1
|
Ineffective penicillin treatment and absence of partner treatment may drive the congenital syphilis epidemic in Brazil. AJOG GLOBAL REPORTS 2022; 2. [PMID: 36081843 PMCID: PMC9451022 DOI: 10.1016/j.xagr.2022.100050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Reducing congenital syphilis has been the focus of Brazilian health programs for decades, yet the cases continue to increase. Although health interventions have targeted HIV screening and treatment, syphilis management continues to be challenging. Syphilis during pregnancy may enhance the HIV maternal seroconversion risk. The potential factors fueling the syphilis epidemic were evaluated in south Brazil, an area of high HIV or syphilis endemicity. OBJECTIVE We hypothesized that ineffective treatment because of a lack of partner treatment, late presentation to care, and reinfection of previously treated mothers were potential drivers of syphilis mother-to-child transmission. STUDY DESIGN Data on women diagnosed with syphilis during pregnancy between January 1, 2008 and December 31, 2018 were obtained from a large urban hospital in Porto Alegre, Brazil. The patients were stratified into effective vs ineffective treatment groups according to the World Health Organization guidelines. Crude and adjusted risk ratios for the prediction of congenital syphilis and adverse fetal or neonatal outcomes were computed using Poisson regression. RESULTS Nearly 56,000 pregnant women delivered over the 11-year period; 1541 (2.8%) had confirmed syphilis during pregnancy, with 934 (61%) receiving ineffective syphilis treatment because of late presentation and diagnosis, delayed treatment initiation, and loss to follow-up with no treatment recorded. Ineffective treatment was associated with maternal education, prenatal care, timing of syphilis diagnosis, venereal diseases research laboratory titers, and maternal HIV coinfection. On multivariate regression analysis, ineffective treatment (adjusted risk ratio, 4.52; 95% confidence interval, 2.35–8.69), absence of prenatal care (adjusted risk ratio, 9.31; 95% confidence interval, 3.77–23.0), syphilis diagnosis at delivery (adjusted risk ratio, 3.08; 95% confidence interval, 2.07–4.58), and maternal nontreponemal titers ≥1:64 (1.09–1.93) were associated with an increased risk of fetal loss. Ineffective treatment (adjusted risk ratio, 1.71; 95% confidence interval, 1.59–1.84), year of diagnosis 2014 to 2016 (adjusted risk ratio, 1.07; 95% confidence interval, 1.02–1.13), absence of prenatal care (adjusted risk ratio, 1.44; 95% confidence interval, 1.17–1.76), and maternal nontreponemal titers >1:4 were associated with an increased risk of congenital syphilis. Although partner treatment reduced the congenital syphilis risk (adjusted risk ratio, 0.60; 95% confidence interval, 0.55–0.66), only 31.8% of partners received treatment. Maternal HIV coinfection was not associated with an increased risk of fetal loss, low birthweight, preterm birth, congenital syphilis, or symptomatic neonatal infection. CONCLUSION Public health initiatives promoting effective syphilis treatment in pregnancy, increased access to high-quality prenatal care, and partner treatment should be considered to reduce congenital syphilis.
Collapse
|
2
|
Yeganeh N, Kreitchmann R, Leng M, Nielsen-Saines K, Gorbach PM, Klausner JD. Diagnosis and treatment of sexually transmitted infections in male partners of pregnant women in Brazil. Int J STD AIDS 2021; 32:1242-1249. [PMID: 34311604 PMCID: PMC8608751 DOI: 10.1177/09564624211032759] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sexually transmitted infections (STIs) can adversely affect a woman's pregnancy and the health of the developing fetus. The source of these infections may be the male sexual partner who remains under-diagnosed and un-treated due to a combination of lack of symptoms, decreased access to health care, and poor health-seeking behaviors. From September 2018 to November 2019, we offered a cohort of pregnant women (gestational age range: 4.6-41 weeks) clinic-based STI testing for HIV and syphilis (via lateral flow assay rapid tests) and for Neisseria (N.) gonorrhoeae, Chlamydia (C.) trachomatis, and Trichomonas (T.) vaginalis (via PCR-based testing) at Santa Casa Hospital and 10 affiliated prenatal clinics in Porto Alegre, Brazil. 400 women between the ages of 18 and 46 years (mean age: 27 years) enrolled and 24% were diagnosed with an STI. Each woman enrolled agreed to invite their male partners to clinic for the same panel of STI testing, and 255 men (64%) between the ages of 18 and 64 years (mean age: 29 years) attended clinic and all accepted full intervention. In these male partners, 40 (16%) were diagnosed with an STI including 22 (8.7%) testing positive for C. trachomatis, 15 (6%) for treponemal antibody (syphilis), 7 (2.8%) for T. vaginalis, 3 (1.2%) for N. gonorrhoeae, and 1 (0.4%) for HIV antibody. In our multivariate analysis, having symptoms of an STI (AOR 4.5, 95% CI 1.3-15.2) and arguing about jealousy (AOR 3.1, 95% CI 1.2-8.2) remained significantly associated with male diagnosis of an STI. Sexually transmitted infections are common in sexual partners of pregnant women in Brazil and should be addressed to prevent reinfection of pregnant women.
Collapse
Affiliation(s)
- Nava Yeganeh
- Department of Pediatrics, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Regis Kreitchmann
- Irmandade da Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil and Federal University Of Health Sciences, Porto Alegre, Brazil
| | - Mei Leng
- Department of Medicine Biostats, UCLA, Los Angeles CA, USA
| | - Karin Nielsen-Saines
- Department of Pediatrics, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Pamina M Gorbach
- Department of Epidemiology, Fielding School of Public Health, UCLA, Los Angeles, CA, USA
| | - Jeffrey D Klausner
- Department of Internal Medicine, Division of Infectious Disease, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| |
Collapse
|
3
|
Yeganeh N, Kreitchmann R, Leng M, Nielsen-Saines K, Gorbach PM, Klausner J. High Prevalence of Sexually Transmitted Infections in Pregnant Women Living in Southern Brazil. Sex Transm Dis 2021; 48:128-133. [PMID: 32976355 PMCID: PMC7817184 DOI: 10.1097/olq.0000000000001276] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/11/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Porto Alegre, Brazil, has the highest rates of congenital syphilis and HIV in the country. Other treatable sexually transmitted infections (STIs) are associated with poor pregnancy and neonatal outcomes, but are only diagnosed by syndromic algorithms. METHODS Between September 2018 and November 2019, we offered all pregnant women clinic-based STI testing for HIV antibody and treponemal antibody (via lateral flow assay rapid tests provided by the Brazilian Government) and for Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis (via polymerase chain reaction-based testing provided by Gene Xpert, Sunnyvale, CA) in 10 public prenatal health clinics in Porto Alegre. Participating women answered a brief survey via audio computer-assisted survey instrument regarding demographics, partnerships, and sexual behaviors. All infected individuals received appropriate treatment and referrals. RESULTS Of 400 pregnant women recruited, 94 (24%) were diagnosed with an STI, including 2% with HIV, 11% with syphilis, 9% with chlamydia, 1% with gonorrhea, 5% with trichomoniasis, and 3% with more than 1 STI. In our multivariate analysis, younger age (adjusted odds ratio [AOR], 1.1; 95% confidence interval [CI], 1-1.2), being non-White (AOR, 1.8; 95% CI, 1.1-3.1), having less education (AOR, 2; 95% CI, 1.2-3.4), and having a relationship <1 year (AOR, 2; 95% CI, 1.1-3.6) were all independent predictors of women having an STI. Endorsing symptoms of an STI (e.g., vaginal ulcers/lesions and vaginal discharge) was not predictive of having a laboratory-diagnosed STI (OR, 1.1; 95% CI, 0.7-1.7). CONCLUSIONS Etiologic-based screening for STIs was uniformly accepted by women attending both hospital-based and primary health clinics in the south of Brazil and can result in appropriate treatment of pregnant women.
Collapse
Affiliation(s)
- Nava Yeganeh
- From the Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Regis Kreitchmann
- Irmandade da Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil
- Federal University of Health Sciences of Porto Alegre
| | - Mei Leng
- UCLA Department of Medicine Biostats
| | - Karin Nielsen-Saines
- From the Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Pamina M. Gorbach
- Department of Epidemiology, Fielding School of Public Health at UCLA
| | - Jeffrey Klausner
- Department of Internal Medicine, David Geffen School of Medicine at UCLA
- Division of Infectious Disease, UCLA CARE Center, Los Angeles, CA
| |
Collapse
|
4
|
Thibaut F, Chagraoui A, Buckley L, Gressier F, Labad J, Lamy S, Potenza MN, Rondon M, Riecher-Rössler A, Soyka M, Yonkers K, Yonkers K. WFSBP * and IAWMH ** Guidelines for the treatment of alcohol use disorders in pregnant women. World J Biol Psychiatry 2019; 20:17-50. [PMID: 30632868 DOI: 10.1080/15622975.2018.1510185] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES These practice guidelines for the treatment of alcohol use disorders during pregnancy were developed by members of the International Task Force of the World Federation of Societies of Biological Psychiatry and the International Association for Women's Mental Health. METHODS We performed a systematic review of all available publications and extracted data from national and international guidelines. The Task Force evaluated the data with respect to the strength of evidence for the efficacy and safety of each medication. RESULTS AND DISCUSSION There is no safe level of alcohol use during pregnancy. Abstinence is recommended. Ideally, women should stop alcohol use when pregnancy is planned and, in any case, as soon as pregnancy is known. Detecting patterns of alcohol maternal drinking should be systematically conducted at first antenatal visit and throughout pregnancy. Brief interventions are recommended in the case of low or moderate risk of alcohol use. Low doses of benzodiazepines, for the shortest duration, may be used to prevent alcohol withdrawal symptoms when high and chronic alcohol intake is stopped and hospitalisation is recommended. Due to the low level of evidence and/or to low benefit/risk ratio, pharmacological treatment for maintenance of abstinence should not be used during pregnancy. At birth, foetal alcohol spectrum disorders must be searched for, and alcohol metabolites should be measured in meconium of neonates in any doubt of foetal alcohol exposure.
Collapse
Affiliation(s)
- Florence Thibaut
- a University Hospital Cochin , Faculty of Medicine Paris Descartes, INSERM U 894, Centre Psychiatry and Neurosciences , Paris , France
| | - Abdeslam Chagraoui
- b Neuronal and Neuroendocrine Differentiation and Communication Laboratory , Institute for Research and Innovation in Biomedicine of Normandy (IRIB), Normandie Univ , UNIROUEN, INSERM, U1239, CHU Rouen , Rouen , France ; Department of Medical Biochemistry , Rouen University Hospital , Rouen , France
| | - Leslie Buckley
- c Addiction Services , University Health Network, University of Toronto , Toronto , Canada
| | - Florence Gressier
- d Department of Psychiatry , INSERM UMR1178 CESP, Univ. Paris-Sud , Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre , Le Kremlin Bicêtre , France
| | - Javier Labad
- e Department of Mental Health , Parc Tauli Hospital Universitari, I3PT ; Department of Psychiatry and Legal Medicine , Universitat Autonoma de Barcelona, CIBERSAM, Sabadell , Barcelona , Spain
| | - Sandrine Lamy
- f Department of Addictology , Ramsay- General de Santé, SSR Petit Colmoulins , Harfleur , France
| | - Marc N Potenza
- g Neuroscience and Child Study , Yale University School of Medicine , New Haven , CT , USA
| | - Marta Rondon
- h Instituto Nacional Materno Perinatal , Lima , Peru
| | - Anita Riecher-Rössler
- i Center for Gender Research and Early Detection , University of Basel Psychiatric Hospital , Basel , Switzerland
| | - Michael Soyka
- j University of Munich , Munich, and Medicalpark Chiemseeblick, Bernau , Germany
| | - Kim Yonkers
- k Center for Wellbeing of Women and Mothers, Psychiatry, of Epidemiology (Chronic Diseases) and of Obstetrics, Gynecology, and Reproductive Sciences , Yale University , New Haven , CT , USA
| | - Kim Yonkers
- Center for Wellbeing of Women and Mothers, Psychiatry, of Epidemiology (Chronic Diseases) and of Obstetrics, Gynecology, and Reproductive Sciences, Yale University, New Haven, CT, USA
| |
Collapse
|
5
|
Use of Audio Computer-Assisted Self-Interviews to Gather Information on Risk Behaviors in a Population of Pregnant Adolescents. J Pediatr 2018; 203:450-453. [PMID: 30244989 DOI: 10.1016/j.jpeds.2018.08.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 07/18/2018] [Accepted: 08/09/2018] [Indexed: 11/24/2022]
Abstract
In a prospective study comparing the use of the Audio Computer-Assisted Self-Interview (ACASI) with a traditional clinical interview in 40 pregnant adolescents, there was significantly greater disclosure of violence with the ACASI method. Better identification of high-risk behaviors may help to optimize care and programing for pregnant adolescents.
Collapse
|
6
|
Latkin CA, Mai NVT, Ha TV, Sripaipan T, Zelaya C, Le Minh N, Morales G, Go VF. Social Desirability Response Bias and Other Factors That May Influence Self-Reports of Substance Use and HIV Risk Behaviors: A Qualitative Study of Drug Users in Vietnam. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2016; 28:417-425. [PMID: 27710083 PMCID: PMC5268760 DOI: 10.1521/aeap.2016.28.5.417] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The accuracy of self-report data may be marred by a range of cognitive and motivational biases, including social desirability response bias. The current study used qualitative interviews to examine self-report response biases among participants in a large randomized clinical trial in Vietnam. A sample of study participants was reinterviewed. The vast majority reported being truthful and emphasized the importance of rapport with the study staff for achieving veridical data. However, some stated that rapport may lead to under reporting of risk behaviors in order not to disappoint study staff. Other factors that appeared to influence accuracy of self-reports include fear that the information may be divulged, desire to enroll in the study, length of the survey, and memory. There are several methods that can be employed to reduce response biases, and future studies should systematically address response bias and include methods to assess whether approaches and survey items are effective in improving accuracy of self-report data.
Collapse
Affiliation(s)
- Carl A Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Nguyen Vu Tuyet Mai
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Tran Viet Ha
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Teerada Sripaipan
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Carla Zelaya
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Nguyen Le Minh
- Thai Nguyen Center for Preventive Medicine, Thai Nguyen, Vietnam
| | - Giuliana Morales
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| | - Vivian F Go
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina
| |
Collapse
|
7
|
Kim SM, Jung JW, Park IW, Ahn CM, Kim YI, Yoo KH, Chun EM, Jung JY, Park YS, Park JH, Kim JY. Gender Differences in Relations of Smoking Status, Depression, and Suicidality in Korea: Findings from the Korea National Health and Nutrition Examination Survey 2008-2012. Psychiatry Investig 2016; 13:239-46. [PMID: 27081387 PMCID: PMC4823202 DOI: 10.4306/pi.2016.13.2.239] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 07/20/2015] [Accepted: 07/24/2015] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE As mental health problems may play an important role in initiating and maintaining cigarette smoking in females and there are an increasing number of female smokers, we evaluated the relationship between smoking status and mental health problems including depression and suicide ideation in women in Korea. METHODS We analyzed the 5-year cumulative data (19 years of age or older, n=32,184) from the Korean National Health and Nutrition Examination Survey (KNHANES) conducted from 2008 to 2012. Logistic regression analyses were used to evaluate associations between cigarette smoking status and mental health parameters while controlling for potentially confounding variables. RESULTS Among current smokers, females showed higher lifetime prevalence in having a depressive episode, a doctor-diagnosed major depression, a current diagnosis of depression, or receiving treatment for depression in comparison with males. In addition, females were more likely to report on having a depressive episode, suicidal ideation and attempts, and psychiatric counselling within the previous year, as compared to males. Female former smokers showed intermediate characteristics in parameters of mental health status within the previous year, ranking between lifetime non-smokers and the current smokers. CONCLUSION Identifying the factors related to mental health status among current smokers can increase opportunities for an early intervention and help reduce the prevalence of smoking and increase smoking cessation rates particularly in females. Developing adaptive coping strategies other than smoking in female youth is potentially important in reducing the initiation of smoking.
Collapse
Affiliation(s)
- Sun Mi Kim
- Department of Psychiatry, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Jae-Woo Jung
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - In-Won Park
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Chul Min Ahn
- Division of Pulmonology, Department of Internal Medicine, Kangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yu-Il Kim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Kwang-Ha Yoo
- Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Eun Mi Chun
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Ji Ye Jung
- Division of Pulmonology, Department of Internal Medicine, Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young Sik Park
- Division of Pulmonology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ju-Heon Park
- Department of Internal Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jae Yeol Kim
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | | |
Collapse
|
8
|
Disclosure of sensitive behaviors across self-administered survey modes: a meta-analysis. Behav Res Methods 2014; 47:1237-1259. [DOI: 10.3758/s13428-014-0533-4] [Citation(s) in RCA: 209] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
9
|
Yeganeh N, Simon M, Dillavou C, Varella I, Santos BR, Fonseca R, Melo M, Lira R, Gorbach P, Nielsen-Saines K. HIV testing of male partners of pregnant women in Porto Alegre, Brazil: a potential strategy for reduction of HIV seroconversion during pregnancy. AIDS Care 2013; 26:790-4. [PMID: 24200084 PMCID: PMC4230890 DOI: 10.1080/09540121.2013.855297] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 10/09/2013] [Indexed: 10/26/2022]
Abstract
Pregnant women have a significantly higher risk of HIV acquisition during gestation than their non-pregnant counterparts due to behavioral and biological factors. Acute seroconversion during gestation results in increased HIV mother-to-child transmission rates and has been identified as a major public health challenge. In order to address potential HIV seroconversion in our pregnant patients, we conducted a prospective cohort study to evaluate the acceptability of offering HIV testing to sexual partners of HIV-negative pregnant women receiving antenatal care at two hospitals in Porto Alegre, Brazil. Over a 14-month study period, HIV-negative pregnant women at two hospital-based clinic sites were encouraged to bring their stable sexual partner for HIV voluntary counseling and testing during prenatal care. Women were re-interviewed following delivery to measure success of the intervention. Of the 1223 HIV-negative pregnant women enrolled in the study, 663 (54%) of their male sexual partners received HIV testing during antenatal care and 4 (0.6%) were diagnosed with HIV infection. A total of 645 women were interviewed at the time of delivery, with 620 (97%) confirming that HIV testing was suggested to their partner. The most common reason provided by women as to why partners did not come for testing was work (69%) and lack of perceived risk (14%). Independent predictors of successful partner testing included being white (odds ratio [OR] 1.59, 95% confidence interval [CI] 1.18-2.12), married (OR 1.78, 95% CI 1.08-2.94), having an older age of sexual debut (OR 0.94, 95% CI 0.9-0.98), and being recruited at Hospital Conceiçao (OR 2.1, 95% CI 1.52-2.88). We conclude that HIV partner testing during prenatal care is acceptable, rendering this intervention attractive to public health programs targeting prevention of sexually transmitted infections.
Collapse
Affiliation(s)
- Nava Yeganeh
- Dept of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States. Division of Infectious Disease-MDCC 22-442 10833 LeConte Ave, Los Angeles, CA 90095. Telephone 310 825-5235. Fax 310 825-9175
| | - Mariana Simon
- Hospital Nossa Senhora da Conceiçao/GHC, Porto Alegre, Brazil. Servico de Infectologia Hospital Nossa Senhora da Conceicao/GHC, Av. Francisco Trein, 596, 91350-200 Porto Alegre, RS Brasil, Telephone: +55-51-3341-5316, Fax: +55-51-3343.2386
| | - Claire Dillavou
- Department of Epidemiology, Fielding School of Public Health at UCLA, Los Angeles, CA United States. CHS 41-295, Box 951772, Los Angeles CA 90095. Telephone 310-794-2555, Fax 310-825-7387
| | - Ivana Varella
- Hospital Nossa Senhora da Conceiçao/GHC, Porto Alegre, Brazil. Servico de Infectologia Hospital Nossa Senhora da Conceicao/GHC, Av. Francisco Trein, 596, 91350-200 Porto Alegre, RS Brasil, Telephone: +55-51-3341-5316, Fax: +55-51-3343.2386
| | - Breno Riegel Santos
- Hospital Nossa Senhora da Conceiçao/GHC, Porto Alegre, Brazil. Servico de Infectologia Hospital Nossa Senhora da Conceicao/GHC, Av. Francisco Trein, 596, 91350-200 Porto Alegre, RS Brasil, Telephone: +55-51-3341-5316, Fax: +55-51-3343.2386
| | - Rosana Fonseca
- Hospital Nossa Senhora da Conceiçao/GHC, Porto Alegre, Brazil. Servico de Infectologia Hospital Nossa Senhora da Conceicao/GHC, Av. Francisco Trein, 596, 91350-200 Porto Alegre, RS Brasil, Telephone: +55-51-3341-5316, Fax: +55-51-3343.2386
| | - Marineide Melo
- Hospital Nossa Senhora da Conceiçao/GHC, Porto Alegre, Brazil. Servico de Infectologia Hospital Nossa Senhora da Conceicao/GHC, Av. Francisco Trein, 596, 91350-200 Porto Alegre, RS Brasil, Telephone: +55-51-3341-5316, Fax: +55-51-3343.2386
| | - Rita Lira
- Hospital Nossa Senhora da Conceiçao/GHC, Porto Alegre, Brazil. Servico de Infectologia Hospital Nossa Senhora da Conceicao/GHC, Av. Francisco Trein, 596, 91350-200 Porto Alegre, RS Brasil, Telephone: +55-51-3341-5316, Fax: +55-51-3343.2386
| | - Pamina Gorbach
- Department of Epidemiology, Fielding School of Public Health at UCLA, Los Angeles, CA United States. CHS 41-295, Box 951772, Los Angeles CA 90095. Telephone 310-794-2555, Fax 310-825-7387
| | - Karin Nielsen-Saines
- Dept of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States. Division of Infectious Disease-MDCC 22-442 10833 LeConte Ave, Los Angeles, CA 90095. Telephone 310 825-5235. Fax 310 825-9175
| |
Collapse
|