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Xavier J, Alcantara LCJ, Fonseca V, Lima M, Castro E, Fritsch H, Oliveira C, Guimarães N, Adelino T, Evaristo M, Rodrigues ES, Santos EV, de La-Roque D, de Moraes L, Tosta S, Neto A, Rosewell A, Mendonça AF, Leite A, Vasconcelos A, Silva de Mello AL, Vasconcelos B, Montalbano CA, Zanluca C, Freitas C, de Albuquerque CFC, Duarte Dos Santos CN, Santos CS, Dos Santos CA, Gonçalves CCM, Teixeira D, Neto DFL, Cabral D, de Oliveira EC, Noia Maciel EL, Pereira FM, Iani F, de Carvalho FP, Andrade G, Bezerra G, de Castro Lichs GG, Pereira GC, Barroso H, Franz HCF, Ferreira H, Gomes I, Riediger IN, Rodrigues I, de Siqueira IC, Silva J, Rico JM, Lima J, Abrantes J, do Nascimento JPM, Wasserheit JN, Pastor J, de Magalhães JJF, Luz KG, Lima Neto LG, Frutuoso LCV, da Silva LB, Sena L, de Sousa LAF, Pereira LA, Demarchi L, Câmara MCB, Astete MG, Almiron M, Lima M, Umaki Zardin MCS, Presibella MM, Falcão MB, Gale M, Freire N, Marques N, de Moura NFO, Almeida Da Silva PE, Rabinowitz P, da Cunha RV, Trinta KS, do Carmo Said RF, Kato R, Stabeli R, de Jesus R, Hans Santos R, Kashima S, Slavov SN, Andrade T, Rocha T, Carneiro T, Nardy V, da Silva V, Carvalho WG, Van Voorhis WC, Araujo WN, de Filippis AMB, Giovanetti M. Increased interregional virus exchange and nucleotide diversity outline the expansion of chikungunya virus in Brazil. Nat Commun 2023; 14:4413. [PMID: 37479700 PMCID: PMC10362057 DOI: 10.1038/s41467-023-40099-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/12/2023] [Indexed: 07/23/2023] Open
Abstract
The emergence and reemergence of mosquito-borne diseases in Brazil such as yellow fever, zika, chikungunya, and dengue have had serious impacts on public health. Concerns have been raised due to the rapid dissemination of the chikungunya virus across the country since its first detection in 2014 in Northeast Brazil. In this work, we carried out on-site training activities in genomic surveillance in partnership with the National Network of Public Health Laboratories that have led to the generation of 422 chikungunya virus genomes from 12 Brazilian states over the past two years (2021-2022), a period that has seen more than 312 thousand chikungunya fever cases reported in the country. These genomes increased the amount of available data and allowed a more comprehensive characterization of the dispersal dynamics of the chikungunya virus East-Central-South-African lineage in Brazil. Tree branching patterns revealed the emergence and expansion of two distinct subclades. Phylogeographic analysis indicated that the northeast region has been the leading hub of virus spread towards other regions. Increased frequency of C > T transitions among the new genomes suggested that host restriction factors from the immune system such as ADAR and AID/APOBEC deaminases might be driving the genetic diversity of the chikungunya virus in Brazil.
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Affiliation(s)
- Joilson Xavier
- Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brazil
- Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Luiz Carlos Junior Alcantara
- Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brazil.
- Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
| | - Vagner Fonseca
- Organização Pan-Americana da Saúde, Organização Mundial da Saúde, Brasília, Brazil
| | - Mauricio Lima
- Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brazil
- Laboratório Central de Saúde Pública de Minas Gerais, Fundação Ezequiel Dias, Belo Horizonte, Brazil
| | - Emerson Castro
- Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brazil
- Laboratório Central de Saúde Pública de Minas Gerais, Fundação Ezequiel Dias, Belo Horizonte, Brazil
| | - Hegger Fritsch
- Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brazil
- Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Carla Oliveira
- Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Natalia Guimarães
- Laboratório Central de Saúde Pública de Minas Gerais, Fundação Ezequiel Dias, Belo Horizonte, Brazil
| | - Talita Adelino
- Laboratório Central de Saúde Pública de Minas Gerais, Fundação Ezequiel Dias, Belo Horizonte, Brazil
| | | | | | | | | | - Laise de Moraes
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Stephane Tosta
- Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brazil
- Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Adelino Neto
- Laboratório Central de Saúde Pública do Piaui, Piauí, Brazil
| | - Alexander Rosewell
- Organização Pan-Americana da Saúde, Organização Mundial da Saúde, Brasília, Brazil
| | | | - Anderson Leite
- Laboratório Central de Saúde Pública de Alagoas, Maceió, Brazil
| | | | | | | | | | - Camila Zanluca
- Instituto Carlos Chagas, Fundação Oswaldo Cruz, Curitiba, Brazil
| | - Carla Freitas
- Coordenação Geral dos Laboratórios de Saúde Pública, Ministério da Saúde, Brasília, Brazil
| | | | | | - Cleiton S Santos
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | | | | | - Dalane Teixeira
- Laboratório Central de Saúde Pública da Paraíba, João Pessoa, Brazil
| | - Daniel F L Neto
- Coordenação Geral dos Laboratórios de Saúde Pública, Ministério da Saúde, Brasília, Brazil
| | - Diego Cabral
- Laboratório Central de Saúde Pública de Pernambuco, Natal, Brazil
| | | | - Ethel L Noia Maciel
- Secretaria de Vigilância em Saúde e Ambiente, Ministério da Saúde, Brasília, Brazil
| | | | - Felipe Iani
- Laboratório Central de Saúde Pública de Minas Gerais, Fundação Ezequiel Dias, Belo Horizonte, Brazil
| | | | | | - Gabriela Bezerra
- Laboratório Central de Saúde Pública de Sergipe, Aracaju, Brazil
| | | | - Glauco Carvalho Pereira
- Laboratório Central de Saúde Pública de Minas Gerais, Fundação Ezequiel Dias, Belo Horizonte, Brazil
| | - Haline Barroso
- Laboratório Central de Saúde Pública da Paraíba, João Pessoa, Brazil
| | | | - Hivylla Ferreira
- Laboratório Central de Saúde Pública do Maranhão, São Luís, Brazil
| | - Iago Gomes
- Laboratório Central de Saúde Pública do Rio Grande do Norte, Natal, Brazil
| | | | | | | | - Jacilane Silva
- Laboratório Central de Saúde Pública de Pernambuco, Natal, Brazil
| | | | - Jaqueline Lima
- Laboratório Central de Saúde Pública da Bahia, Salvador, Brazil
| | - Jayra Abrantes
- Laboratório Central de Saúde Pública do Rio Grande do Norte, Natal, Brazil
| | | | - Judith N Wasserheit
- Department of Global Health and Medicine, University of Washington, Washington, USA
| | - Julia Pastor
- Laboratório Central de Saúde Pública de Pernambuco, Natal, Brazil
| | - Jurandy J F de Magalhães
- Laboratório Central de Saúde Pública de Pernambuco, Natal, Brazil
- Universidade de Pernambuco, Serra Talhada, Brazil
| | | | | | - Livia C V Frutuoso
- Coordenação Geral das Arboviroses, Ministério da Saúde, Brasília, Brazil
| | | | - Ludmila Sena
- Laboratório Central de Saúde Pública de Sergipe, Aracaju, Brazil
| | | | | | - Luiz Demarchi
- Laboratório Central de Saúde Pública do Mato Grosso do Sul, Campo Grande, Brazil
| | - Magaly C B Câmara
- Laboratório Central de Saúde Pública do Rio Grande do Norte, Natal, Brazil
| | | | | | - Maricelia Lima
- Universidade Estadual de Feira de Santana, Feira de Santana, Brazil
| | | | | | - Melissa B Falcão
- Secretaria de Saúde de Feira de Santana, Feira de Santana, Brazil
| | - Michael Gale
- Department of Immunology, University of Washington, Washington, USA
| | - Naishe Freire
- Laboratório Central de Saúde Pública de Pernambuco, Natal, Brazil
| | - Nelson Marques
- Laboratório Central de Saúde Pública do Paraná, Paraná, Brazil
| | - Noely F O de Moura
- Coordenação Geral das Arboviroses, Ministério da Saúde, Brasília, Brazil
| | | | - Peter Rabinowitz
- Department of Environmental and Occupational Health Sciences, University of Washington, Washington, USA
| | - Rivaldo V da Cunha
- Fundação Oswaldo Cruz, Instituto de Tecnologia em Imunobiológicos, Rio de Janeiro, Brazil
| | - Karen S Trinta
- Fundação Oswaldo Cruz, Instituto de Tecnologia em Imunobiológicos, Rio de Janeiro, Brazil
| | | | - Rodrigo Kato
- Coordenação Geral dos Laboratórios de Saúde Pública, Ministério da Saúde, Brasília, Brazil
| | - Rodrigo Stabeli
- Organização Pan-Americana da Saúde, Organização Mundial da Saúde, Brasília, Brazil
| | - Ronaldo de Jesus
- Coordenação Geral dos Laboratórios de Saúde Pública, Ministério da Saúde, Brasília, Brazil
| | | | - Simone Kashima
- Fundação Hemocentro de Ribeirão Preto, Ribeirão Preto, Brazil
| | - Svetoslav N Slavov
- Fundação Hemocentro de Ribeirão Preto, Ribeirão Preto, Brazil
- Center for Research Development, CDC, Butantan Institute, São Paulo, Brazil
| | - Tamires Andrade
- Laboratório Central de Saúde Pública da Paraíba, João Pessoa, Brazil
| | - Themis Rocha
- Laboratório Central de Saúde Pública do Rio Grande do Norte, Natal, Brazil
| | - Thiago Carneiro
- Laboratório Central de Saúde Pública da Paraíba, João Pessoa, Brazil
| | - Vanessa Nardy
- Laboratório Central de Saúde Pública da Bahia, Salvador, Brazil
| | | | | | | | | | | | - Marta Giovanetti
- Instituto René Rachou, Fundação Oswaldo Cruz, Belo Horizonte, Brazil.
- Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
- Sciences and Technologies for Sustainable Development and One Health, University of Campus Bio-Medico, Rome, Italy.
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Xavier J, Alcantara L, Fonseca V, Lima M, Castro E, Fritsch H, Oliveira C, Guimarães N, Adelino T, Evaristo M, Rodrigues ES, Santos EV, de La-Roque D, de Moraes L, Tosta S, Neto A, Rosewell A, Mendonça AF, Leite A, Vasconcelos A, Silva de Mello AL, Vasconcelos B, Montalbano CA, Zanluca C, Freitas C, de Albuquerque CFC, Duarte dos Santos CN, Santos CS, dos Santos CA, Maymone Gonçalves CC, Teixeira D, Neto DFL, Cabral D, de Oliveira EC, Noia Maciel EL, Pereira FM, Iani F, de Carvalho FP, Andrade G, Bezerra G, de Castro Lichs GG, Pereira GC, Barroso H, Ferreira Franz HC, Ferreira H, Gomes I, Riediger IN, Rodrigues I, de Siqueira IC, Silva J, Rico JM, Lima J, Abrantes J, do Nascimento JPM, Wasserheit JN, Pastor J, de Magalhães JJF, Luz KG, Lima Neto LG, Frutuoso LCV, da Silva LB, Sena L, de Sousa LAF, Pereira LA, Demarchi L, Câmara MCB, Astete MG, Almiron M, Lima M, Umaki Zardin MCS, Presibella MM, Falcão MB, Gale M, Freire N, Marques N, de Moura NFO, Almeida Da Silva PE, Rabinowitz P, da Cunha RV, Trinta KS, do Carmo Said RF, Kato R, Stabeli R, de Jesus R, Santos RH, Haddad SK, Slavov SN, Andrade T, Rocha T, Carneiro T, Nardy V, da Silva V, Carvalho WG, Van Voorhis WC, Araujo WN, de Filippis AM, Giovanetti M. Increased interregional virus exchange and nucleotide diversity outline the expansion of the chikungunya virus ECSA lineage in Brazil. medRxiv 2023:2023.03.28.23287733. [PMID: 37034611 PMCID: PMC10081416 DOI: 10.1101/2023.03.28.23287733] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
The emergence and reemergence of mosquito-borne diseases in Brazil such as Yellow Fever, Zika, Chikungunya, and Dengue have had serious impacts on public health. Concerns have been raised due to the rapid dissemination of the chikungunya virus (CHIKV) across the country since its first detection in 2014 in Northeast Brazil. Faced with this scenario, on-site training activities in genomic surveillance carried out in partnership with the National Network of Public Health Laboratories have led to the generation of 422 CHIKV genomes from 12 Brazilian states over the past two years (2021-2022), a period that has seen more than 312 thousand chikungunya fever cases reported in the country. These new genomes increased the amount of available data and allowed a more comprehensive characterization of the dispersion dynamics of the CHIKV East-Central-South-African (ECSA) lineage in Brazil. Tree branching patterns revealed the emergence and expansion of two distinct subclades. Phylogeographic analysis indicated that the northeast region has been the leading hub of virus spread towards other regions. Increased frequency of C>T transitions among the new genomes suggested that host restriction factors from the immune system such as ADAR and AID/APOBEC deaminases might be driving CHIKV ECSA lineage genetic diversity in Brazil.
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Affiliation(s)
- Joilson Xavier
- Instituto Rene Rachou, Fundação Oswaldo Cruz, Minas Gerais, Brazil
- Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Brazil
| | - Luiz Alcantara
- Instituto Rene Rachou, Fundação Oswaldo Cruz, Minas Gerais, Brazil
- Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Brazil
- Correspondence: , &
| | - Vagner Fonseca
- Organização Pan-Americana da Saúde, Organização Mundial da Saúde, Brazil
| | - Mauricio Lima
- Instituto Rene Rachou, Fundação Oswaldo Cruz, Minas Gerais, Brazil
- Laboratório Central de Saúde Pública de Minas Gerais, Fundação Ezequiel Dias, Brazil
| | - Emerson Castro
- Instituto Rene Rachou, Fundação Oswaldo Cruz, Minas Gerais, Brazil
- Laboratório Central de Saúde Pública de Minas Gerais, Fundação Ezequiel Dias, Brazil
| | - Hegger Fritsch
- Instituto Rene Rachou, Fundação Oswaldo Cruz, Minas Gerais, Brazil
- Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Brazil
| | - Carla Oliveira
- Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Natalia Guimarães
- Laboratório Central de Saúde Pública de Minas Gerais, Fundação Ezequiel Dias, Brazil
| | - Talita Adelino
- Laboratório Central de Saúde Pública de Minas Gerais, Fundação Ezequiel Dias, Brazil
| | | | | | | | | | - Laise de Moraes
- Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Bahia, Brazil
| | - Stephane Tosta
- Instituto Rene Rachou, Fundação Oswaldo Cruz, Minas Gerais, Brazil
- Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Brazil
| | - Adelino Neto
- Laboratório Central de Saúde Pública do Piaui, Brazil
| | - Alexander Rosewell
- Organização Pan-Americana da Saúde, Organização Mundial da Saúde, Brazil
| | | | | | | | | | | | | | - Camila Zanluca
- Instituto Carlos Chagas, Fundação Oswaldo Cruz, Paraná, Brazil
| | - Carla Freitas
- Coordenação Geral dos Laboratórios de Saúde Pública, Ministério da Saúde, Brazil
| | | | | | | | | | | | | | - Daniel F. L. Neto
- Coordenação Geral dos Laboratórios de Saúde Pública, Ministério da Saúde, Brazil
| | - Diego Cabral
- Laboratório Central de Saúde Pública de Pernambuco, Brazil
| | | | | | | | - Felipe Iani
- Laboratório Central de Saúde Pública de Minas Gerais, Fundação Ezequiel Dias, Brazil
| | | | | | | | | | | | | | | | | | - Iago Gomes
- Laboratório Central de Saúde Pública do Rio Grande do Norte, Brazil
| | | | | | | | - Jacilane Silva
- Laboratório Central de Saúde Pública de Pernambuco, Brazil
| | | | | | - Jayra Abrantes
- Laboratório Central de Saúde Pública do Rio Grande do Norte, Brazil
| | | | | | - Julia Pastor
- Laboratório Central de Saúde Pública de Pernambuco, Brazil
| | - Jurandy J. F. de Magalhães
- Laboratório Central de Saúde Pública de Pernambuco, Brazil
- Universidade de Pernambuco Campus Serra Talhada
| | | | | | | | | | - Ludmila Sena
- Laboratório Central de Saúde Pública de Sergipe, Brazil
| | | | | | - Luiz Demarchi
- Laboratório Central de Saúde Pública do Mato Grosso do Sul, Brazil
| | | | | | | | | | | | | | - Melissa B. Falcão
- Secretaria de Saúde de Feira de Santana, Feira de Santana, Bahia, Brazil
| | - Michael Gale
- Department of Immunology, University of Washington, USA
| | - Naishe Freire
- Laboratório Central de Saúde Pública de Pernambuco, Brazil
| | | | | | | | - Peter Rabinowitz
- Department of Environmental and Occupational Health Sciences, University of Washington, USA
| | | | - Karen S. Trinta
- Fundação Oswaldo Cruz, Instituto de Tecnologia em Imunobiológicos, Brazil
| | | | - Rodrigo Kato
- Coordenação Geral dos Laboratórios de Saúde Pública, Ministério da Saúde, Brazil
| | - Rodrigo Stabeli
- Organização Pan-Americana da Saúde, Organização Mundial da Saúde, Brazil
| | - Ronaldo de Jesus
- Coordenação Geral dos Laboratórios de Saúde Pública, Ministério da Saúde, Brazil
| | | | | | - Svetoslav N. Slavov
- Fundação Hemocentro de Ribeirão Preto, Brazil
- Center for Research Development, CDC, Butantan Institute, Brazil
| | | | - Themis Rocha
- Laboratório Central de Saúde Pública do Rio Grande do Norte, Brazil
| | | | - Vanessa Nardy
- Laboratório Central de Saúde Pública da Bahia, Brazil
| | | | | | | | | | - Ana M.B. de Filippis
- Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
- Correspondence: , &
| | - Marta Giovanetti
- Instituto Rene Rachou, Fundação Oswaldo Cruz, Minas Gerais, Brazil
- Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Brazil
- Sciences and Technologies for Sustainable Development and One Health, University of Campus Bio-Medico, Italy
- Correspondence: , &
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Santos ME, Ribeiro RA, Protopopescu C, Nishimwe M, Yaya I, Carrieri MP, Araujo WN. Predictors of overall mortality among people living with HIV/AIDS in Brazil, 2007-2015. Eur J Public Health 2019. [DOI: 10.1093/eurpub/ckz185.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In Brazil there are 926,742 people living with HIV/AIDS (PLWHA). Despite the introduction of antiretroviral therapy (ART) in 1996 and treatment for all in 2014, mortality has increased in some regions. This study aimed to estimate the factors associated with overall mortality in PLWHA to recommend public health actions.
Methods
We studied PLWHA aged ≥18 years old, followed-up from 2007 to 2015 in the universal health system in Brazil. We used a national database (disease reporting, laboratory tests, ART and death notifications). Kaplan-Meier method and Cox model were used in survival analysis. The outcome was all-cause deaths. The explanatory variables measured at baseline were sociodemographic characteristics, HIV transmission mode and coinfections by hepatitis B (HBV) and C (HCV). The time-varying variables were CD4 cell count, viral load (VL) and ART status.
Results
Study population (n = 411,281) was mainly male (61%), under 40 years old (61%), Caucasian (37%), with basic education (43%), heterosexual HIV-infection mode (41%), resident in Southeast region (48%). The co-infection rate was 2.5% for HCV, and 1.4% for HBV. Median time to ART initiation was 83 days. During the follow-up period (median: 4 years), 61,757 deaths occurred (6% HCV-coinfected and 2% HBV-coinfected). The global mortality rate was 3.44 [95% confidence interval: 3.42-3.47] per 100 person-years (PY) during 1,793,417 PY. The factors associated with increased mortality in multivariable analyses were male gender, age over 40, non-Caucasian race, HIV infection by drug use, resident in North, Northeast and South regions, HCV and HBV coinfection, VL ≥ 200 copies/mL and starting ART with CD4<200 cells/mm3.
Conclusions
Although PLWHA start ART in less than 3 months after the beginning of follow-up, there is still late treatment (at CD4<200 cells/mm3). Screening should target all populations regardless of risk group. Coinfected individuals should also be early treated for HCV and HBV infections.
Key messages
The results of our study show that all populations should be target for HIV screening regardless of risk group. PLWHA coinfected with hepatitis B and hepatitis C should be also early treated for hepatitis coinfections.
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Affiliation(s)
- M E Santos
- INSERM, IRD, SESSTIM, Aix Marseille University, Marseille, France
- Faculty of Health Sciences, University of Brasilia, Brasilia, Brazil
- ORS, PACA, Marseille, France
| | - R A Ribeiro
- Department of STI, HIV/AIDS and Viral Hepatitis, Ministry of Health of Brazil, Brasilia, Brazil
| | - C Protopopescu
- INSERM, IRD, SESSTIM, Aix Marseille University, Marseille, France
- ORS, PACA, Marseille, France
| | - M Nishimwe
- INSERM, IRD, SESSTIM, Aix Marseille University, Marseille, France
- ORS, PACA, Marseille, France
| | - I Yaya
- INSERM, IRD, University of Montpellier, Montpellier, France
| | - M P Carrieri
- INSERM, IRD, SESSTIM, Aix Marseille University, Marseille, France
- ORS, PACA, Marseille, France
| | - W N Araujo
- Faculty of Ceilandia, University of Brasilia, Brasilia, Brazil
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Costa F, Ribeiro GS, Felzemburgh RDM, Santos N, Reis RB, Santos AC, Fraga DBM, Araujo WN, Santana C, Childs JE, Reis MG, Ko AI. Influence of household rat infestation on leptospira transmission in the urban slum environment. PLoS Negl Trop Dis 2014; 8:e3338. [PMID: 25474580 PMCID: PMC4256176 DOI: 10.1371/journal.pntd.0003338] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [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: 08/18/2014] [Accepted: 10/11/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The Norway rat (Rattus norvegicus) is the principal reservoir for leptospirosis in many urban settings. Few studies have identified markers for rat infestation in slum environments while none have evaluated the association between household rat infestation and Leptospira infection in humans or the use of infestation markers as a predictive model to stratify risk for leptospirosis. METHODOLOGY/PRINCIPAL FINDINGS We enrolled a cohort of 2,003 urban slum residents from Salvador, Brazil in 2004, and followed the cohort during four annual serosurveys to identify serologic evidence for Leptospira infection. In 2007, we performed rodent infestation and environmental surveys of 80 case households, in which resided at least one individual with Leptospira infection, and 109 control households. In the case-control study, signs of rodent infestation were identified in 78% and 42% of the households, respectively. Regression modeling identified the presence of R. norvegicus feces (OR, 4.95; 95% CI, 2.13-11.47), rodent burrows (2.80; 1.06-7.36), access to water (2.79; 1.28-6.09), and un-plastered walls (2.71; 1.21-6.04) as independent risk factors associated with Leptospira infection in a household. We developed a predictive model for infection, based on assigning scores to each of the rodent infestation risk factors. Receiver operating characteristic curve analysis found that the prediction score produced a good/excellent fit based on an area under the curve of 0.78 (0.71-0.84). CONCLUSIONS/SIGNIFICANCE Our study found that a high proportion of slum households were infested with R. norvegicus and that rat infestation was significantly associated with the risk of Leptospira infection, indicating that high level transmission occurs among slum households. We developed an easily applicable prediction score based on rat infestation markers, which identified households with highest infection risk. The use of the prediction score in community-based screening may therefore be an effective risk stratification strategy for targeting control measures in slum settings of high leptospirosis transmission.
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Affiliation(s)
- Federico Costa
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia, Brazil
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut, United States of America
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Bahia, Brazil
| | - Guilherme S. Ribeiro
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia, Brazil
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Bahia, Brazil
| | | | - Norlan Santos
- Federal University of Bahia, Salvador, Bahia, Brazil
| | - Renato Barbosa Reis
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia, Brazil
| | - Andreia C. Santos
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia, Brazil
| | - Deborah Bittencourt Mothe Fraga
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia, Brazil
- Federal University of Bahia, Salvador, Bahia, Brazil
| | | | - Carlos Santana
- Zoonosis Control Center, Brazil Ministry of Health, Salvador, Bahia, Brazil
| | - James E. Childs
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut, United States of America
| | - Mitermayer G. Reis
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia, Brazil
| | - Albert I. Ko
- Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Saúde, Salvador, Bahia, Brazil
- Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, Connecticut, United States of America
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Siqueira AA, Santelli ACFS, Alencar LR, Dantas MP, Dimech CPN, Carmo GMI, Santos DA, Alves RMS, Lucena MBF, Morais M, Assis RMS, Fialho A, Mascarenhas JDP, Costa M, Linhares AC, Leite JPG, Araujo WN, Hatch DL. Outbreak of acute gastroenteritis in young children with death due to rotavirus genotype G9 in Rio Branco, Brazilian Amazon region, 2005. Int J Infect Dis 2010; 14:e898-903. [PMID: 20843719 DOI: 10.1016/j.ijid.2010.03.024] [Citation(s) in RCA: 22] [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] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Accepted: 03/11/2010] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND An epidemic of acute gastroenteritis occurred in Rio Branco City, Acre State, in Brazil's Amazon region in 2005. An investigation was conducted to confirm the etiology and identify possible risk factors for death. METHODS Rio Branco municipality surveillance data for the period May to October 2005 were reviewed. In a case-control study, children who died following acute gastroenteritis were compared to age-matched controls with acute gastroenteritis who survived. Rotavirus A (RV-A) was investigated in 799 stool samples and genotyped by reverse transcription polymerase chain reaction (RT-PCR). RESULTS The cumulative incidence of diarrhea in children aged <5 years was 21%. A fatal outcome was significantly associated with uncovered household water storage containers. RV-A was identified in 88% of samples and G9 was the prevalent genotype (71%). CONCLUSIONS Oral rehydration solution and boiling or chlorinating drinking water likely limited mortality. This epidemic was caused by RV-A genotype G9. After the outbreak, a rotavirus vaccine was introduced into the official childhood immunization schedule in Brazil.
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Affiliation(s)
- Alessandra A Siqueira
- Field Epidemiology Training Program (EPISUS), Secretariat of Health Surveillance (SVS), Ministry of Health, Setor Comercial Sul, Edificio Principal Quadra 04, Bloco A, 3° Andar, Brasília, DF, Brazil.
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Nóbrega AA, Garcia MH, Tatto E, Obara MT, Costa E, Sobel J, Araujo WN. Oral transmission of Chagas disease by consumption of açaí palm fruit, Brazil. Emerg Infect Dis 2009; 15:653-5. [PMID: 19331764 PMCID: PMC2671433 DOI: 10.3201/eid1504.081450] [Citation(s) in RCA: 171] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In 2006, a total of 178 cases of acute Chagas disease were reported from the Amazonian state of Pará, Brazil. Eleven occurred in Barcarena and were confirmed by visualization of parasites on blood smears. Using cohort and case-control studies, we implicated oral transmission by consumption of açaí palm fruit.
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