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Moreira R, Bastos LS, Carvalho LM, Freitas LP, Pacheco AG. Persistent high mortality rates for Diabetes Mellitus and Hypertension after excluding deaths associated with COVID-19 in Brazil, 2020-2022. PLOS Glob Public Health 2024; 4:e0002576. [PMID: 38722828 PMCID: PMC11081286 DOI: 10.1371/journal.pgph.0002576] [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] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 03/11/2024] [Indexed: 05/12/2024]
Abstract
INTRODUCTION The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) posed a significant public health challenge globally, with Brazil being no exception. Excess mortality during this period reached alarming levels. Cardiovascular diseases (CVD), Systemic Hypertension (HTN), and Diabetes Mellitus (DM) were associated with increased mortality. However, the specific impact of DM and HTN on mortality during the pandemic remains poorly understood. METHODS This study analyzed mortality data from Brazil's mortality system, covering the period from 2015 to 2022. Data included all causes of death as listed on death certificates, categorized by International Classification of Diseases 10th edition (ICD-10) codes. Population data were obtained from the Brazilian Census. Mortality ratios (MRs) were calculated by comparing death rates in 2020, 2021, and 2022 to the average rates from 2015 to 2019. Adjusted MRs were calculated using Poisson models. RESULTS Between 2015 and 2022, Brazil recorded a total of 11,423,288 deaths. Death rates remained relatively stable until 2019 but experienced a sharp increase in 2020 and 2021. In 2022, although a decrease was observed, it did not return to pre-pandemic levels. This trend persisted even when analyzing records mentioning DM, HTN, or CVD. Excluding death certificates mentioning COVID-19 codes, the trends still showed increases from 2020 through 2022, though less pronounced. CONCLUSION This study highlights the persistent high mortality rates for DM and HTN in Brazil during the years 2020-2022, even after excluding deaths associated with COVID-19. These findings emphasize the need for continued attention to managing and preventing DM and HTN as part of public health strategies, both during and beyond the COVID-19 pandemic. There are complex interactions between these conditions and the pandemic's impact on mortality rates.
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Affiliation(s)
- Rodrigo Moreira
- Instituto Nacional de Infectologia Evandro Chagas/Fiocruz, Rio de Janeiro, Brasil
| | - Leonardo S. Bastos
- Programa de Computação Científica, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Luiz Max Carvalho
- Escola de Matemática Aplicada, Fundação Getulio Vargas, Rio de Janeiro, Brasil
| | - Laís Picinini Freitas
- École de Santé Publique, Université de Montréal, Montreal, Canada
- Centre de Recherche en Santé Publique, Montreal, Canada
| | - Antonio G. Pacheco
- Programa de Computação Científica, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Picinini Freitas L, Douwes-Schultz D, Schmidt AM, Ávila Monsalve B, Salazar Flórez JE, García-Balaguera C, Restrepo BN, Jaramillo-Ramirez GI, Carabali M, Zinszer K. Zika emergence, persistence, and transmission rate in Colombia: a nationwide application of a space-time Markov switching model. Sci Rep 2024; 14:10003. [PMID: 38693192 PMCID: PMC11063144 DOI: 10.1038/s41598-024-59976-7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 04/17/2024] [Indexed: 05/03/2024] Open
Abstract
Zika, a viral disease transmitted to humans by Aedes mosquitoes, emerged in the Americas in 2015, causing large-scale epidemics. Colombia alone reported over 72,000 Zika cases between 2015 and 2016. Using national surveillance data from 1121 municipalities over 70 weeks, we identified sociodemographic and environmental factors associated with Zika's emergence, re-emergence, persistence, and transmission intensity in Colombia. We fitted a zero-state Markov-switching model under the Bayesian framework, assuming Zika switched between periods of presence and absence according to spatially and temporally varying probabilities of emergence/re-emergence (from absence to presence) and persistence (from presence to presence). These probabilities were assumed to follow a series of mixed multiple logistic regressions. When Zika was present, assuming that the cases follow a negative binomial distribution, we estimated the transmission intensity rate. Our results indicate that Zika emerged/re-emerged sooner and that transmission was intensified in municipalities that were more densely populated, at lower altitudes and/or with less vegetation cover. Warmer temperatures and less weekly-accumulated rain were also associated with Zika emergence. Zika cases persisted for longer in more densely populated areas with more cases reported in the previous week. Overall, population density, elevation, and temperature were identified as the main contributors to the first Zika epidemic in Colombia. We also estimated the probability of Zika presence by municipality and week, and the results suggest that the disease circulated undetected by the surveillance system on many occasions. Our results offer insights into priority areas for public health interventions against emerging and re-emerging Aedes-borne diseases.
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Affiliation(s)
- Laís Picinini Freitas
- Université de Montréal, École de Santé Publique, Montreal, H3N 1X9, Canada.
- Centre de Recherche en Santé Publique, Montreal, H3N 1X9, Canada.
| | - Dirk Douwes-Schultz
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, H3A 1G1, Canada.
| | - Alexandra M Schmidt
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, H3A 1G1, Canada
| | - Brayan Ávila Monsalve
- Universidad Cooperativa de Colombia, Faculty of Medicine, Villavicencio, 500003, Colombia
| | - Jorge Emilio Salazar Flórez
- Instituto Colombiano de Medicina Tropical, Universidad CES, Medellín, 055450, Colombia
- Infectious and Chronic Diseases Study Group (GEINCRO), San Martín University Foundation, Medellín, 050031, Colombia
| | - César García-Balaguera
- Universidad Cooperativa de Colombia, Faculty of Medicine, Villavicencio, 500003, Colombia
| | - Berta N Restrepo
- Instituto Colombiano de Medicina Tropical, Universidad CES, Medellín, 055450, Colombia
| | | | - Mabel Carabali
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, H3A 1G1, Canada
| | - Kate Zinszer
- Université de Montréal, École de Santé Publique, Montreal, H3N 1X9, Canada
- Centre de Recherche en Santé Publique, Montreal, H3N 1X9, Canada
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Santos CVBD, Valiati NCM, Noronha TGD, Porto VBG, Pacheco AG, Freitas LP, Coelho FC, Gomes MFDC, Bastos LS, Cruz OG, Lana RM, Luz PM, Carvalho LMFD, Werneck GL, Struchiner CJ, Villela DAM. The effectiveness of COVID-19 vaccines against severe cases and deaths in Brazil from 2021 to 2022: a registry-based study. Lancet Reg Health Am 2023; 20:100465. [PMID: 36936517 PMCID: PMC10010656 DOI: 10.1016/j.lana.2023.100465] [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] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/17/2023] [Accepted: 02/17/2023] [Indexed: 04/12/2023]
Abstract
Background Brazil started the COVID-19 mass vaccination in January 2021 with CoronaVac and ChAdOx1, followed by BNT162b2 and Ad26.COV2.S vaccines. By the end of 2021, more than 317 million vaccine doses were administered in the adult population. This study aimed at estimating the effectiveness of the primary series of COVID-19 vaccination and booster shots in protecting against severe cases and deaths in Brazil during the first year of vaccination. Methods A cohort dataset of over 158 million vaccination and severe cases records linked from official national registries was analyzed via a mixed-effects Poisson model, adjusted for age, state of residence, time after immunization, and calendar time to estimate the absolute vaccine effectiveness of the primary series of vaccination and the relative effectiveness of the booster. The method permitted analysis of effectiveness against hospitalizations and deaths, including in the periods of variant dominance. Findings Vaccine effectiveness against severe cases and deaths remained over 25% and 50%, respectively, after 19 weeks from primary vaccination of BNT162b2, ChAdOx1, or CoronaVac vaccines. The boosters conferred greater protection than the primary series of vaccination, with heterologous boosters providing marginally greater protection than homologous. The effectiveness against hospitalization during the Omicron dominance in the 60+ years old population started at 61.7% (95% CI, 26.1-86.2) for ChAdOx1, 95.6% (95% CI, 82.4-99.9) for CoronaVac, and 72.3% (95% CI, 51.4-87.4) for the BNT162b2 vaccine. Interpretation This study provides real-world evidence of the effectiveness of COVID-19 vaccination in Brazil, including during the Omicron wave, demonstrating protection even after waning effectiveness. Comparisons of the effectiveness among different vaccines require caution due to potential bias effects related to age groups, periods in the pandemic, and eventual behavioural changes. Funding Fundação Oswaldo Cruz (FIOCRUZ), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Fundação de Amparo a Pesquisa do Estado do Rio de Janeiro (FAPERJ), Pan American Health Organization (PAHO), Departamento de Ciência e Tecnologia da Secretaria de Ciência, Tecnologia, Inovação e Insumos Estratégicos em Saúde do Ministério da Saúde do Brasil (DECIT/SCTIE/MS).
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Affiliation(s)
- Cleber Vinicius Brito Dos Santos
- Departamento de Epidemiologia, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | | | - Tatiana Guimarães de Noronha
- Instituto de Tecnologia em Imunobiológicos Bio-Manguinhos, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
- Programa de Pós-graduação em Ciências Médicas, Faculdade de Medicina, Universidade Federal Fluminense (UFF), Rio de Janeiro, Brazil
| | | | | | - Laís Picinini Freitas
- Programa de Computação Científica, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
| | - Flávio Codeço Coelho
- Escola de Matemática Aplicada, Fundação Getúlio Vargas (FGV), Rio de Janeiro, Brazil
| | | | - Leonardo Soares Bastos
- Programa de Computação Científica, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
| | - Oswaldo Gonçalves Cruz
- Programa de Computação Científica, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
| | - Raquel Martins Lana
- Programa de Computação Científica, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
- Barcelona Supercomputing Center (BSC), Barcelona, Spain
| | - Paula Mendes Luz
- Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Brazil
| | | | - Guilherme Loureiro Werneck
- Departamento de Epidemiologia, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
- Instituto de Estudos em Saúde Coletiva, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Claudio José Struchiner
- Departamento de Epidemiologia, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
- Escola de Matemática Aplicada, Fundação Getúlio Vargas (FGV), Rio de Janeiro, Brazil
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Freitas LP, Lowe R, Koepp AE, Alves SV, Dondero M, Marteleto LJ. Identifying hidden Zika hotspots in Pernambuco, Brazil: a spatial analysis. Trans R Soc Trop Med Hyg 2023; 117:189-196. [PMID: 36326785 PMCID: PMC9977212 DOI: 10.1093/trstmh/trac099] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/23/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Northeast Brazil has the world's highest rate of Zika-related microcephaly. However, Zika case counts cannot accurately describe burden because mandatory reporting was only established when the epidemic was declining in the region. METHODS To advance the study of the Zika epidemic, we identified hotspots of Zika in Pernambuco state, Northeast Brazil, using Aedes-borne diseases (dengue, chikungunya and Zika) and microcephaly data. We used Kulldorff's Poisson purely spatial scan statistic to detect low- and high-risk clusters for Aedes-borne diseases (2014-2017) and for microcephaly (2015-2017), separately. Municipalities were classified according to a proposed gradient of Zika burden during the epidemic, based on the combination of cluster status in each analysis and considering the strength of the evidence. RESULTS We identified 26 Aedes-borne diseases clusters (11 high-risk) and 5 microcephaly clusters (3 high-risk) in Pernambuco. According to the proposed Zika burden gradient, our results indicate that the northeast of Pernambuco and the Sertão region were hit hardest by the Zika epidemic. The first is the most populous area of Pernambuco, while the second has one of the highest rates of social and economic inequality in Brazil. CONCLUSION We successfully identified possible hidden Zika hotspots using a simple methodology combining Aedes-borne diseases and microcephaly information.
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Affiliation(s)
- Laís Picinini Freitas
- Population Research Center, University of Texas at Austin, Austin, Texas 78712-1699, USA
| | - Rachel Lowe
- Department of Earth Sciences, Barcelona Supercomputing Center (BSC), Barcelona 08034, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
- Centre on Climate Change & Planetary Health and Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Andrew E Koepp
- Population Research Center, University of Texas at Austin, Austin, Texas 78712-1699, USA
- Department of Human Development and Family Sciences, University of Texas at Austin, Austin, Texas 78712, USA
| | - Sandra Valongueiro Alves
- Post-graduation Program of Public Health, Centro de Ciências Médicas, Universidade Federal de Pernambuco, Recife, Pernambuco 50670-901, Brazil
| | - Molly Dondero
- Department of Sociology, American University, Washington, D.C. 20016-8072, USA
| | - Letícia J Marteleto
- Population Research Center, University of Texas at Austin, Austin, Texas 78712-1699, USA
- Department of Sociology, University of Texas at Austin, Austin, Texas 78712, USA
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Freitas LP, Carabali M, Yuan M, Jaramillo-Ramirez GI, Balaguera CG, Restrepo BN, Zinszer K. Spatio-temporal clusters and patterns of spread of dengue, chikungunya, and Zika in Colombia. PLoS Negl Trop Dis 2022; 16:e0010334. [PMID: 35998165 PMCID: PMC9439233 DOI: 10.1371/journal.pntd.0010334] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 03/16/2022] [Revised: 09/02/2022] [Accepted: 07/12/2022] [Indexed: 12/03/2022] Open
Abstract
Background Colombia has one of the highest burdens of arboviruses in South America. The country was in a state of hyperendemicity between 2014 and 2016, with co-circulation of several Aedes-borne viruses, including a syndemic of dengue, chikungunya, and Zika in 2015. Methodology/Principal findings We analyzed the cases of dengue, chikungunya, and Zika notified in Colombia from January 2014 to December 2018 by municipality and week. The trajectory and velocity of spread was studied using trend surface analysis, and spatio-temporal high-risk clusters for each disease in separate and for the three diseases simultaneously (multivariate) were identified using Kulldorff’s scan statistics. During the study period, there were 366,628, 77,345 and 74,793 cases of dengue, chikungunya, and Zika, respectively, in Colombia. The spread patterns for chikungunya and Zika were similar, although Zika’s spread was accelerated. Both chikungunya and Zika mainly spread from the regions on the Atlantic coast and the south-west to the rest of the country. We identified 21, 16, and 13 spatio-temporal clusters of dengue, chikungunya and Zika, respectively, and, from the multivariate analysis, 20 spatio-temporal clusters, among which 7 were simultaneous for the three diseases. For all disease-specific analyses and the multivariate analysis, the most-likely cluster was identified in the south-western region of Colombia, including the Valle del Cauca department. Conclusions/Significance The results further our understanding of emerging Aedes-borne diseases in Colombia by providing useful evidence on their potential site of entry and spread trajectory within the country, and identifying spatio-temporal disease-specific and multivariate high-risk clusters of dengue, chikungunya, and Zika, information that can be used to target interventions. Dengue, chikungunya, and Zika are diseases transmitted to humans by the bite of infected Aedes mosquitoes. Between 2014 and 2016 chikungunya and Zika viruses started causing outbreaks in Colombia, one of the countries historically most affected by dengue. We used case counts of the diseases by municipality and week to study the spread trajectory of chikungunya and Zika within Colombia’s territory, and to identify space-time high-risk clusters, i.e., the areas and time periods that dengue, chikungunya, and Zika were more present. Chikungunya and Zika spread similarly in Colombia, but Zika spread faster. The Atlantic coast, a famous touristic destination in the country, was likely the place of entry of chikungunya and Zika in Colombia. The south-western region was identified as a high-risk cluster for all three diseases in separate and simultaneously. This region has a favorable climate for the Aedes mosquitoes and other characteristics that facilitate the diseases’ transmission, such as social deprivation and high population mobility. Our results provide useful information on the locations that should be prioritized for interventions to prevent the entry of new diseases transmitted by Aedes and to reduce the burden of dengue, chikungunya and Zika where they are established.
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Affiliation(s)
- Laís Picinini Freitas
- School of Public Health, University of Montreal, Montreal, Quebec, Canada
- Centre de Recherche en Santé Publique, Montreal, Quebec, Canada
| | - Mabel Carabali
- School of Public Health, University of Montreal, Montreal, Quebec, Canada
- Centre de Recherche en Santé Publique, Montreal, Quebec, Canada
| | - Mengru Yuan
- School of Public Health, University of Montreal, Montreal, Quebec, Canada
| | | | | | - Berta N. Restrepo
- Instituto Colombiano de Medicina Tropical, Universidad CES, Medellín, Colombia
| | - Kate Zinszer
- School of Public Health, University of Montreal, Montreal, Quebec, Canada
- Centre de Recherche en Santé Publique, Montreal, Quebec, Canada
- * E-mail:
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Romeo-Aznar V, Picinini Freitas L, Gonçalves Cruz O, King AA, Pascual M. Author Correction: Fine-scale heterogeneity in population density predicts wave dynamics in dengue epidemics. Nat Commun 2022; 13:1404. [PMID: 35277517 PMCID: PMC8917157 DOI: 10.1038/s41467-022-29163-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Victoria Romeo-Aznar
- Department of Ecology and Evolution, University of Chicago, Chicago, IL, USA.,Departamento de Ecología, Genética y Evolución, and Instituto IEGEBA (CONICET-UBA), Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad Universitaria, Pabellón 2, C1428EHA, Buenos Aires, Argentina.,Mansueto Institute for Urban Innovation, The University of Chicago, Chicago, IL, USA
| | - Laís Picinini Freitas
- Postgraduate Program of Epidemiology in Public Health - Escola Nacional de Saúde Pública Sergio Arouca - Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.,Programa de Computação Científica - Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Aaron A King
- Department of Ecology and Evolutionary Biology, University of Michigan, Ann Arbor, MI, USA.,Center for the Study of Complex Systems, University of Michigan, Ann Arbor, MI, USA.,The Santa Fe Institute, Santa Fe, NM, USA
| | - Mercedes Pascual
- Department of Ecology and Evolution, University of Chicago, Chicago, IL, USA. .,The Santa Fe Institute, Santa Fe, NM, USA.
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Romeo-Aznar V, Picinini Freitas L, Gonçalves Cruz O, King AA, Pascual M. Fine-scale heterogeneity in population density predicts wave dynamics in dengue epidemics. Nat Commun 2022; 13:996. [PMID: 35194017 PMCID: PMC8864019 DOI: 10.1038/s41467-022-28231-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 01/12/2022] [Indexed: 02/05/2023] Open
Abstract
The spread of dengue and other arboviruses constitutes an expanding global health threat. The extensive heterogeneity in population distribution and potential complexity of movement in megacities of low and middle-income countries challenges predictive modeling, even as its importance to disease spread is clearer than ever. Using surveillance data at fine resolution following the emergence of the DENV4 dengue serotype in Rio de Janeiro, we document a pattern in the size of successive epidemics that is invariant to the scale of spatial aggregation. This pattern emerges from the combined effect of herd immunity and seasonal transmission, and is strongly driven by variation in population density at sub-kilometer scales. It is apparent only when the landscape is stratified by population density and not by spatial proximity as has been common practice. Models that exploit this emergent simplicity should afford improved predictions of the local size of successive epidemic waves. Population density can influence the dynamics of emerging infections, but the specific effects at a local (within-city) level are not well understood. Here, the authors investigate the influence of population density on dynamics of dengue outbreaks in Rio de Janeiro and propose that this variable holds the key to how space should be aggregated.
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Affiliation(s)
- Victoria Romeo-Aznar
- Department of Ecology and Evolution, University of Chicago, Chicago, IL, USA.,Departamento de Ecología, Genética y Evolución, and Instituto IEGEBA (CONICET-UBA), Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad Universitaria, Pabellón 2, C1428EHA, Buenos Aires, Argentina.,Mansueto Institute for Urban Innovation, The University of Chicago, Chicago, IL, USA
| | - Laís Picinini Freitas
- Postgraduate Program of Epidemiology in Public Health - Escola Nacional de Saúde Pública Sergio Arouca - Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.,Programa de Computação Científica - Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Aaron A King
- Department of Ecology and Evolutionary Biology, University of Michigan, Ann Arbor, MI, USA.,Center for the Study of Complex Systems, University of Michigan, Ann Arbor, MI, USA.,The Santa Fe Institute, Santa Fe, NM, USA
| | - Mercedes Pascual
- Department of Ecology and Evolution, University of Chicago, Chicago, IL, USA. .,The Santa Fe Institute, Santa Fe, NM, USA.
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Freitas LP, Lana RM, Cruz OG. Challenges for fighting Chagas disease in the 21st century. Mem Inst Oswaldo Cruz 2022; 117:e200409chgsb. [DOI: 10.1590/0074-02760210409chgsb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 12/17/2021] [Indexed: 11/22/2022] Open
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Lana RM, Freitas LP, Codeço CT, Pacheco AG, Carvalho LMFD, Villela DAM, Coelho FC, Cruz OG, Niquini RP, Porto VBG, Gava C, Gomes MFDC, Bastos LS. Identification of priority groups for COVID-19 vaccination in Brazil. CAD SAUDE PUBLICA 2021; 37:e00049821. [PMID: 34644749 DOI: 10.1590/0102-311x00049821] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/29/2021] [Indexed: 12/15/2022] Open
Abstract
In a context of community transmission and shortage of vaccines, COVID-19 vaccination should focus on directly reducing the morbidity and mortality caused by the disease. It was thus essential to define priority groups for vaccination by the Brazilian National Immunization Program (PNI in Portuguese), based on the risk of hospitalization and death from the disease. We calculated overrisk according to sex, age group, and comorbidities using hospitalization and death records from severe acute respiratory illness with confirmation of COVID-19 (SARI-COVID) in all of Brazil in the first 6 months of the epidemic. Higher overrisk was associated with male sex (hospitalization = 1.1 and death = 1.2), age over 45 years for hospitalization (OvRag ranging from 1.1 to 8.5), and age over 55 year for death (OvRag ranging from 1.5 to 18.3). In the groups with comorbidities, chronic kidney disease, diabetes mellitus, cardiovascular disease, and chronic lung disease were associated with overrisk, while there was no such evidence for asthma. Chronic kidney disease or diabetes and age over 60 showed an even stronger association, reaching overrisk of death 14 and 10 times greater than in the general population, respectively. For all the comorbidities, there was higher overrisk at older ages, with a downward gradient in the oldest age groups. This pattern was reversed when examining overrisk in the general population, for both hospitalization and death. The current study provided evidence of overrisk of hospitalization and death from SARI-COVID, assisting the definition of priority groups for COVID-19 vaccination.
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Affiliation(s)
- Raquel Martins Lana
- Programa de Computação Científica, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | | | | | | | | | - Flávio Codeço Coelho
- Fundação Getúlio Vargas, Rio de Janeiro, Brasil.,Institute of Global Health, University of Geneva, Geneva, Switzerland
| | | | - Roberta Pereira Niquini
- Instituto Federal de Educação, Ciência e Tecnologia do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | - Caroline Gava
- Coordenação-geral do Programa Nacional de Imunizações, Ministério da Saúde, Brasília, Brasil
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Freitas LP, Schmidt AM, Cossich W, Cruz OG, Carvalho MS. Spatio-temporal modelling of the first Chikungunya epidemic in an intra-urban setting: The role of socioeconomic status, environment and temperature. PLoS Negl Trop Dis 2021; 15:e0009537. [PMID: 34143771 PMCID: PMC8244893 DOI: 10.1371/journal.pntd.0009537] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 12/17/2020] [Revised: 06/30/2021] [Accepted: 06/03/2021] [Indexed: 01/07/2023] Open
Abstract
Three key elements are the drivers of Aedes-borne disease: mosquito infestation, virus circulating, and susceptible human population. However, information on these aspects is not easily available in low- and middle-income countries. We analysed data on factors that influence one or more of those elements to study the first chikungunya epidemic in Rio de Janeiro city in 2016. Using spatio-temporal models, under the Bayesian framework, we estimated the association of those factors with chikungunya reported cases by neighbourhood and week. To estimate the minimum temperature effect in a non-linear fashion, we used a transfer function considering an instantaneous effect and propagation of a proportion of such effect to future times. The sociodevelopment index and the proportion of green areas (areas with agriculture, swamps and shoals, tree and shrub cover, and woody-grass cover) were included in the model with time-varying coefficients, allowing us to explore how their associations with the number of cases change throughout the epidemic. There were 13627 chikungunya cases in the study period. The sociodevelopment index presented the strongest association, inversely related to the risk of cases. Such association was more pronounced in the first weeks, indicating that socioeconomically vulnerable neighbourhoods were affected first and hardest by the epidemic. The proportion of green areas effect was null for most weeks. The temperature was directly associated with the risk of chikungunya for most neighbourhoods, with different decaying patterns. The temperature effect persisted longer where the epidemic was concentrated. In such locations, interventions should be designed to be continuous and to work in the long term. We observed that the role of the covariates changes over time. Therefore, time-varying coefficients should be widely incorporated when modelling Aedes-borne diseases. Our model contributed to the understanding of the spatio-temporal dynamics of an urban Aedes-borne disease introduction in a tropical metropolitan city.
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Affiliation(s)
- Laís Picinini Freitas
- Programa de Pós-Graduação em Epidemiologia em Saúde Pública, Escola Nacional de Saúde Pública Sergio Arouca (ENSP), Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
- Programa de Computação Científica (PROCC), Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Alexandra M. Schmidt
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - William Cossich
- Department of Physics and Astronomy, University of Bologna, Bologna, Italy
| | - Oswaldo Gonçalves Cruz
- Programa de Computação Científica (PROCC), Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Marilia Sá Carvalho
- Programa de Computação Científica (PROCC), Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Freitas LP, Cruz OG, Lowe R, Sá Carvalho M. Space-time dynamics of a triple epidemic: dengue, chikungunya and Zika clusters in the city of Rio de Janeiro. Proc Biol Sci 2019; 286:20191867. [PMID: 31594497 PMCID: PMC6790786 DOI: 10.1098/rspb.2019.1867] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 12/22/2022] Open
Abstract
Dengue, an arboviral disease transmitted by Aedes mosquitoes, has been endemic in Brazil for decades. However, vector-control strategies have not led to a significant reduction in the disease burden and have not been sufficient to prevent chikungunya and Zika entry and establishment in the country. In Rio de Janeiro city, the first Zika and chikungunya epidemics were detected between 2015 and 2016, coinciding with a dengue epidemic. Understanding the behaviour of these diseases in a triple epidemic scenario is a necessary step for devising better interventions for prevention and outbreak response. We applied scan statistics analysis to detect spatio-temporal clustering for each disease separately and for all three simultaneously. In general, clusters were not detected in the same locations and time periods, possibly owing to competition between viruses for host resources, depletion of susceptible population, different introduction times and change in behaviour of the human population (e.g. intensified vector-control activities in response to increasing cases of a particular arbovirus). Simultaneous clusters of the three diseases usually included neighbourhoods with high population density and low socioeconomic status, particularly in the North region of the city. The use of space–time cluster detection can guide intensive interventions to high-risk locations in a timely manner, to improve clinical diagnosis and management, and pinpoint vector-control measures.
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Affiliation(s)
- Laís Picinini Freitas
- Escola Nacional de Saúde Pública Sergio Arouca (ENSP), Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Oswaldo Gonçalves Cruz
- Programa de Computação Científica (PROCC), Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Rachel Lowe
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, UK.,Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Marilia Sá Carvalho
- Programa de Computação Científica (PROCC), Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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Silva MJSD, Matos GGDO, Lucena JRM, Freitas LP, Oliveira SCD. Learning the art of science publishing. CAD SAUDE PUBLICA 2017; 33:e00200817. [PMID: 29267698 DOI: 10.1590/0102-311x00200817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | - J Rodolfo M Lucena
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Laís Picinini Freitas
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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de-Oliveira-Pinto LM, Gandini M, Freitas LP, Siqueira MM, Marinho CF, Setúbal S, Kubelka CF, Cruz OG, Oliveira SAD. Profile of circulating levels of IL-1Ra, CXCL10/IP-10, CCL4/MIP-1β and CCL2/MCP-1 in dengue fever and parvovirosis. Mem Inst Oswaldo Cruz 2012; 107:48-56. [PMID: 22310535 DOI: 10.1590/s0074-02762012000100007] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 10/10/2011] [Indexed: 04/05/2024] Open
Abstract
Dengue virus (DENV) and parvovirus B19 (B19V) infections are acute exanthematic febrile illnesses that are not easily differentiated on clinical grounds and affect the paediatric population. Patients with these acute exanthematic diseases were studied. Fever was more frequent in DENV than in B19V-infected patients. Arthritis/arthralgias with DENV infection were shown to be significantly more frequent in adults than in children. The circulating levels of interleukin (IL)-1 receptor antagonist (Ra), CXCL10/inducible protein-10 (IP-10), CCL4/macrophage inflammatory protein-1 beta and CCL2/monocyte chemotactic protein-1 (MCP-1) were determined by multiplex immunoassay in serum samples obtained from B19V (37) and DENV-infected (36) patients and from healthy individuals (7). Forward stepwise logistic regression analysis revealed that circulating CXCL10/IP-10 tends to be associated with DENV infection and that IL-1Ra was significantly associated with DENV infection. Similar analysis showed that circulating CCL2/MCP-1 tends to be associated with B19V infection. In dengue fever, increased circulating IL-1Ra may exert antipyretic actions in an effort to counteract the already increased concentrations of IL-1β, while CXCL10/IP-10 was confirmed as a strong pro-inflammatory marker. Recruitment of monocytes/macrophages and upregulation of the humoral immune response by CCL2/MCP-1 by B19V may be involved in the persistence of the infection. Children with B19V or DENV infections had levels of these cytokines similar to those of adult patients.
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Bion FM, Nascimento JS, Antunes NL, Pessoa DC, Lago ES, Freitas LP, Coelho MA, Medeiros RB. [Nutritive value of sunflower seeds (Helianthus annus) (author's transl)]. Rev Bras Pesqui Med Biol 1977; 10:237-40. [PMID: 905604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The nutritive value of sunflower seeds (Helianthus annus) was studied and compared to that of casein. Thirty-six male rats, Wistar strain, aged 23 days, were divided into two groups and fed (a) a sunflower cake meal diet, and (b) a casein diet. The results indicate that due to its high protein level (52.06%) and coefficient of digestibility (95 CD) sunflower can be used as a feeding formula although its PER does not recommend its use as a milk substitute.
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