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Sirivichayakul C, Biswal S, Saez-Llorens X, López-Medina E, Borja-Tabora C, Bravo L, Kosalaraksa P, Alera MT, Reynales H, Rivera L, Watanaveeradej V, Yu D, Espinoza F, Dietze R, Fernando L, Wickramasinghe VP, Moreira ED, Fernando AD, Gunasekera D, Luz K, Venâncio da Cunha R, Oliveira AL, Rauscher M, Fan H, Borkowski A, Escudero I, Tuboi S, Lloyd E, Tricou V, Folschweiller N, LeFevre I, Vargas LM, Wallace D. Efficacy and Safety of a Tetravalent Dengue Vaccine (TAK-003) in Children With Prior Japanese Encephalitis or Yellow Fever Vaccination. J Infect Dis 2024:jiae222. [PMID: 38682569 DOI: 10.1093/infdis/jiae222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 04/22/2024] [Accepted: 04/25/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND We explored the impact of prior Yellow fever (YF) or Japanese encephalitis (JE) vaccination on the efficacy of Takeda's dengue vaccine candidate, TAK-003 (NCT02747927). METHODS Children 4-16 years of age were randomized 2:1 to receive TAK-003 or placebo and were under active febrile surveillance. Symptomatic dengue was confirmed by serotype-specific RT-PCR. YF and JE vaccination history was recorded. RESULTS Of the 20,071 children who received TAK-003 or placebo, 21.1% had a YF and 23.9% had a JE vaccination history at randomization. Fifty-seven months after vaccination, vaccine efficacy was 55.7% (95% CI, 39.7%-67.5%) in those with YF vaccination, 77.8% (70.8%-83.1%) for JE vaccination, and 53.5% (45.4%-60.4%) for no prior YF/JE vaccination. Regional differences in serotype distribution confound these results. The apparent higher vaccine efficacy in the JE vaccination subgroup could be largely explained by serotype-specific efficacy of TAK-003. Within 28 days of any vaccination, the proportions of participants with serious adverse events in the YF/JE prior vaccination population were comparable between the TAK-003 and placebo groups. CONCLUSIONS The available data do not suggest a clinically relevant impact of prior JE or YF vaccination on TAK-003 performance. Overall, TAK-003 was well-tolerated and efficacious in different epidemiological settings.
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Affiliation(s)
- Chukiat Sirivichayakul
- Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Thailand
| | | | - Xavier Saez-Llorens
- Hospital del Niño Dr José Renán Esquivel, Sistema Nacional de Investigación at SENACYT, Centro de Vacunación Internacional (Cevaxin), Panama City, Panama
| | - Eduardo López-Medina
- Centro de Estudios en Infectologia Pediátrica (CEIP), Universidad del Valle and Clínica Imbanaco Grupo Quironsalud, Cali, Colombia
| | | | - Lulu Bravo
- University of the Philippines Manila, Ermita, Philippines
| | | | | | | | - Luis Rivera
- Hospital Maternidad Nuestra Senora de Altagracia, Santo Domingo, Dominican Republic
| | | | - Delia Yu
- De La Salle Health Sciences Institute, Dasmariñas, Philippines
| | - Felix Espinoza
- National Autonomous University of Nicaragua, León, Nicaragua
| | - Reynaldo Dietze
- Núcleo de Doenças Infecciosas, Centro de Ciências da Saúde, Universidade Federal do Espirito Santo, Vitória, Brazil
| | - LakKumar Fernando
- Centre for Clinical Management of Dengue & Dengue Haemorrhagic Fever, Negombo General Hospital, Negombo, Sri Lanka
| | | | - Edson Duarte Moreira
- Associação Obras Sociais Irmã Dulce Hospital Santo Antônio and Oswaldo Cruz Foundation, Bahia, Brazil
| | | | - Dulanie Gunasekera
- Faculty of Medical Sciences, University of Sri Jayawardenenpura, Sri Lanka
| | - Kleber Luz
- Instituto de Medicina Tropical da Universidade Federal do Rio Grande do Norte, Brazil
| | | | | | | | - Huihao Fan
- Clinchoice Inc, Fort Washington, PA, USA
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Shafie AA, Moreira ED, Vidal G, Di Pasquale A, Green A, Tai R, Yoong J. Sustainable Dengue Prevention and Management: Integrating Dengue Vaccination Strategies with Population Perspectives. Vaccines (Basel) 2024; 12:184. [PMID: 38400167 PMCID: PMC10892244 DOI: 10.3390/vaccines12020184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/01/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
The GEMKAP study (2023) unveiled consistent knowledge, attitude, and practice (KAP) levels across Asia-Pacific (APAC) and Latin America (LATAM) countries regarding dengue, with variations in the willingness to vaccinate. Despite an overall KAP parity, the disparities within and between the countries indicated the need for both overarching and tailored strategies. Population-wide gaps in dengue awareness result in suboptimal vaccination priorities and preventive measures. This commentary delves into identifying the drivers and barriers for implementing a multi-pronged dengue prevention and management program, emphasizing the pivotal role of vaccination alongside education and vector control. Drawing on expert interviews in APAC and LATAM, informed by the Consolidated Framework for Implementation Research (CFIR), four key themes emerged: prioritizing and continuously advocating for dengue on national health agendas, fostering stakeholder collaboration, incorporating population perspectives for behavioral change, and designing sustainable dengue prevention and management programs. Successful implementation requires evidence-based decision making and a comprehensive understanding of population dynamics to design adaptive education tailored to diverse population views. This commentary provides actionable strategies for enhancing dengue prevention and management, with a pronounced emphasis on dengue vaccination, advocating for a holistic, population-centric approach for sustained effectiveness.
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Affiliation(s)
- Asrul Akmal Shafie
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Science, Universiti Sains Malaysia, Gelugor 11800, Malaysia;
| | - Edson Duarte Moreira
- Associação Obras Sociais Irmã Dulce Hospital Santo Antônio and Oswaldo Cruz Foundation, Bahia CEP 40.415-006, Brazil;
| | - Gabriela Vidal
- Argentinian Infectious Diseases Society, Buenos Aires C1085, Argentina;
| | - Alberta Di Pasquale
- Regional Medical Affairs Vaccines, Growth and Emerging Markets, Takeda Pharmaceuticals International AG Singapore Branch, Singapore 018981, Singapore; (A.D.P.); (A.G.)
| | - Andrew Green
- Regional Medical Affairs Vaccines, Growth and Emerging Markets, Takeda Pharmaceuticals International AG Singapore Branch, Singapore 018981, Singapore; (A.D.P.); (A.G.)
| | - Rie Tai
- Vista Health Pte Ltd., Singapore 059413, Singapore;
| | - Joanne Yoong
- Research For Impact, Singapore 159964, Singapore
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Tricou V, Yu D, Reynales H, Biswal S, Saez-Llorens X, Sirivichayakul C, Lopez P, Borja-Tabora C, Bravo L, Kosalaraksa P, Vargas LM, Alera MT, Rivera L, Watanaveeradej V, Dietze R, Fernando L, Wickramasinghe VP, Moreira ED, Fernando AD, Gunasekera D, Luz K, Oliveira AL, Tuboi S, Escudero I, Hutagalung Y, Lloyd E, Rauscher M, Zent O, Folschweiller N, LeFevre I, Espinoza F, Wallace D. Long-term efficacy and safety of a tetravalent dengue vaccine (TAK-003): 4·5-year results from a phase 3, randomised, double-blind, placebo-controlled trial. Lancet Glob Health 2024; 12:e257-e270. [PMID: 38245116 DOI: 10.1016/s2214-109x(23)00522-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 09/01/2023] [Accepted: 11/01/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND About half of the world's population lives in dengue-endemic areas. We aimed to evaluate the long-term efficacy and safety of two doses of the tetravalent dengue vaccine TAK-003 in preventing symptomatic dengue disease of any severity and due to any dengue virus (DENV) serotypes in children and adolescents. METHODS In this ongoing double-blind, randomised, placebo-controlled trial, we enrolled healthy participants aged 4-16 years at 26 medical and research centres across eight dengue-endemic countries (Brazil, Colombia, Dominican Republic, Nicaragua, Panama, Philippines, Sri Lanka, and Thailand). The main exclusion criteria were febrile illness (body temperature ≥38°C) at the time of randomisation, hypersensitivity or allergy to any of the vaccine components, pregnancy or breastfeeding, serious chronic or progressive disease, impaired or altered immune function, and previous receipt of a dengue vaccine. Participants were randomly assigned 2:1 (stratified by age and region) using an interactive web response system and dynamic block assignment to receive two subcutaneous doses of TAK-003 or placebo 3 months apart. Investigators, participants, and their parents or legal guardians were blinded to group assignments. Active febrile illness surveillance and RT-PCR testing of febrile illness episodes were performed for identification of virologically confirmed dengue. Efficacy outcomes were assessed in the safety analysis set (all randomly assigned participants who received ≥1 dose) and the per protocol set (all participants who had no major protocol violations), and included cumulative vaccine efficacy from first vaccination to approximately 4·5 years after the second vaccination. Serious adverse events were monitored throughout. This study is registered with ClinicalTrials.gov, NCT02747927. FINDINGS Between Sept 7, 2016, and March 31, 2017, 20 099 participants were randomly assigned (TAK-003, n=13 401; placebo, n=6698). 20 071 participants (10 142 [50·5%] males; 9929 [49·5%] females; safety set) received TAK-003 or placebo, with 18 257 (91·0%) completing approximately 4·5 years of follow-up after the second vaccination (TAK-003, 12 177/13 380; placebo, 6080/6687). Overall, 1007 (placebo: 560; TAK-003: 447) of 27 684 febrile illnesses reported were virologically confirmed dengue, with 188 cases (placebo: 142; TAK-003: 46) requiring hospitalisation. Cumulative vaccine efficacy was 61·2% (95% CI 56·0-65·8) against virologically confirmed dengue and 84·1% (77·8-88·6) against hospitalised virologically confirmed dengue; corresponding efficacies were 53·5% (41·6-62·9) and 79·3% (63·5-88·2) in baseline seronegative participants (safety set). In an exploratory analysis, vaccine efficacy was shown against all four serotypes in baseline seropositive participants. In baseline seronegative participants, vaccine efficacy was shown against DENV-1 and DENV-2 but was not observed against DENV-3 and low incidence precluded evaluation against DENV-4. During part 3 of the trial (approximately 22-57 months after the first vaccination), serious adverse events were reported for 664 (5·0%) of 13 380 TAK-003 recipients and 396 (5·9%) of 6687 placebo recipients; 17 deaths (6 in the placebo group and 11 in the TAK-003 group) were reported, none were considered study-vaccine related. INTERPRETATION TAK-003 demonstrated long-term efficacy and safety against all four DENV serotypes in previously exposed individuals and against DENV-1 and DENV-2 in dengue-naive individuals. FUNDING Takeda Vaccines. TRANSLATIONS For the Portuguese, Spanish translations and plain language summary of the abstract see Supplementary Materials section.
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Affiliation(s)
- Vianney Tricou
- Takeda Pharmaceuticals International, Zurich, Switzerland.
| | - Delia Yu
- Pediatrics, De La Salle Medical and Health Sciences Institute, Dasmariñas, Philippines
| | - Humberto Reynales
- Clinical Research, Centro de Atención e Investigación Médica, CAIMED, Bogotá, Colombia
| | | | - Xavier Saez-Llorens
- Pediatric Infectious Diseases, Hospital del Niño Dr. José Renán Esquivel, Sistema Nacional de Investigación at SENACYT, Centro de Vacunación Internacional (Cevaxin), Panama City, Panama
| | - Chukiat Sirivichayakul
- Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Pio Lopez
- Centro de Estudios en Infectología Pediátrica, Universidad del Valle and Centro Medico Imbanaco, Cali, Colombia
| | - Charissa Borja-Tabora
- Clinical Research Division, Research Institute For Tropical Medicine, Muntinlupa, Philippines
| | - Lulu Bravo
- Pediatrics, University of the Philippines Manila, Ermita, Philippines
| | - Pope Kosalaraksa
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Maria Theresa Alera
- Virology, Philippines-Armed Forces Research Institute of Medical Sciences Virology Research Unit, Cebu City, Philippines
| | - Luis Rivera
- Hospital Maternidad Nuestra Senora de Altagracia, Santo Domingo, Dominican Republic
| | - Veerachai Watanaveeradej
- Department of Pediatrics, Phramongkutklao Hospital and Faculty of Medicine, Kasetsart University, Bangkok, Thailand
| | - Reynaldo Dietze
- Núcleo de Doenças Infecciosas, Centro de Ciencias da Saude-UFES, Vitória, Brazil
| | - LakKumar Fernando
- Centre for Clinical Management of Dengue & Dengue Haemorrhagic Fever, Negombo General Hospital, Negombo, Sri Lanka
| | | | - Edson Duarte Moreira
- Laboratory of Molecular Epidemiology and Biostatistics, Associação Obras Sociais Irmã Dulce Hospital Santo Antônio and Oswaldo Cruz Foundation, Bahia, Brazil
| | | | - Dulanie Gunasekera
- Faculty of Medical Sciences, University of Sri Jayawardenenpura, Nugegoda, Sri Lanka
| | - Kleber Luz
- Instituto de Medicina Tropical da Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | - Ana Lucia Oliveira
- Department of Infectious Diseases, Universidade Federal de Mato Grosso do Sul, Campo Grande, Brazil
| | | | | | | | | | | | - Olaf Zent
- Takeda Pharmaceuticals International, Zurich, Switzerland
| | | | - Inge LeFevre
- Takeda Pharmaceuticals International, Zurich, Switzerland; Regulatory Affairs, GlaxoSmithKline, Zug, Switzerland
| | - Felix Espinoza
- National Autonomous University of Nicaragua, León, Nicaragua
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LeFevre I, Bravo L, Folschweiller N, Medina EL, Moreira ED, Nordio F, Sharma M, Tharenos LM, Tricou V, Watanaveeradej V, Winkle PJ, Biswal S. Bridging the immunogenicity of a tetravalent dengue vaccine (TAK-003) from children and adolescents to adults. NPJ Vaccines 2023; 8:75. [PMID: 37230978 DOI: 10.1038/s41541-023-00670-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 05/10/2023] [Indexed: 05/27/2023] Open
Abstract
Immunobridging is an important methodology that can be used to extrapolate vaccine efficacy estimates to populations not evaluated in clinical studies, and that has been successfully used in developing many vaccines. Dengue, caused by a mosquito-transmitted flavivirus endemic to many tropical and subtropical regions, is traditionally thought of as a pediatric disease but is now a global threat to both children and adults. We bridged immunogenicity data from a phase 3 efficacy study of a tetravalent dengue vaccine (TAK-003), performed in children and adolescents living in endemic areas, with an immunogenicity study in adults in non-endemic areas. Neutralizing antibody responses were comparable in both studies following receipt of a two-dose TAK-003 schedule (months 0 and 3). Similar immune responses were observed across exploratory assessments of additional humoral responses. These data support the potential for clinical efficacy of TAK-003 in adults.
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Affiliation(s)
- Inge LeFevre
- Vaccines Business Unit, Takeda Pharmaceuticals International AG, Zürich, Switzerland
| | - Lulu Bravo
- College of Medicine, University of the Philippines, Manila, Philippines
| | - Nicolas Folschweiller
- Vaccines Business Unit, Takeda Pharmaceuticals International AG, Zürich, Switzerland
| | - Eduardo Lopez Medina
- Centro de Estudios en Infectología Pediatrica CEIP; Department of Pediatrics, Universidad Del Valle; Clínica Imbanaco, Grupo Quironsalud, Cali, Colombia
| | - Edson Duarte Moreira
- Associação Obras Sociais Irmã Dulce Hospital Santo Antônio and Oswaldo Cruz Foundation, Bahia, Brazil
| | | | | | - Leslie M Tharenos
- The Division of Environmental and Occupational Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL, USA
| | - Vianney Tricou
- Vaccines Business Unit, Takeda Pharmaceuticals International AG, Zürich, Switzerland
| | - Veerachai Watanaveeradej
- Department of Pediatrics, Phramongkutklao Hospital and Faculty of Medicine, Kasetsart University, Bangkok, Thailand
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Shafie AA, Moreira ED, Di Pasquale A, Demuth D, Yin JYS. Knowledge, Attitudes and Practices toward Dengue Fever, Vector Control, and Vaccine Acceptance Among the General Population in Countries from Latin America and Asia Pacific: A Cross-Sectional Study (GEMKAP). Vaccines (Basel) 2023; 11:vaccines11030575. [PMID: 36992159 DOI: 10.3390/vaccines11030575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/06/2023] Open
Abstract
Dengue represents a major public health concern. With effective vaccines in development, it is important to identify motivational factors to maximize dengue vaccine uptake. A cross-sectional, quantitative, electronic survey was administered to a nationally representative adult population (n = 3800) in Argentina, Brazil, Colombia, Mexico, Indonesia, Malaysia, and Singapore. Willingness to vaccinate against dengue, and Knowledge, Attitudes, and Practices (KAP) toward dengue, vector control, prevention, and vaccination were determined. The Capability, Opportunity, Motivation for Behavior change (COM-B) framework was used to identify factors correlated with dengue vaccine(s) uptake. KAP scores (standardized, 0–100% scale) resulted in a low global score for Knowledge (48%) and Practice (44%), and a moderate score for Attitude (66%); scores were comparable across countries. Of all respondents, 53% had a high willingness (Score: 8–10/10) to vaccinate against dengue, which was higher (59%) in Latin America (Argentina, Brazil, Colombia, Mexico) than in Asia Pacific (40%) (Indonesia, Malaysia, Singapore). Key factors significantly (p < 0.05) associated with increased willingness to vaccinate included accessibility to the public (subsidies and incentives) and trust in the healthcare system and government. A common approach to dengue prevention across endemic countries––with some country-specific customization, including education, vaccination, and vector control (multi-pronged)––may reduce dengue burden and improve outcomes.
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Affiliation(s)
- Asrul Akmal Shafie
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Science, Universiti Sains Malaysia, George Town 11800, Malaysia
| | - Edson Duarte Moreira
- Associação Obras Sociais Irmã Dulce Hospital Santo Antônio and Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador 40420-000, Brazil
| | - Alberta Di Pasquale
- Regional Medical Affairs, Growth and Emerging Markets, Takeda Pharmaceuticals International AG Singapore Branch, Singapore 018981, Singapore
| | - Dirk Demuth
- Evidence Generation and Publications, Growth and Emerging Markets, Takeda Pharmaceuticals International AG Singapore Branch, Singapore 018981, Singapore
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Borba VZC, Lazaretti-Castro M, da Silva Moreira S, de Almeida MCC, Moreira ED. Epidemiology of Vitamin D (EpiVida) – a study of vitamin D status among healthy adults in Brazil. J Endocr Soc 2022; 7:bvac171. [DOI: 10.1210/jendso/bvac171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
There are few studies of 25-hydroxyvitamin D (25OHD) concentrations in healthy adults in Brazil.
Objective
to estimate the prevalence of vitamin D status and their association with lifestyle, sociodemographic and anthropometric data in three different regions of Brazil.
Methods
cross-sectional study among blood donors of both genders, living in the cities of Salvador, São Paulo and Curitiba during Summer. Blood samples were collected during the procedure. Serum 25OHD and parathyroid hormone (PTH) were measured in the same laboratory using chemiluminescence immunoassays. Information on lifestyle, sociodemographic and anthropometric was gathered by an interview with a standardized questionnaire. Vitamin D deficiency and insufficiency was defined as 25OHD levels below 20 ng/mL and below 30 ng/mL, respectively.
Results
1,004 healthy adults were evaluated with mean levels of 25OHD (28.7 ± 9.27 ng/mL) and PTH (34.4 ± 15.1 pg/mL). The standardized prevalence of vitamin D deficiency and insufficiency was in the study population 15.3% and 50.9%; in Salvador 12.1% and 47.6%, in São Paulo 20.5% and 52.4% and in Curitiba 12.7% and 52.1%, (p = 0.0004). PTH levels were negatively correlated with 25OHD levels. Greater BMI and higher latitude were significant predictors of vitamin D deficiency, whereas skin color (Caucasian), longer duration of sun exposure and current use of dietary supplement were protective.
Conclusions
This study confirmed the high prevalence of vitamin D deficiency and insufficiency even in the midsummer in a healthy population of Brazil. Vitamin D levels are associated with sun exposure, latitude, BMI, skin color and use of supplements.
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Affiliation(s)
| | - Marise Lazaretti-Castro
- Division of Endocrinology, Escola Paulista de Medicina, Universidade Federal de São Paulo , São Paulo , Brazil
| | - Sandra da Silva Moreira
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Brazilian Ministry of Health , Salvador , Brazil
- Clinical Research Center, Charitable Works Foundation of Sister Dulce , Salvador , Brazil
| | | | - Edson Duarte Moreira
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Brazilian Ministry of Health , Salvador , Brazil
- Clinical Research Center, Charitable Works Foundation of Sister Dulce , Salvador , Brazil
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López-Medina E, Biswal S, Saez-Llorens X, Borja-Tabora C, Bravo L, Sirivichayakul C, Vargas LM, Alera MT, Velásquez H, Reynales H, Rivera L, Watanaveeradej V, Rodriguez-Arenales EJ, Yu D, Espinoza F, Dietze R, Fernando LK, Wickramasinghe P, Duarte Moreira E, Fernando AD, Gunasekera D, Luz K, da Cunha RV, Tricou V, Rauscher M, Liu M, LeFevre I, Wallace D, Kosalaraksa P, Borkowski A. Efficacy of a Dengue Vaccine Candidate (TAK-003) in Healthy Children and Adolescents 2 Years after Vaccination. J Infect Dis 2022; 225:1521-1532. [PMID: 33319249 PMCID: PMC9071282 DOI: 10.1093/infdis/jiaa761] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/10/2020] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Takeda's dengue vaccine is under evaluation in an ongoing phase 3 efficacy study; we present a 2-year update. METHODS Children (20 099, 4-16 years old) were randomized to receive 2 doses of TAK-003 or placebo 3 months apart and are under surveillance to detect dengue by serotype-specific RT-PCR. RESULTS Cumulative efficacy against dengue approximately 27 months since first dose was 72.7% (95% confidence interval [CI], 67.1%-77.3%), including 67.0% (95% CI, 53.6%-76.5%) in dengue-naive and 89.2% (95% CI, 82.4%-93.3%) against hospitalized dengue. In the second year, decline in efficacy was observed (56.2%; 95% CI, 42.3%-66.8%) with the largest decline in 4-5 year olds (24.5%; 95% CI, -34.2% to 57.5%); efficacy was 60.6% (95% CI, 43.8%-72.4%) in 6-11 year and 71.2% (95% CI, 41.0%-85.9%) in 12-16 year age groups. As TAK-003 efficacy varies by serotype, changes in serotype dominance partially contributed to efficacy differences in year-by-year analysis. No related serious adverse events occurred during the second year. CONCLUSIONS TAK-003 demonstrated continued benefit independent of baseline serostatus in reducing dengue with some decline in efficacy during the second year. Three-year data will be important to see if efficacy stabilizes or declines further.Clinical Trials Registration. NCT02747927.Takeda's tetravalent dengue vaccine (TAK-003) continued to demonstrate benefit in reducing dengue independent of baseline serostatus up to 2 years after completing vaccination with some decline in efficacy during the second year in 4-16 year olds in dengue-endemic countries.
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Affiliation(s)
- Eduardo López-Medina
- Centro de Estudios en Infectología Pediátrica, Universidad del Valle and Centro Médico Imbanaco, Cali, Colombia
| | | | - Xavier Saez-Llorens
- Hospital del Niño Dr José Renán Esquivel, Sistema Nacional de Investigación, Secretaria Nacional de Ciencia y Tecnologia, Centro de Vacunación Internacional, Panama City, Panama
| | | | - Lulu Bravo
- University of the Philippines Manila, Ermita, Philippines
| | - Chukiat Sirivichayakul
- Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Luis Martinez Vargas
- Centro de Atención e Investigación Médica Dominicana, Santo Domingo, Dominican Republic
| | - Maria Theresa Alera
- Philippines-Armed Forces Research Institute of Medical Sciences Virology Research Unit, Cebu City, Philippines
| | | | | | - Luis Rivera
- Hospital Maternidad Nuestra Senora de Altagracia, Santo Domingo, Dominican Republic
| | | | | | - Delia Yu
- De La Salle Medical and Health Sciences Institute, Dasmariñas, Philippines
| | - Felix Espinoza
- National Autonomous University of Nicaragua, León, Nicaragua
| | - Reynaldo Dietze
- Universidade Federal Do Espirito Santo, Hospital Universitário Cassiano Antônio de Moraes, Vitória, Brazil
| | - Lak Kumar Fernando
- Centre for Clinical Management of Dengue and Dengue Haemorrhagic Fever, Negombo General Hospital, Negombo, Sri Lanka
| | | | - Edson Duarte Moreira
- Associação Obras Sociais Irmã Dulce Hospital Santo Antônio and Oswaldo Cruz Foundation, Bahia, Brazil
| | | | - Dulanie Gunasekera
- Faculty of Medical Sciences, University of Sri Jayawardenenpura, Nugegoda, Sri Lanka
| | - Kleber Luz
- Instituto de Medicina Tropical da Universidade Federal do Rio Grande do Norte, Natal, Brazil
| | | | - Vianney Tricou
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
| | | | - Mengya Liu
- Takeda Vaccines, Inc., Boston, Massachusetts, USA
| | - Inge LeFevre
- Takeda Pharmaceuticals International AG, Zurich, Switzerland
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Duarte FG, Barberino MG, da Silva Moreira S, Reis JN, Spinardi JR, de Almeida RS, Allen KE, Alexander-Parrish R, Brim R, de Araújo Neto CA, Moreira ED. Incidence, aetiology and serotype coverage for pneumococcal vaccines of community-acquired pneumonia in adults: a population-based prospective active surveillance study in Brazil. BMJ Open 2022; 12:e059824. [PMID: 35428648 PMCID: PMC9014102 DOI: 10.1136/bmjopen-2021-059824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 03/30/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine the incidence, aetiology and pneumococcal serotype distribution of community-acquired pneumonia (CAP) in Brazilian adults during a 2-year period. DESIGN Prospective population-based surveillance study. SETTING Patients from two emergency hospitals in Brazil were consecutively included in this study. PARTICIPANTS A total of 111 adults aged 50 years and older with radiographically-confirmed CAP requiring an emergency department visit were prospectively enrolled between January 2018 and January 2020. MAIN OUTCOME MEASURES Incidence rates of CAP were calculated according to age and pathogen. Pathogens were identified by conventional microbiological methods. Additionally, a novel, Luminex-based serotype specific urinary antigen detection assay was used to detect serotypes included in pneumococcal vaccines. RESULTS Mean age of participants was 64 years and 31% were aged ≥70 years. Aetiology was established in 61 (57%) patients; among identified cases, the most common pathogens were Streptococcus pneumoniae (42/61, 69%) and influenza (4/61, 7%). Among serotypes identified from the 42 cases of pneumococcal CAP, estimated coverage ranged by pneumococcal vaccine formulations from 47.6% (13-valent), 59.5% (20-valent, licenced in the USA only) and 71.4% (23-valent). In patients with CAP, 20-valent pneumococcal vaccine serotypes were identified 2.5 times more frequently than 10-valent pneumococcal vaccine serotypes (22.5% vs 9.0%). The incidence rate for CAP in adults aged ≥50 years was 20.1 per 10 000 person-years. In general, the incidence of CAP increased consistently with age, reaching 54.4 (95% CI 36.8 to -76.6) per 10 000 in adults 80 years or older. CONCLUSIONS We observed a high burden of pneumococcal CAP among adults in Brazil. Despite the routine immunisation of children and high-risk adults against pneumococcal disease in the Brazilian national vaccination programme, a persistent burden of pneumococcal CAP caused by vaccine serotypes remains in this population.
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Affiliation(s)
- Fernanda Gross Duarte
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, Bahia, Brazil
| | - Maria Goreth Barberino
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, Bahia, Brazil
| | | | | | | | | | | | | | - Rosa Brim
- Federal University of Bahia, Salvador, Brazil
| | | | - Edson Duarte Moreira
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, Bahia, Brazil
- Centro de Pesquisa Clínica (CPEC), Obras Sociais Irma Dulce, Salvador, Bahia, Brazil
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Duarte FG, Moreira SDS, Barberino MG, de Paula MN, Vianna NA, de Almeida MCC, Moreira ED. Deaths and hospitalizations of victims of non-drug toxicological events in Brazil, 2009 to 2018. Epidemiol Serv Saude 2022; 31:e2022389. [PMID: 36542045 PMCID: PMC9887972 DOI: 10.1590/s2237-96222022000300018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/20/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE to determine the rate of hospitalizations due to acute non-drug poisoning (NDP) events and to analyze mortality arising from these health conditions in Brazil from 2009 to 2018. METHODS this was a time-series study using Prais-Winsten regression to analyze records of hospitalizations for "treatment of intoxication or poisoning due to exposure to non-drug substances" held on the Hospital Information System. RESULTS there were 125,570 hospitalizations due to NDP. The average hospitalization rate was 6.3/100,000 inhabitants, although it was higher in males (8.0/100,000 inhab.) compared to females (4.6/100,000 inhab.). The hospitalization rate and the overall mortality rate due NDP to fell from 9.4 to 4.5/100,000 inhab. and from 2.5 to 1.6/1 million inhab., respectively. CONCLUSIONS there was a reduction in the NDP hospitalization rate and in mortality due to NDP during the decade analyzed.
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Affiliation(s)
- Fernanda Gross Duarte
- Instituto Gonçalo Moniz, Laboratório de Epidemiologia Molecular e
Bioestatística, Salvador, BA, Brazil
| | | | - Maria Goreth Barberino
- Instituto Gonçalo Moniz, Laboratório de Epidemiologia Molecular e
Bioestatística, Salvador, BA, Brazil
| | | | - Nelzair Araújo Vianna
- Instituto Gonçalo Moniz, Laboratório de Epidemiologia Molecular e
Bioestatística, Salvador, BA, Brazil
| | | | - Edson Duarte Moreira
- Instituto Gonçalo Moniz, Laboratório de Epidemiologia Molecular e
Bioestatística, Salvador, BA, Brazil
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Díez-Domingo J, Tinoco JC, Poder A, Dinleyici EC, Nell H, Salamanca de la Cueva I, Ince T, Moreira ED, Ahmed K, Luz K, Kovshirina Y, Medina Pech CE, Akhund T, Romolini V, Costantini M, Mzolo T, Kunnel B, Lechevin I, Aggravi M, Tiberi P, Narendran K, García-Martínez JA, Basile V, Fragapane E, Lattanzi M, Pellegrini M. Immunological non-inferiority of a new fully liquid presentation of the MenACWY-CRM vaccine to the licensed vaccine: results from a randomized, controlled, observer-blind study in adolescents and young adults. Hum Vaccin Immunother 2021; 18:1981085. [PMID: 34614379 PMCID: PMC8966988 DOI: 10.1080/21645515.2021.1981085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
A fully liquid MenACWY-CRM vaccine presentation has been developed, modifying the meningococcal serogroup A (MenA) component from lyophilized to liquid. The safety and immunogenicity of the liquid presentation at the end of the intended shelf-life (aged for 24 or 30 months) were compared to the licensed lyophilized/liquid presentation. This multicenter, randomized (1:1), observer-blind, phase 2b study (NCT03433482) enrolled adolescents and young adults (age 10-40 years). In part 1, 844 participants received one dose of liquid presentation stored for approximately 24 months or licensed presentation. In part 2, 846 participants received one dose of liquid presentation stored for approximately 30 months or licensed presentation. After storage, the MenA free saccharide (FS) level was approximately 25% and O-acetylation was approximately 45%. The primary objective was to demonstrate non-inferiority of the liquid presentation to licensed presentation, as measured by human serum bactericidal assay (hSBA) geometric mean titers (GMTs) against MenA, 1-month post-vaccination. Immune responses against each vaccine serogroup were similar between groups. Between-group ratios of hSBA GMTs for MenA were 1.21 (part 1) and 1.11 (part 2), with two-sided 95% confidence interval lower limits (0.94 and 0.87, respectively) greater than the prespecified non-inferiority margin (0.5), thus meeting the primary study objective. No safety concerns were identified. Despite reduced O-acetylation of MenA and increased FS content, serogroup-specific immune responses induced by the fully liquid presentation were similar to those induced by the licensed MenACWY-CRM vaccine, with non-inferior anti-MenA responses. The safety profiles of the vaccine presentations were similar.
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Affiliation(s)
| | | | - Airi Poder
- Kliiniliste Uuringute Keskus, Tartu, Estonia
| | - Ener Cagri Dinleyici
- Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Haylene Nell
- Tiervlei Trial Centre, Karl Bremer Hospital, Bellville, South Africa
| | | | - Tolga Ince
- Faculty of Medicine, Dokuz Eylul University, Izmir, Turkey
| | - Edson Duarte Moreira
- Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, Brazil
| | - Khatija Ahmed
- Setshaba Research Centre, Tshwane, and Faculty of Health Sciences, Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa
| | - Kleber Luz
- Centro de Pesquisas Clinicas de Natal, Rio Grande do Norta, Brazil
| | - Yulia Kovshirina
- Infectious Diseases and Epidemiology, Siberian State Medical University, Tomsk, Russian Federation
| | | | | | | | | | | | - Barry Kunnel
- Data Strategy & Management, Global Clinical Operations Development - R&D, GSK, Amsterdam, The Netherlands
| | | | | | - Paola Tiberi
- Safety Evaluation and Risk Management, GSK, Siena, Italy
| | - K Narendran
- Global Clinical Operations, GSK, Bangalore, India
| | | | - Venere Basile
- Global Clinical Delivery, Global Clinical Operations Development, GSK, Siena, Italy
| | | | - Maria Lattanzi
- Clinical Research and Development Centre, GSK, Siena, Italy
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Rivera L, Biswal S, Sáez-Llorens X, Reynales H, López-Medina E, Borja-Tabora C, Bravo L, Sirivichayakul C, Kosalaraksa P, Martinez Vargas L, Yu D, Watanaveeradej V, Espinoza F, Dietze R, Fernando L, Wickramasinghe P, Duarte Moreira E, Fernando AD, Gunasekera D, Luz K, Venâncio da Cunha R, Rauscher M, Zent O, Liu M, Hoffman E, LeFevre I, Tricou V, Wallace D, Alera MT, Borkowski A. Three years efficacy and safety of Takeda's dengue vaccine candidate (TAK-003). Clin Infect Dis 2021; 75:107-117. [PMID: 34606595 PMCID: PMC9402653 DOI: 10.1093/cid/ciab864] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background Takeda’s live attenuated tetravalent dengue vaccine candidate (TAK-003) is under evaluation in a long-term clinical trial across 8 dengue-endemic countries. Previously, we have reported its efficacy and safety in both seronegative and seropositive participants and that its performance varies by serotype, with some decline in efficacy from first to second year postvaccination. This exploratory analysis provides an update with cumulative and third-year data. Methods Healthy 4–16 year olds (n = 20099) were randomized 2:1 to receive TAK-003 or placebo (0, 3 month schedule). The protocol included baseline serostatus testing of all participants and detection of all symptomatic dengue throughout the trial with a serotype specific reverse transcriptase-polymerase chain reaction. Results Cumulative efficacy after 3 years was 62.0% (95% confidence interval, 56.6–66.7) against virologically confirmed dengue (VCD) and 83.6% (76.8–88.4) against hospitalized VCD. Efficacy was 54.3% (41.9–64.1) against VCD and 77.1% (58.6–87.3) against hospitalized VCD in baseline seronegatives, and 65.0% (58.9–70.1) against VCD and 86.0% (78.4–91.0) against hospitalized VCD in baseline seropositives. Efficacy against VCD during the third year declined to 44.7% (32.5–54.7), whereas efficacy against hospitalized VCD was sustained at 70.8% (49.6–83.0). Rates of serious adverse events were 2.9% in TAK-003 group and 3.5% in placebo group during the ongoing long-term follow-up (ie, second half of the 3 years following vaccination), but none were related. No important safety risks were identified. Conclusions TAK-003 was efficacious against symptomatic dengue over 3 years. Efficacy declined over time but remained robust against hospitalized dengue. A booster dose evaluation is planned.
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Affiliation(s)
- Luis Rivera
- Hospital Maternidad Nuestra Senora de Altagracia, Santo Domingo, Dominican Republic
| | | | - Xavier Sáez-Llorens
- Hospital del Niño Dr. José Renán Esquivel, Sistema Nacional de Investigación at SENACYT, Centro de Vacunación Internacional (Cevaxin), Panama City, Panama
| | | | - Eduardo López-Medina
- Centro de Estudios en Infectología Pediátrica, Universidad del Valle and Centro Medico Imbanaco, Cali, Colombia
| | | | - Lulu Bravo
- University of the Philippines Manila, Ermita, Philippines
| | - Chukiat Sirivichayakul
- Department of Tropical Pediatrics, Faculty of Tropical Medicine, Mahidol University, Thailand
| | | | | | - Delia Yu
- De La Salle Medical and Health Sciences Institute, Dasmariñas, Philippines
| | | | - Felix Espinoza
- National Autonomous University of Nicaragua, León, Nicaragua
| | - Reynaldo Dietze
- Núcleo de Doenças Infecciosas, Centro de Ciencias da Saude-UFES, Vitória, Brazil
| | - LakKumar Fernando
- Centre for Clinical Management of Dengue & Dengue Haemorrhagic Fever, Negombo General Hospital, Negombo, Sri Lanka
| | | | - Edson Duarte Moreira
- Associação Obras Sociais Irmã Dulce Hospital Santo Antônio and Oswaldo Cruz Foundation, Bahia, Brazil
| | | | - Dulanie Gunasekera
- Faculty of Medical Sciences, University of Sri Jayawardenenpura, Sri Lanka
| | - Kleber Luz
- Instituto de Medicina Tropical da Universidade Federal do Rio Grande do Norte, Brazil
| | | | | | - Olaf Zent
- Takeda Pharmaceuticals International AG., Zurich, Switzerland
| | | | | | - Inge LeFevre
- Takeda Pharmaceuticals International AG., Zurich, Switzerland
| | - Vianney Tricou
- Takeda Pharmaceuticals International AG., Zurich, Switzerland
| | | | - Maria Theresa Alera
- Philippines-Armed Forces Research Institute of Medical Sciences Virology Research Unit, Cebu City, Philippines
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Olsson SE, Restrepo JA, Reina JC, Pitisuttithum P, Ulied A, Varman M, Van Damme P, Moreira ED, Ferris D, Block S, Bautista O, Gallagher N, McCauley J, Luxembourg A. Long-term immunogenicity, effectiveness, and safety of nine-valent human papillomavirus vaccine in girls and boys 9 to 15 years of age: Interim analysis after 8 years of follow-up. Papillomavirus Res 2020; 10:100203. [PMID: 32659510 PMCID: PMC7396911 DOI: 10.1016/j.pvr.2020.100203] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 07/07/2020] [Accepted: 07/08/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The nine-valent human papillomavirus (9vHPV) vaccine protects against infection and disease related to HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58. The pivotal 36-month Phase III immunogenicity study of 9vHPV vaccine in 9- to 15-year-old girls and boys was extended to assess long-term immunogenicity and effectiveness through approximately 10 years after vaccination. We describe results of an interim analysis based on approximately 8 years of follow-up after vaccination. METHODS Participants aged 9-15 years who received three doses of 9vHPV vaccine (at day 1, month 2, and month 6) in the base study and consented to follow-up were enrolled in the long-term follow-up study extension (N = 1272 [females, n = 971; males, n = 301]). Serum was collected at months 66 and 90 to assess antibody responses. For effectiveness analysis, genital swabs were collected (to assess HPV DNA by polymerase chain reaction [PCR]) and external genital examination was conducted (to detect external genital lesions) every 6 months starting when the participant reached 16 years of age. Cervical cytology tests were conducted annually when female participants reached 21 years of age; participants with cytological abnormalities were triaged to colposcopy based on a protocol-specified algorithm. External genital and cervical biopsies of abnormal lesions were performed, and histological diagnoses were adjudicated by a pathology panel. Specimens were tested by PCR to detect HPV DNA. RESULTS Geometric mean titers for each 9vHPV vaccine HPV type peaked around month 7 and gradually decreased through month 90. Seropositivity rates remained >90% through month 90 for each of the 9vHPV vaccine types by HPV immunoglobulin Luminex Immunoassay. No cases of HPV6/11/16/18/31/33/45/52/58-related high-grade intraepithelial neoplasia or genital warts were observed in the per-protocol population (n = 1107) based on a maximum follow-up of 8.2 years (median 7.6 years) post-Dose 3. Incidence rates of HPV6/11/16/18/31/33/45/52/58-related 6-month persistent infection in females and males were 49.2 and 37.3 per 10,000 person-years, respectively, which were within ranges expected in vaccinated cohorts. There were no vaccine-related SAEs or deaths during the period covered by this interim analysis. CONCLUSIONS The 9vHPV vaccine provided sustained immunogenicity and durable effectiveness through approximately 7 and 8 years, respectively, following vaccination of girls and boys aged 9-15 years.
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Affiliation(s)
| | | | - Julio Cesar Reina
- Department of Pediatrics, Universidad del Valle and Centro Medico Imbanaco, Cali, Colombia
| | - Punnee Pitisuttithum
- Vaccine Trial Centre, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Angels Ulied
- Pediatrics Department, EBA Centelles, Centelles, Spain
| | - Meera Varman
- Pediatric Infectious Diseases, Creighton University, Omaha, NE, USA
| | - Pierre Van Damme
- University of Antwerp, Vaccine & Infectious Disease Institute, Centre for the Evaluation of Vaccination, Antwerp, Belgium
| | - Edson Duarte Moreira
- Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Brazilian Ministry of Health, Bahia, Brazil
| | - Daron Ferris
- Department of Obstetrics and Gynecology, Augusta University, Augusta, Georgia, USA
| | - Stanley Block
- Kentucky Pediatric and Adult Research Inc, Bardstown, KY, USA
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Biswal S, Borja-Tabora C, Martinez Vargas L, Velásquez H, Theresa Alera M, Sierra V, Johana Rodriguez-Arenales E, Yu D, Wickramasinghe VP, Duarte Moreira E, Fernando AD, Gunasekera D, Kosalaraksa P, Espinoza F, López-Medina E, Bravo L, Tuboi S, Hutagalung Y, Garbes P, Escudero I, Rauscher M, Bizjajeva S, LeFevre I, Borkowski A, Saez-Llorens X, Wallace D. Efficacy of a tetravalent dengue vaccine in healthy children aged 4-16 years: a randomised, placebo-controlled, phase 3 trial. Lancet 2020; 395:1423-1433. [PMID: 32197105 DOI: 10.1016/s0140-6736(20)30414-1] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND A substantial unmet need remains for safe and effective vaccines against dengue virus disease, particularly for individuals who are dengue-naive and those younger than 9 years. We aimed to assess the efficacy, safety, and immunogenicity of a live attenuated tetravalent dengue vaccine (TAK-003) in healthy children aged 4-16 years. METHODS We present data up to 18 months post-vaccination from an ongoing phase 3, randomised, double-blind trial of TAK-003 in endemic regions of Asia and Latin America (26 medical and research centres across Brazil, Colombia, Dominican Republic, Nicaragua, Panama, Philippines, Sri Lanka, and Thailand). Healthy children aged 4-16 years were randomly assigned 2:1 (stratified by age and region) to receive two doses of TAK-003 or two doses of placebo, 3 months apart. Investigators, participants and their parents or guardians, and sponsor representatives advising on trial conduct were masked to trial group assignments. Participants presenting with febrile illness were tested for virologically confirmed dengue (VCD) by serotype-specific RT-PCR. In timeframes beginning 30 days post-second dose, the primary endpoint (overall vaccine efficacy) was assessed in the first 11 months, and the secondary endpoints (efficacy by baseline serostatus, serotype, hospitalised dengue, and severe dengue) in the first 17 months. This study is registered with ClinicalTrials.gov, NCT02747927. FINDINGS 20 099 participants were randomly assigned and vaccinated between Sept 7, 2016, and Aug 18, 2017; 19 021 (94·6%) were included in the per protocol analysis, and 20 071 (99·9%) in the safety set. The primary endpoint was achieved with an overall vaccine efficacy of 80·2% (95% CI 73·3 to 85·3; 61 cases of VCD in the TAK-003 group vs 149 cases of VCD in the placebo group). In the secondary endpoint assessment timeframe, an overall vaccine efficacy of 73·3% (95% CI 66·5 to 78·8) was observed. Analysis of secondary endpoints showed efficacies of 76·1% (95% CI 68·5 to 81·9) in individuals who were seropositive at baseline, 66·2% (49·1 to 77·5) in individuals who were seronegative at baseline, 90·4% (82·6 to 94·7) against hospitalised dengue, and 85·9% (31·9 to 97·1) against dengue haemorrhagic fever. Efficacy varied by individual serotypes (DENV 1, 69·8% [95% CI 54·8 to 79·9]; DENV 2, 95·1% [89·9 to 97·6]; DENV 3, 48·9% [27·2 to 64·1]; DENV 4, 51·0% [-69·4 to 85·8]). Cumulative rates of serious adverse events were similar in TAK-003 (4·0%) and placebo (4·8%) recipients, and were consistent with expected medical disorders in the study population. Infection was the most frequent reason leading to serious adverse events. 20 participants (<0·1% of the safety set) were withdrawn from the trial due to 21 adverse events by the end of part two; 14 of these participants received TAK-003 and six received placebo. INTERPRETATION TAK-003 was well tolerated and efficacious against symptomatic dengue in children regardless of serostatus before immunisation. Vaccine efficacy varied by serotype, warranting continued follow-up to assess longer-term vaccine performance. FUNDING Takeda Vaccines.
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Affiliation(s)
| | | | - Luis Martinez Vargas
- Centro de Atención e Investigación Médica, Dominicana, Santo Domingo, Dominican Republic
| | | | - Maria Theresa Alera
- Philippines-Armed Forces Research Institute of Medical Sciences Virology Research Unit, Cebu City, Philippines
| | - Victor Sierra
- Centro de Atención e Investigación Médica, Yopal, Colombia
| | | | - Delia Yu
- De La Salle Medical and Health Sciences Institute, Dasmariñas, Philippines
| | | | - Edson Duarte Moreira
- Associação Obras Sociais Irmã Dulce Hospital Santo Antônio and Oswaldo Cruz Foundation, Bahia, Brazil
| | | | - Dulanie Gunasekera
- Faculty of Medical Sciences, University of Sri Jayawardenenpura, Gangodawila, Sri Lanka
| | | | - Felix Espinoza
- National Autonomous University of Nicaragua, León, Nicaragua
| | - Eduardo López-Medina
- Centro de Estudios en Infectología Pediátrica, Universidad del Valle and Centro Médico Imbanaco, Cali, Colombia
| | - Lulu Bravo
- University of the Philippines Manila, Ermita, Philippines
| | | | | | | | | | | | | | - Inge LeFevre
- Takeda Pharmaceuticals International, Zurich, Switzerland
| | | | - Xavier Saez-Llorens
- Hospital del Niño Dr José Renán Esquivel, Sistema Nacional de Investigación at Secretaría Nacional de Ciencia y Tecnología, Centro de Vacunación Internacional (Cevaxin), Panama City, Panama
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Safadi MAP, Martinon-Torres F, Weckx LY, Moreira ED, da Fonseca Lima EJ, Willemsen A, Toneatto D, Habib MA, Borys D. Immunogenicity of the pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) administered concomitantly with the meningococcal serogroup B (4CMenB) vaccine in infants: A post-hoc analysis in a phase 3b, randomised, controlled trial. Vaccine 2019; 37:4858-4863. [PMID: 31327652 DOI: 10.1016/j.vaccine.2019.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 06/24/2019] [Accepted: 07/07/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND No data are currently available on immunogenicity of higher-valent pneumococcal conjugate vaccines when co-administered with a 4-component meningococcal serogroup B vaccine (4CMenB). METHODS Post-hoc analysis of pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) immunogenicity when co-administered with 4CMenB (2 + 1 schedule) and/or a CRM-conjugated meningococcal serogroup C vaccine (MenC-CRM) in a trial assessing 4CMenB reduced schedules and co-administration with MenC-CRM (NCT01339923). Infants were randomized to receive 4CMenB and MenC-CRM (Group 1) or MenC-CRM (Group 2) at 3, 5, and 12 months (M) of age. Both groups received PHiD-CV (3 + 1 schedule) as part of the Brazilian national immunisation programme at 3 M, 5 M, 7 M, and 12 M of age. Antibody responses were assessed pre-vaccination, 1 M post-dose 2, pre-booster, and 1 M post-booster. RESULTS Anti-pneumococcal antibody responses were in similar ranges in the two study groups. CONCLUSIONS 4CMenB co-administration did not seem to impact antibody responses to PHiD-CV in infants.
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Affiliation(s)
| | - Federico Martinon-Torres
- Hospital Clinico Universitario de Santiago de Compostela, Santiago de Compostela, Spain; Genetics, Vaccines and Pediatrics Research Group (GENVIP), Instituto de Investigación Sanitaria de Santiago, University of Santiago de Compostela, Spain.
| | | | - Edson Duarte Moreira
- CPEC - Associação Obras Sociais Irma Dulce and Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, Brazil.
| | | | - Arnold Willemsen
- Plus100 B.V. c/o Biostatistics, GSK, Amsterdam, the Netherlands.
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Mendes Lobão W, Duarte FG, Burns JD, de Souza Teles Santos CA, Chagas de Almeida MC, Reingold A, Duarte Moreira E. Low coverage of HPV vaccination in the national immunization programme in Brazil: Parental vaccine refusal or barriers in health-service based vaccine delivery? PLoS One 2018; 13:e0206726. [PMID: 30418980 PMCID: PMC6231618 DOI: 10.1371/journal.pone.0206726] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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: 06/06/2018] [Accepted: 10/18/2018] [Indexed: 01/22/2023] Open
Abstract
Background The World Health Organization has recommended the introduction of HPV vaccines into national immunization programme (NIP), but vaccination coverage remains low worldwide. We assessed the coverage and the parental acceptance of female and male HPV vaccination in Brazil after its introduction into the NIP. Methods We conducted a random-digit-dial survey of parents in seven major Brazilian cities from July-2015 to October-2016. A knowledge, attitude and practices questionnaire was developed and validated by expert analysis, semantic analysis, and pre-testing. Results 826 out of 2,324 (35.5%) eligible parents completed the interview. Parental acceptance of the HPV vaccine for daughters and sons 18 years of age or less was high (92% and 86%, respectively). Parents refusing vaccination were less likely to know that: HPV is sexually transmitted and causes genital warts, HPV vaccination is more beneficial before sexual debut, and HPV vaccine reactions are minor, and they were more likely to believe HPV vaccination can cause severe adverse events. Parents accepting HPV vaccine for daughters but not forsons were more likely to ignore that the vaccine is recommended for boys. Attitudes associated with HPV vaccine acceptance included: general belief in vaccines, trust in the NIP and in the HPV vaccine efficacy. Among girls eligible for HPV vaccination through the NIP, 58.4% had received a two-dose scheme and 71.1% at least one dose. “No vaccination/missed vaccination at school” was the most common reason for missed HPV vaccination in theNIP. Conclusions One year after introduction in the NIP, most parents surveyed in Brazil accepted HPV vaccination for their daughters and sons. Low coverage in the NIP seemed to be due to challenges in adolescent vaccine delivery and HPV vaccination barriers at health-care centers, rather than to vaccine refusal.
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Affiliation(s)
- William Mendes Lobão
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil
- School of Nursing, State University of Bahia, Salvador, Brazil
| | | | | | | | | | - Arthur Reingold
- School of Public Health, Berkeley, CA, United States of America
| | - Edson Duarte Moreira
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil
- Charitable Works Foundation of Sister Dulce, Salvador, Brazil
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16
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Abstract
OBJECTIVE Long-term complications of type 1 diabetes mellitus (DM1) can be prevented with adequate glycaemic control. However, high levels of glycated haemoglobin (HbA1c) occur in 60%-90% of the patients with DM1. Thus, we aimed to investigate the role of sociodemographic, behavioural and clinical factors on the HbA1c levels of patients with DM1 in Brazil. DESIGN, SETTING AND PARTICIPANTS A cross-sectional study was conducted in ambulatory patients with DM1 aged ≥18 years from 10 Brazilian cities. Sociodemographic, behavioural and clinical data were obtained through interviews. MAIN OUTCOME MEASURES HbA1c level was measured by liquid chromatography. Hierarchical multiple variable linear regression models were used to identify factors correlated with high levels of HbA1c. RESULTS Of 979 patients with DM1, 63.8% were women, and the mean age was 40 (SD 14.6) years. The mean HbA1c level was 9.4% (SD 2.2%), and 89.6% of the patients had HbA1c ≥7.0%. Factors independently correlated with increased HbA1c levels included: lower education, non-participation in diabetes classes/lecture during the year before, having a self-perception of poor adherence to diet and insulin, not having private medical care and not measuring the HbA1c levels in the prior year. Of note, poor adherence to diet and insulin were the independent factors most strongly associated with high levels of HbA1c (mean increment in HbA1c levels of 0.88% and 1.25%, respectively). CONCLUSION Poor glycaemic control, which is common among Brazilian patients with DM1, is associated with lower education, self-perception of insufficient adherence to diet and insulin and inadequate monitoring of HbA1c levels. Specific actions, particularly those targeting improving adherence to diet and insulin, may contribute to successful management of patients with DM1.
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Affiliation(s)
- Carine Sousa Andrade
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil
- School of Nutrition, Federal University of Bahia, Salvador, Brazil
| | - Guilherme Sousa Ribeiro
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - Carlos Antonio Souza Teles Santos
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil
- Department of Exact Sciences, State University of Feira de Santana, Feira de Santana, Brazil
| | | | - Edson Duarte Moreira
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador, Brazil
- Charitable Works Foundation of Sister Dulce, Fundacao Oswaldo Cruz, Salvador, Brazil
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Moreira ED, Giuliano AR, de Hoon J, Iversen OE, Joura EA, Restrepo J, Van Damme P, Vandermeulen C, Ellison MC, Krick A, Shields C, Heiles B, Luxembourg A. Safety profile of the 9-valent human papillomavirus vaccine: assessment in prior quadrivalent HPV vaccine recipients and in men 16 to 26 years of age. Hum Vaccin Immunother 2017; 14:396-403. [PMID: 29211620 PMCID: PMC5806635 DOI: 10.1080/21645515.2017.1403700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A 9-valent HPV (9vHPV) vaccine has been developed to protect against HPV type 6/11/16/18/31/33/45/52/58-related infection and disease. Previous safety analyses from 7 clinical trials conducted in 9vHPV vaccine recipients 9–26 years of age, including comparisons of 9vHPV and quadrivalent HPV (qHPV) vaccines in girls and women 16–26 years of age, showed that the 9vHPV vaccine was generally well tolerated. Additional safety analyses were conducted to include the results of new clinical studies. The safety profile of the 9vHPV vaccine in prior qHPV vaccine recipients (n = 3756 from 1 randomized controlled trial and 2 open-label extension studies) and young men (n = 248 9vHPV and n = 248 qHPV vaccine recipients from 1 randomized controlled trial) was evaluated. Vaccine was administered as a 3-dose regimen (at Day 1 and Months 2 and 6), and adverse events (AEs) were monitored. The most common AEs were injection-site events (91.1% and 79.0% in prior qHPV vaccine recipients and young men, respectively), the majority of which were mild. Discontinuations due to an AE were rare (0.2% and 0.0% among prior qHPV vaccine recipients and young men, respectively). In young men, the AE profile of the 9vHPV vaccine was generally similar to that of the qHPV vaccine. Overall, the 9vHPV vaccine was generally well tolerated in prior qHPV vaccine recipients and in young men, with an AE profile generally consistent with that previously reported with the broader clinical program.
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Affiliation(s)
- E D Moreira
- a Centro de Pesquisa Clínica, Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Brazilian Ministry of Health , Salvador , Bahia , Brazil
| | - A R Giuliano
- b Department of Cancer Epidemiology , Center for Infection Research (CIRC), Moffitt Cancer Center , Tampa , Florida , USA
| | - J de Hoon
- c Center for Clinical Pharmacology, Department of Pharmaceutical and Pharmacological Sciences , KU Leuven , Leuven , Belgium
| | - O-E Iversen
- d Department of Clinical Science , University of Bergen/Womens Clinic, Haukeland University Hospital , Bergen , Norway
| | - E A Joura
- e Department of Gynecology , Comprehensive Cancer Center, Medical University of Vienna , Vienna , Austria
| | - J Restrepo
- f Fundación Centro de Investigación Clínica CIC , Medellín , Colombia
| | - P Van Damme
- g University of Antwerp, Vaccine & Infectious Disease Institute, Centre for the Evaluation of Vaccination , Antwerp , Belgium
| | - C Vandermeulen
- h Leuven University Vaccinology Center, Department of Pharmaceutical and Pharmacological Sciences , KU Leuven , Leuven , Belgium
| | - M C Ellison
- i Merck & Co. Inc., Kenilworth , New Jersey , USA
| | - A Krick
- i Merck & Co. Inc., Kenilworth , New Jersey , USA
| | - C Shields
- i Merck & Co. Inc., Kenilworth , New Jersey , USA
| | - B Heiles
- i Merck & Co. Inc., Kenilworth , New Jersey , USA
| | - A Luxembourg
- i Merck & Co. Inc., Kenilworth , New Jersey , USA
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18
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Martinón-Torres F, Safadi MAP, Martinez AC, Marquez PI, Torres JCT, Weckx LY, Moreira ED, Mensi I, Calabresi M, Toneatto D. Reduced schedules of 4CMenB vaccine in infants and catch-up series in children: Immunogenicity and safety results from a randomised open-label phase 3b trial. Vaccine 2017; 35:3548-3557. [PMID: 28533054 DOI: 10.1016/j.vaccine.2017.05.023] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 04/19/2017] [Accepted: 05/08/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND This study evaluated the immunogenicity and safety of a licensed meningococcal serogroup B vaccine (4CMenB) administered alone according to reduced schedules in infants or catch-up series in children. METHODS In this open-label, multicentre, phase 3b study (NCT01339923), infants randomised 1:1:1 received 4CMenB: 2+1 doses at 3½-5-11months or 6-8-11months of age, 3+1 doses at ages 2½-3½-5-11months. Children aged 2-10years received 2 catch-up doses administered 2months apart. Immune responses were measured by hSBA assays against 4 strains specific for vaccine components fHbp, NadA, PorA and NHBA. Sufficiency of immune responses was defined in groups with 2+1 doses schedules as a lower limit ≥70% for the 97.5% confidence interval of the percentage of infants with hSBA titres ≥4, 1month post-dose 2 for fHbp, NadA, PorA. Adverse events were collected for 7days post-vaccination; serious adverse events (SAEs) throughout the study. RESULTS 754 infants and 404 children were enrolled. Post-primary vaccination, 98-100% of infants across all groups developed hSBA titres ≥4 for fHbp, NadA, PorA, and 48-77% for NHBA. Sufficiency of immune responses in infants receiving 2+1 schedules was demonstrated for fHbp, NadA, PorA after 2 doses of 4CMenB, as pre-specified criteria were met. Following receipt of 2 catch-up doses, 95-99% of children developed hSBA titres ≥4 for 4CMenB components. Similar safety profiles were observed across groups. A total of 45 SAEs were reported, 3 of which were related to vaccination. CONCLUSION Reduced infant schedules and catch-up series in children were immunogenic and safe, having the potential to widen 4CMenB vaccine coverage. FUNDING GlaxoSmithKline Biologicals SA.
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Affiliation(s)
- Federico Martinón-Torres
- Translational Pediatrics and Infectious Diseases, Department of Pediatrics, Hospital Clinico Universitario de Santiago de Compostela, A Choupana, s/n, 15706 Santiago de Compostela, Spain.
| | - Marco Aurelio P Safadi
- Santa Casa de São Paulo School of Medical Sciences, Rua Doutor Cesário Motta Júnior, 61 - Vila Buarque, 01221-020 São Paulo, Brazil.
| | | | | | | | - Lily Yin Weckx
- CRIE UNIFESP, Universidade Federal de Sao Paulo, R. Sena Madureira, 1500 - Vila Clementino, 04021-001São Paulo, Brazil.
| | - Edson Duarte Moreira
- CPEC-Associação Obras Sociais Irma Dulce and Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, Brazil.
| | - Ilhem Mensi
- GSK, Huis Ter Heideweg 62, 3705 LZ Zeist, Amsterdam, The Netherlands.
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19
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P Safadi MA, Martinon-Torres F, Weckx LY, Moreira ED, da Fonseca Lima EJ, Mensi I, Calabresi M, Toneatto D. Immunogenicity and safety of concomitant administration of meningococcal serogroup B (4CMenB) and serogroup C (MenC-CRM) vaccines in infants: A phase 3b, randomized controlled trial. Vaccine 2017; 35:2052-2059. [PMID: 28318767 DOI: 10.1016/j.vaccine.2017.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 02/28/2017] [Accepted: 03/01/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND After implementation of routine infant MenC vaccination, MenB remains a serious cause of meningococcal disease, yet to be targeted by vaccination programs in several countries. This study (NCT01339923) investigated the immunogenicity and safety of MenC CRM-conjugated vaccine (MenC-CRM) concomitantly administered with MenB vaccine (4CMenB). METHODS Infants (N=251) were randomised 1:1 to receive 4CMenB and MenC-CRM (Group 1) or MenC-CRM alone (Group 2) at 3 and 5months (M3, M5) and a booster at 12months of age (M12), and pneumococcal vaccine at M3, M5, M7, M12. Antibody responses to meningococcal vaccines were measured at M3, M6, M12, and M13. Non-inferiority of MenC-CRM response in Group 1 vs Group 2 was demonstrated at M6 and M13, if the lower limit of the 95% confidence interval (LL95%CI) of the difference in percentage of infants with hSBA titres ≥1:8 was >-10%. Sufficiency of MenB response was achieved if LL95%CI of the percentage of infants with hSBA titres ≥1:4 against fHbp, NadA and PorA strains was ≥70% at M6 or ≥75% at M13. Adverse events (AEs) were collected for 7days post-vaccination, and serious AEs (SAEs) and medically attended AEs throughout the study. RESULTS Non-inferiority of MenC response in Group 1 vs Group 2 (LL95%CI -6.4% [M6]; -5.2% [M13]) and sufficiency of MenB response in Group 1 (LL95%CI 92%, 90%, 89% [M6]; 97%, 92%, 93% [M13] against fHbp, NadA, PorA, respectively) were demonstrated. Higher rates of mild to moderate solicited AEs were reported in Group 1. Unsolicited AEs and SAEs incidences were similar across groups. CONCLUSIONS Concomitant administration of MenC-CRM and 4CMenB in infants was immunogenic, resulting in non-inferior responses against MenC compared to MenC-CRM alone and demonstration of sufficient immune response to MenB, after primary and booster vaccination. Reactogenicity was higher for concomitant vaccines administration, but no safety concerns were identified.
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Affiliation(s)
| | | | - Lily Yin Weckx
- CRIE UNIFESP, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Edson Duarte Moreira
- CPEC - Associação Obras Sociais Irma Dulce and Oswaldo Cruz Foundation, Brazilian Ministry of Health, Salvador, Brazil
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20
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Moreira ED, Giuliano AR, Palefsky J, Flores CA, Goldstone S, Ferris D, Hillman RJ, Moi H, Stoler MH, Marshall B, Vuocolo S, Guris D, Haupt RM. Incidence, clearance, and disease progression of genital human papillomavirus infection in heterosexual men. J Infect Dis 2014; 210:192-9. [PMID: 24495910 DOI: 10.1093/infdis/jiu077] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In this analysis, we examine the incidence and clearance of external genital human papillomavirus (HPV) infection among heterosexual males aged 16-24 years. METHODS A total of 1732 males aged 16-24 years old in the placebo arm of a quadrivalent HPV vaccine trial were included in this analysis. Participants were enrolled from 18 countries in Africa, the Asia-Pacific region, Europe, Latin America, and North America. Subjects underwent anogenital examinations and sampling of the penis, scrotum, and perineal/perianal regions. RESULTS The incidence rate of any HPV DNA genotype 6, 11, 16, and/or 18 detection was 9.0 cases per 100 person-years. Rates of HPV DNA detection were highest in men from Africa. Median time to clearance of HPV genotypes 6, 11, 16, and 18 DNA was 6.1, 6.1, 7.7, and 6.2 months, respectively. Median time to clearance of persistently detected HPV 6, 11, 16, and 18 DNA was 6.7, 3.2, 9.2, and 4.7 months, respectively. CONCLUSION The study results suggest that the acquisition of HPV 6, 11, 16, and/or 18 in males is common and that many of these so-called infections are subsequently cleared, similar to findings for women. Nevertheless, given the high rate of HPV detection among young men, HPV vaccination of males may reduce infection in men and reduce the overall burden of HPV-associated disease in the community.
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Affiliation(s)
- Edson Duarte Moreira
- Associação Obras Sociais Irmã Dulce and Oswaldo Cruz Foundation, Brazilian Ministry of Health, Bahia
| | - Anna R Giuliano
- Center for Infection Research in Cancer, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Joel Palefsky
- Department of Medicine, University of California-San Francisco
| | | | | | - Daron Ferris
- Gynecologic Cancer Prevention Center, Georgia Health Sciences University, Augusta
| | - Richard J Hillman
- Western Sydney Sexual Health Centre, University of Sydney, Australia
| | - Harald Moi
- Olafia STI Clinic, Oslo University Hospital, University of Oslo, Norway
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21
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Moreira ED, Silveira PCB, Neves RCS, Souza C, Nunes ZO, Almeida MDCC. Correction: Glycemic control and diabetes management in hospitalized patients in Brazil. Diabetol Metab Syndr 2013; 5:78. [PMID: 24321395 PMCID: PMC3883525 DOI: 10.1186/1758-5996-5-78] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 11/11/2013] [Indexed: 11/10/2022] Open
Affiliation(s)
- Edson Duarte Moreira
- Clinical Research Center, Charitable Works Foundation of Sister Dulce, Av. Bonfim 161, Salvador, Bahia 40.415-000, Brasil
- Division of Cancer Epidemiology, McGill University, 546, Pine Avenue West, Montreal H2W 1S, Quebec, Canada
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Rua Waldemar Falcão 121, Salvador, Bahia 40.296-710, Brasil
| | | | - Raimundo Celestino Silva Neves
- Clinical Research Center, Charitable Works Foundation of Sister Dulce, Av. Bonfim 161, Salvador, Bahia 40.415-000, Brasil
| | - Clodoaldo Souza
- Clinical Research Center, Charitable Works Foundation of Sister Dulce, Av. Bonfim 161, Salvador, Bahia 40.415-000, Brasil
| | - Zaira Onofre Nunes
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Rua Waldemar Falcão 121, Salvador, Bahia 40.296-710, Brasil
| | - Maria da Conceição C Almeida
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Rua Waldemar Falcão 121, Salvador, Bahia 40.296-710, Brasil
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Flues K, Moraes-Silva IC, Mostarda C, Souza PRM, Diniz GP, Moreira ED, Piratello AC, Chaves MLB, De Angelis K, Salemi VMC, Irigoyen MC, Caldini EG. Cardiac and pulmonary arterial remodeling after sinoaortic denervation in normotensive rats. Auton Neurosci 2011; 166:47-53. [PMID: 22079748 DOI: 10.1016/j.autneu.2011.10.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 10/09/2011] [Accepted: 10/12/2011] [Indexed: 10/15/2022]
Abstract
Blood pressure variability (BPV) and baroreflex dysfunction may contribute to end-organ damage process. We investigated the effects of baroreceptor deficit (10 weeks after sinoaortic denervation - SAD) on hemodynamic alterations, cardiac and pulmonary remodeling. Cardiac function and morphology of male Wistar intact rats (C) and SAD rats (SAD) (n=8/group) were assessed by echocardiography and collagen quantification. BP was directly recorded. Ventricular hypertrophy was quantified by the ratio of left ventricular weight (LVW) and right ventricular weight (RVW) to body weight (BW). BPV was quantified in the time and frequency domains. The atrial natriuretic peptide (ANP), alpha-skeletal actin (α-skelectal), collagen type I and type III genes mRNA expression were evaluated by RT-PCR. SAD did not change BP, but increased BPV (11±0.49 vs. 5±0.3 mmHg). As expected, baroreflex was reduced in SAD. Pulmonary artery acceleration time was reduced in SAD. In addition, SAD impaired diastolic function in both LV (6.8±0.26 vs. 5.02±0.21 mmHg) and RV (5.1±0.21 vs. 4.2±0.12 mmHg). SAD increased LVW/BW in 9% and RVW/BW in 20%, and augmented total collagen (3.8-fold in LV, 2.7-fold in RV, and 3.35-fold in pulmonary artery). Also, SAD increased type I (~6-fold) and III (~5-fold) collagen gene expression. Denervation increased ANP expression in LV (75%), in RV (74%) and increased α-skelectal expression in LV (300%) and in RV (546%). Baroreflex function impairment by SAD, despite not changing BP, induced important adjustments in cardiac structure and pulmonary hypertension. These changes may indicate that isolated baroreflex dysfunction can modulate target tissue damage.
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Affiliation(s)
- K Flues
- Experimental Hypertension Laboratory, Hypertension Unit, Heart Institute, Department of Pathology, University of Sao Paulo Medical School, São Paulo, SP, Brazil
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Fernandes TL, Piratello AC, Farah V, Fiorino P, Moreira ED, Irigoyen MC, Krieger EM. Effect of carotid and aortic baroreceptors on cardiopulmonary reflex: the role of autonomic function. Braz J Med Biol Res 2010; 43:681-6. [PMID: 20625658 DOI: 10.1590/s0100-879x2010000700011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Accepted: 05/24/2010] [Indexed: 11/22/2022] Open
Abstract
We determined the sympathetic and parasympathetic control of heart rate (HR) and the sensitivity of the cardiopulmonary receptors after selective carotid and aortic denervation. We also investigated the participation of the autonomic nervous system in the Bezold-Jarish reflex after selective removal of aortic and carotid baroreceptors. Male Wistar rats (220-270 g) were divided into three groups: control (CG, N = 8), aortic denervation (AG, N = 5) and carotid denervation (CAG, N = 9). AG animals presented increased arterial pressure (12%) and HR (11%) compared with CG, while CAG animals presented a reduction in arterial pressure (16%) and unchanged HR compared with CG. The sequential blockade of autonomic effects by atropine and propranolol indicated a reduction in vagal function in CAG (a 50 and 62% reduction in vagal effect and tonus, respectively) while AG showed an increase of more than 100% in sympathetic control of HR. The Bezold-Jarish reflex was evaluated using serotonin, which induced increased bradycardia and hypotension in AG and CAG, suggesting that the sensitivity of the cardiopulmonary reflex is augmented after selective denervation. Atropine administration abolished the bradycardic responses induced by serotonin in all groups; however, the hypotensive response was still increased in AG. Although the responses after atropine were lower than the responses before the drug, indicating a reduction in vagal outflow after selective denervation, our data suggest that both denervation procedures are associated with an increase in sympathetic modulation of the vessels, indicating that the sensitivity of the cardiopulmonary receptors was modulated by baroreceptor fibers.
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Affiliation(s)
- T L Fernandes
- Unidade de Hipertensão, Instituto do Coração, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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Mendes ABV, Fittipaldi JAS, Neves RCS, Chacra AR, Moreira ED. Prevalence and correlates of inadequate glycaemic control: results from a nationwide survey in 6,671 adults with diabetes in Brazil. Acta Diabetol 2010; 47:137-45. [PMID: 19655083 PMCID: PMC2859160 DOI: 10.1007/s00592-009-0138-z] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Accepted: 07/14/2009] [Indexed: 12/21/2022]
Abstract
Diabetes is a significant public health burden on the basis of its increased incidence, morbidity, and mortality. This study aimed to estimate the prevalence of inadequate glycaemic control and its correlates in a large multicentre survey of Brazilian patients with diabetes. A cross-sectional study was conducted in a consecutive sample of patients aged 18 years or older with either type 1 or type 2 diabetes, attending health centres located in ten large cities in Brazil (response rate = 84%). Information about diabetes, current medications, complications, diet, and satisfaction with treatment were obtained by trained interviewers, using a standardized questionnaire. Glycated haemoglobin (HbA(1c)) was measured by high-performance liquid chromatography in a central laboratory. Patients with HbA(1c) > or = 7 were considered to have inadequate glycaemic control. Overall 6,701 patients were surveyed, 979 (15%) with type 1 and 5,692 (85%) with type 2 diabetes. The prevalence of inadequate glycaemic control was 76%. Poor glycaemic control was more common in patients with type 1 diabetes (90%) than in those with type 2 (73%), P < 0.001. Characteristics significantly associated with improved glycaemic control included: fewer years of diabetes duration, multi professional care, participation in a diabetes health education program, and satisfaction with current diabetes treatment. Despite increased awareness of the benefits of tight glycaemic control, we found that few diabetic patients in Brazil met recommended glycaemic control targets. This may contribute to increased rates of diabetic complications, which may impact health care costs. Our data support the public health message of implementation of early, aggressive management of diabetes.
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Affiliation(s)
| | | | - Raimundo Celestino Silva Neves
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Rua Waldemar Falcão 121, Salvador, Bahia 40296-710 Brazil
| | | | - Edson Duarte Moreira
- Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Rua Waldemar Falcão 121, Salvador, Bahia 40296-710 Brazil
- Clinical Research Center, Charitable Works Foundation of Sister Dulce, Av. Bonfim 161, Salvador, 40415-006 Brazil
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Trindade AS, Moreira ED, Silva GJJ, Krieger EM. Evidence that blood pressure remains under the control of arterial baroreceptors in renal hypertensive rats. Braz J Med Biol Res 2010; 42:954-7. [PMID: 19784480 DOI: 10.1590/s0100-879x2009001000013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Accepted: 09/04/2009] [Indexed: 11/22/2022] Open
Abstract
The purpose of the present study was to determine the range of the influence of the baroreflex on blood pressure in chronic renal hypertensive rats. Supramaximal electrical stimulation of the aortic depressor nerve and section of the baroreceptor nerves (sinoaortic denervation) were used to obtain a global analysis of the baroreceptor-sympathetic reflex in normotensive control and in chronic (2 months) 1-kidney, 1-clip hypertensive rats. The fall in blood pressure produced by electrical baroreceptor stimulation was greater in renal hypertensive rats than in normotensive controls (right nerve: -47 +/- 8 vs -23 +/- 4 mmHg; left nerve: -51 +/- 7 vs -30 +/- 4 mmHg; and both right and left nerves: -50 +/- 8 vs -30 +/- 4 mmHg; P < 0.05). Furthermore, the increase in blood pressure level produced by baroreceptor denervation in chronic renal hypertensive rats was similar to that observed in control animals 2-5 h (control: 163 +/- 5 vs 121 +/- 1 mmHg; 1K-1C: 203 +/- 7 vs 170 +/- 5 mmHg; P < 0.05) and 24 h (control: 149 +/- 3 vs 121 +/- 1 mmHg; 1K-1C: 198 +/- 8 vs 170 +/- 5 mmHg; P < 0.05) after sinoaortic denervation. Taken together, these data indicate that the central and peripheral components of the baroreflex are acting efficiently at higher arterial pressure in renal hypertensive rats when the aortic nerve is maximally stimulated or the activity is abolished.
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Affiliation(s)
- A S Trindade
- Departamento de Ciências Biológicas, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, SP, Brasil
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Munford V, Gilio AE, de Souza EC, Cardoso DM, Cardoso DDDDP, Borges AMT, Costa PSSD, Melgaço IAM, Rosa H, Carvalho PRA, Goldani MZ, Moreira ED, Santana C, El Khoury A, Ikedo F, Rácz ML. Rotavirus gastroenteritis in children in 4 regions in Brazil: a hospital-based surveillance study. J Infect Dis 2009; 200 Suppl 1:S106-13. [PMID: 19817590 DOI: 10.1086/605037] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [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
BACKGROUND Rotavirus is a major cause of gastroenteritis in children. Knowledge of rotavirus genotypes is important for vaccination strategies. METHODS During 2005-2006, rotavirus surveillance studies were conducted in São Paulo, Salvador, Goiânia, and Porto Alegre, Brazil. Stool samples were collected from children <5 years of age who had diarrhea and were screened by the Rotaclone Enzyme Immunoassay for the presence of rotavirus. Confirmed rotavirus-positive samples were characterized for P and G genotypes by reverse-transcriptase polymerase chain reaction. RESULTS A total of 510 stool samples were collected. Of these, 221 (43.3%) were positive for rotavirus. Overall, G9 was the predominant G type, followed by G2, and G1; P[4] and P[8] were the predominant P types. The most frequent G/P genotype combination detected was G2P[4], followed by G9P[8], G9P[4], and G1P[8]. G2P[4] was the predominant type in Goiânia and Salvador; G9P[8] and G1P[8] were predominant in São Paulo and Porto Alegre, respectively. CONCLUSIONS The prevalence, seasonality, and genotype distribution of rotavirus infection varied in different regions in Brazil. With immunization programs, continuous monitoring of rotavirus types is important to detect novel and emerging strains.
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Affiliation(s)
- Veridiana Munford
- Virology Laboratories, Department of Microbiology, Institute of Biomedical Sciences, MSD Brazil
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Buvat J, Glasser D, Neves RCS, Duarte FG, Gingell C, Moreira ED. Sexual problems and associated help-seeking behavior patterns: results of a population-based survey in France. Int J Urol 2009; 16:632-8. [PMID: 19456984 DOI: 10.1111/j.1442-2042.2009.02316.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To report the sexual activity, the prevalence of sexual problems and related help-seeking behavior among adults in France. METHODS A telephone survey was conducted in 2001 and 2002. Interviews were based on a standardized questionnaire including demographic details, overall health, relationships, and sexual behaviors, attitudes and beliefs. RESULTS A total of 1500 individuals (750 men, 750 women) aged 40 to 80 years completed the survey. Eighty-one percent of men and 65% of women had engaged in sexual intercourse during the 12 months preceding the interview. Premature ejaculation (16%) and erectile dysfunction (15%) were the most frequently reported sexual problems among men. Lack of sexual interest (21%) and a lack of sexual pleasure (18%) were the most frequently reported ones among women. Only 10% of men and 8% of women had been asked by a doctor about possible sexual problems during a routine visit in the last 3 years. CONCLUSIONS Many middle aged and older men and women in France report continued sexual interest and activity. Although a number of sexual problems are seen in this population, only a minority of individuals seek medical help for these disorders. This is largely due to believing that the problem is not serious, not being bothered by the problem, and/or a lack of awareness of available treatments.
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Affiliation(s)
- Jacques Buvat
- Centre Etude et de Traitement de la Pathologie de l'Appareil Reproducteur et de la Psychosomatique (ETPARP), Lille, France
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Laumann EO, Glasser DB, Neves RCS, Moreira ED. A population-based survey of sexual activity, sexual problems and associated help-seeking behavior patterns in mature adults in the United States of America. Int J Impot Res 2009; 21:171-8. [PMID: 19242482 DOI: 10.1038/ijir.2009.7] [Citation(s) in RCA: 147] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
To study sexual activity, the prevalence of sexual dysfunction and related help-seeking behaviors among mature adults in the United States of America, a telephone survey was conducted in 2001-2002. A total of 1491 individuals (742 men/749 women) aged 40-80 years completed the survey. Overall, 79.4% of men and 69.3% of women had engaged in sexual intercourse during the 12 months preceding the interview. Early ejaculation (26.2%) and erectile difficulties (22.5%) were the most common male sexual problems. A lack of sexual interest (33.2%) and lubrication difficulties (21.5%) were the most common female sexual problems. Less than 25% of men and women with a sexual problem had sought help for their sexual problem(s) from a health professional. Many men and women in the United States report continued sexual interest and activity into middle age and beyond. Although a number of sexual problems are highly prevalent, few people seek medical help.
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Affiliation(s)
- E O Laumann
- Department of Sociology, University of Chicago, USA
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Moreira ED, De Siqueira IC, Alcantara AP, Guereiro De Moura CG, De Carvalho WA, Riley L. Antimicrobial resistance of Escherichia coli strains causing community-acquired urinary tract infections among insured and uninsured populations in a large urban center. J Chemother 2008; 18:255-60. [PMID: 17129835 DOI: 10.1179/joc.2006.18.3.255] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
We assessed the susceptibility of Escherichia coli strains causing communityacquired urinary tract infection (UTI) in a large urban center in Brazil, comparing two different populations (patients with health insurance vs. uninsured). 581 nonduplicate strains of E. coli were isolated. The prevalence of antimicrobial resistance was greater than 20% for ampicillin (51%), trimethoprim-sulfamethoxazole (43%), tetracycline (41%) and chloramphenicol (22%). Overall, 12% of the E. coli isolates were resistant to ciprofloxacin. Resistance prevalences to most antimicrobials were similar in the two study populations. Our data provide much needed information on the prevalence of antimicrobial resistance among E. coli causing communityacquired UTI in Brazil. Antimicrobial resistance among strains of E. coli causing community-acquired UTIs was relatively high, particularly resistance to ciprofloxacin.
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Affiliation(s)
- E D Moreira
- Centro de Pesquisas Gonçalo Moniz, Fundaçāo Oswaldo Cruz, Salvador, Bahia, Brazil.
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Dos-Santos WLC, Jesus EE, Paranhos-Silva M, Pereira AM, Santos JC, Baleeiro CO, Nascimento EG, Moreira ED, Oliveira GGS, Pontes-de-Carvalho LC. Associations among immunological, parasitological and clinical parameters in canine visceral leishmaniasis: Emaciation, spleen parasitism, specific antibodies and leishmanin skin test reaction. Vet Immunol Immunopathol 2008; 123:251-9. [PMID: 18359091 DOI: 10.1016/j.vetimm.2008.02.004] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2007] [Revised: 12/27/2007] [Accepted: 02/08/2008] [Indexed: 10/22/2022]
Abstract
Associations among parameters commonly used as markers of infection by Leishmania sp., or of susceptibility to visceral leishmaniasis, were investigated in 325 stray dogs from an area where this disease is endemic. Evidence of infection (presence of Leishmania in splenic cultures, positive leishmanin skin test (LST) or detection of anti-Leishmania antibody activity in the serum) was found in 57% of the animals. Both evidence of weight loss (chi(2)-test, P=0.0005) and presence of specific antibody activity in the serum (chi(2)-test, P<0.0001) were directly associated with positive splenic culture. The frequencies of animals with positive splenic culture were directly correlated with the intensities of antibody activity in the serum as measured by ELISA (relative risk of 3.4 for animals with moderate antibody levels and relative risk of 8.43 for animals with high-antibody levels). A negative association was observed between positive leishmanin skin test results and emaciation (chi(2), P=0.0089). Furthermore, animals with positive splenic cultures and negative leishmanin skin test results had higher levels of total serum IgG (Kruskal-Wallis test, P=0.001) and IgG2 (Kruskal-Wallis test, P=0.05) than animals with negative splenic cultures, and were more emaciated than animals with negative LST results and positive splenic cultures. The data presented herein suggest that associating these common parameters may improve their performance in predicting susceptibility to canine visceral leishmaniasis.
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Affiliation(s)
- W L C Dos-Santos
- Centro de Pesquisas Gonçalo Moniz-FIOCRUZ, Fundação Oswaldo Cruz, Rua Waldemar Falcão 121, Candeal, 40.296-710 Salvador, BA, Brazil
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Lacerda JEDC, Consolim-Colombo FM, Moreira ED, Ida F, Silva GJJ, Irigoyen MC, Krieger EM. Influence of cardiopulmonary reflex on the sympathetic activity during myocardial infarction. Auton Neurosci 2007; 133:128-35. [PMID: 17188942 DOI: 10.1016/j.autneu.2006.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2006] [Revised: 10/27/2006] [Accepted: 10/31/2006] [Indexed: 11/22/2022]
Abstract
The time-course of changes in renal sympathetic nerve activity (RSNA), arterial and cardiopulmonary baroreflexes sensitivities was evaluated in conscious rats eight hours (8 h) and ten days (10 day) after myocardial infarction (MI), induced by coronary artery ligation. RSNA was recorded by a platinum electrode implanted in left renal nerve. Arterial and cardiopulmonary baroreflexes sensitivities were evaluated by changes in blood pressure and serotonin administration, respectively. Both 8 h and 10 day groups presented hypotension (103+/-4 vs. 102+/-2 vs. 115+/-4 mm Hg), but only 8 h showed tachycardia (422+/-22 vs. 378+/-11 vs. 384+/-9 bpm) when compared to Control rats. RSNA was depressed 8 h after MI and increased in 10 day group (12+/-2 vs. 39+/-8 vs. 22+/-2 mV/cycle). Although arterial baroreflex control of heart rate was similar in all groups, the arterial baroreflex control of RSNA in 8 h group was impaired during reductions (-0.35+/-0.10 vs. -1.66+/-0.23 vs. -0.09+/-0.14 mV/cycle/mm Hg) or increases (-0.77+/-0.17 vs. -1.63+/-0.58 vs. -1.66+/-0.17 mV/cycle/mm Hg) in blood pressure when compared to Control animals. Moreover, cardiopulmonary baroreflex bradycardic response was increased in 8 h rats and normalized in 10 day group. The results suggest that the increased cardiopulmonary baroreflex sensitivity in 8 h may contribute to the reduction in the tonic level of RSNA as well as in the impairment of the baroreflex control of RSNA in the presence of hypotension.
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Affiliation(s)
- J E de C Lacerda
- Hypertension Unit, Heart Institute (InCor), Medical School, University of São Paulo, Av. Enéas de Carvalho Aguiar 44, São Paulo, SP 05403-000, Brazil
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Barroso U, Dultra A, De Bessa J, Barros DG, Maron F, Barroso DV, Moreira ED. Comparative analysis of the frequency of lower urinary tract dysfunction among institutionalised and non-institutionalised children. BJU Int 2006; 97:813-5. [PMID: 16536780 DOI: 10.1111/j.1464-410x.2006.06034.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To evaluate the level of symptoms of lower urinary tract dysfunction (LUTD) in orphans in institutions, and compare these data with schoolchildren of the same age group who were not institutionalised, as LUTD in children is related to factors such as social isolation and low self-esteem, with other psychological changes also being cited, although it is unknown whether these problems are primary or secondary to the symptoms of LUTD. PATIENTS AND METHODS Children institutionalised in orphanages with no parental presence and who are isolated from a family environment are probably more sensitive to psychological disturbances. Psychological changes have been associated with symptoms of urgency and urinary incontinence. Thus 89 orphans were compared with 143 schoolchildren not in institutions. A questionnaire was devised and completed by the care-taking staff in the orphanage, while for the schoolchildren the parents completed the questionnaire. The mean age in the institutionalised children was 7.9 years and that of the control group 7.8 years (P = 0.32). Thirty-nine (44%) of the orphans were boys, vs 74 (54%) of the control group (P = 0.17). RESULTS The incidence of urgency, diurnal urinary incontinence, nocturnal enuresis and constipation in the orphans and in the control group were: 45 (51%) and 57 (40) (P = 0.17), 36 (40%) and 19 (13%) (P < 0.001), 39 (47%) and 38 (27%) (P = 0.002), and 27 (30%) and 43 (30%) (P = 0.76), respectively. CONCLUSION Children living in orphanages have a significantly higher level of diurnal urinary incontinence and nocturnal enuresis than those not in an institution.
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Affiliation(s)
- Ubirajara Barroso
- Division of Urology, Section of Paediatric Urology, Federal University of Bahia, São Rafael Hospital and Bahiana School of Medicine and Public Health, Salvador, Bahia, Brazil.
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Moreira ED, de Oliveira BG, Neves RCS, Costa S, Karic G, Filho JOC. Assessment of knowledge and attitudes of young uninsured women toward human papillomavirus vaccination and clinical trials. J Pediatr Adolesc Gynecol 2006; 19:81-7. [PMID: 16624694 DOI: 10.1016/j.jpag.2006.01.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
STUDY OBJECTIVE To assess knowledge and attitudes of young uninsured women toward human papillomavirus (HPV) vaccination and clinical trials. DESIGN Cross-sectional study. SETTING Clinic-based sample in Brazil. PARTICIPANTS A consecutive sample of 204 women aged 16 to 23 years, attending a public outpatient gynecological clinic. INTERVENTIONS A questionnaire administered by in-person interview. MAIN OUTCOME MEASURES Data on knowledge and attitudes towards HPV vaccination. RESULTS Overall, 72% of the respondents would enroll in a HPV vaccine trial, despite the fact that 69% of women were ignorant of what HPV may cause, and only 10% acknowledged that HPV might lead to cervical cancer. The need of a placebo arm (31%) and three vaccinations injections (26%) were the trial design characteristics most cited for deterring participation. Factors promoting participation were "careful/detailed consultations by the same physician" (92%), "access to more information on women's health" (84%), and "office visits on time" (79%); whereas "clinic too far from home" (36%), "fear of adverse events" (29%), and "gynecologic examination discomfort" (25%) were the most commonly reported reasons for not enrolling in a trial. Being sexually active, more than three lifetime sexual partners and perception of high risk for cervical cancer were predictors of participation in a HPV vaccine trial. CONCLUSIONS Knowledge of HPV infection and cervical cancer is low in this urban, young population. Thus, when planning HPV vaccine trials, it is important to consider implementing educational programs to provide knowledge of the benefits of a preventive vaccine and information on the etiology of and risk factors for cervical cancer.
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Affiliation(s)
- Edson Duarte Moreira
- Núcleo de Apoio à Pesquisa, Associação Obras Sociais Irmã Dulce, Salvador, Bahia, Brazil; Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil.
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Moreira ED, Oliveira BG, Ferraz FM, Costa S, Costa Filho JO, Karic G. Knowledge and attitudes about human papillomavirus, Pap smears, and cervical cancer among young women in Brazil: implications for health education and prevention. Int J Gynecol Cancer 2006; 16:599-603. [PMID: 16681732 DOI: 10.1111/j.1525-1438.2006.00377.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
The objective of the study was to assess knowledge and attitudes about human papillomavirus (HPV), cervical cancer, and Papanicolaou (Pap) smears among young women. A questionnaire was administered to 204 women aged 16-23 years, attending a public clinic. Data were gathered on sociodemographic characteristics, knowledge, and attitudes related to HPV. Overall, 92% of women reported current/previous sexual activity, 42% perceived themselves at high risk of acquiring a sexually transmitted disease, 67% did not know that HPV can cause cervical cancer/warts, and only 10% acknowledged that HPV might lead to cervical cancer. In general, women had a poor knowledge on HPV diagnosis/treatment, condyloma signs, and Pap smear test. The main reasons for not having a Pap smear test done before were embarrassment (63%) and fear of pain (61%). Knowledge of HPV infection and cervical cancer was low in this urban young population. Our findings recommend for greater HPV education of the public and health care practitioners.
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Affiliation(s)
- E D Moreira
- Núcleo de Apoio à Pesquisa, Fundação Irmã Dulce, Salvador, Bahia, Brazil.
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Moreira ED, Nassri VB, Santos RS, Matos JF, de Carvalho WA, Silvani CS, Santana e Sant'ana C. Association of Helicobacter pylori infection and giardiasis: Results from a study of surrogate markers for fecal exposure among children. World J Gastroenterol 2005; 11:2759-63. [PMID: 15884117 PMCID: PMC4305911 DOI: 10.3748/wjg.v11.i18.2759] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate whether Helicobacter pylori (H pylori) infection is associated with hepatitis A virus (HAV) infection, presence of enteroparasites, and other surrogates of fecal exposure.
METHODS: We conducted a cross-sectional study in 121 children consecutively admitted at a pediatric hospital in Salvador, Brazil. H pylori and HAV infection were identified by the presence of serum antibodies. Stool specimens were examined for the presence of ova and parasites. A structured questionnaire inquiring about sanitary conditions and life style was applied to each subject.
RESULTS: Fifty-one of the 121 children (42.1%) were found to be seropositive for H pylori, and 45 (37.2%) for HAV. The seroprevalence of H pylori and HAV both increased significantly with age. Cross-tabulation of data showed that 26 (21.5%) were seropositive and 51 (42.1%) were negative for both H pylori and HAV antibodies (χ2 = 7.18, OR = 2.8, CI 1.30-5.97). The age adjusted OR for an HAV-infected child being H pylori positive was 2.3 (CI 1.02-5.03). The agreement between H pylori and HAV seropositivity was fair (κ = 0.24). After controlling for possible confounding, the variables remaining independently associated with seropositivity to H pylori were age, presence of Giardia lamblia in feces (OR = 3.2, 95%CI, 1.1-9.5) and poor garbage disposal quality (OR = 2.4, 95%CI, 1.1-5.1).
CONCLUSION: Our data suggest that H pylori infection is associated with surrogate markers of fecal exposure. Thus, we conclude that the fecal-oral route is relevant in the transmission of HP among children in an urban setting of a developing country. The association observed between G. lamblia and H pylori infection may have several explanations. Further studies to investigate this relationship are warranted.
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Affiliation(s)
- Edson Duarte Moreira
- Department of Epidemiology and Biostatistics, Oswaldo Cruz Foundation, Brazilian Ministry of Health, Rua Waldemar Falcao 121 Salvador, Bahia, CEP 40.295-001, Brazil.
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Moreira ED, Brock G, Glasser DB, Nicolosi A, Laumann EO, Paik A, Wang T, Gingell C. Help-seeking behaviour for sexual problems: the global study of sexual attitudes and behaviors. Int J Clin Pract 2005; 59:6-16. [PMID: 15707457 DOI: 10.1111/j.1742-1241.2005.00382.x] [Citation(s) in RCA: 232] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
The Global Study of Sexual Attitudes and Behaviors (GSSAB) investigated various aspects of sex and relationships among 27,500 men and women aged 40-80 years. Here, we report help-seeking behaviours for sexual problems in this population. A questionnaire was administered using the accepted survey method in each country. Although almost half of all sexually active respondents had experienced at least one sexual problem, less than 19% of them (18.0% of men and 18.8% of women) had attempted to seek medical help for their problem(s). The most frequent action taken by men and women was to talk to their partner (39%). Only 9% of men and women had been asked about their sexual health by a doctor in a routine visit during the past 3 years. Although sexual problems are highly prevalent, few men and women seek medical help for these problems. Overall, men and women show similar help-seeking behaviours.
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Affiliation(s)
- E D Moreira
- Gonçalo Moniz Research Center,Oswaldo Cruz Foundation and Diretoria Científica, Hospital São Rafael, Salvador, Brazil.
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Abstract
OBJECTIVE To describe the characteristics from people with head injury at Salvador city, as well, to point out the most frequent age groups, their disabilities and lethality rates. METHOD Assessment and notification of 555 medical files from victims with head injury assisted at the General Hospital of Bahia during 2001. RESULTS 82.9% from all victims were male and 17.1% female; the most frequent age group was 21 to 30 years; the most relevant cause of head injury was traffic accident (40.7%), followed by physical violence with or without weapons (25.4%) and falls (24%). CONCLUSION The most evident profile group involved in accidents with head trauma implications was young male that usually had traffic injuries, with expressive rates of disabilities and lethality.
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Affiliation(s)
- José Roberto Tude Melo
- Hospital Geral do Estado de Bahia, Curso de Pós-Graduação em Medicina e Saúde, Universidade Federal da Bahia, Salvador BA, Brazil.
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Moreira ED, Mendes de Souza VM, Sreenivasan M, Nascimento EG, Pontes de Carvalho L. Assessment of an optimized dog-culling program in the dynamics of canine Leishmania transmission. Vet Parasitol 2004; 122:245-52. [PMID: 15262002 DOI: 10.1016/j.vetpar.2004.05.019] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2004] [Accepted: 05/21/2004] [Indexed: 10/26/2022]
Abstract
In Brazil, zoonotic visceral leishmaniasis (ZVL) control programs based on the mass elimination of seropositive dogs have failed to reduce the number of leishmaniasis cases. However, these programs have been done under sub-optimal conditions. We studied a cohort of dogs in an urban area in Brazil to determine, whether a dog-culling program optimized with: (i) replacement of a relatively low-sensitivity indirect immune-fluorescent test on blood eluate by a more sensitive enzyme-linked immunosorbent assay on serum blood samples; (ii) shortening of the time interval from serodiagnosis to removal of dogs; (iii) screening a high proportion of the dog population could reduce the incidence of canine Leishmania infection (CLI). The study ran from December 1997 to July 2000, with four follow-up assessments performed at approximately 8-month intervals. All dogs seropositive for anti-Leishmania antibodies were promptly eliminated. A large number of new dogs immigrated to the study area throughout the study period. They comprised 43.8-49.8% of the cohort at each follow-up assessment, and upto 15% of them already had Leishmania infection. Overall, 42 news cases of CLI were identified, for a crude incidence rate of 11.8 cases per 100 dog-years (95% CI 8.6-15.6). In the first, second, third and fourth follow-up assessments the incidence rates were 8.2 (95% CI 3.0-17.9), 12.2 (95% CI 6.3-21.2), 16.4 (95% CI 8.5-28.6) and 13.6 (95% CI 7.1-23.8), respectively. There was no statistically significant change in these rates throughout the study period. Our results suggest that dog-culling programs do not reduce the incidence of CLI, even with an optimized intervention. Possible reasons for this failure include: currently available serologic methods lack sufficient sensitivity and/or specificity to accurately identify all infected dogs warranting removal in order to prevent Leishmania transmission; destroyed dogs are immediately replaced by susceptible puppies, and quite often, by already infected dogs; and other reservoirs may be involved in maintaining canine infection. Further efforts on ZVL control should be directed to developing new strategies or to testing control methods already in place with properly designed trials.
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Affiliation(s)
- Edson Duarte Moreira
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Rua Waldemar Falcão 121, Salvador, Bahia CEP 40295-001, Brazil.
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De Angelis K, Wichi RB, Jesus WRA, Moreira ED, Morris M, Krieger EM, Irigoyen MC. Exercise training changes autonomic cardiovascular balance in mice. J Appl Physiol (1985) 2004; 96:2174-8. [PMID: 14729725 DOI: 10.1152/japplphysiol.00870.2003] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.1] [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: 11/22/2022] Open
Abstract
Experiments were performed to investigate the influence of exercise training on cardiovascular function in mice. Heart rate, arterial pressure, baroreflex sensitivity, and autonomic control of heart rate were measured in conscious, unrestrained male C57/6J sedentary ( n = 8) and trained mice ( n = 8). The exercise training protocol used a treadmill (1 h/day; 5 days/wk for 4 wk). Baroreflex sensitivity was evaluated by the tachycardic and bradycardic responses induced by sodium nitroprusside and phenylephrine, respectively. Autonomic control of heart rate and intrinsic heart rate were determined by use of methylatropine and propranolol. Resting bradycardia was observed in trained mice compared with sedentary animals [485 ± 9 vs. 612 ± 5 beats/min (bpm)], whereas mean arterial pressure was not different between the groups (106 ± 2 vs. 108 ± 3 mmHg). Baroreflex-mediated tachycardia was significantly enhanced in the trained group (6.97 ± 0.97 vs. 1.6 ± 0.21 bpm/mmHg, trained vs. sedentary), whereas baroreflex-mediated bradycardia was not altered by training. The tachycardia induced by methylatropine was significantly increased in trained animals (139 ± 12 vs. 40 ± 9 bpm, trained vs. sedentary), whereas the propranolol effect was significantly reduced in the trained group (49 ± 11 vs. 97 ± 11 bpm, trained vs. sedentary). Intrinsic heart rate was similar between groups. In conclusion, dynamic exercise training in mice induced a resting bradycardia and an improvement in baroreflex-mediated tachycardia. These changes are likely related to an increased vagal and decreased sympathetic tone, similar to the exercise response observed in humans.
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Affiliation(s)
- K De Angelis
- Hypertension Unit, Heart Institute University of São Paulo, Medical School, 05403-000 São Paulo, Brazil
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Moreira ED, Santos RS, Nassri VB, Reis AT, Guerra AL, Alcântara APG, Matos JF, Carvalho WA, Moura CGG, Silvani CS, Sant'Ana CS. Risk factors for Helicobacter pylori infection in children: is education a main determinant? Epidemiol Infect 2004; 132:327-35. [PMID: 15061508 PMCID: PMC2870109 DOI: 10.1017/s0950268803001572] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
To investigate potential risk factors associated with Helicobacter pylori (Hp) infection, we performed a case-control study in 167 consecutively selected hospitalized children in Salvador, Brazil. Hp infection was identified by the presence of IgG against Hp in serum samples. Data were gathered using a structured questionnaire, 38.3% children were found to be seropositive and classified as cases, and 61.7% were seronegative controls. After multivariate analysis, independent variables associated with Hp infection included: the educational attainment of the child's provider > or = 11 years (OR 0.1, 95% CI 0.01-0.9), poor garbage disposal service (OR 2.2, 95% CI 1.0-4.9), thumb sucking (OR 4.6, 95% CI 1.1-19.8), brushing teeth more than once a day (OR 5.6, 95% CI 1.8-17.7), having a pet dog (OR 2.5, 95% CI 1.0-6.1), and a history of chronic urticaria (OR 4.0, 95% CI 1.5-10.8). The risk factors identified are consistent with some, but not all, previous studies supporting either oral-oral or faecal-oral transmission of Hp. Our data suggested that a higher educational attainment might play an important role in preventing Hp infection.
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Affiliation(s)
- E D Moreira
- Núcleo de Apoio à Pesquisa, Associação Obras Sociais Irmã Dulce, Salvador, Bahia, Brazil
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Abdo CHN, Oliveira WM, Moreira ED, Fittipaldi JAS. Prevalence of sexual dysfunctions and correlated conditions in a sample of Brazilian women—results of the Brazilian study on sexual behavior (BSSB). Int J Impot Res 2004; 16:160-6. [PMID: 14961047 DOI: 10.1038/sj.ijir.3901198] [Citation(s) in RCA: 154] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The objective of this study was to assess the prevalence and risk factors of female sexual dysfunctions across a selection of social groups. In all, 1219 women in the community, aged 18 y or older, answered a 38-question self-applicable questionnaire. Statistical analysis was performed using multivariate logistic regression. The average age was 35.6 y (s.d.=12.31) and the average number of sexual intercourses was 2.8 (s.d.=1.94) a week. At least one sexual dysfunction was reported by 49% of the women; lack of sexual desire (LSD) by 26.7%; pain during sexual intercourse (PSI) by 23.1% and orgasmic dysfunction (OD) by 21%. Women aged over 40 y represented an LSD and OD risk factor, whereas women aged over 25 y showed less likelihood of presenting PSI. The educational level was inversely correlated with the risk of LSD, OD and PSI. Depression and cardiopathies increased PSI occurrences and women with diabetes mellitus showed a higher probability of developing LSD and OD. In conclusion, almost half the women had at least one sexual dysfunction, and prevalence increased with age and lower educational levels. Preventive medical care for the female population, mainly for patients with chronic and/or degenerative diseases, considerably reduced the chances of sexual dysfunction.
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Affiliation(s)
- C H N Abdo
- Department and Institute of Psychiatry, University of São Paulo Medical School, Rua Gil Eanes 492, 04601-041 São Paulo-SP, Brazil.
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Nicolosi A, Glasser DB, Moreira ED, Villa M. Prevalence of erectile dysfunction and associated factors among men without concomitant diseases: a population study. Int J Impot Res 2003; 15:253-7. [PMID: 12934052 DOI: 10.1038/sj.ijir.3901010] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We interviewed a population sample of 2412 men aged 40-70 y in Brazil, Italy, Japan and Malaysia about medical history, lifestyle habits and sexual behavior. Men were classified as having moderate or complete erectile dysfunction (ED) if they reported to be sometimes or never able to achieve and maintain an erection satisfactory for sexual intercourse, respectively. There were 1335 men with no diagnosis of cardiovascular or prostate diseases, diabetes, ulcer or depression, nor taking hormones. The prevalence of ED was 16.1%. ED was associated with age (the risk increased 8% per y), moderate (odds ratio (OR)=2.2) or severe (OR=4.9) lower urinary tract symptoms and smoking (OR=2.3 for >30 cigarettes/day). It was inversely associated with physical activity (OR=0.5) and higher educational levels. Between the ages of 40 and 70 y, almost one in six 'healthy' men is affected by ED. Further research should look at preclinical disease stages and genetic factors.
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Affiliation(s)
- A Nicolosi
- Department of Epidemiology, Institute of Biomedical Technologies, National Research Council, Milan, Italy.
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Moreira ED, Lbo CFL, Diament A, Nicolosi A, Glasser DB. Incidence of erectile dysfunction in men 40 to 69 years old: results from a population-based cohort study in Brazil. Urology 2003; 61:431-6. [PMID: 12597962 DOI: 10.1016/s0090-4295(02)02158-1] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To estimate the incidence of erectile dysfunction (ED) in Brazilian men 40 to 69 years old at study entry during an average 2-year follow-up and study the effect of age, socioeconomic status, and medical conditions on the risk of developing ED. METHODS We analyzed data from a randomly sampled cohort of men living in Salvador, Bahia (Brazil), a racially diverse city with a population of 2.3 million. A total of 602 men completed the baseline interview in 1998 and 501 completed follow-up in 2000. The analysis sample consisted of 428 (83.4%) of 513 men without ED at baseline. The men were interviewed in person, using a standardized questionnaire, and ED was assessed by a single global self-rating question. RESULTS The crude incidence rate for ED was 65.6 cases per 1000 person-years (95% confidence interval 49.6 to 85.2). The incidence rate increased with age and was 33.3, 53.7, and 189.5 cases per 1000 person-years for men 40 to 49, 50 to 59, and 60 to 69 years old, respectively. The age-adjusted risk of developing new-onset ED was higher for men with lower education, diabetes, hypertension, and benign prostatic hyperplasia. Population projections for men 40 to 69 years old suggest that approximately 68,600 new cases of ED in Bahia and 1,025,600 in Brazil would be expected annually. CONCLUSIONS The incidence of ED in Brazilian men was 2.5-fold higher than that in the Massachusetts Male Aging Study (26/1000 person-years) and increased with age, lower education, diabetes, hypertension, and benign prostatic hyperplasia.
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Affiliation(s)
- Edson Duarte Moreira
- Núcleo de Epidemiologia e Estatística, Centro de Pesquisas Gonçalo Moniz-Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
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Moreira ED, Lisboa Lôbo CF, Villa M, Nicolosi A, Glasser DB. Prevalence and correlates of erectile dysfunction in Salvador, northeastern Brazil: a population-based study. Int J Impot Res 2002; 14 Suppl 2:S3-9. [PMID: 12161762 DOI: 10.1038/sj.ijir.3900892] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Our objectives were to determine the prevalence of erectile dysfunction (ED) in Brazil and to explore potential sociodemographic, medical, and lifestyle correlates. A cross-sectional, population-based, household survey was conducted in Salvador, Bahia, Brazil. Cluster samples of representative households were randomly selected for interviews. Of 654 eligible subjects, 602 (92%) participated. A structured questionnaire was administered by trained interviewers. ED was categorized as 'none', 'mild', 'moderate', or 'severe' according to the ability to 'attain and/or maintain an erection satisfactory for sexual intercourse'. All data were obtained by self-report. The age-adjusted prevalence of ED was 39.5% (minimal 25.1%, moderate 13.1%, severe 1.3%). Prevalence and severity increased with age. Having never been married, diabetes, depression, or prostate disease and current depressive or lower urinary tract symptoms were significantly (P<0.05) associated with increased prevalence. Medical, sociodemographic, and lifestyle variables associated with ED may alert physicians to patients at risk for ED and offer insight to its etiology.
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Affiliation(s)
- E D Moreira
- Núcleo de Epidemiologia e Estatística, Centro de Pesquisas Gonçalo Moniz-Fundação Oswaldo Cruz, Brazil
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Neto AF, de Freitas Rodrigues MA, Saraiva Fittipaldi JA, Moreira ED. The epidemiology of erectile dysfunction and its correlates in men with chronic renal failure on hemodialysis in Londrina, southern Brazil. Int J Impot Res 2002; 14 Suppl 2:S19-26. [PMID: 12161764 DOI: 10.1038/sj.ijir.3900894] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Erectile dysfunction (ED) is a common condition in aging men, but little is known about the prevalence of ED in some specific groups of patients such as those with end-stage renal disease (ESRD). A cross-sectional study was conducted to determine the prevalence of ED in ESRD patients undergoing hemodialysis in two clinics of Londrina, Brazil. The prevalence and severity of ED were assessed using the International Index of Erectile Function and a single global question. The dependence of ED on independent variables was evaluated by logistic regression. Some degree of ED was found in 86.4% of our sample (n=118). Complete ED was reported by 25.4% of subjects, moderate ED by 35.4%, and minimal ED by 24.6%. Subjects < 50 y old had a prevalence of moderate/complete ED of 52.6%, whereas in men > or = 50 y old, it was 70.5%. Age, diabetes, and low income were significantly associated with ED. Although highly prevalent, only a low percentage of uremic ESRD patients on hemodialysis were being treated for ED. Our data suggest that ED is related to uremia and other comorbid conditions that often accompany ESRD.
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Affiliation(s)
- A F Neto
- Departamento de Cirurgia, Faculdade de Medicina da Universidade Estadual de Londrina, Paraná, Brazil
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Abstract
CONTEXT Recent population-based surveys suggest that the prevalence of erectile dysfunction is between 30% and 56% among men over the age of 40. Most of these studies, however, are from the United States or Europe. We need estimates of erectile dysfunction from samples of Brazilian populations, as societies that differ ethnically, culturally, and economically may also differ with respect to potential risk factors for erectile dysfunction. OBJECTIVE To determine the prevalence of erectile dysfunction and its potential correlates. SETTING Santos, State of São Paulo. DESIGN Cross-sectional study. PARTICIPANTS A population-based sample of men aged 40-70 years. Out of 718 men invited, 342 (47.6%) returned a completed questionnaire. MAIN MEASUREMENTS Data on demographic variables, medical history, lifestyle habits and degree of erectile dysfunction. RESULTS The prevalence of any degree of erectile dysfunction was 45.9% (minimal, 33.9%; moderate, 8.5%; complete, 3.5%) and increased with age. In bivariate age-adjusted analyses comparing men with no erectile dysfunction or minimal erectile dysfunction with those with moderate or complete erectile dysfunction, histories of diabetes or hypertension, depressive symptoms, heavy smoking and obesity were significantly associated with increased prevalence of erectile dysfunction, whereas moderate alcohol consumption was inversely associated with erectile dysfunction. In the multivariate model, age was a strong predictor of erectile dysfunction, while history of diabetes or hypertension and heavy smoking remained significantly associated with increased prevalence of erectile dysfunction. CONCLUSION We found higher prevalence of erectile dysfunction (45.9%) among men older than 40 years old in Brazil. The variables associated with erectile dysfunction may alert physicians to patients who are at risk of erectile dysfunction as well as offer clues to the etiology of erectile dysfunction. Physicians should routinely ask their patients about sexual health and erectile dysfunction.
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Affiliation(s)
- Edson Duarte Moreira
- Epidemiology and Statistics Unit, Gonçalo Moniz Research Center, Oswaldo Cruz Foundation, Salvador, Bahia, Brazil.
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Moreira ED, Susser E. Guidelines on how to assess the validity of results presented in subgroup analysis of clinical trials. Rev Hosp Clin Fac Med Sao Paulo 2002; 57:83-8. [PMID: 12071157 DOI: 10.1590/s0041-87812002000200007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In observational studies, identification of associations within particular subgroups is the usual method of investigation. As an exploratory method, it is the bread and butter of epidemiological research. Nearly everything that has been learned in epidemiology has been derived from the analysis of subgroups. In a randomized clinical trial, the entire purpose is the comparison of the test subjects and the controls, and when there is particular interest in the results of treatment in a certain section of trial participants, a subgroup analysis is performed. These subgroups are examined to see if they are liable to a greater benefit or risk from treatment. Thus, analyzing patient subsets is a natural part of the process of improving therapeutic knowledge through clinical trials. Nevertheless, the reliability of subgroup analysis can often be poor because of problems of multiplicity and limitations in the numbers of patients studied. The naive interpretation of the results of such examinations is a cause of great confusion in the therapeutic literature. We emphasize the need for readers to be aware that inferences based on comparisons between subgroups in randomized clinical trials should be approached more cautiously than those based on the main comparison. That is, subgroup analysis results derived from a sound clinical trial are not necessarily valid; one must not jump to conclusions and accept the validity of subgroup analysis results without an appropriate judgment.
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Affiliation(s)
- Edson Duarte Moreira
- School of Public Health, Division of Epidemiology, Columbia University, New York, USA
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Abstract
Results of subgroup analysis (SA) reported in randomized clinical trials (RCT) cannot be adequately interpreted without information about the methods used in the study design and the data analysis. Our aim was to show how often inaccurate or incomplete reports occur. First, we selected eight methodological aspects of SA on the basis of their importance to a reader in determining the confidence that should be placed in the author's conclusions regarding such analysis. Then, we reviewed the current practice of reporting these methodological aspects of SA in clinical trials in four leading journals, i.e., the New England Journal of Medicine, the Journal of the American Medical Association, the Lancet, and the American Journal of Public Health. Eight consecutive reports from each journal published after July 1, 1998 were included. Of the 32 trials surveyed, 17 (53%) had at least one SA. Overall, the proportion of RCT reporting a particular methodological aspect ranged from 23 to 94%. Information on whether the SA preceded/followed the analysis was reported in only 7 (41%) of the studies. Of the total possible number of items to be reported, NEJM, JAMA, Lancet and AJPH clearly mentioned 59, 67, 58 and 72%, respectively. We conclude that current reporting of SA in RCT is incomplete and inaccurate. The results of such SA may have harmful effects on treatment recommendations if accepted without judicious scrutiny. We recommend that editors improve the reporting of SA in RCT by giving authors a list of the important items to be reported.
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Affiliation(s)
- E D Moreira
- Núcleo de Epidemiologia e Estatística, Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Rua Waldemar Falçao, 121, 40295-001 Salvador, BA, Brasil.
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Abstract
OBJECTIVES To determine the prevalence of erectile dysfunction (ED) and explore its potential sociodemographic, medical, and lifestyle correlates. METHODS While attending the "Health Awareness Fair" in nine major cities in Brazil, 1286 men completed a questionnaire regarding ED, demographic data, and medical conditions. ED was assessed by a single global self-rating question, in which subjects were asked to describe themselves as able to achieve and maintain an erection good enough for sexual intercourse always, usually, sometimes, or never, and the responses were used to classify the subjects as having no, minimal, moderate, or complete ED, respectively. Age-adjusted bivariate and multivariate analyses were carried out to calculate the prevalence odds ratios and 95% confidence intervals for the potential covariates. RESULTS Overall, 46.2% of men reported some degree of ED (minimal 31.5%, moderate 12.1%, complete 2.6%). The prevalence of complete ED increased 10 times from 1% to 11% between subjects younger than 40 and older than 70 years; moderate ED rose from 8% to 27%, and minimal ED remained constant at approximately 31%. In bivariate age-adjusted analyses, low educational attainment, black race/ethnicity, homo/bisexuality, and a history of diabetes, hypertension, or depression were significantly (P <0.05) associated with an increased prevalence of ED. In the multivariate logistic regression model, these variables remained significantly associated with ED. CONCLUSIONS The results of our study show that ED is a major health problem in Brazil and both the severity and prevalence increase with age. The medical, sociodemographic, and lifestyle variables associated with ED may alert physicians to patients who are at risk of ED, as well as offer clues to the etiology of ED.
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Affiliation(s)
- E D Moreira
- Núcleo de Epidemiologia e Estatística, Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
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Bezerra SM, dos Santos CM, Moreira ED, Krieger EM, Michelini LC. Chronic AT(1) receptor blockade alters autonomic balance and sympathetic responses in hypertension. Hypertension 2001; 38:569-75. [PMID: 11566933 DOI: 10.1161/hy09t1.095393] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In the coarctation hypertension model, we have shown that chronic treatment with losartan causes both normalization of impaired reflex control of heart rate and partial correction of the depressed aortic nerve activity/pressure relationship, even with the persistence of hypertension. In the present study, we analyzed the effects of angiotensin II blockade on the efferent pathways of coarcted and sham-operated groups treated chronically with vehicle or losartan (10 mg/kg per day PO). Hypertension was induced by subdiaphragmatic aortic coarctation, and the treatments lasted 9 days (4 control and 5 experimental days). On day 5, autoregressive power spectral analysis was performed on heart rate recordings made in conscious rats. Other groups were used for sympathetic splanchnic nerve activity recordings made simultaneously with pressure (anesthetized rats) at basal condition and during loading/unloading of baroreceptors. Losartan treatment induced a significant reduction in basal pressure but did not interfere with the development of hypertension (similar pressure increases of 24% and 28% over control values in losartan and vehicle groups, respectively). In vehicle-treated rats, establishment of hypertension was accompanied by a marked change in power spectral density from high- (1.19+/-0.06 Hz, 33+/-6%) to low-frequency components (0,42+/-0.03 Hz, 54+/-6%), with increased low-frequency-to-high-frequency ratio. When compared with sham-operated vehicle-treated rats, there was also increase in the gain of sympathetic activity/pressure relationship, with displacement of lower plateau toward high levels of sympathetic activity. No changes in the power spectral density and sympathetic activity/pressure relationship were observed when hypertension developed in the presence of chronic angiotensin type 1 (AT(1)) receptor blockade. The data suggest that angiotensin II, activated during the establishment of coarctation hypertension, acts via AT(1) receptors to alter sympathovagal balance, facilitating the sympathetic outflow to heart and peripheral circulation during baroreceptors unloading. Data also indicate that the observed effects are not conditioned by preexisting pressure levels.
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Affiliation(s)
- S M Bezerra
- Department of Physiology and Biophysics, ICB, University of São Paulo, São Paulo, SP, Brazil
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