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Dias LKS, Sanhueza-Sanzana C, Pinheiro FML, Martins AF, Correia FGS, de Aguiar IWO, Ferreira NC, Stolow J, Rutherford G, Teixeira MG, Pires RDJ, de Almeida RLF, Coelho ICB, Frota CC, Kendall C, Kerr LRFS. Use of insect repellent as personal protection among women of childbearing age in an arbovirus endemic area in Northeastern Brazil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2024; 27:e240025. [PMID: 38747743 PMCID: PMC11093518 DOI: 10.1590/1980-549720240025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 01/11/2024] [Accepted: 01/30/2024] [Indexed: 05/19/2024] Open
Abstract
OBJECTIVE To analyze the factors associated with the individual use of insect repellent by women of childbearing age living in area endemic for arboviruses in Fortaleza, Brazil. METHODS This is a cohort study carried out between 2018 and 2019 with women aged between 15 and 39 years in Fortaleza, state of Ceará, Brazil. A total of 1,173 women users of one of the four selected primary health care units participated in the study. The outcome was divided into: continued use, discontinued use, and nonuse of insect repellent. Crude and adjusted multinominal logistic regression analysis was carried out guided by a hierarchical model, with presentation of the respective odds ratio (OR) and 95% confidence intervals (95%CI). The independent variables include: socioeconomic and demographic data, environmental and sanitary characteristics, knowledge of the insect repellent, and behavioral and pregnancy-related aspects. RESULTS Only 28% of the participants reported using insect repellent during the two waves of the cohort. Women with higher education (OR=2.55; 95%CI 1.44-4.51); who are employed (OR=1.51; 95%CI 1.12-2.03); who received guidance from healthcare professionals (OR=1.74; 95%CI 1.28-2.36) and the media (OR=1.43; 95%CI 1.01-2.02); who intensified precautions against mosquitoes during the epidemic (OR=3.64; 95%CI 2.29-5.78); and who were pregnant between 2016 and 2019 (OR=2.80; 95%CI 1.83-4.30) had increased odds for continued use of insect repellent. CONCLUSION The use of insect repellent among women of childbearing age was associated with a higher level of education, employment, guidance on insect repellent provided by healthcare professionals and the media, behavioral changes to protect against mosquitoes during the Zika virus epidemic, and pregnancy when occurring as of the beginning of the epidemic period.
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Affiliation(s)
- Livia Karla Sales Dias
- Universidade Federal do Ceará, School of Medicine, Department of Community Health – Fortaleza (CE), Brazil
| | - Carlos Sanhueza-Sanzana
- Universidade Federal do Ceará, School of Medicine, Department of Community Health – Fortaleza (CE), Brazil
| | | | - Adriano Ferreira Martins
- Universidade Federal do Ceará, School of Medicine, Department of Community Health – Fortaleza (CE), Brazil
| | | | | | - Nayane Cavalcante Ferreira
- Universidade Federal do Ceará, School of Medicine, Department of Community Health – Fortaleza (CE), Brazil
| | - Jeni Stolow
- Tulane University, Tulane School of Public Health and Tropical Medicine, Department of Social Behavior and Population Science – New Orleans (LA), USA
| | - George Rutherford
- University of California, Department of Epidemiology and Biostatistics – San Francisco, California (CA), USA
| | - Maria Gloria Teixeira
- Universidade Federal da Bahia, Institute of Collective Health – Salvador (BA), Brazil
| | - Roberto da Justa Pires
- Universidade Federal do Ceará, School of Medicine, Department of Community Health – Fortaleza (CE), Brazil
| | | | - Ivo Castelo Branco Coelho
- Universidade Federal do Ceará, School of Medicine, Department of Pathology and Legal Medicine – Fortaleza (CE), Brazil
| | - Cristiane Cunha Frota
- Universidade Federal do Ceará, School of Medicine, Department of Pathology and Legal Medicine – Fortaleza (CE), Brazil
| | - Carl Kendall
- Universidade Federal do Ceará, School of Medicine, Department of Community Health – Fortaleza (CE), Brazil
- Tulane University, Tulane School of Public Health and Tropical Medicine, Department of Social Behavior and Population Science – New Orleans (LA), USA
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Calado AM, Seixas F, Dos Anjos Pires M. Virus as Teratogenic Agents. Methods Mol Biol 2024; 2753:105-142. [PMID: 38285335 DOI: 10.1007/978-1-0716-3625-1_4] [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] [Indexed: 01/30/2024]
Abstract
Viral infectious diseases are important causes of reproductive disorders, as abortion, fetal mummification, embryonic mortality, stillbirth, and congenital abnormalities in animals and in humans. In this chapter, we provide an overview of some virus, as important agents in teratology.We begin by describing the Zika virus, whose infection in humans had a very significant impact in recent years and has been associated with major health problems worldwide. This virus is a teratogenic agent in humans and has been classified as a public health emergency of international concern (PHEIC).Then, some viruses associated with reproductive abnormalities on animals, which have a significant economic impact on livestock, are described, as bovine herpesvirus, bovine viral diarrhea virus, Schmallenberg virus, Akabane virus, and Aino virus.For all viruses mentioned in this chapter, the teratogenic effects and the congenital malformations associated with fetus and newborn are described, according to the most recent scientific publications.
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Affiliation(s)
- Ana Margarida Calado
- Animal and Veterinary Research Centre (CECAV), UTAD, and Associate Laboratory for Animal and Veterinary Science (AL4Animals), Department of Veterinary Sciences, School of Agrarian and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal
| | - Fernanda Seixas
- Animal and Veterinary Research Centre (CECAV), UTAD, and Associate Laboratory for Animal and Veterinary Science (AL4Animals), Department of Veterinary Sciences, School of Agrarian and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal
| | - Maria Dos Anjos Pires
- Animal and Veterinary Research Centre (CECAV), UTAD, and Associate Laboratory for Animal and Veterinary Science (AL4Animals), Department of Veterinary Sciences, School of Agrarian and Veterinary Sciences (ECAV), University of Trás-os-Montes e Alto Douro (UTAD), Vila Real, Portugal.
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Ximenes RADA, Miranda-Filho DDB, Martinez-Espinoza FE, Brasil P. Still on the Brazilian Response to the Microcephaly Epidemic: A Meta-analysis of 1,548 Pregnant Women from 13 Cohorts to Evaluate the Risk of Adverse Outcomes. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2023; 45:169-170. [PMID: 37224837 PMCID: PMC10208725 DOI: 10.1055/s-0043-1769107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
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Araújo LMC, Guimarães-do-Carmo VJ, Andrade TGVS, Claudino SC, Soares DM, Melo RS. Musculoskeletal pain and quality of life in mothers of children with microcephaly, due to congenital Zika virus syndrome. Child Care Health Dev 2023; 49:268-280. [PMID: 35959527 DOI: 10.1111/cch.13039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/07/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE The purpose of this study is to observe the prevalence and intensity of musculoskeletal pain and the quality of life in mothers of children with microcephaly and also to compare the scores of the quality of life domains between mothers who had or did not have musculoskeletal pain. METHODS This is a cross-sectional study that evaluated mothers of children with a clinical diagnosis of microcephaly, due to congenital Zika virus syndrome, in the state of Pernambuco, northeast region, Brazil. To assess musculoskeletal pain, the Nordic Questionnaire of Musculoskeletal Symptoms was used, pain intensity was assessed by the Visual Analogue Scale and quality of life by the SF-36 Questionnaire. RESULTS Of the 63 mothers evaluated, 59 (93.7%) reported currently experiencing musculoskeletal pain. The lumbar spine was the body region with the highest prevalence of pain (77.8%), followed by the thoracic spine (57.1%) and cervical spine (50.8%). Pain intensity was higher in the lumbar spine (6.00 ± 0.47), thoracic spine (4.44 ± 0.52) and shoulders (3.81 ± 0.51). The domains that presented the lowest scores in the quality of life assessment were general health status (49.0 ± 3.19), emotional aspects (49.7 ± 5.88) and pain (49.7 ± 2.50). Mothers who had musculoskeletal pain had lower scores in all domains of quality of life assessment compared to mothers who did not have pain, demonstrating significant differences for functional capacity (P = 0.035), physical aspects (P = 0.047) and pain (P = 0.002). CONCLUSION A high prevalence of musculoskeletal pain was observed in mothers of children with microcephaly, with a higher prevalence and intensity in the lumbar spine. The domains related to physical and emotional health presented the worst scores in the quality of life of the evaluated mothers and the presence of musculoskeletal pain reduced the quality of life of the mothers of children with microcephaly in this study.
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Affiliation(s)
| | | | | | | | - Diego Moura Soares
- Department of Dentistry, Faculdade Pernambucana de Saúde (FPS), Recife, Brazil
| | - Renato S Melo
- Department of Physical Therapy, Universidade Federal de Pernambuco (UFPE), Recife, Brazil.,Laboratory of Pediatric Studies, (LEPed), Universidade Federal de Pernambuco (UFPE), Recife, Brazil
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Krokovsky L, Guedes DRD, Santos FCF, Sales KGDS, Bandeira DA, Pontes CR, Leal WS, Ayres CFJ, Paiva MHS. Potential Nosocomial Infections by the Zika and Chikungunya Viruses in Public Health Facilities in the Metropolitan Area of Recife, Brazil. Trop Med Infect Dis 2022; 7:tropicalmed7110351. [PMID: 36355893 PMCID: PMC9694620 DOI: 10.3390/tropicalmed7110351] [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: 09/15/2022] [Revised: 10/13/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022] Open
Abstract
Since 2015, the Dengue, Zika, and Chikungunya viruses gained notoriety for their impact in public health in many parts of the globe, including Brazil. In Recife, the capital of Pernambuco State, the introduction of ZIKV impacted human population tremendously, owing to the increase in the number of neurological cases, such as the Guillain−Barré and congenital Zika disorders. Later, Recife was considered to be the epicenter for ZIKV epidemics in Brazil. For arboviral diseases, there are some risk factors, such as climate changes, low socioeconomic conditions, and the high densities of vectors populations, that favor the broad and rapid dispersion of these three viruses in the city. Therefore, continuous arbovirus surveillance provides an important tool for detecting these arboviruses and predicting new outbreaks. The purpose of the present study was to evaluate the circulation of DENV, ZIKV, and CHIKV by RT-qPCR in mosquitoes collected in health care units from the metropolitan area of Recife (MAR), during 2018. A total of 2321 female mosquitoes (357 pools) belonging to two species, Aedes aegypti and Culex quinquefasciatus, were collected from 18 different healthcare units, distributed in five cities from the MAR. Twenty-three pools were positive for ZIKV, out of which, seventeen were of C. quinquefasciatus and six were of A. aegypti. Positive pools were collected in 11/18 health care units screened, with Cq values ranging from 30.0 to 37.4 and viral loads varying from 1.88 × 107 to 2.14 × 109 RNA copies/mL. Nosocomial Aedes- and Culex-borne transmission of arbovirus are widely ignored by surveillance and vector control programs, even though healthcare-associated infections (HAI) are considered a serious threat to patient safety worldwide. Although the results presented here concern only the epidemiological scenario from 2018 in MAR, the potential of hospital-acquired transmission through mosquito bites is being overlooked by public health authorities. It is, therefore, of the ultimate importance to establish specific control programs for these locations.
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Affiliation(s)
- Larissa Krokovsky
- Entomology Department, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife 50740-465, Brazil
| | | | | | | | | | | | - Walter Soares Leal
- Department of Molecular and Cellular Biology, University of California, Davis, CA 95616, USA
| | | | - Marcelo Henrique Santos Paiva
- Entomology Department, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife 50740-465, Brazil
- Life Sciences Center, Agreste Academic Center, Federal University of Pernambuco, Caruaru 55002-970, Brazil
- Correspondence: ; Tel.: +55-81-21012552
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6
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Melo NDL, de Sousa DF, Laporta GZ. Microcephaly and Associated Risk Factors in Newborns: A Systematic Review and Meta-Analysis Study. Trop Med Infect Dis 2022; 7:261. [PMID: 36288003 PMCID: PMC9611276 DOI: 10.3390/tropicalmed7100261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 12/03/2022] Open
Abstract
Congenital microcephaly is caused by a multitude of drivers affecting maternal−fetal health during pregnancy. It is a rare outcome in high-income industrial countries where microcephaly rates are in the range of 0.3−0.9 per 1000 newborns. Prevalence of microcephaly varies considerably across developing countries and can go as high as 58 cases per 1000 live births in pregnancies exposed to infection by Zika virus (ZIKV). Not only ZIKV-infected pregnancies, but other drivers can modulate the occurrence and severity of this outcome. Here, we sought to test the ZIKV−microcephaly association vs. competing hypotheses using a meta-analysis with 8341 microcephaly cases pooled from 10,250,994 newborns in the Americas, Africa, and Asia. Analysis of risk ratios (RR) showed teratogens the most likely microcephaly-associated risk factor (RR = 3.43; 95%-CI 2.69−4.38; p-value < 0.0001), while the statistical significance of the ZIKV−microcephaly association was marginal (RR = 2.12; 95%-CI 1.01−4.48; p-value = 0.048). Other congenital infections showed strong but variable associations with microcephaly (RR = 15.24; 95%-CI 1.74−133.70; p-value = 0.014). Microcephaly cases were associated with impoverished socioeconomic settings, but this association was statistically non-significant (RR = 2.75; 95%-CI 0.55−13.78; p-value = 0.22). The marginal ZIKV−microcephaly association and statistical significance of the competing hypotheses suggest maternal ZIKV infection might not be a cause of microcephaly alone.
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Affiliation(s)
- Natália de L. Melo
- Graduate Research and Innovation Program, Centro Universitario FMABC, Santo André 09060-870, Brazil
- College of Medicine, Estacio University, Juazeiro 48924-999, Brazil
| | - Danilo F. de Sousa
- College of Nursing, Federal University of Ceara, Fortaleza 60020-181, Brazil
| | - Gabriel Z. Laporta
- Graduate Research and Innovation Program, Centro Universitario FMABC, Santo André 09060-870, Brazil
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Paixão ES, Fernandes QHRF, Cardim LL, Pescarini JM, Costa MCN, Falcão IR, Brickley EB, Santos AC, Portela Souza A, Carvalho-Sauer RDCO, Smeeth L, Rodrigues LC, Barreto ML, Teixeira MG. Socioeconomic risk markers of congenital Zika syndrome: a nationwide, registry-based study in Brazil. BMJ Glob Health 2022; 7:bmjgh-2022-009600. [PMID: 36175039 PMCID: PMC9528618 DOI: 10.1136/bmjgh-2022-009600] [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: 05/12/2022] [Accepted: 08/29/2022] [Indexed: 11/04/2022] Open
Abstract
While it is well known that socioeconomic markers are associated with a higher risk of arbovirus infections, research on the relationship between socioeconomic factors and congenital Zika syndrome (CZS) remains limited. This study investigates the relationship between socioeconomic risk markers and live births with CZS in Brazil. We conducted a population-based study using data from all registered live births in Brazil (Live Births Information System) linked with the Public Health Event Record from 1 January 2015 to 31 December 2018. We used logistic regression models to estimate the OR and 95% CIs of CZS based on a three-level framework. In an analysis of 11 366 686 live births, of which 3353 had CZS, we observed that live births of self-identified black or mixed race/brown mothers (1.72 (95% CI 1.47 to 2.01) and 1.37 (95% CI 1.24 to 1.51)) were associated with a higher odds of CZS. Live births from single women compared with married women and those from women with less than 12 years of education compared with those with more than 12 years of education also had higher odds of CZS. In addition, live births following fewer prenatal care appointments had increased odds of CZS in the nationwide data. However, in the analyses conducted in the Northeast region (where the microcephaly epidemic started before the link with Zika virus was established and before preventive measures were known or disseminated), no statistical association was found between the number of prenatal care appointments and the odds of CZS. This study shows that live births of the most socially vulnerable women in Brazil had the greatest odds of CZS. This disproportionate distribution of risk places an even greater burden on already socioeconomically disadvantaged groups, and the lifelong disabilities caused by this syndrome may reinforce existing social and health inequalities.
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Affiliation(s)
- Enny S Paixão
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK .,Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil
| | - Qeren Hapuk R Ferreira Fernandes
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil
| | - Luciana L Cardim
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil
| | - Julia M Pescarini
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Ila R Falcão
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil
| | - Elizabeth B Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Andreia Costa Santos
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - André Portela Souza
- School of Economics and Center for Applied Microeconomic Studies, Getulio Vargas Foundation, São Paulo, Brazil
| | | | - Liam Smeeth
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Laura C Rodrigues
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Mauricio L Barreto
- Center of Data and Knowledge Integration for Health (CIDACS), Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil
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Krokovsky L, Paiva MHS, Guedes DRD, Barbosa RMR, de Oliveira ALS, Anastácio DB, Pontes CR, Ayres CFJ. Arbovirus Surveillance in Field-Collected Mosquitoes From Pernambuco-Brazil, During the Triple Dengue, Zika and Chikungunya Outbreak of 2015-2017. FRONTIERS IN TROPICAL DISEASES 2022. [DOI: 10.3389/fitd.2022.875031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The (re) emergence of arboviruses around the world is a public health concern once severe outbreaks are usually associated with these infections. The co-circulation of Dengue (DENV), Zika (ZIKV) and Chikungunya (CHIKV) viruses in the past few years has caused a unique epidemic situation in Brazil. The northeast region of the country was the most affected by clinical complications from such arboviruses’ infections, including neurological disorders caused by ZIKV. In this particular region, Aedes mosquitoes are the main vectors of DENV, ZIKV and CHIKV, with Culex quinquefasciatus also considered as a potential vector of ZIKV. Therefore, virological surveillance in mosquitoes contributes to understanding the epidemiological profile of these diseases. Here, we report the circulation of DENV, ZIKV and CHIKV in Aedes spp. and Cx. quinquefasciatus female mosquitoes collected in areas with a high arbovirus circulation in humans in the Metropolitan Region of Recife, Pernambuco, Brazil, during the triple-epidemics of 2015-17. All the field-caught mosquitoes were sent to the laboratory for arbovirus screening after RNA extraction and RT-PCR/RT-qPCR. A total of 6,227 females were evaluated and, as a result, DENV, ZIKV and CHIKV were identified in Ae. aegypti, Ae. taeniorhynchus and Cx. quinquefasciatus mosquito pools. In addition, DENV and ZIKV were isolated in C6/36 cells. In conclusion, it is important to highlight that arbovirus surveillance performed in mosquitoes from DENV-ZIKV-CHIKV hotspots areas can serve as an early-warning system to target vector control actions more efficiently in each studied area.
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Scott P. Women, Administered Insecurity, and Multiple Alignments to Assuage Gender Inequalities in the Brazilian Zika Epidemic. Front Glob Womens Health 2021; 2:716612. [PMID: 34927135 PMCID: PMC8678269 DOI: 10.3389/fgwh.2021.716612] [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: 05/28/2021] [Accepted: 11/01/2021] [Indexed: 11/22/2022] Open
Abstract
This article deals with the Brazilian Zika epidemic that started in 2015 and became an important event for understanding Gender and Power in health treatment contexts. It discusses a combination of reinforcement of gender normed care and therapeutic itineraries overburdening mothers and the construction of political awareness and practice associated with demands for state services. Working with a concept of administered insecurity elaborated to understand people displaced during the implementation of planned government development policies, it argues that the planned nature of health systems, despite their explicit emphasis on the objective of treating the health of the population, also generate administered insecurity as planned administrators of scarcity. It uses data from a 4-year research project entitled “Doing Ethnography on Care” in Recife, Brazil, to show the multiplicity of contexts that are brought out through the practice of mothers in providing care for their Zika-syndrome stricken children, and how they reflect varying power relations that constantly re-dimension maternity along lines of gender relations in different institutional domains of treatment and research. The severe gender inequality in caring for infants was partially assuaged by multiple alignments made by the mothers and infants promoting dialogue and practice in varied contexts, including interaction with the research team. Family and Community Relations, Mediation, Favors, Accusations, Judicialization, Collective Action, formation of Associations, and learning to produce videos are seen as constructors of complex meaning and practice of mothering in a way in which gender goes beyond the limits of an overburdening practice of care. Gender provides a significant difference for mothers whose knowledge and familiarity of domains of health and health-related provision of services and knowledge, forged in their search for treatment for their child, create and legitimate spaces for the exercise of informed citizenship and a sharp awareness and resistance to practices by the state and other agents who administer insecurity. The final remarks synthesize some of the more important reconfigurations of gender relations and power in the context of the Zika epidemic and alerts to the challenge of the transitory nature of an epidemic and the gradual, and not so gradual, exhaustion of institutional interest for the dilemma of the mothers and also shows the role of anthropological research in promoting gender equality in epidemic contexts.
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Affiliation(s)
- Parry Scott
- FAGES, Graduate Program in Anthropology, Federal University of Pernambuco, Recife, Brazil
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10
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Nunes PS, Guimarães RA, Martelli CMT, de Souza WV, Turchi MD. Zika virus infection and microcephaly: spatial analysis and socio-environmental determinants in a region of high Aedes aegypti infestation in the Central-West Region of Brazil. BMC Infect Dis 2021; 21:1107. [PMID: 34706662 PMCID: PMC8549329 DOI: 10.1186/s12879-021-06805-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 10/19/2021] [Indexed: 11/25/2022] Open
Abstract
Background More than 5 years after the Zika virus (ZIKV) epidemic, Zika infection remains a major concern in regions with high Aedes infestation. The objectives of this study were (i) to identify clusters of ZIKV infection and microcephaly, and/or central nervous system (CNS) alterations associated with congenital infection during the epidemic peak in 2016 and subsequently, in 2017 and 2018; (ii) to measure the non-spatial correlation between ZIKV infection and microcephaly and/or CNS alterations associated with congenital infection; and (iii) to analyse the sociodemographic/economic, health, and environmental determinants associated with the incidence of ZIKV in a region of high infestation by Aedes aegypti in the Central-West Region of Brazil. Methods This ecological study analysed 246 municipalities in the state of Goiás (6.9 million inhabitants). The data were obtained from the Information System for Notifiable Diseases (ZIKV cases) and the Public Health Event Registry (microcephaly and/or CNS alterations associated with congenital infection). Incidence rates and prevalence of ZIKA infection were smoothed by an empirical Bayesian estimator (LEbayes), producing the local empirical Bayesian rate (LEBR). In the spatial analysis, ZIKV infection and microcephaly cases were georeferenced by the municipality of residence for 2016 and grouped for 2017 and 2018. Global Moran's I and the Hot Spot Analysis tool (Getis-Ord Gi* statistics) were used to analyse the spatial autocorrelation and clusters of ZIKV infection and microcephaly, respectively. A generalised linear model from the Poisson family was used to assess the association between ecological determinants and the smoothing incidence rate of ZIKV infection. Results A total of 9892 cases of acute ZIKV infection and 121 cases of microcephaly were confirmed. The mean LEBR of the ZIKV infection in the 246 municipalities was 22.3 cases/100,000 inhabitants in 2016, and 10.3 cases/100,000 inhabitants in 2017 and 2018. The LEBR of the prevalence rate of microcephaly and/or CNS alterations associated with congenital infection was 7 cases/10,000 live births in 2016 and 2 cases/10,000 live births during 2017–2018. Hotspots of ZIKV infection and microcephaly cases were identified in the capital and neighbouring municipalities in 2016, with new clusters in the following years. In a multiple regression Poisson analysis, ZIKV infection was associated with higher population density, the incidence of dengue, Aedes larvae infestation index, and average rainfall. The important determinant of ZIKV infection incidence reduction was the increase in households attended by endemic disease control agents. Conclusions Our analyses were able to capture, in a more granular way, aspects that make it possible to inform public managers of the sentinel areas identified in the post-epidemic hotspots. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06805-1.
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Affiliation(s)
- Patrícia Silva Nunes
- Federal Institute of Education, Science and Technology of Goiás, Goiânia, Brazil. .,Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil.
| | - Rafael Alves Guimarães
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil.,Faculty of Nursing, Federal University of Goiás, Goiânia, Brazil
| | | | | | - Marília Dalva Turchi
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Brazil.
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Wilder-Smith A, Brickley EB, Ximenes RADA, Miranda-Filho DDB, Turchi Martelli CM, Solomon T, Jacobs BC, Pardo CA, Osorio L, Parra B, Lant S, Willison HJ, Leonhard S, Turtle L, Ferreira MLB, de Oliveira Franca RF, Lambrechts L, Neyts J, Kaptein S, Peeling R, Boeras D, Logan J, Dolk H, Orioli IM, Neumayr A, Lang T, Baker B, Massad E, Preet R. The legacy of ZikaPLAN: a transnational research consortium addressing Zika. Glob Health Action 2021; 14:2008139. [PMID: 35377284 PMCID: PMC8986226 DOI: 10.1080/16549716.2021.2008139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Global health research partnerships with institutions from high-income countries and low- and middle-income countries are one of the European Commission's flagship programmes. Here, we report on the ZikaPLAN research consortium funded by the European Commission with the primary goal of addressing the urgent knowledge gaps related to the Zika epidemic and the secondary goal of building up research capacity and establishing a Latin American-European research network for emerging vector-borne diseases. Five years of collaborative research effort have led to a better understanding of the full clinical spectrum of congenital Zika syndrome in children and the neurological complications of Zika virus infections in adults and helped explore the origins and trajectory of Zika virus transmission. Individual-level data from ZikaPLAN`s cohort studies were shared for joint analyses as part of the Zika Brazilian Cohorts Consortium, the European Commission-funded Zika Cohorts Vertical Transmission Study Group, and the World Health Organization-led Zika Virus Individual Participant Data Consortium. Furthermore, the legacy of ZikaPLAN includes new tools for birth defect surveillance and a Latin American birth defect surveillance network, an enhanced Guillain-Barre Syndrome research collaboration, a de-centralized evaluation platform for diagnostic assays, a global vector control hub, and the REDe network with freely available training resources to enhance global research capacity in vector-borne diseases.
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Affiliation(s)
- Annelies Wilder-Smith
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.,Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | | | | | | | | | - Tom Solomon
- NIHR Health Protection Research Unit for Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences University of Liverpool, Liverpool, UK
| | - Bart C Jacobs
- Departments of Neurology and Immunology, Erasmus Universitair Medisch Centrum Rotterdam, The Netherlands
| | - Carlos A Pardo
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | | | - Suzannah Lant
- NIHR Health Protection Research Unit for Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences University of Liverpool, Liverpool, UK
| | - Hugh J Willison
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Sonja Leonhard
- Departments of Neurology and Immunology, Erasmus Universitair Medisch Centrum Rotterdam, The Netherlands
| | - Lance Turtle
- NIHR Health Protection Research Unit for Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences University of Liverpool, Liverpool, UK
| | | | | | - Louis Lambrechts
- Insect-Virus Interactions Unit, Institut Pasteur, UMR2000, CNRS, 75015 Paris, France
| | - Johan Neyts
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Laboratory of Virology and Chemotherapy, Leuven, Belgium
| | - Suzanne Kaptein
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Laboratory of Virology and Chemotherapy, Leuven, Belgium
| | - Rosanna Peeling
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - James Logan
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Helen Dolk
- Centre for Maternal, Fetal and Infant Research, Institute for Nursing and Health Research, Ulster University, Ulster, United Kingdom
| | - Ieda M Orioli
- RELAMC and ECLAMC at Genetics Department, Federal University of Rio de Janeiro, Brazil
| | - Andreas Neumayr
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Trudie Lang
- The Global Health Network, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Bonny Baker
- The Global Health Network, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Eduardo Massad
- School of Medicine, University of Sao Paulo and Fundacao Getulio Vargas, Sao Paulo, Brazil
| | - Raman Preet
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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12
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Vancamp P, Spirhanzlova P, Sébillot A, Butruille L, Gothié JD, Le Mével S, Leemans M, Wejaphikul K, Meima M, Mughal BB, Roques P, Remaud S, Fini JB, Demeneix BA. The pyriproxyfen metabolite, 4'-OH-PPF, disrupts thyroid hormone signaling in neural stem cells, modifying neurodevelopmental genes affected by ZIKA virus infection. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2021; 285:117654. [PMID: 34289950 DOI: 10.1016/j.envpol.2021.117654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/25/2021] [Accepted: 06/11/2021] [Indexed: 06/13/2023]
Abstract
North-Eastern Brazil saw intensive application of the insecticide pyriproxyfen (PPF) during the microcephaly outbreak caused by the Zika virus (ZIKV). ZIKV requires the neural RNA-binding protein Musashi-1 to replicate. Thyroid hormone (TH) represses MSI1. PPF is a suspected TH disruptor. We hypothesized that co-exposure to the main metabolite of PPF, 4'-OH-PPF, could exacerbate ZIKV effects through increased MSI1 expression. Exposing an in vivo reporter model, Xenopus laevis, to 4'-OH-PPF decreased TH signaling and increased msi1 mRNA and protein, confirming TH-antagonistic properties. Next, we investigated the metabolite's effects on mouse subventricular zone-derived neural stem cells (NSCs). Exposure to 4'-OH-PPF dose-dependently reduced neuroprogenitor proliferation and dysregulated genes implicated in neurogliogenesis. The highest dose induced Msi1 mRNA and protein, increasing cell apoptosis and the ratio of neurons to glial cells. Given these effects of the metabolite alone, we considered if combined infection with ZIKV worsened neurogenic events. Only at the fourth and last day of incubation did co-exposure of 4'-OH-PPF and ZIKV decrease viral replication, but viral RNA copies stayed within the same order of magnitude. Intracellular RNA content of NSCs was decreased in the combined presence of 4'-OH-PPF and ZIKV, suggesting a synergistic block of transcriptional machinery. Seven out of 12 tested key genes in TH signaling and neuroglial commitment were dysregulated by co-exposure, of which four were unaltered when exposed to 4'-OH-PPF alone. We conclude that 4'-OH-PPF is an active TH-antagonist, altering NSC processes known to underlie correct cortical development. A combination of the TH-disrupting metabolite and ZIKV could aggravate the microcephaly phenotype.
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Affiliation(s)
- Pieter Vancamp
- Laboratory Molecular Physiology and Adaptation, CNRS UMR 7221, Muséum National d'Histoire Naturelle, Department Adaptations of Life, F-75005, Paris, France
| | - Petra Spirhanzlova
- Laboratory Molecular Physiology and Adaptation, CNRS UMR 7221, Muséum National d'Histoire Naturelle, Department Adaptations of Life, F-75005, Paris, France
| | - Anthony Sébillot
- Laboratory Molecular Physiology and Adaptation, CNRS UMR 7221, Muséum National d'Histoire Naturelle, Department Adaptations of Life, F-75005, Paris, France
| | - Lucile Butruille
- Laboratory Molecular Physiology and Adaptation, CNRS UMR 7221, Muséum National d'Histoire Naturelle, Department Adaptations of Life, F-75005, Paris, France
| | - Jean-David Gothié
- Laboratory Molecular Physiology and Adaptation, CNRS UMR 7221, Muséum National d'Histoire Naturelle, Department Adaptations of Life, F-75005, Paris, France
| | - Sébastien Le Mével
- Laboratory Molecular Physiology and Adaptation, CNRS UMR 7221, Muséum National d'Histoire Naturelle, Department Adaptations of Life, F-75005, Paris, France
| | - Michelle Leemans
- Laboratory Molecular Physiology and Adaptation, CNRS UMR 7221, Muséum National d'Histoire Naturelle, Department Adaptations of Life, F-75005, Paris, France
| | - Karn Wejaphikul
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Marcel Meima
- Department of Internal Medicine, Academic Center for Thyroid Diseases, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Bilal B Mughal
- Laboratory Molecular Physiology and Adaptation, CNRS UMR 7221, Muséum National d'Histoire Naturelle, Department Adaptations of Life, F-75005, Paris, France
| | - Pierre Roques
- Immunology of Viral Infections and Autoimmune Diseases, IDMIT Department, IBFJ, CEA, Université Paris Sud, INSERM U1184, 92265, Fontenay-aux-Roses, France
| | - Sylvie Remaud
- Laboratory Molecular Physiology and Adaptation, CNRS UMR 7221, Muséum National d'Histoire Naturelle, Department Adaptations of Life, F-75005, Paris, France
| | - Jean-Baptiste Fini
- Laboratory Molecular Physiology and Adaptation, CNRS UMR 7221, Muséum National d'Histoire Naturelle, Department Adaptations of Life, F-75005, Paris, France
| | - Barbara A Demeneix
- Laboratory Molecular Physiology and Adaptation, CNRS UMR 7221, Muséum National d'Histoire Naturelle, Department Adaptations of Life, F-75005, Paris, France.
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13
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Zika virus infection in pregnant women and their children: A review. Eur J Obstet Gynecol Reprod Biol 2021; 265:162-168. [PMID: 34508989 DOI: 10.1016/j.ejogrb.2021.07.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 12/20/2022]
Abstract
Zika virus (ZIKV) is an arthropod-borne virus (arbovirus) transmitted primarily by Aedes mosquitoes. ZIKV can be transmitted to humans by non-vector borne mechanisms such as sexual intercourse, maternal-foetal transmission or blood transfusion. In 2015, ZIKV emerged in the Americas, and spread to 87 countries and territories with autochthonous transmission, distributed across four of the six WHO regions. Most ZIKV infections in pregnancy are asymptomatic, but mother to child transmission of the virus can occur in 20 to 30% of cases and cause severe foetal and child defects. Children exposed to ZIKV while in utero might develop a pattern of structural anomalies and functional disabilities secondary to central nervous system damage, known as congenital Zika syndrome, and whose most common clinical feature is microcephaly. Normocephalic children born to mothers with ZIKV infection in pregnancy, and with no observable Zika-associated birth defects, may also present with later neurodevelopmental delay or post-natal microcephaly. Screening and detection of ZIKV infection in pregnancy is essential, because most women with ZIKV infection are asymptomatic and clinical manifestations are non-specific. However, the diagnosis of ZIKV infection poses multiple challenges due to limited resources and scarce laboratory capabilities in most affected areas, the narrow window of time that the virus persists in the bloodstream, the large proportion of asymptomatic infections, and the cross-reactivity with other flaviviruses such as Dengue virus (DENV). Molecular methods (RT-PCR) are the most reliable tool to confirm ZIKV infection, as serodiagnosis requires confirmation with neutralization tests in case of inconclusive or positive serology results. Prenatal ultrasound assessment is essential for monitoring foetal development and early detection of possible severe anomalies. A mid- and long-term follow-up of children exposed to ZIKV while in utero is necessary to promptly detect clinical manifestations of possible neurological impairment. Tweetable abstract: Zika virus infection during pregnancy is a cause of pregnancy loss and disability in children. Protection against mosquito bites, access to sexual and reproductive health services, prompt screening and detection of ZIKV infection in pregnancy, and prenatal ultrasound monitoring are key control strategies whilst a vaccine is not available.
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14
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Oliveira DMDS, Miranda-Filho DDB, Ximenes RADA, Montarroyos UR, Martelli CMT, Brickley EB, Gouveia MDCL, Ramos RC, Rocha MÂW, Araujo TVBD, Eickmann SH, Rodrigues LC, Bernardes JPDOS, Pinto MHT, Soares KPND, Araújo CMTD, Militão-Albuquerque MDFP, Santos ACOD. Comparison of Oropharyngeal Dysphagia in Brazilian Children with Prenatal Exposure to Zika Virus, With and Without Microcephaly. Dysphagia 2021; 36:583-594. [PMID: 32886254 PMCID: PMC8289769 DOI: 10.1007/s00455-020-10173-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 08/24/2020] [Indexed: 01/12/2023]
Abstract
Severe brain damage associated with Zika-related microcephaly (ZRM) have been reported to result in oropharyngeal dysphagia (OPD); however, it is unknown if OPD presents in children with prenatal Zika virus (ZIKV) exposure but only mild or undetectable abnormalities. The aims of this study were: to compare the frequency and characteristics of OPD in children with ZRM and in children without microcephaly born to mothers who tested polymerase chain reaction positive (PCR+) for ZIKV during pregnancy; and to investigate the concordance of caregiver reports of OPD with the diagnosis from the clinical swallowing assessment (CSA). Between Mar/2017 and May/2018, we evaluated 116 children (n = 58 with microcephaly, n = 58 children without microcephaly born to ZIKV PCR + mothers) participating in the Microcephaly Epidemic Research Group (MERG) cohort of children born during the 2015-2016 ZIKV epidemic in Pernambuco, Brazil. To assess OPD we used: a CSA; a clinical assessment of the stomatognathic system; and a questionnaire administered to caregivers. The frequency of OPD was markedly higher in children with ZRM (79.3%) than in the exposed but normocephalic group (8.6%). The children with microcephaly also presented more frequently with anatomic and functional abnormalities in the stomatognathic system. There was a high degree of agreement between the caregiver reports of OPD and the CSA (κ = 0.92). In conclusion, our findings confirm that OPD is a feature of Congenital Zika Syndrome that primarily occurs in children with microcephaly and provide support for policies in which children are referred for rehabilitation with an OPD diagnosis based on caregiver report.
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Affiliation(s)
- Danielle Maria da Silva Oliveira
- Faculdade de Ciência Médicas/Hospital Universitário Oswaldo Cruz/ Universidade de Pernambuco, Setor NIR- ZIKA, Rua Arnóbio Marques, no. 310, Santo Amaro, Recife, PE CEP 50100-130 Brazil
| | - Demócrito de Barros Miranda-Filho
- Faculdade de Ciência Médicas/Hospital Universitário Oswaldo Cruz/ Universidade de Pernambuco, Setor NIR- ZIKA, Rua Arnóbio Marques, no. 310, Santo Amaro, Recife, PE CEP 50100-130 Brazil
| | - Ricardo Arraes de Alencar Ximenes
- Faculdade de Ciência Médicas/Hospital Universitário Oswaldo Cruz/ Universidade de Pernambuco, Setor NIR- ZIKA, Rua Arnóbio Marques, no. 310, Santo Amaro, Recife, PE CEP 50100-130 Brazil
- Universidade Federal de Pernambuco, Av. Prof. Moraes Rego, 1235 - Cidade Universitária, Recife, Pernambuco Brazil
| | - Ulisses Ramos Montarroyos
- Faculdade de Ciência Médicas/Hospital Universitário Oswaldo Cruz/ Universidade de Pernambuco, Setor NIR- ZIKA, Rua Arnóbio Marques, no. 310, Santo Amaro, Recife, PE CEP 50100-130 Brazil
| | - Celina Maria Turchi Martelli
- Instituto Aggeu Magalhães, Campus da UFPE - Av. Prof. Moraes Rego, S/N - Cidade Universitária, Recife, Pernambuco Brazil
| | - Elizabeth B. Brickley
- London School of Hygiene and Tropical Medicine, London, Keppel St, Bloomsbury, London, WC1E 7HT UK
| | | | - Regina Coeli Ramos
- Faculdade de Ciência Médicas/Hospital Universitário Oswaldo Cruz/ Universidade de Pernambuco, Setor NIR- ZIKA, Rua Arnóbio Marques, no. 310, Santo Amaro, Recife, PE CEP 50100-130 Brazil
| | - Maria Ângela Wanderley Rocha
- Faculdade de Ciência Médicas/Hospital Universitário Oswaldo Cruz/ Universidade de Pernambuco, Setor NIR- ZIKA, Rua Arnóbio Marques, no. 310, Santo Amaro, Recife, PE CEP 50100-130 Brazil
| | | | - Sophie Helena Eickmann
- Universidade Federal de Pernambuco, Av. Prof. Moraes Rego, 1235 - Cidade Universitária, Recife, Pernambuco Brazil
| | - Laura Cunha Rodrigues
- London School of Hygiene and Tropical Medicine, London, Keppel St, Bloomsbury, London, WC1E 7HT UK
| | - Jeyse Polliane de Oliveira Soares Bernardes
- Faculdade de Ciência Médicas/Hospital Universitário Oswaldo Cruz/ Universidade de Pernambuco, Setor NIR- ZIKA, Rua Arnóbio Marques, no. 310, Santo Amaro, Recife, PE CEP 50100-130 Brazil
| | - Maria Helena Teixeira Pinto
- Faculdade de Ciência Médicas/Hospital Universitário Oswaldo Cruz/ Universidade de Pernambuco, Setor NIR- ZIKA, Rua Arnóbio Marques, no. 310, Santo Amaro, Recife, PE CEP 50100-130 Brazil
| | | | | | | | - Ana Célia Oliveira dos Santos
- Faculdade de Ciência Médicas/Hospital Universitário Oswaldo Cruz/ Universidade de Pernambuco, Setor NIR- ZIKA, Rua Arnóbio Marques, no. 310, Santo Amaro, Recife, PE CEP 50100-130 Brazil
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15
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Why Did ZIKV Perinatal Outcomes Differ in Distinct Regions of Brazil? An Exploratory Study of Two Cohorts. Viruses 2021; 13:v13050736. [PMID: 33922578 PMCID: PMC8146858 DOI: 10.3390/v13050736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 12/26/2022] Open
Abstract
The Zika virus (ZIKV) epidemic in Brazil occurred in regions where dengue viruses (DENV) are historically endemic. We investigated the differences in adverse pregnancy/infant outcomes in two cohorts comprising 114 pregnant women with PCR-confirmed ZIKV infection in Rio de Janeiro, Southeastern Brazil (n = 50) and Manaus, in the north region of the country (n = 64). Prior exposure to DENV was evaluated through plaque reduction neutralizing antibody assays (PRNT 80) and DENV IgG serologies. Potential associations between pregnancy outcomes and Zika attack rates in the two cities were explored. Overall, 31 women (27%) had adverse pregnancy/infant outcomes, 27 in Rio (54%) and 4 in Manaus (6%), p < 0.001. This included 4 pregnancy losses (13%) and 27 infants with abnormalities at birth (24%). A total of 93 women (82%) had evidence of prior DENV exposure, 45 in Rio (90%) and 48 in Manaus (75%). Zika attack rates differed; the rate in Rio was 10.28 cases/10,000 and in Manaus, 0.6 cases/10,000, p < 0.001. Only Zika attack rates (Odds Ratio: 17.6, 95% Confidence Interval 5.6–55.9, p < 0.001) and infection in the first trimester of pregnancy (OR: 4.26, 95% CI 1.4–12.9, p = 0.011) were associated with adverse pregnancy and infant outcomes. Pre-existing immunity to DENV was not associated with outcomes (normal or abnormal) in patients with ZIKV infection during pregnancy.
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16
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Jacques IJAA, Katz L, Sena MA, Guimarães ABG, Silva YL, Albuquerque GDM, Pereira RO, de Albuquerque CAMC, Silva MAL, Oliveira PAS, Albuquerque MDFPM, Cordeiro MT, Marques ETA, França RFO, Martelli CMT, Castanha PMS, Braga C. High Incidence of Zika or Chikungunya Infection among Pregnant Women Hospitalized Due to Obstetrical Complications in Northeastern Brazil-Implications for Laboratory Screening in Arbovirus Endemic Area. Viruses 2021; 13:v13050744. [PMID: 33922819 PMCID: PMC8145990 DOI: 10.3390/v13050744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/11/2021] [Accepted: 04/20/2021] [Indexed: 12/16/2022] Open
Abstract
The diagnostic of arbovirus-related obstetric complications in high-risk pregnancy and childbirth care is challenging, especially in endemic areas. We conducted a prospective study to track active or recent Zika (ZIKV), dengue (DENV), or chikungunya (CHIKV) virus infection among hospitalized pregnant women (PW) with obstetric complications in a hospital at the epicenter of Zika outbreak and ZIKV-related microcephaly in Brazil. Clinical data and blood samples were collected at enrollment and 10 days after the admission of study participants, between October 2018 and May 2019. Further clinical data were extracted from medical records. Samples were screened by molecular and serological tests. Out of 780 participants, 93.1% (95% CI: 91.1–94.7%) presented previous DENV exposure (IgG). ZIKV, CHIKV, and/or DENV laboratory markers of recent or active infection were detected in 130 PW, yielding a prevalence of 16.6% (95% CI: 14.2–19.5%); 9.4% (95% CI: 7.4–11.7%), 7.4% (95% CI: 5.7–9.7%), and 0.38% (95% CI: 0.1–1.2%) of CHIKV, ZIKV, and DENV infections, respectively. Most ZIKV infections were detected by molecular assays (89.6%), while CHIKV infections were detected by serology (95.9%). Our findings highlight the need for arbovirus infections screening in PW with obstetrical complications, potentially associated to these infections in endemic areas regardless of the signs or symptoms suggestive of arboviral disease.
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Affiliation(s)
- Iracema J. A. A. Jacques
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz Pernambuco, Recife CEP 50740-465, PE, Brazil; (I.J.A.A.J.); (M.A.S.); (A.B.G.G.); (Y.L.S.); (M.A.L.S.); (P.A.S.O.); (M.d.F.P.M.A.); (M.T.C.); (R.F.O.F.); (C.M.T.M.)
| | - Leila Katz
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife CEP 50070-550, PE, Brazil; (L.K.); (G.D.M.A.); (R.O.P.); (C.A.M.C.d.A.)
| | - Marília A. Sena
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz Pernambuco, Recife CEP 50740-465, PE, Brazil; (I.J.A.A.J.); (M.A.S.); (A.B.G.G.); (Y.L.S.); (M.A.L.S.); (P.A.S.O.); (M.d.F.P.M.A.); (M.T.C.); (R.F.O.F.); (C.M.T.M.)
| | - Ana B. G. Guimarães
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz Pernambuco, Recife CEP 50740-465, PE, Brazil; (I.J.A.A.J.); (M.A.S.); (A.B.G.G.); (Y.L.S.); (M.A.L.S.); (P.A.S.O.); (M.d.F.P.M.A.); (M.T.C.); (R.F.O.F.); (C.M.T.M.)
| | - Yasmim L. Silva
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz Pernambuco, Recife CEP 50740-465, PE, Brazil; (I.J.A.A.J.); (M.A.S.); (A.B.G.G.); (Y.L.S.); (M.A.L.S.); (P.A.S.O.); (M.d.F.P.M.A.); (M.T.C.); (R.F.O.F.); (C.M.T.M.)
| | - Gabriela D. M. Albuquerque
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife CEP 50070-550, PE, Brazil; (L.K.); (G.D.M.A.); (R.O.P.); (C.A.M.C.d.A.)
| | - Raisa O. Pereira
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife CEP 50070-550, PE, Brazil; (L.K.); (G.D.M.A.); (R.O.P.); (C.A.M.C.d.A.)
| | - Camila A. M. C. de Albuquerque
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife CEP 50070-550, PE, Brazil; (L.K.); (G.D.M.A.); (R.O.P.); (C.A.M.C.d.A.)
| | - Maria Almerice L. Silva
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz Pernambuco, Recife CEP 50740-465, PE, Brazil; (I.J.A.A.J.); (M.A.S.); (A.B.G.G.); (Y.L.S.); (M.A.L.S.); (P.A.S.O.); (M.d.F.P.M.A.); (M.T.C.); (R.F.O.F.); (C.M.T.M.)
| | - Paula A. S. Oliveira
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz Pernambuco, Recife CEP 50740-465, PE, Brazil; (I.J.A.A.J.); (M.A.S.); (A.B.G.G.); (Y.L.S.); (M.A.L.S.); (P.A.S.O.); (M.d.F.P.M.A.); (M.T.C.); (R.F.O.F.); (C.M.T.M.)
| | - Maria de Fátima P. M. Albuquerque
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz Pernambuco, Recife CEP 50740-465, PE, Brazil; (I.J.A.A.J.); (M.A.S.); (A.B.G.G.); (Y.L.S.); (M.A.L.S.); (P.A.S.O.); (M.d.F.P.M.A.); (M.T.C.); (R.F.O.F.); (C.M.T.M.)
| | - Marli T. Cordeiro
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz Pernambuco, Recife CEP 50740-465, PE, Brazil; (I.J.A.A.J.); (M.A.S.); (A.B.G.G.); (Y.L.S.); (M.A.L.S.); (P.A.S.O.); (M.d.F.P.M.A.); (M.T.C.); (R.F.O.F.); (C.M.T.M.)
| | - Ernesto T. A. Marques
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, PA 15261, USA; (E.T.A.M.J.); (P.M.S.C.)
| | - Rafael F. O. França
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz Pernambuco, Recife CEP 50740-465, PE, Brazil; (I.J.A.A.J.); (M.A.S.); (A.B.G.G.); (Y.L.S.); (M.A.L.S.); (P.A.S.O.); (M.d.F.P.M.A.); (M.T.C.); (R.F.O.F.); (C.M.T.M.)
| | - Celina M. T. Martelli
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz Pernambuco, Recife CEP 50740-465, PE, Brazil; (I.J.A.A.J.); (M.A.S.); (A.B.G.G.); (Y.L.S.); (M.A.L.S.); (P.A.S.O.); (M.d.F.P.M.A.); (M.T.C.); (R.F.O.F.); (C.M.T.M.)
| | - Priscila M. S. Castanha
- Department of Infectious Diseases and Microbiology, University of Pittsburgh, Pittsburgh, PA 15261, USA; (E.T.A.M.J.); (P.M.S.C.)
- Faculdade de Ciências Médicas, Universidade de Pernambuco, Recife CEP 50100-130, PE, Brazil
| | - Cynthia Braga
- Instituto Aggeu Magalhães, Fundação Oswaldo Cruz Pernambuco, Recife CEP 50740-465, PE, Brazil; (I.J.A.A.J.); (M.A.S.); (A.B.G.G.); (Y.L.S.); (M.A.L.S.); (P.A.S.O.); (M.d.F.P.M.A.); (M.T.C.); (R.F.O.F.); (C.M.T.M.)
- Instituto de Medicina Integral Prof. Fernando Figueira, Recife CEP 50070-550, PE, Brazil; (L.K.); (G.D.M.A.); (R.O.P.); (C.A.M.C.d.A.)
- Correspondence: ; Tel.: +55-81-2101-2577
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Three-Year Clinical Follow-Up of Children Intrauterine Exposed to Zika Virus. Viruses 2021; 13:v13030523. [PMID: 33810110 PMCID: PMC8005078 DOI: 10.3390/v13030523] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 02/01/2023] Open
Abstract
Congenital Zika virus (ZIKV) infection may present with a broad spectrum of clinical manifestations. Some sequelae, particularly neurodevelopmental problems, may have a later onset. We conducted a prospective cohort study of 799 high-risk pregnant women who were followed up until delivery. Eighty-three women and/or newborns were considered ZIKV exposed and/or infected. Laboratory diagnosis was made by polymerase chain reaction in the pregnant mothers and their respective newborns, as well as Dengue virus, Chikungunya virus, and ZIKV serology. Serology for toxoplasmosis, rubella, cytomegalovirus, herpes simplex virus, and syphilis infections were also performed in microcephalic newborns. The newborns included in the study were followed up until their third birthday. Developmental delay was observed in nine patients (13.2%): mild cognitive delay in three patients, speech delay in three patients, autism spectrum disorder in two patients, and severe neurological abnormalities in one microcephalic patient; sensorineural hearing loss, three patients and dysphagia, six patients. Microcephaly due to ZIKV occurred in three patients (3.6%). Clinical manifestations can appear after the first year of life in children infected/exposed to ZIKV, emphasizing the need for long-term follow-up.
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Almeida RS, Ferreira MLB, Sonon P, Cordeiro MT, Sadissou I, Diniz GTN, Militão-Albuquerque MDFP, Franca RFDO, Donadi EA, Lucena-Silva N. Cytokines and Soluble HLA-G Levels in the Acute and Recovery Phases of Arbovirus-Infected Brazilian Patients Exhibiting Neurological Complications. Front Immunol 2021; 12:582935. [PMID: 33776990 PMCID: PMC7994272 DOI: 10.3389/fimmu.2021.582935] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 01/08/2021] [Indexed: 12/19/2022] Open
Abstract
Severe neurological complications following arbovirus infections have been a major concern in seasonal outbreaks, as reported in the Northeast region of Brazil, where the same mosquito transmitted Zika (ZIKV), Dengue (DENV), and Chikungunya (CHIKV) viruses. In this study, we evaluated the levels of 36 soluble markers, including cytokines, chemokines, growth factors, and soluble HLA-G (Luminex and ELISA) in: i) serum and cerebrospinal fluid (CSF), during the acute phase and two years after the infection (recovery phase, only serum), ii) the relationship among all soluble molecules in serum and CSF, and iii) serum of infected patients without neurological complications, during the acute infection. Ten markers (sHLA-G, IL-10, IL-22, IL-8, MIP-1α, MIP-1β, MCP-1, HGF, VEGF, and IL-1RA) exhibited differential levels between the acute and recovery phases, with pronounced increases in MIP-1α (P<0.0001), MCP-1 (P<0.0001), HGF (P= 0.0001), and VEGF (P<0.0001) in the acute phase. Fourteen molecules (IL-1β, IL-2, IL-3, IL-4, IL-5, IL-6, IL-7, IL-9, IL-13, IL-15, IL-17A, IFN-α, TNF, and G-CSF) exhibited distinct levels between arbovirus patients presenting or not neurological complications. IL-8, EGF, IL-6, and MCP-1 levels were increased in CSF, while RANTES and Eotaxin levels were higher in serum. Soluble serum (IL-22, RANTES, Eotaxin) and CSF (IL-8, EGF, IL-3) mediators may discriminate putative risks for neurological complications following arbovirus infections. Neurological complications were associated with the presence of a predominant inflammatory profile, whereas in non-complicated patients an anti-inflammatory profile may predominate. Mediators associated with neuroregeneration (EGF and IL-3) may be induced in response to neurological damage. Broad spectrum immune checkpoint molecules (sHLA-G) interact with cytokines, chemokines, and growth factors. The identification of soluble markers may be useful to monitor neurological complications and may aid in the development of novel therapies against neuroinflammation.
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Affiliation(s)
- Renata Santos Almeida
- Laboratory of Immunogenetics, Department of Immunology, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, Brazil
| | | | - Paulin Sonon
- Laboratory of Immunogenetics, Department of Immunology, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, Brazil.,Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Marli Tenório Cordeiro
- Department of Virology and Experimental Therapy, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, Brazil
| | - Ibrahim Sadissou
- Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - George Tadeu Nunes Diniz
- Department of Collective Health, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, Brazil
| | | | | | | | - Norma Lucena-Silva
- Laboratory of Immunogenetics, Department of Immunology, Aggeu Magalhães Institute, Oswaldo Cruz Foundation, Recife, Brazil
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Freitas LCDS, Nunes AA, Meneguci J, Nascimento Neto GCD, Castro SDS. ASSOCIATION OF CONGENITAL ANOMALIES IN LIVE BIRTHS WITH THEIR OBSTETRIC-NEONATAL AND SOCIODEMOGRAPHIC PROFILES. TEXTO & CONTEXTO ENFERMAGEM 2021. [DOI: 10.1590/1980-265x-tce-2020-0256] [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
ABSTRACT Objective: to identify the association of congenital anomalies in live births with the obstetric-neonatal and sociodemographic profile. Methods: an ecological study, conducted in 2019, with 251,444 live births, identified through the database of the Live Birth Information System of the Minas Gerais Health Secretariat. Descriptive statistics and binary logistic regression were adopted for the analysis. Results: 1,865 cases of anomalies (0.7%) were found, with predominance of deformity of the musculoskeletal system in 789 (42.3%) live births. The variables that presented a significant association with congenital anomalies were single mothers, age ≥35 years old, inadequately performed prenatal care initiated in the third trimester of pregnancy, double (or more) pregnancy, preterm births, cesarean delivery, fetal breech presentation, exclusive assistance by the medical professional during delivery, newborn with high-risk 5-minute Apgar score, low birth weight, and male gender. Conclusion: in 2019, the congenital malformations in the state of Minas Gerais were associated with single women, aged ≥35 years old, who underwent inadequate and late prenatal care, and with double or more pregnancies. In relation to the newborns, the malformations were associated with a high risk for late sequelae, weight between ≤1,000 g and <2.500 g, and male gender.
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20
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Marbán-Castro E, Arrieta GJ, Martínez MJ, González R, Bardají A, Menéndez C, Mattar S. High Seroprevalence of Antibodies against Arboviruses among Pregnant Women in Rural Caribbean Colombia in the Context of the Zika Virus Epidemic. Antibodies (Basel) 2020; 9:antib9040056. [PMID: 33096597 PMCID: PMC7709128 DOI: 10.3390/antib9040056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/27/2020] [Accepted: 09/09/2020] [Indexed: 12/03/2022] Open
Abstract
Mosquito-borne viruses such as dengue (DENV), chikungunya (CHIKV), and Zika (ZIKV) have spread in recent decades. We aimed to assess seroprevalence of arboviral infections in pregnant women living in Cereté, Caribbean Colombia. In 2016 a cross-sectional facility-based sero-survey study was performed among pregnant women (N = 90). Most of them (66%) reported at least one symptom or sign compatible with arboviral infection over the previous 15 days. All screened women had a positive IgG for DENV, 89% for ZIKV, and 82% for CHIKV. One woman tested positive for ZIKV IgM. This study shows the high exposure among pregnant women to arboviruses in endemic areas, shown by the high seroprevalence of past arboviral infections. Given the evidence on the potential risks of these arboviral infections on pregnancy and infant outcomes, these results highlight the need for continuous epidemiological surveillance of arboviral diseases, particularly among those most of risk of their harmful consequences.
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Affiliation(s)
- Elena Marbán-Castro
- ISGlobal, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (M.J.M.); (R.G.); (A.B.); (C.M.)
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-93-227-5400 (ext. 4142)
| | - Germán J. Arrieta
- Corporación Universitaria del Caribe (CECAR), Grupo de Salud Pública, Sincelejo 700001, Colombia;
- Clínica Salud Social, Sincelejo 700001, Colombia;
| | - Miguel J. Martínez
- ISGlobal, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (M.J.M.); (R.G.); (A.B.); (C.M.)
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Raquel González
- ISGlobal, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (M.J.M.); (R.G.); (A.B.); (C.M.)
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Azucena Bardají
- ISGlobal, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (M.J.M.); (R.G.); (A.B.); (C.M.)
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça 1929, Mozambique
| | - Clara Menéndez
- ISGlobal, Hospital Clínic, Universitat de Barcelona, 08036 Barcelona, Spain; (M.J.M.); (R.G.); (A.B.); (C.M.)
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Manhiça 1929, Mozambique
| | - Salim Mattar
- Clínica Salud Social, Sincelejo 700001, Colombia;
- Instituto de Investigaciones Biológicas del Trópico, Universidad de Córdoba, Montería 230002, Colombia
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21
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Ramond A, Lobkowicz L, Clemente NS, Vaughan A, Turchi MD, Wilder-Smith A, Brickley EB. Postnatal symptomatic Zika virus infections in children and adolescents: A systematic review. PLoS Negl Trop Dis 2020; 14:e0008612. [PMID: 33006989 PMCID: PMC7556487 DOI: 10.1371/journal.pntd.0008612] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 10/14/2020] [Accepted: 07/17/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Recent Zika virus (ZIKV) outbreaks in the Pacific and the Americas have highlighted clinically significant congenital neurological abnormalities resulting from ZIKV infection in pregnancy. However, little is known about ZIKV infections in children and adolescents, a group that is potentially vulnerable to ZIKV neurovirulence. METHODS We conducted a systematic review on the clinical presentation and complications of children and adolescents aged 0 to 18 years with a robust diagnosis of ZIKV infection. We searched PubMed, Web of Science, LILACs, and EMBASE until 13 February 2020 and screened reference lists of eligible articles. We assessed the studies' risk of bias using pre-specified criteria. FINDINGS Our review collated the evidence from 2543 pediatric ZIKV cases representing 17 countries and territories, identified in 1 cohort study, 9 case series and 22 case reports. The most commonly observed signs and symptoms of ZIKV infection in children and adolescents were mild and included fever, rash, conjunctivitis and arthralgia. The frequency of neurological complications was reported only in the largest case series (identified in 1.0% of cases) and in an additional 14 children identified from hospital-based surveillance studies and case reports. ZIKV-related mortality was primarily accompanied by co-morbidity and was reported in one case series (<0.5% of cases) and three case reports. One death was attributed to complications of Guillain-Barré Syndrome secondary to ZIKV infection. CONCLUSIONS AND RELEVANCE Based on the current evidence, the clinical presentation of ZIKV infection in children and adolescents appears to be primarily mild and similar to the presentation in adults, with rare instances of severe complications and/or mortality. However, reliable estimation of the risks of ZIKV complications in these age groups is limited by the scarcity and quality of published data. Additional prospective studies are needed to improve understanding of the relative frequency of the signs, symptoms, and complications associated with pediatric ZIKV infections and to investigate any potential effects of early life ZIKV exposure on neurodevelopment.
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Affiliation(s)
- Anna Ramond
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ludmila Lobkowicz
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Nuria Sanchez Clemente
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Aisling Vaughan
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Marília Dalva Turchi
- Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Goiânia, Brasil (Institute of Tropical Pathology and Public Health, Federal University of Goias, Goiânia, Brazil)
| | - Annelies Wilder-Smith
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Elizabeth B. Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
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22
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Romero-Acosta K, Marbán-Castro E, Arroyo-Alvis K, Arrieta G, Mattar S. Perceptions and Emotional State of Mothers of Children with and without Microcephaly after the Zika Virus Epidemic in Rural Caribbean Colombia. Behav Sci (Basel) 2020; 10:bs10100147. [PMID: 32992703 PMCID: PMC7599807 DOI: 10.3390/bs10100147] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/13/2020] [Accepted: 07/27/2020] [Indexed: 12/26/2022] Open
Abstract
Zika virus (ZIKV) infection during pregnancy can cause neurological manifestations such as microcephaly. The aim of this study was to explore perceptions of ZIKV and mental health in women exposed to ZIKV during pregnancy in Colombia. This was a mixed-methods study based on structured interviews and psychological tests. Structured interviews were transcribed and analysed with Atlas Ti software. A grounded theory approach was applied. Quantitative analysis was performed with Statistical Package for Social Science, SPSS, V. 20. The study was approved by the Ethics Committee of the Universidad de Córdoba, Montería. Seventeen women participated in the study; nine of them were mothers of children with microcephaly. Maternal age ranged from 16 to 41 years old. The main themes discussed during interviews were: feelings, support, sources of information, and consequences on children's health. Women with children affected by microcephaly showed worse mental health compared to women with normocephalic children. Maternal mental health worsened after 24 months from giving birth. Perceptions regarding disease severity and lack of knowledge were considered to affect maternal mental health. Social support and spirituality were key determinants for caregivers. Future research is needed to further study coping mechanisms and mental health outcomes over time by affected populations.
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Affiliation(s)
- Kelly Romero-Acosta
- Faculty of Humanities and Education, Corporación Universitaria del Caribe CECAR, Sincelejo 700001, Colombia; (K.R.-A.); (K.A.-A.); (G.A.)
| | - Elena Marbán-Castro
- Department of Maternal, Child, and Reproductive health, ISGlobal, Hospital Clínic-Universitat de Barcelona, 08036 Barcelona, Spain
- Correspondence:
| | - Katy Arroyo-Alvis
- Faculty of Humanities and Education, Corporación Universitaria del Caribe CECAR, Sincelejo 700001, Colombia; (K.R.-A.); (K.A.-A.); (G.A.)
| | - Germán Arrieta
- Faculty of Humanities and Education, Corporación Universitaria del Caribe CECAR, Sincelejo 700001, Colombia; (K.R.-A.); (K.A.-A.); (G.A.)
- Clinica Salud Social SAS, Sincelejo 700002, Colombia
| | - Salim Mattar
- Instituto de Investigaciones Biológicas del Trópico, Universidad de Córdoba, Montería 230002, Colombia;
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23
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Sanchez Clemente N, Brickley EB, Paixão ES, De Almeida MF, Gazeta RE, Vedovello D, Rodrigues LC, Witkin SS, Passos SD. Zika virus infection in pregnancy and adverse fetal outcomes in São Paulo State, Brazil: a prospective cohort study. Sci Rep 2020; 10:12673. [PMID: 32728054 PMCID: PMC7391725 DOI: 10.1038/s41598-020-69235-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 07/09/2020] [Indexed: 01/17/2023] Open
Abstract
Robust epidemiological and biological evidence supports a causal link between prenatal Zika Virus (ZIKV) infection and congenital brain abnormalities including microcephaly. However, it remains uncertain if ZIKV infection in pregnancy also increases the risk for other adverse fetal and birth outcomes. In a prospective cohort study we investigated the influence of ZIKV on the prevalence of prematurity, low birth weight, small-for-gestational-age, and fetal death as well as microcephaly (i.e., overall and disproportionate) in the offspring of women attending a high-risk pregnancy clinic during the recent ZIKV outbreak in Brazil. During the recruitment period (01 March 2016-23 August 2017), urine samples were tested for ZIKV by RT-PCR from all women attending the high-risk pregnancy clinic at Jundiaí University Hospital and from the neonates after delivery. Of the 574 women evaluated, 44 (7.7%) were ZIKV RT-PCR positive during pregnancy. Of the 409 neonates tested, 19 (4.6%) were ZIKV RT-PCR positive in the first 10 days of life. In this cohort, maternal ZIKV exposure was not associated with increased risks of prematurity, low birth weight, small-for-gestational-age, or fetal death. However, relative to ZIKV-negative neonates, ZIKV-positive infants had a five-fold increased risk of microcephaly overall (RR 5.1, 95% CI 1.2-22.5) and a ten-fold increased risk of disproportionate microcephaly (RR 10.3, 95% CI 2.0-52.6). Our findings provide new evidence that, in a high-risk pregnancy cohort, ZIKV RT-PCR positivity in the neonate at birth is strongly associated with microcephaly. However, ZIKV infection during pregnancy does not appear to influence the risks of prematurity, low birth weight, small-for-gestational-age or fetal death in women who already have gestational comorbidities. The results suggest disproportion between neonatal head circumference and weight may be a useful screening indicator for the detection of congenital microcephaly associated with ZIKV infection.
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Affiliation(s)
- Nuria Sanchez Clemente
- Department of Epidemiology, University of São Paulo, São Paulo, Brazil.
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Elizabeth B Brickley
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Enny S Paixão
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | | | - Rosa E Gazeta
- Jundiaí Medical School, Jundiaí University, São Paulo, Brazil
| | | | - Laura C Rodrigues
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Steven S Witkin
- Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
- Institute of Tropical Medicine, University of Sao Paulo Medical School, São Paulo, Brazil
| | - Saulo D Passos
- Jundiaí Medical School, Jundiaí University, São Paulo, Brazil
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24
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Frota LMDCP, Sampaio RF, Miranda JL, Brasil RMC, Gontijo APB, Mambrini JVDM, Brandão MDB, Mancini MC. Children with congenital Zika syndrome: symptoms, comorbidities and gross motor development at 24 months of age. Heliyon 2020; 6:e04130. [PMID: 32577556 PMCID: PMC7303558 DOI: 10.1016/j.heliyon.2020.e04130] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 12/30/2019] [Accepted: 06/01/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Children with congenital Zika syndrome (CZS) maintain severe motor impairments at the end of the first year of life. Presence of certain symptoms and comorbidities increase these children's vulnerability. AIMS To evaluate gross motor function of a group of Brazilian children with CZS at 24 months of age and to investigate the association between the presence of CZS symptoms and comorbidities with gross motor development. METHODS AND PROCEDURES Fifty children with CZS participated in the study. Information was collected from medical charts, and gross motor development was evaluated by the Gross Motor Function Measure (GMFM)-88. GMFM-88 scores were compared among comorbid groups. Three subgroups of children were identified by cluster analysis, based on information from head circumference at birth, symptoms, comorbidities and gross motor function. OUTCOMES AND RESULTS Significant associations (p < 0.001) were observed between number of comorbidities/symptoms and dimensions A (r = -0.57) and B (r = -0.58) of the GMFM-88. Children were grouped into 3 clusters, with different gross motor skills. Children with epilepsy and dysphagia composed the cluster with smaller median scores for dimensions A and B of the GMFM-88. CONCLUSIONS AND IMPLICATIONS The presence of CZS symptoms and comorbidities compromise the gross motor repertoire of children with CZS at 24 months.
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Affiliation(s)
- Lêda Maria da Costa Pinheiro Frota
- Interinstitutional Doctorate Program (Dinter) UFC-UFMG Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais, Center for Treatment and Early Stimulation - NUTEP, Rua - Papi Júnior, 1225, Rodolfo Teófilo,60, 430-235, Fortaleza, Ceará, Brazil
| | - Rosana Ferreira Sampaio
- Department of Physical Therapy, Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Av. Antonio Carlos 6627, Campus Pampulha, 31270-901, Belo Horizonte, Minas Gerais, Brazil
| | - José Lucivan Miranda
- Department of Maternal and Child Health. Universidade Federal do Ceará, Center for Treatment and Early Stimulation - NUTEP, Rua -Papi Júnior, 1225, Rodolfo Teófilo, 60, 430-235, Fortaleza, Ceará, Brazil
| | - Rita Maria Cavalcante Brasil
- Center for Treatment and Early Stimulation - NUTEP, Rua Papi Júnior, 1225, Rodolfo Teófilo, 60, 430-235, Fortaleza, Ceará, Brazil
| | - Ana Paula Bensemann Gontijo
- Department of Physical Therapy, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais. Av. Antonio Carlos 6627, Campus Pampulha, 31270-901, Belo Horizonte, Minas Gerais, Brazil
| | | | - Marina de Brito Brandão
- Department of Occupational Therapy, Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Av. Antonio Carlos 6627, Campus Pampulha, 31270-901, Belo Horizonte, Minas Gerais, Brazil
| | - Marisa Cotta Mancini
- Department of Occupational Therapy, Graduate Program in Rehabilitation Sciences, School of Physical Education, Physical Therapy and Occupational Therapy, Universidade Federal de Minas Gerais, Av. Antonio Carlos 6627, Campus Pampulha, 31270-901, Belo Horizonte, Minas Gerais, Brazil
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25
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Cavalcante ACP, de Olinda RA, Gomes A, Traxler J, Smith M, Santos S. Spatial modelling of the infestation indices of Aedes aegypti: an innovative strategy for vector control actions in developing countries. Parasit Vectors 2020; 13:197. [PMID: 32299496 PMCID: PMC7164210 DOI: 10.1186/s13071-020-04070-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 04/09/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Larval indices such as the house index (HI), Breteau index (BI) and container index (CI) are widely used to interpret arbovirus vector density in surveillance programmes. However, the use of such data as an alarm signal is rarely considered consciously when planning programmes. The present study aims to investigate the spatial distribution pattern of the infestation of Aedes aegypti, considering the data available in the Ae. aegypti Infestation Index Rapid Survey (LIRAa) for the city of Campina Grande, Paraíba State in Brazil. METHODS The global and local Moran's indices were used in spatial analysis to measure the effects of spatial dependencies between neighbourhoods, using secondary data related to HI and BI gathered from surveillance service. RESULTS Our analysis shows that there is a predominance of high rates of mosquito infestation, placing Campina Grande at a near-constant risk of arbovirus outbreaks and epidemics. A highly significant Moran's index value (P < 0.001) was observed, indicating a positive spatial dependency between the neighbourhoods in Campina Grande. Using the Moran mapping and LISA mapping, the autocorrelation patterns of Ae. aegypti infestation rates among neighbourhoods have revealed hotpots that should be considered a priority to preventive actions of the entomological surveillance services. Predominance of high infestation rates and clearer relationships of these between neighbourhoods were observed between the months of May and July, the period with the highest rainfall in the city. CONCLUSIONS This analysis is an innovative strategy capable of providing detailed information on infestation locations to the relevant public health authorities, which will enable a more efficient allocation of resources, particularly for arbovirus prevention.
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Affiliation(s)
| | - Ricardo Alves de Olinda
- Public Health Program, Universidade Estadual da Paraíba, Campina Grande, Paraíba, CEP 58429-500, Brazil
| | - Alexandrino Gomes
- Public Health Program, Universidade Estadual da Paraíba, Campina Grande, Paraíba, CEP 58429-500, Brazil
| | - John Traxler
- University of Wolverhampton, Institute of Education, Walsall Campus, Gorway Road, Walsall, WS1 3BD, UK
| | - Matt Smith
- University of Wolverhampton, Institute of Education, Walsall Campus, Gorway Road, Walsall, WS1 3BD, UK
| | - Silvana Santos
- Public Health Program, Universidade Estadual da Paraíba, Campina Grande, Paraíba, CEP 58429-500, Brazil.
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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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Abstract
Intermittent outbreaks of infectious diseases have had profound and lasting effects on societies throughout history. Those events have powerfully shaped the economic, political, and social aspects of human civilization, with their effects often lasting for centuries. Epidemic outbreaks have defined some of the basic tenets of modern medicine, pushing the scientific community to develop principles of epidemiology, prevention, immunization, and antimicrobial treatments. This chapter outlines some of the most notable outbreaks that took place in human history and are relevant for a better understanding of the rest of the material. Starting with religious texts, which heavily reference plagues, this chapter establishes the fundamentals for our understanding of the scope, social, medical, and psychological impact that some pandemics effected on civilization, including the Black Death (a plague outbreak from the fourteenth century), the Spanish Flu of 1918, and the more recent outbreaks in the twenty-first century, including SARS, Ebola, and Zika.
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