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Cunha M, Costa F, Ribeiro GS, Carvalho MS, Reis RB, Nery Jr N, Pischel L, Gouveia EL, Santos AC, Queiroz A, Wunder Jr. EA, Reis MG, Diggle PJ, Ko AI. Rainfall and other meteorological factors as drivers of urban transmission of leptospirosis. PLoS Negl Trop Dis 2022; 16:e0007507. [PMID: 35404948 PMCID: PMC9022820 DOI: 10.1371/journal.pntd.0007507] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 04/21/2022] [Accepted: 03/17/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Leptospirosis is an important public health problem affecting vulnerable urban slum populations in developing country settings. However, the complex interaction of meteorological factors driving the temporal trends of leptospirosis remain incompletely understood. METHODS AND FINDINGS From March 1996-March 2010, we investigated the association between the weekly incidence of leptospirosis and meteorological anomalies in the city of Salvador, Brazil by using a dynamic generalized linear model that accounted for time lags, overall trend, and seasonal variation. Our model showed an increase of leptospirosis cases associated with higher than expected rainfall, lower than expected temperature and higher than expected humidity. There was a lag of one-to-two weeks between weekly values for significant meteorological variables and leptospirosis incidence. Independent of the season, a weekly cumulative rainfall anomaly of 20 mm increased the risk of leptospirosis by 12% compared to a week following the expected seasonal pattern. Finally, over the 14-year study period, the annual incidence of leptospirosis decreased significantly by a factor of 2.7 (8.3 versus 3.0 per 100,000 people), independently of variations in climate. CONCLUSIONS Strategies to control leptospirosis should focus on avoiding contact with contaminated sources of Leptospira as well as on increasing awareness in the population and health professionals within the short time window after low-level or extreme high-level rainfall events. Increased leptospirosis incidence was restricted to one-to-two weeks after those events suggesting that infectious Leptospira survival may be limited to short time intervals.
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Affiliation(s)
- Marcelo Cunha
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Ministério da Saúde, Rio de Janeiro, Brazil
| | - Federico Costa
- Instituto de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
- Faculty of Health and Medicine, University of Lancaster, Lancaster, United Kingdom
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Heaven, Connecticut, United States of America
| | - Guilherme S. Ribeiro
- Instituto de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Brazil
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
| | - Marilia S. Carvalho
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Ministério da Saúde, Rio de Janeiro, Brazil
| | - Renato B. Reis
- Instituto de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Brazil
| | - Nivison Nery Jr
- Instituto de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Lauren Pischel
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Heaven, Connecticut, United States of America
| | - Edilane L. Gouveia
- Instituto de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Brazil
| | - Andreia C. Santos
- Instituto de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Brazil
| | - Adriano Queiroz
- Instituto de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Brazil
| | - Elsio A. Wunder Jr.
- Instituto de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Brazil
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Heaven, Connecticut, United States of America
| | - Mitermayer G. Reis
- Instituto de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Brazil
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Heaven, Connecticut, United States of America
- Faculdade de Medicina, Universidade Federal da Bahia, Salvador, Brazil
| | - Peter J Diggle
- Faculty of Health and Medicine, University of Lancaster, Lancaster, United Kingdom
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Heaven, Connecticut, United States of America
| | - Albert I. Ko
- Instituto de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Brazil
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Heaven, Connecticut, United States of America
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Lima JBT, Ribeiro GS, Cordeiro SM, Gouveia EL, Salgado K, Spratt BG, Godoy D, Reis MG, Ko AI, Reis JN. Poor clinical outcome for meningitis caused by Haemophilus influenzae serotype A strains containing the IS1016-bexA deletion. J Infect Dis 2010; 202:1577-84. [PMID: 20932170 DOI: 10.1086/656778] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Since the introduction of Haemophilus influenzae type b (Hib) conjugate vaccines, meningitis caused by serotypes other than Hib has gained in importance. We conducted active hospital-based surveillance for meningitis over an 11-year period in Salvador, Brazil. H. influenzae isolates were serotyped and analyzed by polymerase chain reaction, pulsed-field gel electrophoresis, and DNA sequencing to identify strains with a specific deletion (IS1016) in the bexA gene (IS1016-bexA). We identified 43 meningitis cases caused by non-type b H. influenzae: 28 (65%) were caused by type a (Hia), 9 (21%) were caused by noncapsulated strains, and 3 (7%) each were caused by types e and f. Hia isolates clustered in 2 clonal groups; clonal group A strains (n = 9) had the IS1016-bexA deletion. Among children <5 years of age, meningitis caused by Hia from clonal group A had higher case-fatality than meningitis caused by clonal group B. Despite small numbers, these results indicate that the presence of the IS1016-bexA deletion is associated with enhanced virulence in non-type b H. influenzae.
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Affiliation(s)
- Josilene B T Lima
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, Brazil
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Gouveia EL, Metcalfe J, de Carvalho ALF, Aires TSF, Villasboas-Bisneto JC, Queirroz A, Santos AC, Salgado K, Reis MG, Ko AI. Leptospirosis-associated severe pulmonary hemorrhagic syndrome, Salvador, Brazil. Emerg Infect Dis 2008; 14:505-8. [PMID: 18325275 PMCID: PMC2570821 DOI: 10.3201/eid1403.071064] [Citation(s) in RCA: 176] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report the emergence of leptospirosis-associated severe pulmonary hemorrhagic syndrome (SPHS) in slum communities in Salvador, Brazil. Although active surveillance did not identify SPHS before 2003, 47 cases were identified from 2003 through 2005; the case-fatality rate was 74%. By 2005, SPHS caused 55% of the deaths due to leptospirosis.
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Cordeiro SM, Neves AB, Ribeiro CT, Petersen ML, Gouveia EL, Ribeiro GS, Lôbo TS, Reis JN, Salgado KM, Reis MG, Ko AI. Hospital-based surveillance of meningococcal meningitis in Salvador, Brazil. Trans R Soc Trop Med Hyg 2007; 101:1147-53. [PMID: 17681359 PMCID: PMC2042916 DOI: 10.1016/j.trstmh.2007.06.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Revised: 06/14/2007] [Accepted: 06/14/2007] [Indexed: 11/28/2022] Open
Abstract
This study aimed to describe the clinical, epidemiological and microbiological features of meningococcal meningitis in Salvador, Brazil. Between February 1996 and January 2001, a hospital-based surveillance prospectively identified cases of culture-positive meningococcal meningitis. Demographic and clinical data were collected through interview and medical chart review. Antisera and monoclonal antibodies were used to determine the serogroup and serotype:serosubtype of the isolates, respectively. Surveillance identified a total of 408 cases of meningococcal meningitis, with a case fatality rate of 8% (32/397). The mean annual incidence for the 304 culture-positive cases residing in metropolitan Salvador was 1.71 cases per 100,000 population. Infants <1 year old presented the highest incidence (14.7 cases per 100,000 population). Of the 377 serogrouped isolates, 82%, 16%, 2% and 0.3% were serogroups B, C, W135 and Y, respectively. A single serotype:serosubtype (4,7:P1.19,15) accounted for 64% of all cases. Continued surveillance is necessary to characterise strains and to define future prevention and control strategies.
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Affiliation(s)
- Soraia M. Cordeiro
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Rua Waldemar Falcão 121, Salvador, Bahia 40296-710, Brazil
| | - Alan B. Neves
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Rua Waldemar Falcão 121, Salvador, Bahia 40296-710, Brazil
| | - Cássio T. Ribeiro
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Rua Waldemar Falcão 121, Salvador, Bahia 40296-710, Brazil
| | - Maya L. Petersen
- Joint Medical Program/Division of Epidemiology, School of Public Health, University of California, Berkeley, CA, USA
| | - Edilane L. Gouveia
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Rua Waldemar Falcão 121, Salvador, Bahia 40296-710, Brazil
| | - Guilherme S. Ribeiro
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Rua Waldemar Falcão 121, Salvador, Bahia 40296-710, Brazil
| | - Tatiana S. Lôbo
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Rua Waldemar Falcão 121, Salvador, Bahia 40296-710, Brazil
| | - Joice N. Reis
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Rua Waldemar Falcão 121, Salvador, Bahia 40296-710, Brazil
- School of Pharmacy, Federal University of Bahia, Salvador, Brazil
| | - Kátia M. Salgado
- Couto Maia Hospital, Bahia Secretary of Health, Salvador, Brazil
| | - Mitermayer G. Reis
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Rua Waldemar Falcão 121, Salvador, Bahia 40296-710, Brazil
| | - Albert I. Ko
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Rua Waldemar Falcão 121, Salvador, Bahia 40296-710, Brazil
- Division of International Medicine and Infectious Diseases, Weill Medical College of Cornell University, New York, USA
- * Corresponding author. Tel.: +55 71 3176 2302; fax: +55 71 3176 2281. E-mail address: (A.I. Ko)
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Ribeiro GS, Lima JBT, Reis JN, Gouveia EL, Cordeiro SM, Lobo TS, Pinheiro RM, Ribeiro CT, Neves AB, Salgado K, Silva HR, Reis MG, Ko AI. Haemophilus influenzae meningitis 5 years after introduction of the Haemophilus influenzae type b conjugate vaccine in Brazil. Vaccine 2007; 25:4420-8. [PMID: 17449150 DOI: 10.1016/j.vaccine.2007.03.024] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2006] [Revised: 03/06/2007] [Accepted: 03/13/2007] [Indexed: 11/15/2022]
Abstract
The long-term impact of Haemophilus influenzae type b (Hib) conjugate vaccine, introduced throughout Latin America in the late 1990s, has not been evaluated. Active surveillance for H. influenzae meningitis was performed from August 9, 1996 to August 8, 2004 in Metropolitan Salvador, Brazil. Five years after the introduction of Hib conjugate vaccine, Hib meningitis incidence decreased from 2.39 to 0.06 cases per 100,000 population (98%) overall, and from 60.9 to 3.1 cases per 100,000 population (95%) in children <1 year of age. A transient serotype replacement phenomenon was observed associated with a small increase of meningitis due to two H. influenzae type a clonal groups. These findings indicate that Hib immunization campaign has led to the virtual elimination of Hib disease in this region.
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Affiliation(s)
- Guilherme S Ribeiro
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Rua Waldemar Falcão 121, Bahia 40296-710, Salvador, Brazil
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Ribeiro GS, Reis JN, Cordeiro SM, Lima JBT, Gouveia EL, Petersen M, Salgado K, Silva HR, Zanella RC, Almeida SCG, Brandileone MC, Reis MG, Ko AI. Prevention of Haemophilus influenzae type b (Hib) meningitis and emergence of serotype replacement with type a strains after introduction of Hib immunization in Brazil. J Infect Dis 2003; 187:109-16. [PMID: 12508153 DOI: 10.1086/345863] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2002] [Revised: 09/23/2002] [Indexed: 11/03/2022] Open
Abstract
Surveillance for Haemophilus influenzae meningitis cases was performed in Salvador, Brazil, before and after introduction of H. influenzae type b (Hib) immunization. The incidence of Hib meningitis decreased 69% during the 1-year period after initiation of Hib immunization (from 2.62 to 0.81 cases/100,000 person-years; P<.001). In contrast, the incidence for H. influenzae type a meningitis increased 8-fold (from 0.02 to 0.16 cases/100,000 person-years; P=.008). Pulsed-field gel electrophoretic analysis demonstrated that H. influenzae type a isolates belonged to 2 clonally related groups, both of which were found before Hib immunization commenced. Therefore, Hib immunization contributed to an increased risk for H. influenzae type a meningitis through selection of circulating H. influenzae type a clones. The risk attributable to serotype replacement is small in comparison to the large reduction in Hib meningitis due to immunization. However, these findings highlight the need to maintain surveillance as the use of conjugate vaccines expands worldwide.
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Affiliation(s)
- Guilherme S Ribeiro
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, Bahia, Brazil
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Ko AI, Reis JN, Coppola SJ, Gouveia EL, Cordeiro SM, Lôbo TS, Pinheiro RM, Salgado K, Ribeiro Dourado CM, Tavares-Neto J, Rocha H, Galvão Reis M, Johnson WD, Riley LW. Clonally related penicillin-nonsusceptible Streptococcus pneumoniae serotype 14 from cases of meningitis in Salvador, Brazil. Clin Infect Dis 2000; 30:78-86. [PMID: 10619737 DOI: 10.1086/313619] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Active hospital-based surveillance in the city of Salvador, Brazil, from December 1995 through October 1998, identified 221 patients with confirmed pneumococcal meningitis. Of these 221 patients, 29 (13%) had isolates with intermediate-level resistance to penicillin. Infection with these penicillin-nonsusceptible isolates was significantly associated with age of <2 years (P<.0019), previous antibiotic use (P<.0006), and coresistance to trimethoprim-sulfamethoxazole (P<.0000). Serotype 14 was the most prevalent serotype (55.2%) of penicillin-nonsusceptible isolates. Strain typing by repetitive element BOX polymerase chain reaction (PCR) analysis showed that penicillin-nonsusceptible serotype 14 isolates had closely related BOX PCR patterns, whereas penicillin-susceptible serotype 14 isolates each had distinct, unrelated patterns. Penicillin-nonsusceptible serotype 14 isolates from Salvador and other Brazilian cities had similar BOX PCR patterns. These observations indicate that in Brazil a large proportion of cases of penicillin-nonsusceptible pneumococcal meningitis appear to be caused by a closely related group of serotype 14 strains that may have disseminated to widely separate geographic areas.
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Affiliation(s)
- A I Ko
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz/Ministério da Saúde, Bahia 40295-001, Brazil. albertko@cpunet. com.br
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