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Packer CH, Prabhu M. COVID-19 in Pregnancy: An Update for Clinicians. Clin Obstet Gynecol 2024; 67:565-575. [PMID: 38967474 DOI: 10.1097/grf.0000000000000885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2024]
Abstract
In this review, we will discuss the risks of COVID-19 on maternal, obstetric, and neonatal outcomes. We will also review the safety of COVID-19 vaccination in pregnancy, as well as review the management of COVID-19 in pregnancy.
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Affiliation(s)
- Claire H Packer
- Department of Maternal Fetal Medicine, Massachusetts General Hospital, Boston, Massachusetts
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2
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Jackson R, Woodward K, Ireland M, Larkin C, Kurinczuk JJ, Knight M, Gale C, Johnson S, Cornish R, Chakkarapani E. Antenatal and neonatal exposure to SARS-CoV-2 and children's development: a systematic review and meta-analysis. Pediatr Res 2024; 96:40-50. [PMID: 38114608 PMCID: PMC11257989 DOI: 10.1038/s41390-023-02954-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/14/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023]
Abstract
OBJECTIVES To conduct a systematic review of the impact of antenatal and neonatal exposure to SARS-CoV-2 on developmental outcomes in preterm and term-born infants. METHODS We searched Embase, Emcare, MEDLINE, PsycINFO, Web of Science and grey literature on May 27, 2022 and updated on May 8, 2023. Studies defining exposure with a positive SARS-CoV-2 protein or genetic material, used a contemporaneous non-exposed cohort, and reported developmental outcomes up to 2 years of age were included. RESULTS Four out of 828 screened studies were included. Meta-analysis included 815 infants screened for developmental delay (n = 306 exposed; n = 509 non-exposed) between 3- and 11-months of age. Among term-born infants, we did not find an increased risk of delay in communication (odd's ratio: 0.73 (95% CI: 0.24-2.24)), gross motor (1.50 (0.62, 3.62)), fine motor (2.90 (0.58, 14.43)), problem-solving (1.19 (0.54, 2.66)) or personal-social development (1.93 (0.78, 4.75)) in exposed infants. The number of preterm-born infants in the exposed (n = 37) and comparison cohorts (n = 41) were too few to report meaningful comparisons. CONCLUSION Evidence regarding the potential impact of antenatal or neonatal exposure to SARS-CoV-2 infection on developmental outcomes in early infancy is limited and inconsistent. Larger cohorts with outcomes beyond the first year of life are needed. IMPACT The current evidence examining associations between SARS-CoV-2 exposure during the neonatal period and developmental outcomes in infancy is limited by there being few studies with extremely small sample sizes. Based on sparse data there was no consistent association between antenatal or neonatal exposure to SARS-CoV-2 infection and an adverse impact on developmental outcomes below 12 months of age for babies born preterm or at term. This study highlights that larger cohorts with outcomes assessed beyond the first year are needed to determine the potential longer-term impact of SARS-CoV-2 infection exposure on child development.
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Affiliation(s)
- Rebecca Jackson
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Kathryn Woodward
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Meg Ireland
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Conor Larkin
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Imperial College London, London, United Kingdom
| | - Samantha Johnson
- Department of Population Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Rosie Cornish
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Ela Chakkarapani
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom.
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Andescavage N, Lu YC, Wu Y, Kapse K, Keller J, Von Kohorn I, Afifi A, Vezina G, Henderson D, Wessel DL, du Plessis AJ, Limperopoulos C. Intrauterine exposure to SARS-CoV-2 infection and early newborn brain development. Cereb Cortex 2024; 34:bhae041. [PMID: 38385890 PMCID: PMC10883413 DOI: 10.1093/cercor/bhae041] [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: 10/30/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 02/23/2024] Open
Abstract
Epidemiologic studies suggest that prenatal exposures to certain viruses may influence early neurodevelopment, predisposing offspring to neuropsychiatric conditions later in life. The long-term effects of maternal COVID-19 infection in pregnancy on early brain development, however, remain largely unknown. We prospectively enrolled infants in an observational cohort study for a single-site study in the Washington, DC Metropolitan Area from June 2020 to November 2021 and compared these infants to pre-pandemic controls (studied March 2014-February 2020). The primary outcomes are measures of cortical morphometry (tissue-specific volumes), along with global and regional measures of local gyrification index, and sulcal depth. We studied 210 infants (55 infants of COVID-19 unexposed mothers, 47 infants of COVID-19-positive mothers, and 108 pre-pandemic healthy controls). We found increased cortical gray matter volume (182.45 ± 4.81 vs. 167.29 ± 2.92) and accelerated sulcal depth of the frontal lobe (5.01 ± 0.19 vs. 4.40 ± 0.13) in infants of COVID-19-positive mothers compared to controls. We found additional differences in infants of COVID-19 unexposed mothers, suggesting both maternal viral exposures, as well as non-viral stressors associated with the pandemic, may influence early development and warrant ongoing follow-up.
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Affiliation(s)
- Nickie Andescavage
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC 20010, United States
- Division of Neonatology, Children’s National Hospital, 111 Michigavn Ave. NW, Washington, DC 20010, United States
- Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, 2300 Eye St. NW Washington, DC 20052, United States
| | - Yuan-Chiao Lu
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC 20010, United States
| | - Yao Wu
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC 20010, United States
| | - Kushal Kapse
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC 20010, United States
| | - Jennifer Keller
- Department of Obstetrics and Gynecology, School of Medicine and Health Sciences, George Washington University, 2300 Eye Ste. NW, Washington, DC 20052, United States
| | - Isabelle Von Kohorn
- Department of Neonatology, Holy Cross Hospital, 1500 Forest Glen Rd. Silver Spring, MD 20910, United States
| | - Ashraf Afifi
- Department of Hospital-Based Regional Neonatology at Woodbridge, Children’s National Hospital, 111 Michigan Ave. NW, Washington, DC 20010, United States
| | - Gilbert Vezina
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC 20010, United States
| | - Deidtra Henderson
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC 20010, United States
| | - David L Wessel
- Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, 2300 Eye St. NW Washington, DC 20052, United States
- Critical Care Medicine, Children’s National Hospital, 111 Michigan Ave. NW, Washington, DC 20010, United States
| | - Adre J du Plessis
- Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, 2300 Eye St. NW Washington, DC 20052, United States
- Prenatal Pediatrics Institute, Children’s National Hospital, 111 Michigan Ave. NW Washington, DC 20010, United States
| | - Catherine Limperopoulos
- Developing Brain Institute, Children's National Hospital, 111 Michigan Ave. NW, Washington, DC 20010, United States
- Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, 2300 Eye St. NW Washington, DC 20052, United States
- Prenatal Pediatrics Institute, Children’s National Hospital, 111 Michigan Ave. NW Washington, DC 20010, United States
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Manti S, Spoto G, Nicotera AG, Di Rosa G, Piedimonte G. Impact of respiratory viral infections during pregnancy on the neurological outcomes of the newborn: current knowledge. Front Neurosci 2024; 17:1320319. [PMID: 38260010 PMCID: PMC10800711 DOI: 10.3389/fnins.2023.1320319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/14/2023] [Indexed: 01/24/2024] Open
Abstract
Brain development is a complex process that begins during pregnancy, and the events occurring during this sensitive period can affect the offspring's neurodevelopmental outcomes. Respiratory viral infections are frequently reported in pregnant women, and, in the last few decades, they have been related to numerous neuropsychiatric sequelae. Respiratory viruses can disrupt brain development by directly invading the fetal circulation through vertical transmission or inducing neuroinflammation through the maternal immune activation and production of inflammatory cytokines. Influenza virus gestational infection has been consistently associated with psychotic disorders, such as schizophrenia and autism spectrum disorder, while the recent pandemic raised some concerns regarding the effects of severe acute respiratory syndrome coronavirus 2 on neurodevelopmental outcomes of children born to affected mothers. In addition, emerging evidence supports the possible role of respiratory syncytial virus infection as a risk factor for adverse neuropsychiatric consequences. Understanding the mechanisms underlying developmental dysfunction allows for improving preventive strategies, early diagnosis, and prompt interventions.
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Affiliation(s)
- Sara Manti
- Pediatric Unit, Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Messina, Italy
| | - Giulia Spoto
- Unit of Child Neurology and Psychiatry, Department of Biomedical and Dental Sciences and of Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Antonio Gennaro Nicotera
- Unit of Child Neurology and Psychiatry, Department of Human Pathology in Adult and Developmental Age “Gaetano Barresi”, University of Messina, Messina, Italy
| | - Gabriella Di Rosa
- Unit of Child Neurology and Psychiatry, Department of Biomedical and Dental Sciences and of Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Giovanni Piedimonte
- Department of Pediatrics, Biochemistry and Molecular Biology, Tulane University, New Orleans, LA, United States
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Özen B, Us Z, Toplu A, Vizdiklar C, Selalmaz Y, Çulpan Y, Aşik ZT, Kaşkal M, Açikgöz BN, Gülçebi Idriz Oğlu M, Karaalp A, Onat F, Yananli HR, Gülhan R. Favipiravir does not appear to be a major teratogen: Case series from Türkiye. J Gynecol Obstet Hum Reprod 2024; 53:102693. [PMID: 37984519 DOI: 10.1016/j.jogoh.2023.102693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 10/09/2023] [Accepted: 11/17/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Favipiravir has gained attention during the Coronavirus Disease-2019 pandemic due to its potential antiviral effect against Severe Acute Respiratory Syndrome Coronavirus-2. Favipiravir has been identified as a teratogen in animal studies, but there is limited human data. We aimed to evaluate the pregnancy outcomes of women exposed to favipiravir during the pandemic. MATERIAL AND METHODS Pregnant women who were exposed to favipiravir and applied to Marmara University School of Medicine Medical Pharmacology Outpatient Clinic Teratology Information Service between December 2020-September 2021 are included in the study. The demographic information, medical and obstetric histories of patients were acquired during admission, the outcomes of the pregnancies and the characteristics of the infants were gathered by regular phone calls. The infants whose parents consented were evaluated by a pediatrician for general well-being and congenital anomalies. RESULTS 22 pregnant women were included in this study. 81.8 % received the recommended favipiravir dose (8000 mg in 5 days), in the first trimester. Two patients were lost to follow-up, there was one elective termination and 19 live births. Congenital anomalies were found in 2 infants, one of whom had 9q34 duplication syndrome. Except for these, all newborns examined by the pediatrician were healthy. DISCUSSION Within a limited case series, a subset of the infants exposed to favipiravir prenatally were followed up to 1 year of age. Two infants exhibited congenital malformations that cannot be directly linked to favipiravir due to confounding variables. Considering the limited data published, favipiravir does not appear to be a major teratogen.
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Affiliation(s)
- Berna Özen
- Department of Medical Pharmacology, School of Medicine, Marmara University, Istanbul, Türkiye
| | - Zeynep Us
- Department of Medical Pharmacology, School of Medicine, Marmara University, Istanbul, Türkiye
| | - Aylin Toplu
- Department of Medical Pharmacology, School of Medicine, Marmara University, Istanbul, Türkiye
| | - Caner Vizdiklar
- Department of Medical Pharmacology, School of Medicine, Marmara University, Istanbul, Türkiye
| | | | - Yekta Çulpan
- Turkish Medicines and Medical Devices Agency, Ankara, Türkiye; Department of Medical Biology and Genetic, Institute of Health Sciences, Marmara University, Istanbul, Türkiye
| | - Zehranur Turgan Aşik
- Department of Medical Pharmacology, School of Medicine, Marmara University, Istanbul, Türkiye
| | - Mert Kaşkal
- Department of Medical Pharmacology, School of Medicine, Marmara University, Istanbul, Türkiye
| | - Büşra Nazli Açikgöz
- Unit of Pediatric Genetics, Department of Pediatrics, Hacettepe University Medical Faculty, Ankara, Türkiye
| | - Medine Gülçebi Idriz Oğlu
- Department of Medical Pharmacology, School of Medicine, Marmara University, Istanbul, Türkiye; Epilepsy Research and Implementation Centre, Marmara University, Istanbul, Türkiye
| | - Atila Karaalp
- Department of Medical Pharmacology, School of Medicine, Biruni University, Istanbul, Türkiye
| | - Filiz Onat
- Department of Medical Pharmacology, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Türkiye; Epilepsy Research and Implementation Centre, Marmara University, Istanbul, Türkiye
| | - Hasan Raci Yananli
- Department of Medical Pharmacology, School of Medicine, Marmara University, Istanbul, Türkiye; Epilepsy Research and Implementation Centre, Marmara University, Istanbul, Türkiye
| | - Rezzan Gülhan
- Department of Medical Pharmacology, School of Medicine, Marmara University, Istanbul, Türkiye; Epilepsy Research and Implementation Centre, Marmara University, Istanbul, Türkiye.
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Klein AZ, Kunatharaju S, Golder S, Levine LD, Figueiredo JC, Gonzalez-Hernandez G. Association Between COVID-19 During Pregnancy and Preterm Birth by Trimester of Infection: A Retrospective Cohort Study Using Longitudinal Social Media Data. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.11.17.23298696. [PMID: 38045356 PMCID: PMC10690358 DOI: 10.1101/2023.11.17.23298696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Background Preterm birth, defined as birth at <37 weeks of gestation, is the leading cause of neonatal death globally and, together with low birthweight, the second leading cause of infant mortality in the United States. There is mounting evidence that COVID-19 infection during pregnancy is associated with an increased risk of preterm birth; however, data remain limited by trimester of infection. The ability to study COVID-19 infection during the earlier stages of pregnancy has been limited by available sources of data. The objective of this study was to use self-reports in large-scale, longitudinal social media data to assess the association between trimester of COVID-19 infection and preterm birth. Methods In this retrospective cohort study, we used natural language processing and machine learning, followed by manual validation, to identify pregnant Twitter users and to search their longitudinal collection of publicly available tweets for reports of COVID-19 infection during pregnancy and, subsequently, a preterm birth or term birth (i.e., a gestational age ≥37 weeks) outcome. Among the users who reported their pregnancy on Twitter, we also identified a 1:1 age-matched control group, consisting of users with a due date prior to January 1, 2020-that is, without COVID-19 infection during pregnancy. We calculated the odds ratios (ORs) with 95% confidence intervals (CIs) to compare the overall rates of preterm birth for pregnancies with and without COVID-19 infection and by timing of infection: first trimester (weeks 1-13), second trimester (weeks 14-27), or third trimester (weeks 28-36). Results Through August 2022, we identified 298 Twitter users who reported COVID-19 infection during pregnancy, a preterm birth or term birth outcome, and maternal age: 94 (31.5%) with first-trimester infection, 110 (36.9%) second-trimester infection, and 95 (31.9%) third-trimester infection. In total, 26 (8.8%) of these 298 users reported preterm birth: 8 (8.5%) were infected during the first trimester, 7 (6.4%) were infected during the second trimester, and 12 (12.6%) were infected during the third trimester. In the 1:1 age-matched control group, 13 (4.4%) of the 298 users reported preterm birth. Overall, the risk of preterm birth was significantly higher for pregnancies with COVID-19 infection compared to those without (OR 2.1, 95% CI 1.06-4.16). In particular, the risk of preterm birth was significantly higher for pregnancies with COVID-19 infection during the third trimester (OR 3.17, CI 1.39-7.21). Conclusion The results of our study suggest that COVID-19 infection particularly during the third trimester is associated with an increased risk of preterm birth.
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Borges MASB, Florentino PTV, Cerqueira-Silva T, de Carvalho LF, de Araújo Oliveira V, Aguilar GMO, Prado RDS, Soranz D, Werneck GL, Pescarini JM, da Costa PSS, Barreto ML, de Oliveira Garcia MH, Penna GO, Barral-Netto M, Paixão ES. Factors associated with COVID-19 vaccination among pregnant women in Rio De Janeiro City, Brazil. Sci Rep 2023; 13:18235. [PMID: 37880238 PMCID: PMC10600223 DOI: 10.1038/s41598-023-44370-6] [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: 06/15/2023] [Accepted: 10/07/2023] [Indexed: 10/27/2023] Open
Abstract
COVID-19 vaccination during pregnancy is safe and effective in reducing the risk of complications. However, the uptake is still below targets worldwide. This study aimed to explore the factors associated with COVID-19 vaccination uptake among pregnant women since data on this topic is scarce in low-to-middle-income countries. A retrospective cohort study included linked data on COVID-19 vaccination and pregnant women who delivered a singleton live birth from August 1, 2021, to July 31, 2022, in Rio de Janeiro City, Brazil. Multiple logistic regression was performed to identify factors associated with vaccination during pregnancy, applying a hierarchical model and describing odds ratio with 95% confidence intervals. Of 65,304 pregnant women included in the study, 53.0% (95% CI, 52-53%) received at least one dose of COVID-19 vaccine during pregnancy. Higher uptake was observed among women aged older than 34 (aOR 1.21, 95%CI 1.15-1.28), black (aOR 1.10, 1.04-1.16), or parda/brown skin colour (aOR 1.05, 1.01-1.09), with less than eight years of education (aOR 1.09, 1.02-1.17), living without a partner (aOR 2.24, 2.16-2.34), more than six antenatal care appointments (aOR 1.92, 1.75-2.09), and having a previous child loss (OR 1.06, 1.02-1.11). These results highlight the need for targeted educational campaigns, trustful communication, and accessibility strategies for specific populations to improve vaccination uptake during pregnancy.
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Affiliation(s)
- Moara Alves Santa Bárbara Borges
- Instituto de Patologia Tropical e Saúde Pública da Universidade Federal de Goiás, Goiânia, 74605-050, Brazil.
- Programa de Pós-Graduação em Ciências da Saúde da Faculdade de Medicina da Universidade Federal de Goiás, Goiânia, 74605-050, Brazil.
| | - Pilar Tavares Veras Florentino
- Centro de Integração de Dados e Conhecimento para Saúde (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, 40296-710, Brazil
| | - Thiago Cerqueira-Silva
- Centro de Integração de Dados e Conhecimento para Saúde (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, 40296-710, Brazil
| | - Luciana Freire de Carvalho
- Secretaria Municipal de Saúde, Rio de Janeiro, 20211-110, Brazil
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, 21941-592, Brazil
| | - Vinícius de Araújo Oliveira
- Centro de Integração de Dados e Conhecimento para Saúde (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, 40296-710, Brazil
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, 40110-100, Brazil
| | | | | | - Daniel Soranz
- Secretaria Municipal de Saúde, Rio de Janeiro, 20211-110, Brazil
| | - Guilherme Loureiro Werneck
- Departamento de Epidemiologia, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, 20550-013, Brazil
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro, Rio de Janeiro, 21941-592, Brazil
| | - Julia M Pescarini
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
| | - Paulo Sérgio Sucasas da Costa
- Programa de Pós-Graduação em Ciências da Saúde da Faculdade de Medicina da Universidade Federal de Goiás, Goiânia, 74605-050, Brazil
| | - Mauricio Lima Barreto
- Centro de Integração de Dados e Conhecimento para Saúde (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, 40296-710, Brazil
| | | | - Gerson Oliveira Penna
- Núcleo de Medicina Tropical, Universidade de Brasília, Escola de Governo Fiocruz Brasília, Brasília, 70904-130, Brazil
| | - Manoel Barral-Netto
- Centro de Integração de Dados e Conhecimento para Saúde (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, 40296-710, Brazil
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, 40110-100, Brazil
| | - Enny S Paixão
- Department of Infectious Diseases Epidemiology, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
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