BackgroundMany countries have reported an increase in the incidence of pertussis, which has become a global public health concern.MethodsIn this study, the epidemiology of pertussis in Brazil was assessed retrospectively using surveillance data gathered from case notification forms from 2007 to 2014.ResultsFrom 2007 to 2014, 80,068 suspected cases of pertussis were reported in Brazil. Of these, 24,612 (32 %) were confirmed by various criteria. The annual distribution of confirmed cases demonstrated a significant increase in incidence rate since 2012. A seasonal pattern in which cases occur most frequently between the end of spring and midsummer has been identified. Among the confirmed cases, 34.5 % occurred in infants aged 0–2 months, 22.4 % occurred in infants aged 3–6 months, 21 % occurred in children aged 7 months to 4 years, and 8 % were reported in adults >21 years. Of the confirmed cases, 47.2 % met only clinical criteria, 15.5 % met clinical and epidemiological criteria, and 36.6 % were confirmed in a laboratory. The overall case fatality rate was 2.1 %, reaching 4.7 % among infants aged 0–2 months. The complications most commonly reported in the notification forms were pneumonia, encephalitis, dehydration, otitis, and malnutrition. Of the confirmed cases, 23.1 % occurred in subjects who received at least 3 doses of the pertussis vaccine. Within this group, there were 1098 infants aged 7 to 15 months and 2079 children aged 16 months to 4 years. In 2012, 18 states did not achieve 95 % immunization coverage, a number that dropped to 10 and 6 in 2013 and 2014, respectively.ConclusionsBrazil’s main challenges in facing pertussis resurgence will be to offer the best quality medical attention to reduce mortality, to improve the infrastructure for laboratory diagnosis and to increase vaccination coverage. Additional studies to assess the effectiveness of the current vaccination schedule and basic research on the genetics and evolution of circulating B. pertussis strains are also needed.
Background The pathophysiology of COVID-19 includes immune-mediated hyperinflammation, which could potentially lead to respiratory failure and death. Granulocyte-macrophage colony-stimulating factor (GM-CSF) is among cytokines that contribute to the inflammatory processes. Lenzilumab, a GM-CSF neutralising monoclonal antibody, was investigated in the LIVE-AIR trial to assess its efficacy and safety in treating COVID-19 beyond available treatments. Methods In LIVE-AIR, a phase 3, randomised, double-blind, placebo-controlled trial, hospitalised adult patients with COVID-19 pneumonia not requiring invasive mechanical ventilation were recruited from 29 sites in the USA and Brazil and were randomly assigned (1:1) to receive three intravenous doses of lenzilumab (600 mg per dose) or placebo delivered 8 h apart. All patients received standard supportive care, including the use of remdesivir and corticosteroids. Patients were stratified at randomisation by age and disease severity. The primary endpoint was survival without invasive mechanical ventilation to day 28 in the modified intention-to-treat population (mITT), comprising all randomised participants who received at least one dose of study drug under the documented supervision of the principal investigator or sub-investigator. Adverse events were assessed in all patients who received at least one dose of study drug. This trial is registered with ClinicalTrials.gov , NCT04351152 , and is completed. Findings Patients were enrolled from May 5, 2020, until Jan 27, 2021. 528 patients were screened, of whom 520 were randomly assigned and included in the intention-to-treat population. 479 of these patients (n=236, lenzilumab; n=243, placebo) were included in the mITT analysis for the primary outcome. Baseline demographics were similar between groups. 311 (65%) participants were males, mean age was 61 (SD 14) years at baseline, and median C-reactive protein concentration was 79 (IQR 41–137) mg/L. Steroids were administered to 449 (94%) patients and remdesivir to 347 (72%) patients; 331 (69%) patients received both treatments. Survival without invasive mechanical ventilation to day 28 was achieved in 198 (84%; 95% CI 79–89) participants in the lenzilumab group and in 190 (78%; 72–83) patients in the placebo group, and the likelihood of survival was greater with lenzilumab than placebo (hazard ratio 1·54; 95% CI 1·02–2·32; p=0·040). 68 (27%) of 255 patients in the lenzilumab group and 84 (33%) of 257 patients in the placebo group experienced at least one adverse event that was at least grade 3 in severity based on CTCAE criteria. The most common treatment-emergent adverse events of grade 3 or higher were related to respiratory disorders (26%) and cardiac disorders (6%) and none led to death. Interpretation Lenzilumab significantly improved survival without invasive mechanical ventilation in hospitalised patients with CO...
O Brasil figura entre os países com o maior número de casos de dengue no mundo. Sistemas de notificação são fundamentais para acompanhar a evolução do agravo, porém são pouco preenchidos. O conhecimento do nível educacional dos indivíduos é importante para o entendimento do papel da desigualdade social no risco de adoecimento. O objetivo deste artigo é descrever o preenchimento da escolaridade nas fichas de notificação para dengue disponibilizadas pelo Sistema de Informação de Agravos de Notificação (SINAN) entre 2008 e 2017, por sexo e faixa etária, entre as capitais das regiões Nordeste e Sudeste do país. O desfecho de interesse foi o preenchimento da variável escolaridade. As probabilidades preditas de preenchimento da escolaridade foram obtidas utilizando-se modelos logísticos multiníveis. Esse preenchimento foi baixo nas capitais, sendo em oito delas inferior a 30% no período. A chance de ter a escolaridade preenchida decresceu com o avançar da idade, independentemente do sexo e do ano. Mulheres com até 60 anos apresentaram maiores chances de preenchimento da escolaridade que os homens. De um modo geral, os homens registraram 9% menos chances de ter a escolaridade preenchida do que as mulheres. No modelo com interação houve uma intensificação da diferença, ou seja, houve uma piora no preenchimento com o progredir da idade, principalmente entre as mulheres. Diante do exposto, o mau preenchimento das fichas favorece a geração de dados deficientes e duvidosos, e a escolaridade, embora pouco valorizada no ato do preenchimento, tem importância central nesta conjuntura.
We report a case of encephalitis associated with Zika virus infection and reactivation of varicella-zoster virus in the central nervous system of a Brazilian child. This case raises the possibility that reactivation of the latent varicella-zoster virus may be a mechanism of neurological impairment induced by acquired Zika virus infection.
Introduction: Malaria is not considered endemic in State of Piauí. Methods: Malaria epidemiology was examined using surveillance data. Results: During 2002-2013, of the 484 cases of malaria, 217 were classifi ed as probably acquired in Piauí, most frequently in the Campo Largo, Buriti dos Lopes, and Luzilândia municipalities, and 267 were considered probably imported, from the States of Pará, Maranhão, Amazonas, Roraima, and Rondônia. Probably-imported cases occurred throughout the year, while 80.2% of the probably-acquired cases occurred in April-August, peaking at the end of the rainy season. Conclusions: Malaria surveillance should be intensifi ed. Further ecoepidemiological and entomological studies are needed.
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