BackgroundIn recent decades the epidemic of asymptomatic sexually transmitted infections has extended deep into Brazil, including small towns and rural areas. The purpose of this study was to investigate the epidemiology of HIV, syphilis, and hepatitis B (HBV) and hepatitis C viruses (HCV), and to evaluate immunization coverage against hepatitis B in a group of rural workers in Brazil.MethodsIn 2016, a cross-sectional study was conducted with 937 manual sugarcane cutters of the Midwest and Northeast Regions of Brazil. All individuals were interviewed and screened for HIV, syphilis, HBV and HCV. Correlating factors with lifetime HBV infection were investigated using logistic regression. Positive Predictive Values, Negative Predictive Values, sensitivity and specificity were also calculated relative to vaccination against Hepatitis B, comparing anti-HBs titers to vaccination reports.ResultsMost reported previous hospitalization (55%), occupational injuries (54%), sharing of personal items (45.8%), alcohol consumption (77.2%), multiple sexual partners in previous 12 months (39.8%), and no condom use during sexual intercourse in last 12 months (46.5%). Only 0.2% reported using injection drugs. Anti-HIV-1 was detected in three individuals (0.3%). Serological markers of lifetime syphilis (treponemal test) were detected in 2.5% (95% CI: 1.6–3.6) of participants, and active syphilis (treponemal test and VDRL) present in 1.2%. No samples were positive for anti-HCV. The prevalence of lifetime HBV infection (current or past infection) was 15.9%, and 0.7% (95% CI 0.4 to 1.5) were HBsAg-positive. Previous hospitalization (OR 1.53, CI 1.05–2.24, p < 0.01) and multiple sexual partners in the last 12 months (OR 1.80, CI 1.25–2.60, p < 0.01) were predictors for lifetime HBV infection. Although 46.7% (95% CI 43.4–49.9) of individuals reported having been vaccinated against hepatitis B, only 20.6% (95% CI 18.1–23.3) showed serological evidence of previous hepatitis B vaccination (positive for anti-HBs alone).ConclusionsThe high prevalence of syphilis and HBV compared to the general population and the high frequency of risk behaviors show the potential for sexual and parenteral dissemination of these agents in this rural population. In addition, the low frequency of hepatitis B vaccinated individuals suggests a need for improved vaccination services.
IntroductionThe objective of this study was to estimate the prevalence of Sexually Transmitted Infections and to explore the general understanding of transmission and prevention of these infections among the homeless in Goiânia, Central Brazil. MethodsThis is a cross-sectional study. Between August 2014 and June 2015, residents of a public homeless shelter were recruited in Goiânia, Goiás, in Central Brazil. Survey items included demographics and knowledge of STIs. Blood samples were submitted to rapid tests for HIV, syphilis, and hepatitis B (HBV), and a positive result on any one or more of these tests indicated the presence of an STI. This study was approved by the Research Ethics Committee of the Federal University of Goiás.ResultsThe sample included 209 homeless persons. The mean age of participants was 38 years. The prevalence of STI was 27.8% (58/209), for HIV 3.3% (7/209), syphilis 24.9% (52/209) and hepatitis B 1.0% (2/209). When asked about transmission of HIV, syphilis, and hepatitis B in public restrooms, 4.8%, 8.6% and 10.5% reported that this can occur, respectively. On syringe sharing as an IST transmission route, 78%, 11.5% and 23.9% believe that HIV, syphilis and hepatitis B can be acquired through this parenteral media, respectively. The male condom was investigated as a method of prevention for these sexual infections, and 73.7%, 38.3% and 14.4% affirmed the efficacy of condom use for protection against HIV, syphilis and hepatitis B, respectively. It was found that age (PR: 1.01; 95% CI: 1.00–1.03) and confirming HIV transmission through syringe sharing (PR: 0.47; 95% CI: 0.27–0.81) were statistically significant associated with STI positivity (p≤0.05).ConclusionThe dissemination of knowledge about STIs is an important tool for breaking the chain of transmission of sexual infections. In Brazil, access of the homeless population to health and sexuality education services can be improved using mobile health teams, known as Street Outreach Offices.
Universal immunization against hepatitis B has contributed to reducing incidence of the disease, but older individuals remain susceptible to acquiring the hepatitis B virus worldwide. Thus, this study aimed to investigate the epidemiology of HBV infection in individuals aged 50 years and over in central Brazil and to evaluate the immunogenicity of the monovalent vaccine against hepatitis B in this age group using two vaccine regimens. Method: Initially, a cross-sectional and analytical study was carried out to investigate the epidemiology of hepatitis B. Then, individuals without proof of vaccination for hepatitis B were recruited for a phase IV randomized and controlled clinical trial using two vaccine regimens: Intervention Regimen (IR) (three doses of 40 μg at months 0, 1 and 6) vs. Comparison Regimen (CR) (three doses of 20 μg at months 0, 1 and 6). Results: The overall prevalence of exposure to HBV was 16.6% (95% CI: 14.0%–9.5%). In the clinical trial, statistical differences in protective titers were observed (p = 0.007; IR 96% vs. CR 86%) and the geometric mean of anti-HBs titers was higher in individuals who received the IR (518.2 mIU/mL vs. 260.2 mIU/mL). In addition, the proportion of high responders was higher among those who received the IR (65.3%). Conclusion: reinforced doses should be used in individuals aged 50 years or older to overcome the lower efficacy of the vaccine against hepatitis B.
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