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BackgroundDengue is a reportable disease in Brazil; however, pregnancy has been included in the application form of the Brazilian notification information system only after 2006. To estimate the severity of maternal dengue infection, the available data that were compiled from January 2007 to December 2008 by the official surveillance information system of the city of Rio de Janeiro were reviewed.Methods and Principal FindingsDuring the study period, 151,604 cases of suspected dengue infection were reported. Five hundred sixty-one women in their reproductive age (15–49 years) presented with dengue infection; 99 (18.1%) pregnant and 447 (81.9%) non-pregnant women were analyzed. Dengue cases were categorized using the 1997 WHO classification system, and DHF/DSS were considered severe disease. The Mann-Whitney test was used to compare maternal age, according to gestational period, and severity of disease. A chi-square test was utilized to evaluate the differences in the proportion of dengue severity between pregnant and non-pregnant women. Univariate analysis was performed to compare outcome variables (severe dengue and non-severe dengue) and explanatory variables (pregnancy, gestational age and trimester) using the Wald test. A multivariate analysis was performed to assess the independence of statistically significant variables in the univariate analysis. A p-value<0.05 was considered statistically significant.A higher percentage of severe dengue infection among pregnant women was found, p = 0.0001. Final analysis demonstrated that pregnant women are 3.4 times more prone to developing severe dengue (OR: 3.38; CI: 2.10–5.42). Mortality among pregnant women was superior to non-pregnant women.ConclusionPregnant women have an increased risk of developing severe dengue infection and dying of dengue.

Objectives: To analyze the prevalence and the factors associated with intestinal parasites infections in children and adolescents enrolled in elementary schools from São João del-Rei, Southeast Brazil.Methods: In this sectional study, coproscopic examinations were performed by spontaneous sedimentation and Kato-Katz techniques in 1,172 schoolchildren. Multivariate logistic regression models were adjusted for the study of factors associated with infections in general and separately for helminthes and protozoon.Results: The prevalence of infection was 29%, ranging from 7 to 83% between schools of lower and higher occurrence respectively. The presence of toilets in the home was associated with a lower prevalence of helminths; the increasing age of the students was associated with a higher rates of protozoon and parasites in general, while the presence of water filter and living in urban area were associated with a lower prevalence of the three outcomes. In all regions, the consumption of preventive medication against helminths was recorded. Conclusions:Inequalities in living conditions have changed the prevalence of parasitosis differently among the study regions. The study underscores the need to promote the use of water filters in endemic areas houses and to evaluate the preventive use of anti-helminthic drugs in the dynamic of individual health. Control measures that take into account the factors described should be a priority.Key-words: protozoan infections; helminths; /epidemiology; risk factors; health inequalities. RESUMOObjetivos: Analisar a prevalência de infecções por parasitos intestinais em crianças e adolescentes matriculados em escolas de ensino fundamental no município de São João del-Rei, Minas Gerais, e os fatores associados à infecção.Métodos Factors associated with intestinal parasites in a population of children and adolescents múltipla para o estudo dos fatores associados às infecções em geral e, separadamente, por helmintos e por protozoários.Resultados: A prevalência de infecções foi de 29%, havendo uma variação de 7 a 83%, respectivamente, entre as escolas de menor e maior ocorrência. A presença de instalação sanitária no domicílio foi associada a uma ocorrência menor de helmintos; o aumento na idade dos escolares associou-se a uma maior ocorrência de protozoários e de parasitos em geral; enquanto a presença de filtro de água e a localização do domicílio em área urbana mostraram-se associadas a uma ocorrência menor dos três desfechos analisados. Em todas as regiões, foi registrado o consumo de medicação preventiva contra helmintos.Conclusões: Desigualdades nas condições de vida tornaram as prevalências diferenciadas entre as regiões do estudo. O estudo ressalta a necessidade de promover o uso de filtros de água nas residências de áreas endêmicas e de avaliar o consumo preventivo de medicamentos anti-helmínticos na dinâmica e na saúde dos indivíduos. Medidas de controle que levem em conta os fatores descritos devem ser prioritárias em nível de Saúde Pública.Palavras-chave: infecções p...

Identification of factors associated with Leishmania infection in dogs is essential for targeting visceral leishmaniasis control actions. Thus, the present study analyzed some of these factors in a population of dogs in a Brazilian municipality, along with the limitations of control strategies implemented there. The association between the exposure variables and occurrences of infection was analyzed through logistic regression models. The disease control interventions were treated qualitatively. Out of the 755 animals examined, 13.6% (103/755) were seropositive. Of these, 23.3% (24/103) were asymptomatic and 76.7% (79/103) presented at least one clinical sign possibly associated with visceral leishmaniasis. With weak associations, purebred, shorthaired, over 5 years of age, male and large dogs were more prone to infection. The latter two variables formed the final regression model and the association with dog size was statistically significant. The control strategies developed presented limitations and a great number of seronegative dogs was culled. The data presented contribute towards better understanding of the dynamics of infection in canine visceral leishmaniasis and indicate that actions aimed towards adequate implementation of Visceral Leishmaniasis control program in Brazilian endemic areas should be prioritized.

Evaluation of rotavirus enhanced epidemiologic surveillance Evaluación de la vigilancia epidemiológica ampliada del rotavirus RESUMO Objetivo: Conhecer as práticas de vigilância do Rotavírus, identificando os pontos positivos e as dificuldades encontradas através do modelo de avaliação da Vigilância Epidemiológica Ampliada das Doenças Diarreicas por Rotavírus (VER). Métodos: Tratou-se de uma pesquisa avaliativa realizada em dois diferentes estados brasileiros, entre março a novembro de 2010. Participaram da avaliação 14 atores no total (do nível central, estadual e municipal), sendo submetidos a entrevistas gravadas utilizando questionários semiestruturados, além da realização de análise documental e observação direta da rotina do serviço dentro das respectivas unidades. Essas informações permitiram alimentar uma matriz de julgamento e evidenciar os variados aspectos componentes da operacionalização do sistema. Resultados: Foram observados pontos positivos (a sensibilidade de captação de casos, a aceitabilidade do sistema por parte dos técnicos envolvidos, a estrutura física adequada e a capacitação e atualização dos técnicos) e dificuldades operacionais (a escassez de recursos humanos e financeiros, e a baixa oportunidade do sistema de informação) na condução das atividades da vigilância. Conclusão: Os resultados encontrados sugerem a baixa efetividade do sistema de vigilância adotado, indicando que a vigilância do tipo sentinela pode não ser a mais adequada para o sistema de saúde desses estados estudados.

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Currently, it is estimated that 37.6 million people are living with the HIV/AIDS virus worldwide, placing HIV/AIDS among the ten leading causes of death, mostly among low- and lower-middle-income countries. Despite the effective intervention in the prevention and treatment, this reduction did not occur equally among populations, subpopulations and geographic regions. This difference in the occurrence of the disease is associated with the social determinants of health (SDH), which could affect the transmission and maintenance of HIV. With the recognition of the importance of SDH in HIV transmission, the development of mathematical models that incorporate these determinants could increase the accuracy and robustness of the modeling. This article aims to propose a theoretical and conceptual way of including SDH in the mathematical modeling of HIV/AIDS. The theoretical mathematical model with the Social Determinants of Health has been developed in stages. For the selection of SDH that were incorporated into the model, a narrative literature review was conducted. Secondly, we proposed an extended model in which the population (N) is divided into Susceptible (S), HIV-positive (I), Individual with AIDS (A) and individual under treatment (T). Each SDH had a different approach to embedding in the model. We performed a calibration and validation of the model. A total of 31 SDH were obtained in the review, divided into four groups: Individual Factors, Socioeconomic Factors, Social Participation, and Health Services. In the end, four determinants were selected for incorporation into the model: Education, Poverty, Use of Drugs and Alcohol abuse, and Condoms Use. the section “Numerical simulation” to simulate the influence of the poverty rate on the AIDS incidence and mortality rates. We used a Brazilian dataset of new AIDS cases and deaths, which is publicly available. We calibrated the model using a multiobjective genetic algorithm for the years 2003 to 2019. To forecast from 2020 to 2035, we assumed two lines of poverty rate representing (i) a scenario of increasing and (ii) a scenario of decreasing. To avoid overfitting, we fixed some parameters and estimated the remaining. The equations presented with the chosen SDH exemplify some approaches that we can adopt when thinking about modeling social effects on the occurrence of HIV. The model was able to capture the influence of the employment/poverty on the HIV/AIDS incidence and mortality rates, evidencing the importance of SDOH in the occurrence of diseases. The recognition of the importance of including the SDH in the modeling and studies on HIV/AIDS is evident, due to its complexity and multicausality. Models that do not take into account in their structure, will probably miss a great part of the real trends, especially in periods, as the current on, of economic crisis and strong socioeconomic changes.

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