential GQ structures by analyzing published ZIKV genome sequences using an in-house algorithm. Biophysical and biochemical analysis of the RNA sequences containing these potential GQ sequences suggested the existence of such structures in the ZIKV genomes. Studies with known GQ structure-binding and -stabilizing ligands such as Braco-19 and TMPyP4 provided support for this contention. The presence of these ligands in cell culture media led to significant inhibition of infectious ZIKV yield, as well as reduced viral genome replication and viral protein production. Overall, our results, for the first time, show that ZIKV replication can be inhibited by GQ structure-binding and -stabilizing compounds and suggest a new strategy against ZIKV infection mitigation and control.
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Affiliation(s)
- Prativa Majee
- Discipline of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Madhya Pradesh 453552, India
| | - Aryamav Pattnaik
- School of Veterinary Medicine and Biomedical Sciences and Nebraska Center for Virology, University of Nebraska-Lincoln, Lincoln, NE 68583, USA
| | - Bikash R Sahoo
- School of Veterinary Medicine and Biomedical Sciences and Nebraska Center for Virology, University of Nebraska-Lincoln, Lincoln, NE 68583, USA
| | - Uma Shankar
- Discipline of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Madhya Pradesh 453552, India
| | - Asit K Pattnaik
- School of Veterinary Medicine and Biomedical Sciences and Nebraska Center for Virology, University of Nebraska-Lincoln, Lincoln, NE 68583, USA
| | - Amit Kumar
- Discipline of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Madhya Pradesh 453552, India
| | - Debasis Nayak
- Discipline of Biosciences and Biomedical Engineering, Indian Institute of Technology Indore, Madhya Pradesh 453552, India
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22
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Lima FMDS, Iriart JAB. Discussões sobre os direitos sexuais e reprodutivos das mulheres após o surgimento do zika vírus no Brasil. SAUDE E SOCIEDADE 2021. [DOI: 10.1590/s0104-12902021200784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Este estudo buscou compreender como a epidemia do zika vírus e suas consequências sobre o desenvolvimento fetal influenciaram a percepção de gestantes de diferentes situações socioeconômicas sobre os direitos sexuais e reprodutivos em uma capital da região nordeste do Brasil. Trata-se de uma pesquisa qualitativa, desenvolvida a partir de dezoito entrevistas semiestruturadas, sendo nove com gestantes do setor público de saúde e nove com gestantes do setor privado de saúde. Os resultados demonstraram que entre gestantes atendidas pelo setor público de saúde há uma alta ocorrência de gestações não intencionais, relacionadas principalmente a dificuldades no acesso aos serviços de saúde e informação. As gestantes de uma maneira geral passaram a desenvolver cuidados a fim de reduzir o risco de infecção pelo zika vírus, comportamento não compartilhado por seus parceiros, apesar da possibilidade de transmissão sexual do vírus. Por fim, a ampliação da discussão sobre os direitos reprodutivos, proposta pela Ação Direta de Inconstitucionalidade 5581, ainda divide opiniões entre as mulheres quanto a possibilidade de interrupção da gestação em casos de infecção pelo zika vírus, sendo que as argumentações favoráveis denunciam as injustiças sociais, enquanto as contrárias mobilizam questões de cunho moral e religioso.
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23
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Freitas DA, Souza-Santos R, Carvalho LMA, Barros WB, Neves LM, Brasil P, Wakimoto MD. Congenital Zika syndrome: A systematic review. PLoS One 2020; 15:e0242367. [PMID: 33320867 PMCID: PMC7737899 DOI: 10.1371/journal.pone.0242367] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 10/31/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The signs and symptoms of Zika virus infection are usually mild and self-limited. However, the disease has been linked to neurological complications such as Guillain-Barré syndrome and peripheral nerve involvement, and also to abortion and fetal deaths due to vertical transmission, resulting in various congenital malformations in newborns, including microcephaly. This review aimed to describe the o signs and symptoms that characterize the congenital Zika syndrome. METHODS AND FINDINGS A systematic review was performed with a protocol and described according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The search strategy yielded 2,048 studies. After the exclusion of duplicates and application of inclusion criteria, 46 studies were included. The main signs and symptoms associated with the congenital Zika syndrome were microcephaly, parenchymal or cerebellar calcifications, ventriculomegaly, central nervous system hypoplasia or atrophy, arthrogryposis, ocular findings in the posterior and anterior segments, abnormal visual function and low birthweight for gestational age. CONCLUSIONS Zika virus infection during pregnancy can cause a series of changes in the growth and development of children, while impacting the healthcare system due to the severity of cases. Our findings outline the disease profile in newborns and infants and may contribute to the development and updating of more specific clinical protocols.
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Affiliation(s)
- Danielle A. Freitas
- National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Reinaldo Souza-Santos
- National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Liege M. A. Carvalho
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Wagner B. Barros
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Luiza M. Neves
- Fernandes Figueira Institute, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Patrícia Brasil
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Mayumi D. Wakimoto
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
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Singh T, Otero CE, Li K, Valencia SM, Nelson AN, Permar SR. Vaccines for Perinatal and Congenital Infections-How Close Are We? Front Pediatr 2020; 8:569. [PMID: 33384972 PMCID: PMC7769834 DOI: 10.3389/fped.2020.00569] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 08/04/2020] [Indexed: 12/26/2022] Open
Abstract
Congenital and perinatal infections are transmitted from mother to infant during pregnancy across the placenta or during delivery. These infections not only cause pregnancy complications and still birth, but also result in an array of pediatric morbidities caused by physical deformities, neurodevelopmental delays, and impaired vision, mobility and hearing. Due to the burden of these conditions, congenital and perinatal infections may result in lifelong disability and profoundly impact an individual's ability to live to their fullest capacity. While there are vaccines to prevent congenital and perinatal rubella, varicella, and hepatitis B infections, many more are currently in development at various stages of progress. The spectrum of our efforts to understand and address these infections includes observational studies of natural history of disease, epidemiological evaluation of risk factors, immunogen design, preclinical research of protective immunity in animal models, and evaluation of promising candidates in vaccine trials. In this review we summarize this progress in vaccine development research for Cytomegalovirus, Group B Streptococcus, Herpes simplex virus, Human Immunodeficiency Virus, Toxoplasma, Syphilis, and Zika virus congenital and perinatal infections. We then synthesize this evidence to examine how close we are to developing a vaccine for these infections, and highlight areas where research is still needed.
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Affiliation(s)
- Tulika Singh
- Duke University Medical Center, Duke Human Vaccine Institute, Durham, NC, United States
- Department of Molecular Genetics and Microbiology, Duke University, Durham, NC, United States
| | - Claire E. Otero
- Duke University Medical Center, Duke Human Vaccine Institute, Durham, NC, United States
| | - Katherine Li
- Duke University Medical Center, Duke Human Vaccine Institute, Durham, NC, United States
| | - Sarah M. Valencia
- Duke University Medical Center, Duke Human Vaccine Institute, Durham, NC, United States
| | - Ashley N. Nelson
- Duke University Medical Center, Duke Human Vaccine Institute, Durham, NC, United States
| | - Sallie R. Permar
- Duke University Medical Center, Duke Human Vaccine Institute, Durham, NC, United States
- Department of Molecular Genetics and Microbiology, Duke University, Durham, NC, United States
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25
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Berkenbrock JA, Grecco-Machado R, Achenbach S. Microfluidic devices for the detection of viruses: aspects of emergency fabrication during the COVID-19 pandemic and other outbreaks. Proc Math Phys Eng Sci 2020; 476:20200398. [PMID: 33363440 PMCID: PMC7735301 DOI: 10.1098/rspa.2020.0398] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 10/05/2020] [Indexed: 12/17/2022] Open
Abstract
Extensive testing of populations against COVID-19 has been suggested as a game-changer quest to control the spread of this contagious disease and to avoid further disruption in our social, healthcare and economical systems. Nonetheless, testing millions of people for a new virus brings about quite a few challenges. The development of effective tests for the new coronavirus has become a worldwide task that relies on recent discoveries and lessons learned from past outbreaks. In this work, we review the most recent publications on microfluidics devices for the detection of viruses. The topics of discussion include different detection approaches, methods of signalling and fabrication techniques. Besides the miniaturization of traditional benchtop detection assays, approaches such as electrochemical analyses, field-effect transistors and resistive pulse sensors are considered. For emergency fabrication of quick test kits, the local capabilities must be evaluated, and the joint work of universities, industries, and governments seems to be an unequivocal necessity.
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Affiliation(s)
- José Alvim Berkenbrock
- Department of Electrical and Computer Engineering, University of Saskatchewan, Saskatoon, SK, Canada
| | - Rafaela Grecco-Machado
- Department of Anatomy, Physiology and Pharmacology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Sven Achenbach
- Department of Electrical and Computer Engineering, University of Saskatchewan, Saskatoon, SK, Canada
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Abstract
Zika virus epidemics have potential large-scale population effects. Controlled studies of mice and nonhuman primates indicate that Zika affects fecundity, raising concerns about miscarriage in human populations. In regions of Brazil, Zika risk peaked months before residents learned about the epidemic and its relation to congenital anomalies. This spatiotemporal variation supports analysis of both biological effects of Zika infection on fertility and the effects of learning about Zika risk on reproductive behavior. Causal inference techniques used with vital statistics indicate that the epidemic caused reductions in birth cohort size of approximately one-quarter 18 months after Zika infection risk peaked but 10 months after public health messages advocated childbearing delay. The evidence is consistent with small but not statistically detectable biological reductions in fecundity, as well as large strategic changes in reproductive behavior to temporally align childbearing with reduced risk to infant health. The behavioral effects are larger for more-educated and older women, which may reflect facilitated access to information and to family planning services within high-risk, mosquito-infested urban locations as well as perceptions about the opportunity costs of risks to pregnancy and infant survival.
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Affiliation(s)
- Marcos A Rangel
- Sanford School of Public Policy, Duke University, 302 Towerview Road, Rubenstein Hall, Office 262, Durham, NC, 27708, USA.
- Bureau for Research and Economic Analysis of Development (BREAD), London, UK.
| | - Jenna Nobles
- Department of Sociology, University of Wisconsin-Madison, Madison, WI, USA
| | - Amar Hamoudi
- Center for Demography and Ecology, University of Wisconsin-Madison, Madison, WI, USA
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27
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Immunopathology of Zika virus infection. Adv Virus Res 2020; 107:223-246. [PMID: 32711730 DOI: 10.1016/bs.aivir.2020.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Zika virus (ZIKV) is a mosquito-borne virus of the flavivirus genus in the Flaviviridae family. Flaviviruses are single-stranded, positive-sense RNA viruses that have been responsible for numerous human epidemics. Notable flaviviruses include mosquito-borne viruses such as yellow fever virus (YFV), Dengue virus (DENV), West Nile virus (WNV), Japanese encephalitis virus (JEV), as well as tick-borne viruses including Powassan virus (POWV) and tick-borne encephalitis virus (TBEV). Despite having been relatively obscure until the past decade, ZIKV has become a major global health concern, and is a topic of active research following multiple outbreaks across the globe. Here, we discuss ZIKV pathogenesis and the associated immunopathology, as well as advances in research, therapies, and vaccines developed using models of ZIKV pathogenesis.
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Gerzson LR, Almeida CSD, Silva JHD, Schüler-Faccini L. Motor development in non-microcephalic infants born to mothers with Zika Virus infection during pregnancy. FISIOTERAPIA E PESQUISA 2020. [DOI: 10.1590/1809-2950/19015227022020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT This cross-sectional study sought to evaluate motor development in infants exposed to ZIKV born with normal head circumference (HC). Thirty one children, distributed into two groups, participated in the study: 15 whose mothers were infected by ZIKV during pregnancy, born with HC from −1.9 to +2 Z-scores, adjusted for sex and gestational age (exposed group); and 16 randomly selected infants without known prenatal exposure to ZIKV, paired by sex and age (control group). Alberta Infant Motor Scale (AIMS) was used to evaluate gross motor development. We found no significant difference between the exposed and control groups. However, considering that AIMS is a screening test that assesses only the gross motor development and the small size of our sample, infants exposed to ZIKV during pregnancy should be continuously evaluated for different aspects of their development.
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Affiliation(s)
| | | | | | - Lavinia Schüler-Faccini
- Universidade Federal do Rio Grande do Sul, Brazil; Universidade Federal do Rio Grande do Sul, Brazil; Hospital de Clínicas de Porto Alegre, Brazil
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29
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Abstract
In late 2015, the Brazilian Ministry of Health and the Pan American Health Organization classified the increase in congenital malformations associated with the Zika virus (ZIKV) as a public health emergency. The risk of ZIKV-related congenital syndrome poses a threat to reproductive outcomes that could result in declining numbers of live births and potentially fertility. Using monthly microdata on live births from the Brazilian Information System on Live Births (SINASC), this study examines live births and fertility trends amid the ZIKV epidemic in Brazil. Findings suggest a decline in live births that is stratified across educational and geographic lines, beginning approximately nine months after the link between ZIKV and microcephaly was publicly announced. Although declines in total fertility rates were small, fertility trends estimated by age and maternal education suggest important differences in how Zika might have impacted Brazil's fertility structure. Further findings confirm the significant declines in live births in mid-2016 even when characteristics of the municipality are controlled for; these results highlight important nuances in the timing and magnitude of the decline. Combined, our findings illustrate the value of understanding how the risk of a health threat directed at fetuses has led to declines in live births and fertility.
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Affiliation(s)
- Letícia J Marteleto
- Population Research Center and Department of Sociology, University of Texas at Austin, Austin, TX, USA.
| | - Gilvan Guedes
- Demography Department and Center for Development and Regional Planning (Cedeplar), Universidade Federal de Minas Gerais, Pampulha, Belo Horizonte, Brazil
| | - Raquel Z Coutinho
- Demography Department and Center for Development and Regional Planning (Cedeplar), Universidade Federal de Minas Gerais, Pampulha, Belo Horizonte, Brazil
| | - Abigail Weitzman
- Population Research Center and Department of Sociology, University of Texas at Austin, Austin, TX, USA
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30
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Anderson EJ, Ernst KC, Martins FF, Martins CDS, Koss MP. Women's Health Perceptions and Beliefs Related to Zika Virus Exposure during the 2016 Outbreak in Northern Brazil. Am J Trop Med Hyg 2020; 102:629-633. [PMID: 31933455 DOI: 10.4269/ajtmh.19-0311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
During the 2016 Zika pandemic in Brazil, women's perceptions of infection risk, ability to adhere to Zika prevention strategies, or access to services following exposure were not emphasized in the public health response. Women in Fortaleza, Brazil, responded to a questionnaire on social factors related to perceived Zika risk and access to health care in June 2016. Data were coded using prespecified categories, and response frequency was reported. Of 37 respondents, most reported a lack of public services to support mosquito control (n = 19) or delayed access to reproductive health care (n = 14). Only 22% described specific maternal risks or fetal outcomes as a consequence of Zika infection. Respondents indicated an overall disconnect between public health efforts and women's perceptions of their reproductive control, including limited support concerning microcephaly in infants. Interventions targeting Zika may require a greater emphasis on strengthening health systems and infrastructure to realistically prevent transmission.
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Affiliation(s)
| | - Kacey C Ernst
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, Arizona
| | | | | | - Mary P Koss
- Department of Health Promotion Sciences, University of Arizona, Tucson, Arizona
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31
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Schwarz ER, Oliveira LJ, Bonfante F, Pu R, Pozor MA, Maclachlan NJ, Beachboard S, Barr KL, Long MT. Experimental Infection of Mid-Gestation Pregnant Female and Intact Male Sheep with Zika Virus. Viruses 2020; 12:v12030291. [PMID: 32156037 PMCID: PMC7150993 DOI: 10.3390/v12030291] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/24/2020] [Accepted: 03/06/2020] [Indexed: 12/11/2022] Open
Abstract
Zika virus (ZIKV) is an arbovirus that causes birth defects, persistent male infection, and sexual transmission in humans. The purpose of this study was to continue the development of an ovine ZIKV infection model; thus, two experiments were undertaken. In the first experiment, we built on previous pregnant sheep experiments by developing a mid-gestation model of ZIKV infection. Four pregnant sheep were challenged with ZIKV at 57–64 days gestation; two animals served as controls. After 13–15 days (corresponding with 70–79 days of gestation), one control and two infected animals were euthanized; the remaining animals were euthanized at 20–22 days post-infection (corresponding with 77–86 days of gestation). In the second experiment, six sexually mature, intact, male sheep were challenged with ZIKV and two animals served as controls. Infected animals were serially euthanized on days 2–6 and day 9 post-infection with the goal of isolating ZIKV from the male reproductive tract. In the mid-gestation study, virus was detected in maternal placenta and spleen, and in fetal organs, including the brains, spleens/liver, and umbilicus of infected fetuses. Fetuses from infected animals had visibly misshapen heads and morphometrics revealed significantly smaller head sizes in infected fetuses when compared to controls. Placental pathology was evident in infected dams. In the male experiment, ZIKV was detected in the spleen, liver, testes/epididymides, and accessory sex glands of infected animals. Results from both experiments indicate that mid-gestation ewes can be infected with ZIKV with subsequent disruption of fetal development and that intact male sheep are susceptible to ZIKV infection and viral dissemination and replication occurs in highly vascular tissues (including those of the male reproductive tract).
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Affiliation(s)
- Erika R. Schwarz
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL 32608, USA; (E.R.S.); (R.P.); (S.B.)
| | - Lilian J. Oliveira
- Department of Infectious Diseases and Immunology, College of Veterinary Medicine, University of Florida, Gainesville, FL 32608, USA;
| | - Francesco Bonfante
- Laboratory of Experimental Animal Models, Division of Comparative Biomedical Sciences, Instituto Zooprofilattico Sperimentale delle Venezie, 35020 Legnaro, Italy;
| | - Ruiyu Pu
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL 32608, USA; (E.R.S.); (R.P.); (S.B.)
| | - Malgorzata A. Pozor
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32611, USA;
| | - N. James Maclachlan
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis, CA 95616, USA;
| | - Sarah Beachboard
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL 32608, USA; (E.R.S.); (R.P.); (S.B.)
| | - Kelli L. Barr
- Department of Biology, College of Arts and Sciences, Baylor University, Waco, TX 76798, USA;
| | - Maureen T. Long
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL 32608, USA; (E.R.S.); (R.P.); (S.B.)
- Correspondence:
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Gerzson LR, de Almeida CS, Silva JHD, Feitosa MMA, de Oliveira LN, Schuler-Faccini L. Neurodevelopment of Nonmicrocephalic Children, After 18 Months of Life, Exposed Prenatally to Zika Virus. J Child Neurol 2020; 35:278-282. [PMID: 31878830 DOI: 10.1177/0883073819892128] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this work was to evaluate the cognitive, language, and motor development, after 18 months of life, of nonmicrocephalic children born to mothers with Zika virus infection during pregnancy. Participants were 37 children aged 18-29 months divided into 2 groups: 17 nonmicrocephalic children born to mothers who had Zika virus infection during pregnancy (ZIKVG) and 20 nonmicrocephalic children with no maternal history of infection matched by sex and age (control group). A semistructured interview and the Bayley Scale of Infant and Toddler Development (Bayley III) were used for their evaluation. One child in the ZIKVG presented low cognitive score, the same in the control group. There were no statistical differences between the 2 groups regarding cognitive, language, and motor development. This sample, although small, showed that a significant proportion of nonmicrocephalic children exposed prenatally to Zika virus had normal development. A longer follow-up is necessary to observe if no other adverse outcomes will appear in the future.
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Affiliation(s)
- Laís Rodrigues Gerzson
- Graduate Program in Child and Adolescent Health, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Carla Skilhan de Almeida
- Department of Physiotherapy, Physical Education and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Juliana Herrero da Silva
- Graduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Lucia Nunes de Oliveira
- Graduate Program in Science of Information, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lavínia Schuler-Faccini
- SIAT, Information Service on Teratogenic Agents, Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
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33
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Diniz D, Ali M, Ambrogi I, Brito L. Understanding sexual and reproductive health needs of young women living in Zika affected regions: a qualitative study in northeastern Brazil. Reprod Health 2020; 17:22. [PMID: 32028969 PMCID: PMC7006063 DOI: 10.1186/s12978-020-0869-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 01/19/2020] [Indexed: 12/28/2022] Open
Abstract
Background In 2016, the World Health Organization declared a Public Health Emergency of International Concern due to Zika’s association with microcephaly and other neurological disorders. Brazil was the epicenter of this epidemic and the most affected region has the lowest Human Development Index and the highest rates of adolescent pregnancy. Despite the end of the epidemic, Brazil continues to be the epicenter of Zika illness. This study examined the barriers faced by young women who seek sexual and reproductive health (SRH) care services living in affected areas and their attitudes towards SRH needs and the available services. Methods Individual semi-structured interviews were conducted with 22 young women, aged 14–24 years in three Zika affected municipalities in the Brazilian Northeast. This qualitative research used thematic analysis for data analysis. Results Almost half (n = 10) of the participants had their first pregnancy during adolescence (from 12 to 19), all of which were unintended. Lack of information and barriers to access family planning were found to contribute to the unmet need for contraception. Participants reported knowledge gaps about contraception. Zika was not considered a health concern and participants were unaware of the possibility of Zika’s sexual transmission. Conclusions The young women’s knowledge and attitudes towards their SRH needs highlight the barriers to access care. It also implies that comprehensive, biopsychosocial and political, understanding is necessary in order to adequately provide SRH to this population and meet their needs. The government should place women at the center of any public health response to an emergency affecting women of reproductive age and focus on improving access to information and family planning services in a culturally and age appropriate manner.
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Affiliation(s)
- Debora Diniz
- Rights and Justice Regional Deputy Director - International Planned Parenthood Federation/Western Hemisphere Region (IPPF/WHR), Caixa Postal 8011, Brasília, DF, 70094-971, Brazil
| | - Moazzam Ali
- Department of Reproductive Health and Research (RHR), World Health Organization, Avenue Appia 20, CH-1211, Geneva 27, Switzerland.
| | - Ilana Ambrogi
- Researcher at Anis - Institute of Bioethics, Caixa Postal 8011, Brasília, DF, 70094-971, Brazil
| | - Luciana Brito
- Director of Research at Anis - Institute of Bioethics, Caixa Postal 8011, Brasília, DF, 70094-971, Brazil.
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34
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Association of past dengue fever epidemics with the risk of Zika microcephaly at the population level in Brazil. Sci Rep 2020; 10:1752. [PMID: 32019953 PMCID: PMC7000767 DOI: 10.1038/s41598-020-58407-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 12/17/2019] [Indexed: 11/08/2022] Open
Abstract
Despite all the research done on the first Zika virus (ZIKV) epidemics, it was only after the Brazilian epidemic that the Congenital Zika Syndrome was described. This was made possible due to the large number of babies born with microcephaly in the Northeast region (NE) in a narrow time. We hypothesize that the fivefold difference in the rate of microcephalic neonates between the NE and other regions is partially an effect of the population prior immunity against Dengue viruses (DENV), that cross-react with ZIKV. In this ecological study, we analysed the interaction between dengue fever epidemics from 2001 to 2014 and the 2015/2016 microcephaly epidemic in 400 microregions in Brazil using random-effects models under a Bayesian approach. The estimated effect of the time lag between the most recent large dengue epidemic (>400/100,000 inhabitants) and the microcephaly epidemic ranged from protection (up to 6 years prior) to an increased risk (from 7 to 12 years). This sustained window of protection, larger than described in previous longitudinal studies, is possibly an effect of herd immunity and of multiple exposures to DENV that could boost immunity.
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35
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Kelly AH, Lezaun J, Löwy I, Matta GC, de Oliveira Nogueira C, Rabello ET. Uncertainty in times of medical emergency: Knowledge gaps and structural ignorance during the Brazilian Zika crisis. Soc Sci Med 2020; 246:112787. [DOI: 10.1016/j.socscimed.2020.112787] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 12/19/2019] [Accepted: 01/03/2020] [Indexed: 01/22/2023]
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36
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Block LN, Aliota MT, Friedrich TC, Schotzko ML, Mean KD, Wiepz GJ, Golos TG, Schmidt JK. Embryotoxic impact of Zika virus in a rhesus macaque in vitro implantation model†. Biol Reprod 2020; 102:806-816. [PMID: 31901091 DOI: 10.1093/biolre/ioz236] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/23/2019] [Accepted: 12/31/2019] [Indexed: 12/29/2022] Open
Abstract
Zika virus (ZIKV) infection is associated with adverse pregnancy outcomes in humans, and infection in the first trimester can lead to miscarriage and stillbirth. Vertical and sexual transmissions of ZIKV have been demonstrated, yet the impact of infection during the initial stages of pregnancy remains unexplored. Here we defined the impact of ZIKV on early embryonic and placental development with a rhesus macaque model. During in vitro fertilization (IVF), macaque gametes were inoculated with a physiologically relevant dose of 5.48log10 plaque-forming units (PFU) of Zika virus/H.sapiens-tc/PUR/2015/PRVABC59_v3c2. Exposure at fertilization did not alter blastocyst formation rates compared to controls. To determine the impact of ZIKV exposure at implantation, hatched blastocysts were incubated with 3.26log10, 4.26log10, or 5.26log10 PFU, or not exposed to ZIKV, followed by extended embryo culture for 10 days. ZIKV exposure negatively impacted attachment, growth, and survival in comparison to controls, with exposure to 5.26log10 PFU ZIKV resulting in embryonic degeneration by day 2. Embryonic secretion of pregnancy hormones was lower in ZIKV-exposed embryos. Increasing levels of infectious virus were detected in the culture media post-exposure, suggesting that the trophectoderm is susceptible to productive ZIKV infection. These results demonstrate that ZIKV exposure severely impacts the zona-free blastocyst, whereas exposure at the time of fertilization does not hinder blastocyst formation. Overall, early stages of pregnancy may be profoundly sensitive to infection and pregnancy loss, and the negative impact of ZIKV infection on pregnancy outcomes may be underestimated.
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Affiliation(s)
- Lindsey N Block
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, USA.,Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Matthew T Aliota
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Saint Paul, MN, USA
| | - Thomas C Friedrich
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, USA.,Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI, USA
| | - Michele L Schotzko
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Katherine D Mean
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Gregory J Wiepz
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Thaddeus G Golos
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, USA.,Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI, USA and.,Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, WI, USA
| | - Jenna Kropp Schmidt
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, USA
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37
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Gao Y, Tai W, Wang N, Li X, Jiang S, Debnath AK, Du L, Chen S. Identification of Novel Natural Products as Effective and Broad-Spectrum Anti-Zika Virus Inhibitors. Viruses 2019; 11:E1019. [PMID: 31684080 PMCID: PMC6893700 DOI: 10.3390/v11111019] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 10/31/2019] [Indexed: 12/15/2022] Open
Abstract
Zika virus (ZIKV) infection during pregnancy leads to severe congenital Zika syndrome, which includes microcephaly and other neurological malformations. No therapeutic agents have, so far, been approved for the treatment of ZIKV infection in humans; as such, there is a need for a continuous effort to develop effective and safe antiviral drugs to treat ZIKV-caused diseases. After screening a natural product library, we have herein identified four natural products with anti-ZIKV activity in Vero E6 cells, including gossypol, curcumin, digitonin, and conessine. Except for curcumin, the other three natural products have not been reported before to have anti-ZIKV activity. Among them, gossypol exhibited the strongest inhibitory activity against almost all 10 ZIKV strains tested, including six recent epidemic human strains. The mechanistic study indicated that gossypol could neutralize ZIKV infection by targeting the envelope protein domain III (EDIII) of ZIKV. In contrast, the other natural products inhibited ZIKV infection by targeting the host cell or cell-associated entry and replication stages of ZIKV. A combination of gossypol with any of the three natural products identified in this study, as well as with bortezomib, a previously reported anti-ZIKV compound, exhibited significant combinatorial inhibitory effects against three ZIKV human strains tested. Importantly, gossypol also demonstrated marked potency against all four serotypes of dengue virus (DENV) human strains in vitro. Taken together, this study indicates the potential for further development of these natural products, particularly gossypol, as the lead compound or broad-spectrum inhibitors against ZIKV and other flaviviruses, such as DENV.
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Affiliation(s)
- Yaning Gao
- Department of Natural Medicines, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China.
- Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY 10065, USA.
| | - Wanbo Tai
- Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY 10065, USA.
| | - Ning Wang
- Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY 10065, USA.
| | - Xiang Li
- Department of Natural Medicines, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China.
| | - Shibo Jiang
- Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY 10065, USA.
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai 200032, China.
| | - Asim K Debnath
- Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY 10065, USA.
| | - Lanying Du
- Lindsley F. Kimball Research Institute, New York Blood Center, New York, NY 10065, USA.
| | - Shizhong Chen
- Department of Natural Medicines, School of Pharmaceutical Sciences, Peking University, Beijing 100191, China.
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38
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Affiliation(s)
- Didier Musso
- From Aix Marseille Université, Institut de Recherche pour le Développement (IRD), Assistance Publique-Hôpitaux de Marseille, Service de Santé des Armées, Vecteurs-Infections Tropicales et Méditerranéennes (VITROME), and Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France (D.M.); private practice, Punaauia, Tahiti, French Polynesia (D.M.); Laboratoire Eurofins Labazur Guyane, Eurofins, French Guiana (D.M.); the Department of Epidemiology of Infectious Diseases, Yale School of Public Health, New Haven, CT (A.I.K.); Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil (A.I.K.); and the Materno-foetal and Obstetrics Research Unit, Department Femme-Mère-Enfant, Centre Hospitalier Universitaire Vaudois, and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland (D.B.)
| | - Albert I Ko
- From Aix Marseille Université, Institut de Recherche pour le Développement (IRD), Assistance Publique-Hôpitaux de Marseille, Service de Santé des Armées, Vecteurs-Infections Tropicales et Méditerranéennes (VITROME), and Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France (D.M.); private practice, Punaauia, Tahiti, French Polynesia (D.M.); Laboratoire Eurofins Labazur Guyane, Eurofins, French Guiana (D.M.); the Department of Epidemiology of Infectious Diseases, Yale School of Public Health, New Haven, CT (A.I.K.); Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil (A.I.K.); and the Materno-foetal and Obstetrics Research Unit, Department Femme-Mère-Enfant, Centre Hospitalier Universitaire Vaudois, and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland (D.B.)
| | - David Baud
- From Aix Marseille Université, Institut de Recherche pour le Développement (IRD), Assistance Publique-Hôpitaux de Marseille, Service de Santé des Armées, Vecteurs-Infections Tropicales et Méditerranéennes (VITROME), and Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France (D.M.); private practice, Punaauia, Tahiti, French Polynesia (D.M.); Laboratoire Eurofins Labazur Guyane, Eurofins, French Guiana (D.M.); the Department of Epidemiology of Infectious Diseases, Yale School of Public Health, New Haven, CT (A.I.K.); Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil (A.I.K.); and the Materno-foetal and Obstetrics Research Unit, Department Femme-Mère-Enfant, Centre Hospitalier Universitaire Vaudois, and Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland (D.B.)
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39
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Dudley DM, Aliota MT, Mohr EL, Newman CM, Golos TG, Friedrich TC, O'Connor DH. Using Macaques to Address Critical Questions in Zika Virus Research. Annu Rev Virol 2019; 6:481-500. [PMID: 31180813 PMCID: PMC7323203 DOI: 10.1146/annurev-virology-092818-015732] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Zika virus (ZIKV) and nonhuman primates have been inextricably linked since the virus was first discovered in a sentinel rhesus macaque in Uganda in 1947. Soon after ZIKV was epidemiologically associated with birth defects in Brazil late in 2015, researchers capitalized on the fact that rhesus macaques are commonly used to model viral immunity and pathogenesis, quickly establishing macaque models for ZIKV infection. Within months, the susceptibility of pregnant macaques to experimental ZIKV challenge and ZIKV-associated abnormalities in fetuses was confirmed. This review discusses key unanswered questions in ZIKV immunity and in the pathogenesis of thecongenital Zika virus syndrome. We focus on those questions that can be best addressed in pregnant nonhuman primates and lessons learned from developing macaque models for ZIKV amid an active epidemic.
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Affiliation(s)
- Dawn M Dudley
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53711, USA; , ,
| | - Matthew T Aliota
- Department of Veterinary and Biomedical Sciences, University of Minnesota, Twin Cities, Saint Paul, Minnesota 55108, USA;
| | - Emma L Mohr
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin 53792, USA;
| | - Christina M Newman
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53711, USA; , ,
| | - Thaddeus G Golos
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin 53715, USA; ,
- Departments of Comparative Biosciences and Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - Thomas C Friedrich
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin 53715, USA; ,
- Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, Wisconsin 53706, USA
| | - David H O'Connor
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, Wisconsin 53711, USA; , ,
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, Wisconsin 53715, USA; ,
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40
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Amaral P, Resende de Carvalho L, Hernandes Rocha TA, da Silva NC, Vissoci JRN. Geospatial modeling of microcephaly and zika virus spread patterns in Brazil. PLoS One 2019; 14:e0222668. [PMID: 31557165 PMCID: PMC6762139 DOI: 10.1371/journal.pone.0222668] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 09/04/2019] [Indexed: 11/29/2022] Open
Abstract
Microcephaly and Zika Virus infection (ZIKV) were declared Public Health Emergencies of International Concern by the World Health Organization in 2016. Brazil was considered the epicenter of the outbreak. However, the occurrence of both ZIKV and microcephaly in Brazil was not evenly distributed across the country. To better understand this phenomenon, we investigate regional characteristics at the municipal level that can be associated with the incidence of microcephaly, our response variable, and its relationship with ZIKV and other predictors. All epidemiological data in this study was provided by the Ministry of Health official database (DATASUS). Microcephaly was only confirmed after birth and the diagnostic was made regardless of the mother’s ZIKV status. Using exploratory spatial data analysis and spatial autoregressive Tobit models, our results show that microcephaly incidence is significantly, at 95% confidence level, related not only to ZIKV, but also to access to primary care, population size, gross national product, mobility and environmental attributes of the municipalities. There is also a significant spatial autocorrelation of the dependent variable. The results indicate that municipalities that show a high incidence of microcephaly tend to be clustered in space and that incidence of microcephaly varies considerably across regions when correlated only with ZIKV, i.e. that ZIKV alone cannot explain the differences in microcephaly across regions and their correlation is mediated by regional attributes.
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Affiliation(s)
- Pedro Amaral
- CEDEPLAR/UFMG, Center for Development and Regional Planning, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- * E-mail:
| | - Lucas Resende de Carvalho
- CEDEPLAR/UFMG, Center for Development and Regional Planning, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Thiago Augusto Hernandes Rocha
- PAHO/WHO, Brasília, Federal District, Brazil
- CEPEAD/UFMG, Center of Higher Studies and Research in Administration, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Núbia Cristina da Silva
- CEPEAD/UFMG, Center of Higher Studies and Research in Administration, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - João Ricardo Nickenig Vissoci
- Duke University, Duke School of Medicine, Department of Surgery, Division of Emergency Medicine, Durham, North Carolina, United States of America
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Kuper H, Lyra TM, Moreira MEL, de Albuquerque MDSV, de Araújo TVB, Fernandes S, Jofre-Bonet M, Larson H, Lopes de Melo AP, Mendes CHF, Moreira MCN, do Nascimento MAF, Penn-Kekana L, Pimentel C, Pinto M, Simas C, Valongueiro S. Social and economic impacts of congenital Zika syndrome in Brazil: Study protocol and rationale for a mixed-methods study. Wellcome Open Res 2019; 3:127. [PMID: 31667356 PMCID: PMC6807146 DOI: 10.12688/wellcomeopenres.14838.2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2019] [Indexed: 12/22/2022] Open
Abstract
Global concern broke out in late 2015 as thousands of children in Brazil were born with microcephaly, which was quickly linked to congenital infection with Zika virus (ZIKV). ZIKV is now known to cause a wider spectrum of severe adverse outcomes-congenital Zika syndrome (CZS)-and also milder impairments. This study aimed to explore the social and economic impacts of CZS in Brazil. Data was collected through mixed methods across two settings: Recife City and Jaboatão dos Guararapes in Pernambuco State (the epicentre of the epidemic), and the city of Rio de Janeiro (where reports of ZIKV infection and CZS were less frequent). Data was collected May 2017-January 2018. Ethical standards were adhered to throughout the research. In-depth qualitative interviews were conducted with: mothers and other carers of children with CZS (approximately 30 per setting), pregnant women (10-12 per setting), men and women of child-bearing age (16-20 per setting), and health professionals (10-12 per setting). Thematic analysis was undertaken independently by researchers from at least two research settings, and these were shared for feedback. A case-control study was undertaken to quantitatively explore social and economic differences between caregivers of a child with CZS (cases) and caregivers with an unaffected child (controls). We aimed to recruit 100 cases and 100 controls per setting, from existing studies. The primary caregiver, usually the mother, was interviewed using a structured questionnaire to collect information on: depression, anxiety, stress, social support, family quality of life, health care and social service use, and costs incurred by families. Multivariable logistic regression analyses were used to compare outcomes for cases and controls. Costs incurred as a result of CZS were estimated from the perspective of the health system, families and society. Modelling was undertaken to estimate the total economic burden of CZS from those three perspectives.
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Affiliation(s)
- Hannah Kuper
- International Centre for Evidence in Disability, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Tereza Maciel Lyra
- Aggeu Magalhães Institute, FIOCRUZ/PE, Recife, Brazil.,Faculty of Medicine, University of Pernambuco, Recife, Brazil
| | | | | | | | - Silke Fernandes
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Heidi Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ana Paula Lopes de Melo
- Aggeu Magalhães Institute, FIOCRUZ/PE, Recife, Brazil.,Public Health Department, Federal University of Pernambuco, Recife, Brazil
| | | | | | | | - Loveday Penn-Kekana
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Marcia Pinto
- Fernando Figueira Maternal and Children's Institute, Rio de Janeiro, Brazil
| | - Clarissa Simas
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Sandra Valongueiro
- Postgraduate Programme in Public Health, Federal University of Pernambuco, Recife, Brazil
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42
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Kuper H, Lyra TM, Moreira MEL, de Albuquerque MDSV, de Araújo TVB, Fernandes S, Jofre-Bonet M, Larson H, Lopes de Melo AP, Mendes CHF, Moreira MCN, do Nascimento MAF, Penn-Kekana L, Pimentel C, Pinto M, Simas C, Valongueiro S. Social and economic impacts of congenital Zika syndrome in Brazil: Study protocol and rationale for a mixed-methods study. Wellcome Open Res 2019; 3:127. [PMID: 31667356 DOI: 10.12688/wellcomeopenres.14838.1] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2018] [Indexed: 11/20/2022] Open
Abstract
Global concern broke out in late 2015 as thousands of children in Brazil were born with microcephaly, which was quickly linked to congenital infection with Zika virus (ZIKV). ZIKV is now known to cause a wider spectrum of severe adverse outcomes-congenital Zika syndrome (CZS)-and also milder impairments. This study aimed to explore the social and economic impacts of CZS in Brazil. Data was collected through mixed methods across two settings: Recife City and Jaboatão dos Guararapes in Pernambuco State (the epicentre of the epidemic), and the city of Rio de Janeiro (where reports of ZIKV infection and CZS were less frequent). Data was collected May 2017-January 2018. Ethical standards were adhered to throughout the research. In-depth qualitative interviews were conducted with: mothers and other carers of children with CZS (approximately 30 per setting), pregnant women (10-12 per setting), men and women of child-bearing age (16-20 per setting), and health professionals (10-12 per setting). Thematic analysis was undertaken independently by researchers from at least two research settings, and these were shared for feedback. A case-control study was undertaken to quantitatively explore social and economic differences between caregivers of a child with CZS (cases) and caregivers with an unaffected child (controls). We aimed to recruit 100 cases and 100 controls per setting, from existing studies. The primary caregiver, usually the mother, was interviewed using a structured questionnaire to collect information on: depression, anxiety, stress, social support, family quality of life, health care and social service use, and costs incurred by families. Multivariable logistic regression analyses were used to compare outcomes for cases and controls. Costs incurred as a result of CZS were estimated from the perspective of the health system, families and society. Modelling was undertaken to estimate the total economic burden of CZS from those three perspectives.
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Affiliation(s)
- Hannah Kuper
- International Centre for Evidence in Disability, Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
| | - Tereza Maciel Lyra
- Aggeu Magalhães Institute, FIOCRUZ/PE, Recife, Brazil.,Faculty of Medicine, University of Pernambuco, Recife, Brazil
| | | | | | | | - Silke Fernandes
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Heidi Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ana Paula Lopes de Melo
- Aggeu Magalhães Institute, FIOCRUZ/PE, Recife, Brazil.,Public Health Department, Federal University of Pernambuco, Recife, Brazil
| | | | | | | | - Loveday Penn-Kekana
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Marcia Pinto
- Fernando Figueira Maternal and Children's Institute, Rio de Janeiro, Brazil
| | - Clarissa Simas
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Sandra Valongueiro
- Postgraduate Programme in Public Health, Federal University of Pernambuco, Recife, Brazil
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Schwarz ER, Pozor MA, Pu R, Barr KL, Beachboard SE, MacLachlan NJ, Prakoso D, Long MT. Experimental Infection of Pregnant Female Sheep with Zika Virus During Early Gestation. Viruses 2019; 11:v11090795. [PMID: 31470560 PMCID: PMC6784126 DOI: 10.3390/v11090795] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 08/22/2019] [Accepted: 08/27/2019] [Indexed: 12/18/2022] Open
Abstract
Zika virus (ZIKV) is a vertically and sexually transmissible virus resulting in severe congenital malformation. The goal of this study was to develop an ovine model of ZIKV infection. Between 28–35 days gestation (DG), four pregnant animals were infected with two doses of 6 × 106 PFU of ZIKV; four control animals received PBS. Animals were evaluated for 45 days (D) post-infection (PI) and necropsies were performed. Viral RNA was detected in infected ewe peripheral blood mononuclear cells (PBMC) during the first week PI; however, all fluids and tissues were negative upon culture. Anti-ZIKV IgM (1:400) and neutralizing antibodies were detected in all infected animals. Clinical disease, virus, or ZIKV antibodies were not detected in control ewes. After two weeks PI, fetal loss occurred in two infected animals, and at necropsy, three infected animals had placental petechiation and ecchymosis and one had hydramnion. Fetal morphometrics revealed smaller cranial circumference to crown-rump length ratios (p < 0.001) and relative brain weights (p = 0.038) in fetuses of infected animals compared with control fetuses. Immunophenotyping indicated an increase in B cells (p = 0.012) in infected sheep. Additionally, in vitro experiments using both adult and fetal cell lines demonstrated that ovine cells are highly permissive to ZIKV infection. In conclusion, ZIKV infection of pregnant sheep results in a change in fetal growth and gestational outcomes.
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Affiliation(s)
- Erika R Schwarz
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Malgorzata A Pozor
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Ruiyu Pu
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Kelli L Barr
- Department of Biology, Colleges of Arts and Sciences, Baylor University, Waco, TX 76798, USA
| | - Sarah E Beachboard
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL 32611, USA
| | - N James MacLachlan
- Department of Pathology, Microbiology, and Immunology, School of Veterinary Medicine, University of California, Davis, CA 95616, USA
| | - Dhani Prakoso
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL 32611, USA
| | - Maureen T Long
- Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL 32611, USA.
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44
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Rational Design of Zika Virus Subunit Vaccine with Enhanced Efficacy. J Virol 2019; 93:JVI.02187-18. [PMID: 31189716 PMCID: PMC6694833 DOI: 10.1128/jvi.02187-18] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 06/10/2019] [Indexed: 01/07/2023] Open
Abstract
Zika virus (ZIKV) infection in pregnant women can lead to fetal deaths and malformations. We have previously reported that ZIKV envelope protein domain III (EDIII) is a subunit vaccine candidate with cross-neutralization activity; however, like many other subunit vaccines, its efficacy is limited. To improve the efficacy of this subunit vaccine, we identified a nonneutralizing epitope on ZIKV EDIII surrounding residue 375, which is buried in the full-length envelope protein but becomes exposed in recombinant EDIII. We then shielded this epitope with an engineered glycan probe. Compared to the wild-type EDIII, the mutant EDIII induced significantly stronger neutralizing antibodies in three mouse strains and also demonstrated significantly improved efficacy by fully protecting mice, particularly pregnant mice and their fetuses, against high-dose lethal ZIKV challenge. Moreover, the mutant EDIII immune sera significantly enhanced the passive protective efficacy by fully protecting mice against lethal ZIKV challenge; this passive protection was positively associated with neutralizing antibody titers. We further showed that the enhanced efficacy of the mutant EDIII was due to the shielding of the immunodominant nonneutralizing epitope surrounding residue 375, which led to immune refocusing on the neutralizing epitopes. Taken together, the results of this study reveal that an intrinsic limitation of subunit vaccines is their artificially exposed immunodominant nonneutralizing epitopes, which can be overcome through glycan shielding. Additionally, the mutant ZIKV protein generated in this study is a promising subunit vaccine candidate with high efficacy in preventing ZIKV infections in mice.IMPORTANCE Viral subunit vaccines generally show low efficacy. In this study, we revealed an intrinsic limitation of subunit vaccine designs: artificially exposed surfaces of subunit vaccines contain epitopes unfavorable for vaccine efficacy. More specifically, we identified an epitope on Zika virus (ZIKV) envelope protein domain III (EDIII) that is buried in the full-length envelope protein but becomes exposed in recombinant EDIII. We further shielded this epitope with a glycan, and the resulting mutant EDIII vaccine demonstrated significantly enhanced efficacy over the wild-type EDIII vaccine in protecting animal models from ZIKV infections. Therefore, the intrinsic limitation of subunit vaccines can be overcome through shielding these artificially exposed unfavorable epitopes. The engineered EDIII vaccine generated in this study is a promising vaccine candidate that can be further developed to battle ZIKV infections.
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Diniz D, Brito L, Ambrogi I, Tavares AB, Ali M. Understanding the sexual and reproductive health needs in Brazil's Zika-affected region: placing women at the center of the discussion. Int J Gynaecol Obstet 2019; 147:268-270. [PMID: 31314905 DOI: 10.1002/ijgo.12924] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 05/27/2019] [Accepted: 07/15/2019] [Indexed: 11/06/2022]
Abstract
Zika is no longer high on the public health agenda. There is a lack of information about Zika infection transmission, prevention, and its effects in Brazil.
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Affiliation(s)
- Debora Diniz
- Law School Faculty, University of Brasilia, Brasilia, Brazil.,International Planned Parenthood Federation, Western Hemisphere, New York, NY, USA
| | | | | | - Adriano Bueno Tavares
- Department of Reproductive Health and Research (RHR), World Health Organization, Geneva, Switzerland
| | - Moazzam Ali
- Department of Reproductive Health and Research (RHR), World Health Organization, Geneva, Switzerland
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Wenham C, Arevalo A, Coast E, Corrêa S, Cuellar K, Leone T, Valongueiro S. Zika, abortion and health emergencies: a review of contemporary debates. Global Health 2019; 15:49. [PMID: 31340836 PMCID: PMC6657045 DOI: 10.1186/s12992-019-0489-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/03/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The Zika outbreak provides pertinent case study for considering the impact of health emergencies on abortion decision-making and/or for positioning abortion in global health security debates. MAIN BODY This paper provides a baseline of contemporary debates taking place in the intersection of two key health policy areas, and seeks to understand how health emergency preparedness frameworks and the broader global health security infrastructure is prepared to respond to future crises which implicate sexual and reproductive rights. Our paper suggests there are three key themes that emerge from the literature; 1) the lack of consideration of sexual and reproductive health (SRH) services in outbreak response 2) structural inequalities permeate the landscape of health emergencies, epitomised by Zika, and 3) the need for rights based approaches to health. CONCLUSION Global health security planning and response should specifically include programmatic activity for SRH provision during health emergencies.
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Affiliation(s)
- Clare Wenham
- Department of Health Policy, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE UK
| | - Amaral Arevalo
- Instituto de Medicina Social-Universidade do Estado do Rio de Janeiro, Rua São Francisco Xavier 524, Maracanã, Bloco D, 7° andar, UERJ, Rio de Janeiro, RJ 20550-013 Brazil
| | - Ernestina Coast
- Department of International Development, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE UK
| | - Sonia Corrêa
- ABIA, Sexuality Policy Watch, Avenida Presidente Vargas, 446, 13th floor, CEP 20071-907, Rio de Janeiro, RJ Brazil
| | - Katherine Cuellar
- National Faculty of Public Health, Universidad de Antioquia, Calle 62 #52-59, Medellín, Colombia
| | - Tiziana Leone
- Department of International Development, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE UK
| | - Sandra Valongueiro
- Post-graduate Programe of Public Health, Federal University of Pernambuco, Av Prof Moraes Rego, s/n. Hospital das Clínicas, Bloco “E” – 4° Andar. Cidade Universitária CEP: 50.670-901, Recife, PE Brazil
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Hay JA, Nouvellet P, Donnelly CA, Riley S. Potential inconsistencies in Zika surveillance data and our understanding of risk during pregnancy. PLoS Negl Trop Dis 2018; 12:e0006991. [PMID: 30532143 PMCID: PMC6301717 DOI: 10.1371/journal.pntd.0006991] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 12/20/2018] [Accepted: 11/12/2018] [Indexed: 02/05/2023] Open
Abstract
Background A significant increase in microcephaly incidence was reported in Northeast Brazil at the end of 2015, which has since been attributed to an epidemic of Zika virus (ZIKV) infections earlier that year. Further incidence of congenital Zika syndrome (CZS) was expected following waves of ZIKV infection throughout Latin America; however, only modest increases in microcephaly and CZS incidence have since been observed. The quantitative relationship between ZIKV infection, gestational age and congenital outcome remains poorly understood. Methodology/Principle findings We characterised the gestational-age-varying risk of microcephaly given ZIKV infection using publicly available incidence data from multiple locations in Brazil and Colombia. We found that the relative timings and shapes of ZIKV infection and microcephaly incidence curves suggested different gestational risk profiles for different locations, varying in both the duration and magnitude of gestational risk. Data from Northeast Brazil suggested a narrow window of risk during the first trimester, whereas data from Colombia suggested persistent risk throughout pregnancy. We then used the model to estimate which combination of behavioural and reporting changes would have been sufficient to explain the absence of a second microcephaly incidence wave in Bahia, Brazil; a population for which we had two years of data. We found that a 18.9-fold increase in ZIKV infection reporting rate was consistent with observed patterns. Conclusions Our study illustrates how surveillance data may be used in principle to answer key questions in the absence of directed epidemiological studies. However, in this case, we suggest that currently available surveillance data are insufficient to accurately estimate the gestational-age-varying risk of microcephaly from ZIKV infection. The methods used here may be of use in future outbreaks and may help to inform improved surveillance and interpretation in countries yet to experience an outbreak of ZIKV infection. Zika virus (ZIKV) infection is associated with the rise of microcephaly cases observed in Northeast Brazil at the end of 2015. For women in endemic or at-risk areas, understanding how the relationship between time of infection and microcephaly risk varies through pregnancy is important in informing family planning. However, a relatively modest number of congenital Zika syndrome cases have been observed following subsequent waves of ZIKV infection, limiting our understanding of gestational risk. We used a mathematical model to quantify the shape and magnitude of the gestational-age-varying risk to a fetus. Although the risk profile should be conserved regardless of location, we estimated different profiles when using surveillance data from locations in Northeast Brazil and Colombia. Our results suggest that time-dependent reporting changes likely confound the interpretation of currently available surveillance data. Furthermore, we investigated a range of behavioural and reporting rate changes that could explain two waves of ZIKV infection in Bahia, Brazil despite only one wave of microcephaly. Plausible changes in reporting could explain these data whilst remaining consistent with the hypothesis that ZIKV infection carries a significant risk of microcephaly. Further evidence is needed to disentangle the true risk of congenital Zika syndrome from time-varying reporting changes.
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Affiliation(s)
- James A. Hay
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College, London, UK
| | - Pierre Nouvellet
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College, London, UK
- School of Life Sciences, University of Sussex, Brighton, UK
| | - Christl A. Donnelly
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College, London, UK
- Department of Statistics, University of Oxford, Oxford, UK
| | - Steven Riley
- MRC Centre for Global Infectious Disease Analysis, Department of Infectious Disease Epidemiology, Imperial College, London, UK
- * E-mail:
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48
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Barbeito-Andrés J, Schuler-Faccini L, Garcez PP. Why is congenital Zika syndrome asymmetrically distributed among human populations? PLoS Biol 2018; 16:e2006592. [PMID: 30142150 PMCID: PMC6126861 DOI: 10.1371/journal.pbio.2006592] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/06/2018] [Indexed: 12/12/2022] Open
Abstract
Zika virus (ZIKV) is a health burden due to the severe neurological abnormalities that arise after congenital infection. Although multiple experimental studies have linked ZIKV with neural birth defects, the scientific community has not been able to fully explain why Congenital Zika Syndrome (CZS) was only apparent after the virus entered the Americas and why these occurrences have an asymmetric geographic distribution. Here, we review the impact of ZIKV infection on human populations by exploring evolutionary changes in the virus’ genome as well as examining the diverse genetic and environmental cofactors of the human hosts.
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Affiliation(s)
- Jimena Barbeito-Andrés
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Institute for Studies in Neuroscience and Complex Systems Studies, ENyS, CONICET, Buenos Aires, Argentina
| | - Lavínia Schuler-Faccini
- Departament of Genetics, Institute of Biosciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Instituto Nacional de Genetica Medica Populacional, Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Patricia Pestana Garcez
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- * E-mail:
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