We report the early growth and neurologic findings of 48 infants in Brazil diagnosed with probable congenital Zika virus syndrome and followed to age 1–8 months. Most of these infants had microcephaly (86.7%) and craniofacial disproportion (95.8%). The clinical pattern included poor head growth with increasingly negative z-scores, pyramidal/extrapyramidal symptoms, and epilepsy.

To investigate the role of type II 5′-deiodinase (5′D-II) in the expression of mitochondrial uncoupling protein (UCP) in brown adipose tissue (BAT), we injected intact male rats with reverse (r) 3,5,3′-triiodothyronine (T3; 100 μg ⋅ 100 g body wt−1 ⋅ day−1), an inhibitor of 5′D-II, for 2–5 days. UCP decreased by ∼20% in rats kept at 28°C and failed to increase during cold exposure (4°C). Next, thyroxine treatment (1–10 μg ⋅ 100 g body wt−1 ⋅ day−1) increased nuclear T3 in rats kept at 28 or 4°C. In these rats, nuclear T3 correlated positively with UCP. In addition, T3 (1–50 μg ⋅ 100 g body wt−1 ⋅ day−1) given to intact rats (5–15 days; 28°C) induced an approximately twofold increase in UCP. In these T3-treated animals, the interscapular BAT thermal response to norepinephrine infusion also correlated positively with T3 dose and UCP content. Treatment with propranolol or reserpine failed to block the T3 induction of UCP (∼1.8- and ∼2.3-fold). The results emphasize the importance of local 5′D-II and reveal an independent role of T3 in the expression of UCP.

1) hypothyroidism is associated with a blunted IBF thermal response to NE; 2) two- to fourfold changes in mitochondrial UCP1 concentration are not necessarily translated into heat production during NE infusion.

OBJECTIVE To estimate the 2020 all-cause and COVID-19 excess mortality according to sex, age, race/color, and state, and to compare mortality rates by selected causes with that of the five previous years in Brazil. METHODS Data from the Mortality Information System were used. Expected deaths for 2020 were estimated from 2015 to 2019 data using a negative binomial log-linear model. RESULTS Excess deaths in Brazil in 2020 amounted to 13.7%, and the ratio of excess deaths to COVID-19 deaths was 0.90. Reductions in deaths from cardiovascular diseases (CVD), respiratory diseases, and external causes, and an increase in ill-defined causes were all noted. Excess deaths were also found to be heterogeneous, being higher in the Northern, Center-Western, and Northeastern states. In some states, the number of COVID-19 deaths was lower than that of excess deaths, whereas the opposite occurred in others. Moreover, excess deaths were higher in men aged 20 to 59, and in black, yellow, or indigenous individuals. Meanwhile, excess mortality was lower in women, in individuals aged 80 years or older, and in whites. Additionally, deaths among those aged 0 to 19 were 7.2% lower than expected, with reduction in mortality from respiratory diseases and external causes. There was also a drop in mortality due to external causes in men and in those aged 20 to 39 years. Moreover, reductions in deaths from CVD and neoplasms were noted in some states and groups. CONCLUSION There is evidence of underreporting of COVID-19 deaths and of the possible impact of restrictive measures in the reduction of deaths from external causes and respiratory diseases. The impacts of COVID-19 on mortality were heterogeneous among the states and groups, revealing that regional, demographic, socioeconomic, and racial differences expose individuals in distinct ways to the risk of death from both COVID-19 and other causes.

This study estimated the percentages of incomplete immunization with new vaccines and old vaccines and associated factors in children 13 to 35 months of age belonging to a birth cohort in São Luís, the capital of Maranhão State, Brazil. The sample was probabilistic, with 3,076 children born in 2010. Information on vaccination was obtained from the Child's Health Card. The new vaccines, namely those introduced in 2010, were meningococcal C and 10-valent pneumococcal, and the old vaccines, or those already on the childhood immunization schedule, were BCG, hepatitis B, human rotavirus, polio, tetravalent (diphtheria, tetanus, pertussis, Haemophilus influenzae b), yellow fever, and triple viral (measles, mumps, rubella). The study used hierarchical modeling and Poisson regression with robust variance. Prevalence ratios (PR) and 95% confidence intervals (95%CI) were calculated. Incomplete immunization was higher with new vaccines (51.1%) than with old vaccines (33.2%). Children 25 to 35 months of age (PR = 1.27; 95%CI: 1.14-1.41) and those in economic classes D/E (PR = 1.20; 95%CI: 1.06-1.35) were only significantly associated with new vaccines; low maternal schooling (PR = 1.58; 95%CI: 1.21-2.06), unavailability of outpatient and/or hospital care for the child (PR = 1.20; 95%CI: 1.04-1.38), and unavailability of the vaccine in health services (PR: 1.28; 95%CI: 1.12-1.46) were only associated with old vaccines. Immunization strategies should consider the vulnerability of older preschool-age children and those belonging to classes D and E, especially when new vaccines are introduced, as well as children of mothers with low schooling. Strategies should also address problems with the availability of health services and vaccines.

BackgroundAlthough the Zika virus (ZIKV) epidemic ceased to be a public health emergency by the end of 2016, studies to improve knowledge about this emerging disease are still needed, especially those investigating a causal relationship between ZIKV in pregnant women and microcephaly in neonates. However, there are still many challenges in describing the relationship between ZIKV and microcephaly. The few studies focusing on the epidemiological profile of ZIKV and its changes over time are largely limited to systematic reviews of case reports and dispersal mapping of ZIKV spread over time without quantitative methods to analyze patterns and their covariates. Since Brazil has been at the epicenter of the ZIKV epidemic, this study examines the geospatial association between ZIKV and microcephaly in Brazil.MethodsOur study is categorized as a retrospective, ecological study based on secondary databases. Data were obtained from January to December 2016, from the following data sources: Brazilian System for Epidemiological Surveillance, Disease Notification System, System for Specialized Management Support, and Brazilian Institute of Geography and Statistics. Data were aggregated by municipality. Incidence rates were estimated per 100,000 inhabitants. Analyses consisted of mapping the aggregated incidence rates of ZIKV and microcephaly, followed by a Getis-Ord-Gi spatial cluster analysis and a Bivariate Local Moran’s I analysis.ResultsThe incidence of ZIKV cases is changing the virus’s spatial pattern, shifting from Brazil’s Northeast region to the Midwest and North regions. The number of municipalities in clusters of microcephaly incidence is also shifting from the Northeast region to the Midwest and North, after a time lag is considered. Our findings suggest an increase in microcephaly incidence in the Midwest and North regions, associated with high levels of ZIKV infection months before.ConclusionThe greatest burden of microcephaly shifted from the Northeast to other Brazilian regions at the beginning of 2016. Brazil’s Midwest region experienced an increase in microcephaly incidence associated with ZIKV incidence. This finding highlights an association between an increase in ZIKV infection with a rise in microcephaly cases after approximately three months.

Background: Little is known regarding the developmental consequences of congenital Zika syndrome (CZS) without microcephaly at birth. Most previously published clinical series were descriptive and they had small sample sizes. Study design: We conducted a cohort study to compare the growth, clinical, and motor development outcomes for 110 children with CZS born with and without microcephaly up to their third birthday. Ninety-three had their head circumference (HC) at birth abstracted and they did not have hypertensive hydrocephalus at birth, where 61 were born with microcephaly and 32 without. Results: The HC z-scores decreased steeply from birth to six months of age, i.e., from -3.77 to -6.39 among those with microcephaly at birth and from -1.03 to -3.84 among those without. Thus, at 6 months of age, the mean HC z-scores for children born without microcephaly were nearly the same as those for children born with microcephaly. Children born without microcephaly were less likely to have brain damage, ophthalmic abnormalities, and drug-resistant epilepsy, but the differences in many conditions were not statistically significant. Conclusions: Children born without microcephaly were only slightly less likely to present severe neurologic impairment and to develop postnatal-onset microcephaly, and some of the original differences between the groups tended to dissipate with age.

During 45 days without electrical power, 57 individuals (8.7% of the population) from the village of Antônio Dino (municipality of Turiaçu, Northeastern Brazil) were attacked by bats and 16 died from human rabies. The aim of the study was to analyze the factors associated with bat attacks and the development of human rabies. Of the 46 individuals, who suffered bat attacks, 36 (78.3%) were under 17 years of age. The risk factors associated with bat attacks were age under 17 years, having observed bats inside the bedroom and having been without electrical power in the house. Age under 17 years and having been without electrical power in the house were factors associated with human rabies. The objective of this study was to analyze factors associated with bat attacks and human rabies in an outbreak of bat-transmitted human rabies. DESCRIPTORS: METHODSThe village of Antônio Dino has 685 inhabitants and is 320 km away from the capital of the state of Maranhão, in the Northeast of Brazil. It is located in the municipality of Turiaçu, in a well-preserved area of the Amazon forest. The population, which has low purchasing power and no fi xed source of income, survives by growing cassava and rice. There are no health care services available in the village, and the residents travel 32 km, when they need medical care. In September, 2005, the transformer that distributed power to the village failed, leaving 223 (87.1%) of 256 homes without electricity. In due course, bats attacked 57 (8.3%) residents, of which 16 (28.1%) developed HR and died.In 13 cases, antigenic typing of the virus with a panel of monoclonal antibodies was carried out at the Pasteur Institute in São Paulo and variant three of the rabies virus was identifi ed. This variant is usually isolated from samples taken from the bat species Desmodus rotundus. In three other cases, confi rmation was made by means of clinical and epidemiological criteria. Interventions to curb the epidemic were put in place, during which 73 bat captures were made, yielding a total of 263 animals, of which 251 (95%) belonged to the species Desmodus rotundus. The bats were not tested for antibodies against rabies virus.A convenience sample of 148 individuals (21.6%) of the village population was selected from the most affected areas. They were enrolled and divided into two groups: group 1-comprised of 102 individuals, who were not attacked by bats; and group 2 -made up of 46 (80.7%) of the 57 individuals attacked by bats, including 16 who developed HR and died. In the cases of death, disease was diagnosed by interview with a member of the family and review of medical notes.