Monitoramento das Produções

by Claire J. Heath, Elysse N. Grossi-Soyster, Bryson A. Ndenga, Francis M. Mutuku, Malaya K. Sahoo, Harun N. Ngugi, Joel O. Nbakaya, Peter Siema, Uriel Kitron, Nayer Zahiri, Jimmy Hortion, Jesse J. Waggoner, Charles H. King, Benjamin A. Pinsky, A. Desiree LaBeaud

Arboviruses are among the most important emerging pathogens due to their increasing public health impact. In Kenya, continued population growth and associated urbanization are conducive to vector spread in both urban and rural environments, yet mechanisms of viral amplification in vector populations is often overlooked when assessing risks for outbreaks. Thus, the characterization of local arbovirus circulation in mosquito populations is imperative to better inform risk assessments and vector control practices. Aedes species mosquitoes were captured at varying stages of their life cycle during different seasons between January 2014 and May 2016 at four distinct sites in Kenya, and tested for chikungunya (CHIKV), dengue (DENV) and Zika (ZIKV) viruses by RT-PCR. CHIKV was detected in 45 (5.9%) and DENV in 3 (0.4%) mosquito pools. No ZIKV was detected. Significant regional variation in prevalence was observed, with greater frequency of CHIKV on the coast. DENV was detected exclusively on the coast. Both viruses were detected in immature mosquitoes of both sexes, providing evidence of transovarial transmission of these arboviruses in local mosquitoes. This phenomenon may be driving underlying viral maintenance that may largely contribute to periodic re-emergence among humans in Kenya.

by Harald Krenzlin, Christoph Bettag, Veit Rohde, Florian Ringel, Naureen Keric
Background The coronavirus disease 2019 (COVID-19) pandemic poses an unprecedented challenge to health-care systems around the world. As approximately one-third of the world´s population is living under “lockdown” conditions, medical resources are being reallocated and hospital admissions are limited to emergencies. We examined the decision-making impact of these actions and their effects on access to hospital treatment in patients with neurosurgical conditions. Methods This retrospective cohort study analyzes hospital admissions of two major neurosurgical services in Germany during the nationwide lockdown period (March 16th to April 16th, 2020). Spinal or cranial conditions requiring immediate hospital admission and treatment constituted emergencies. Results A total of 243 in-patients were treated between March 16th and April 16th 2020 (122 patients at the University Medical Center Mainz, 121 patients at the University Medical Center Göttingen). Of these, 38.0±16% qualified as emergency admission. Another 1,688 admissions were reviewed during the same periods in 2018 and 2019, providing a frame of reference. Overall, emergency admissions declined by 44.7±0.7% during lockdown. Admissions for cranial emergencies fell by 48.1±4.44%, spinal emergencies by 30.9±14.6%. Conclusion Above findings indicate that in addition to postponing elective procedures, emergency admissions were dramatically curtailed during the COVID-19 lockdown. As this surely is unexpected and unintended, reasons are undoubtedly complex. As consequences in morbidity and mortality are still unpredictable, efforts should be made to accommodate all patients in need of hospital access going forward.

by Weiwei Ping, Jianzhong Zheng, Xiaohong Niu, Chongzheng Guo, Jinfang Zhang, Hui Yang, Yan Shi
Objective Since December 2019, an increasing number of cases of the 2019 novel coronavirus disease (COVID-19) infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been identified in Wuhan, Hubei Province, China. Now, more cases have been reported in 200 other countries and regions. The pandemic disease not only affects physical health who suffered it, but also affects the mental health of the general population. This study aims to know about the impact of the COVID-19 epidemic on the health-related quality of life (HRQOL) of living using EQ-5D in general population in China. Methods An online-based survey was developed and participants were recruited via social media. The questionnaires included demographic and socioeconomic data, health status, the condition epidemic situation and EQ-5D scale. The relationships of all factors and the scores of EQ-5D were analyzed. Logistic regression model were used to the five health dimensions. Results The respondents obtained a mean EQ-5D index score of 0.949 and a mean VAS score of 85.52.The most frequently reported problem were pain/discomfort (19.0%) and anxiety/depression (17.6%). Logistic regression models showed that the risk of pain/discomfort and anxiety/depression among people with aging, with chronic disease, lower income, epidemic effects, worry about get COVID-19 raised significantly. Conclusion The article provides important evidence on HRQOL during the COVID-19 pandemic. The risk of pain/discomfort and anxiety/depression in general population in China raised significantly with aging, with chronic disease, lower income, epidemic effects, worried about get COVID-19 during the COVID-19 pandemic. The results from each categorical data can be used for future healthcare measures among general population.

Title: Saúde mental e atenção psicossocial na pandemia COVID-19: crianças na pandemia COVID-19
Authors: Marin, Angela Helena; Andrada, Bárbara Costa; Schmidt, Beatriz; Melo, Bernardo Dolabella; Lima, Carolyne Cesar; Fernandes, Claudia Mascarenhas; Ventura, Cristina; Pereira, Daphne Rodrigues; Serpeloni, Fernanda; Katz, Ilana; Silva, Iolete Ribeiro da; Lopes, Juliana Crespo; Manara, Kalil Maihub; Moysés, Maria Aparecida; Abelson, Maria Isabel; Rosa, Mariana; Kadri, Michele; Magrin, Nicolly Papacidero; Almeida, Patrícia; Arantes, Ricardo Lugon; Paludo, Simone dos Santos; Assis, Simone Gonçalves
Abstract: O objetivo desta cartilha é apresentar aspectos referentes à
saúde mental e à atenção psicossocial a crianças na pandemia da
COVID-19. Serão destacados, em particular, estressores relacionados
à intensificação das interações familiares articulados à fragilização
do funcionamento das redes de apoio. Além disso, também será
enfatizada a atenção às crianças com demandas específicas de saúde
e às refugiadas ou migrantes. Assim, pretende-se oferecer subsídios
para a prática de profissionais da saúde que trabalhem junto a crianças
e suas famílias, buscando auxiliá-las a lidar com situações desafiadoras
que podem ser enfrentadas durante essa emergência de saúde pública.
É importante que tais profissionais façam valer seu compromisso ético
com essa população, no sentido de manter e garantir seus direitos civis,
bem como eliminar as possíveis barreiras sociais que impedem sua
experiência e participação com equidade, em igualdade de condições
com as demais pessoas

by Zhenhuan Cao, Tongzeng Li, Lianchun Liang, Haibo Wang, Feili Wei, Sha Meng, Miaotian Cai, Yulong Zhang, Hui Xu, Jiaying Zhang, Ronghua Jin

The outbreak of Coronavirus Disease (COVID-19) in Wuhan have affected more than 250 countries and regions worldwide. However, most of the clinical studies have been focused on Wuhan, and little is known about the disease outside of Wuhan in China. In this retrospective cohort study, we report the early clinical features of 80 patients with COVID-19 admitted to the hospital in Beijing. The results show that 27 (33.8%) patients had severe illness. Six (7.5%) patients were admitted to the ICU, and 3 (3.8%) patients died. Forty-eight percent (39/80) of the patients had a history of living/traveling in Wuhan. Patients with severe- illness were significantly older (average age, 71 years old vs 44 years old) and had a high incidence of expectoration (59.3% vs 34.0%), shortness of breath (92.6% vs 9.4%), anorexia (51.9% vs 18.9%) and confusion(18.5% vs 0%) compared with nonsevere patients. The systolic blood pressure (median, 130 mmHg vs 120 mmHg) was higher and the oxygen saturation (median, 98.3% vs 92.0%) was significantly lower in severe patients than nonsevere patients. In addition, myoglobin (median, 56.0 ng/mL vs 35.0 ng/mL), troponin I (median, 0.02 pg/mL vs 0.01 pg/mL), C-reactive protein (median, 69.7 mg/L vs 12.9 mg/L) and neutrophils (median, 3.3×109/L vs 2.2×109/L) were significantly increased, while lymphocytes (median, 0.8×109/L vs 1.2×109/L), albumin (mean, 32.8 g/L vs 36.8 g/L) and the creatinine clearance rate (median, 91.2 vs 108.2 ml/min/1.73m2) were significantly decreased among severe patients. Our study revealed that older patients with high levels of C-reactive protein, myoglobin, troponin I, and neutrophil and high systolic blood pressure as well as low levels of lymphocytes, and albumin and a low creatinine clearance rate and oxygen saturation were more likely to have severe disease.

by Baptiste Vasey, Anuraj H. Shankar, Bobby Brooke Herrera, Aniuska Becerra, Kris Xhaja, Marion Echenagucia, Sara R. Machado, Diana Caicedo, John Miller, Paolo Amedeo, Elena N. Naumova, Irene Bosch, Norma Blumenfeld deBosch

Dengue is a major public health problem worldwide with distinct clinical manifestations: an acute presentation (dengue fever, DF) similar to other febrile illnesses (OFI) and a more severe, life-threatening form (severe dengue, SD). Due to nonspecific clinical presentation during the early phase of dengue infection, differentiating DF from OFI has remained a challenge, and current methods to determine severity of dengue remain poor early predictors. We present a prospective clinical cohort study conducted in Caracas, Venezuela from 2001–2005, designed to determine whether clinical and hematological parameters could distinguish DF from OFI, and identify early prognostic biomarkers of SD. From 204 enrolled suspected dengue patients, there were 111 confirmed dengue cases. Piecewise mixed effects regression and nonparametric statistics were used to analyze longitudinal records. Decreased serum albumin and fibrinogen along with increased D-dimer, thrombin-antithrombin complex, activated partial thromboplastin time and thrombin time were prognostic of SD on the day of defervescence. In the febrile phase, the day-to-day rates of change in serum albumin and fibrinogen concentration, along with platelet counts, were significantly decreased in dengue patients compared to OFI, while the day-to-day rates of change of lymphocytes (%) and thrombin time were increased. In dengue patients, the absolute lymphocytes to neutrophils ratio showed specific temporal increase, enabling classification of dengue patients entering the critical phase with an area under the ROC curve of 0.79. Secondary dengue patients had elongation of Thrombin time compared to primary cases while the D-dimer formation (fibrinolysis marker) remained always lower for secondary compared to primary cases. Based on partial analysis of 31 viral complete genomes, a high frequency of C-to-T transitions located at the third codon position was observed, suggesting deamination events with five major hot spots of amino acid polymorphic sites outside in non-structural proteins. No association of severe outcome was statistically significant for any of the five major polymorphic sites found. This study offers an improved understanding of dengue hemostasis and a novel way of approaching dengue diagnosis and disease prognosis using piecewise mixed effect regression modeling. It also suggests that a better discrimination of the day of disease can improve the diagnostic and prognostic classification power of clinical variables using ROC curve analysis. The piecewise mixed effect regression model corroborated key early clinical determinants of disease, and offers a time-series approach for future vaccine and pathogenesis clinical studies.

Title: Molecular alterations in the extracellular matrix in the brains of newborns with congenital Zika syndrome
Authors: Aguiar, Renato S.; Pohl, Fabio; Morais, Guilherme L.; Nogueira, Fabio C. S.; Carvalho, Joseane B.; Guida, Letícia; Arge, Luis W. P.; Melo, Adriana; Moreira, Maria Elisabeth Lopes; Cunha, Daniela P; Gomes, Leonardo; Portari, Elyzabeth A.; Velasquez, Erika; Melani, Rafael D.; Pezzuto, Paula; Castro, Fernanda L. de; Geddes, Victor E. V.; Gerber, Alexandra L.; Azevedo, Girlene S.; Schamber-Reis, Bruno L.; Gonçalves, Alessandro L.; Junqueira-de-Azevedo, Inácio; Nishiyama, Milton Y.; Ho, Paulo L.; Schanoski, Alessandra S.; Schuch, Viviane; Tanuri, Amilcar; Chimelli, Leila; Vasconcelos, Zilton Farias Meira de; Domont, Gilberto B.; Vasconcelos, Ana T. R.; Nakaya, Helder I.
Abstract: A infecção pelo vírus zika (ZIKV) durante a gravidez pode causar um conjunto de anormalidades graves no feto, conhecidas como síndrome congênita do zika (CZS). Experimentos com modelos animais e sistemas in vitro contribuíram substancialmente para a nossa compreensão da fisiopatologia da infecção pelo ZIKV. Aqui, para investigar a base molecular da CZS em humanos, usamos uma abordagem de biologia de sistemas para integrar dados transcriptômicos, proteômicos e genômicos dos cérebros post-mortem de neonatos com CZS. Observamos que os colágenos foram bastante reduzidos em expressão nos cérebros de CZS nos níveis de RNA e de proteínas e que os neonatos com CZS tinham vários polimorfismos de nucleotídeo único em genes que codificam colágeno que estão associados à osteogênese imperfeita e à artrogripose. Esses achados foram validados por imuno-histoquímica e análise comparativa da abundância de colágeno em amostras infectadas e não infectadas por ZIKV. Além disso, mostramos um aumento dependente de ZIKV na expressão de fatores de adesão celular que são essenciais para o crescimento de neurites e a orientação do axônio, achados consistentes com os defeitos de migração neuronal observados na CZS. Juntos, esses achados fornecem informações sobre as alterações moleculares subjacentes no cérebro infectado pelo ZIKV e revelam genes hospedeiros associados à suscetibilidade à CZS.
Description: Data and materials availability: The transcriptomic dataset associated with the current article is publicly available at GEO (www.ncbi.nlm.nih.gov/geo/), Project accession GSE125554. The proteomics dataset associated with the current article is publicly available in ProteomeXchange (www.proteomexchange.org/), Project accession PXD012461. The exome dataset associated to our study is publicly available in SRA-NCBI (www.ncbi.nlm.nih.gov/sra), SRA accession PRJNA517145. All other data needed to evaluate the conclusions in the paper are present in the paper and/or the Supplementary Materials.

Title: O uso intensivo da internet por crianças e adolescentes no contexto da COVID-19 e os riscos para violências autoinflingidas
Authors: Deslandes, Suely Ferreira; Coutinho, Tiago
Abstract: O presente ensaio busca discutir as implicações do isolamento social devido à pandemia do COVID-19 para o uso intensivo da internet entre crianças e adolescentes e suas possíveis consequências para a prática de violências autoinflingidas. Discutimos brevemente o potencial ansiogênico e a reprodução de um “medo global” que se consolidam com a exposição maciça e sem mediação dos conteúdos consumidos, que podem aumentar as vulnerabilidades para estresse e ideações suicidas. Centramos nosso debate sobre práticas “recreativas”, denominadas de “desafios” com poder autolesivo, realizados por adolescentes no site Youtube. Essa prática revelou-se crescente a partir das medidas de isolamento social. Nossa reflexão sobre esses riscos é feita a partir da perspectiva teórica da sociabilidade digital, e suas implicações nas interações de adolescentes mediadas pela internet.

Title: Epidemiologia, ciências sociais e políticas de saúde no enfrentamento da COVID-19
Authors: Silva, Antônio Augusto Moura da; Minayo, Maria Cecília de Souza; Gomes, Romeu
Abstract: Neste fascículo, a Revista Ciência & Saúde Coletiva publica um temático sobre a COVID-19, fruto da demanda espontânea, no qual são publicados estudos que mostram a contribuição da epidemiologia, das ciências sociais e das políticas de saúde no enfrentamento dessa doença. Sabe-se que o registro de casos da COVID-19 abrange apenas uma pequena parte dos infectados e não se sabe qual a proporção de casos assintomáticos. Hallal et al., por meio de testes rápidos para diagnóstico da COVID-19, a partir da detecção da prevalência da infecção em sintomáticos e assintomáticos, planejam estimar o percentual de casos assintomáticos na população. Isso é muito importante, pois, se o percentual de casos assintomáticos for elevado, a letalidade da doença será mais baixa do que o valor atualmente estimado de 1,4%3. Publicamos o protocolo desse importante estudo, ainda em andamento.

by Lindsay N. Carpp, Youyi Fong, Matthew Bonaparte, Zoe Moodie, Michal Juraska, Ying Huang, Brenda Price, Yingying Zhuang, Jason Shao, Lingyi Zheng, Laurent Chambonneau, Robert Small, Saranya Sridhar, Carlos A. DiazGranados, Peter B. Gilbert

We previously showed that Month 13 50% plaque reduction neutralization test (PRNT50) neutralizing antibody (nAb) titers against dengue virus (DENV) correlated with vaccine efficacy (VE) of CYD-TDV against symptomatic, virologically-confirmed dengue (VCD) in the CYD14 and CYD15 Phase 3 trials. While PRNT is the gold standard nAb assay, it is time-consuming and costly. We developed a next-generation high-throughput microneutralization (MN) assay and assessed its suitability for immune-correlates analyses and immuno-bridging applications. We analyzed MN and PRNT50 titers measured at baseline and Month 13 in a randomly sampled immunogenicity subset, and at Month 13 in nearly all VCD cases through Month 25. For each serotype, MN and PRNT50 titers showed high correlations, at both baseline and Month 13, with MN yielding a higher frequency of baseline-seronegatives. For both assays, Month 13 titer correlated inversely with VCD risk. Like PRNT50, high Month 13 MN titers were associated with high VE, and estimated VE increased with average Month 13 MN titer. We also studied each assay as a valid surrogate endpoint based on the Prentice criteria, which supported each assay as a valid surrogate for DENV-1 but only partially valid for DENV-2, -3, and -4. In addition, we applied Super-Learner to assess how well demographic, Month 13 MN, and/or Month 13 PRNT50 titers could predict Month 13–25 VCD outcome status; prediction was best when using demographic, MN, and PRNT50 information. We conclude that Month 13 MN titer performs comparably to Month 13 PRNT50 titer as a correlate of risk, correlate of vaccine efficacy, and surrogate endpoint. The MN assay could potentially be used to assess nAb titers in immunogenicity studies, immune-correlates studies, and immuno-bridging applications. Additional research would be needed for assessing the utility of MN titer in correlates analyses of other DENV endpoints and over longer follow-up periods.

Title: The global scientific research response to the public health emergency of Zika virus infection
Authors: Oliveira, Juliane Fonseca de; Pescarini, Julia Moreira; Rodrigues, Moreno de Souza; Almeida, Bethania de Araujo; Henriques, Claudio Maierovitch Pessanha; Gouveia, Fabio Castro; Rabello, Elaine Teixeira; Matta, Gustavo Correa; Barreto, Mauricio L.; Sampaio, Ricardo Barros

by Kyran M. Staunton, Jacob E. Crawford, Devon Cornel, Peter Yeeles, Mark Desnoyer, Josh Livni, Jodi Holeman, F. Stephen Mulligan, Nigel Snoad, Scott A. Ritchie

As Aedes aegypti continues to expand its global distribution, the diseases it vectors (dengue, Zika, chikungunya and yellow fever) are of increasing concern. Modern efforts to control this species include “rear and release” strategies where lab-reared mosquitoes are distributed throughout the landscape to replace or suppress invasive populations. These programs require intensive surveillance efforts to monitor their success, and the Biogents Sentinel (BGS) trap is one of the most effective tools for sampling adult Ae. aegypti. BGS trap catches can be highly variable throughout landscapes, so we investigated the potential impacts of environmental factors on adult Ae. aegypti capture rates during a “rear and release” program in California to better understand the relative contributions of true variability in population density across a landscape and trap context. We recorded male and female Ae. aegypti catches from BGS traps, with and without CO2, throughout control sites where no mosquitoes were released and in treatment sites where males infected with Wolbachia were released. BGS trap catches were positively influenced by higher proportions of shade or bushes in the front yard of the premises as well as the presence of potential larval habitats such as subterranean vaults. In contrast, an increase in residential habitat within a 100 m radius of trap locations negatively influenced BGS trap catches. For male Ae. aegypti, increased visual complexity of the trap location positively influenced capture rates, and the presence of yard drains negatively affected catch rates in control sites. Lastly, for BGS traps using CO2, higher catch rates were noted from traps placed greater than one meter from walls or fences for both male and female mosquitoes. These results have important implications for surveillance programs of Ae. aegypti throughout the Californian urban environment including adult monitoring during “rear and release” programs.

by Laura E. Lamb, Sarah N. Bartolone, Elijah Ward, Michael B. Chancellor

Novel Corona virus/Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2 or 2019-nCoV), and the subsequent disease caused by the virus (coronavirus disease 2019 or COVID-19), is an emerging global health concern that requires a rapid diagnostic test. Quantitative reverse transcription PCR (qRT-PCR) is currently the standard for SARS-CoV-2 detection; however, Reverse Transcription Loop-Mediated Isothermal Amplification (RT-LAMP) may allow for faster and cheaper field based testing at point-of-risk. The objective of this study was to develop a rapid screening diagnostic test that could be completed in 30–45 minutes. Simulated patient samples were generated by spiking serum, urine, saliva, oropharyngeal swabs, and nasopharyngeal swabs with a portion of the SARS-CoV-2 nucleic sequence. RNA isolated from nasopharyngeal swabs collected from actual COVID-19 patients was also tested. The samples were tested using RT-LAMP as well as by conventional qRT-PCR. Specificity of the RT-LAMP was evaluated by also testing against other related coronaviruses. RT-LAMP specifically detected SARS-CoV-2 in both simulated patient samples and clinical specimens. This test was performed in 30–45 minutes. This approach could be used for monitoring of exposed individuals or potentially aid with screening efforts in the field and potential ports of entry.

Title: Desafios e oportunidades para telessaúde em tempos da pandemia pela COVID-19: uma reflexão sobre os espaços e iniciativas no contexto brasileiro
Authors: Caetano, Rosângela; Silva, Angélica Baptista; Guedes, Ana Cristina Carneiro Menezes; Paiva, Carla Cardi Nepomuceno de; Ribeiro, Gizele da Rocha; Santos, Daniela Lacerda; Silva, Rondineli Mendes da
Abstract: A COVID-19 tem representado um desafio global aos sistemas de saúde, expandindo em velocidade crescente de óbitos, de pacientes críticos com pneumonia e necessidade de suporte respiratório. Métodos alternativos para controlar a propagação da doença, como o isolamento social, medidas extremas de quarentena e o rastreio dos contactantes dos casos têm sido utilizados no mundo. Contudo, essas medidas podem não ser totalmente eficazes para combater a escalada da COVID-19 em compasso às preparações nacionais necessárias às novas demandas de cuidado. Ampla gama de tecnologias digitais pode ser usada para aprimorar essas estratégias de saúde pública, e a pandemia gerou um frenesi relacionado à telessaúde. No Brasil, esse campo tem crescido acentuadamente nos últimos anos. Todavia, a despeito da intensa proliferação de normativas, ainda inexistia, até a epidemia, um marco regulatório plenamente consolidado no país. O surgimento da COVID-19 marca um momento profícuo de expansão das aplicações e usos da telessaúde, como forma de melhorar a resposta do sistema de saúde à crise em curso. O artigo discute a contribuição da telessaúde para o enfrentamento da COVID-19 e as iniciativas recentes desencadeadas no país, como oportunidades para a consolidação da telemedicina e de aperfeiçoamento do Sistema Único de Saúde. Concluiu-se que a telessaúde oferece capacidades para triagem, cuidado e tratamento remotos, auxilia o monitoramento, vigilância, detecção e prevenção, e para a mitigação dos impactos aos cuidados de saúde indiretamente relacionados a COVID-19. As iniciativas desencadeadas nesse processo podem reconfigurar o espaço futuro da telemedicina na prática dos serviços no território.

by Beniamino Caputo, Gianluca Russo, Mattia Manica, Francesco Vairo, Piero Poletti, Giorgio Guzzetta, Stefano Merler, Carolina Scagnolari, Angelo Solimini
Key results Both outbreaks started in small towns, but cases were also detected in nearby larger cities where transmission was limited to small clusters. The time spans between the first and the last symptom onsets were similar between the 2 outbreaks, and the delay from the symptom onset of the index case and the first case notified was considerable. Comparable infection and transmission rates were observed in laboratory. The basic reproductive number (R0) was estimated in the range of 1.8–6 (2007) and 1.5–2.6 (2017). Clinical characteristics were similar between outbreaks, and no acute complications were reported, though a higher frequency of ocular symptoms, myalgia, and rash was observed in 2017. Very little is known about the immune mediator profile of CHIKV-infected patients during the 2 outbreaks. Regarding public health responses, after the 2007 outbreak, the Italian Ministry of Health developed national guidelines to implement surveillance and good practices to prevent and control autochthonous transmission. However, only a few regional authorities implemented it, and the perception of outbreak risk and knowledge of clinical symptoms and transmission dynamics by general practitioners remained low. Major conclusions Efforts should be devoted to developing suitable procedures for early detection of virus circulation in the population, possibly through the analysis of medical records in near real time. Increasing the awareness of CHIKV of general practitioners and public health officials through tailored education may be effective, especially in small coastal towns where the outbreak risk may be higher. A key element is also the shift of citizen awareness from considering Aedes mosquitoes not only as a nuisance problem but also as a public health one. We advocate the need of strengthening the surveillance and of promoting the active participation of the communities to prevent and contain future outbreaks.

Title: Cadernos CRIS-Fiocruz: Panorama da Resposta Global à COVID-19 - Maio - 2020
Description: Informe produzido pelo CRIS-Fiocruz, sobre a semana de 19 a 25 de maio de 2020; Projeto Gráfico: Antonio Augusto Farah de Mesquita

Title: Discursos sobre o aborto na epidemia de zika: análise da cobertura dos jornais O Globo e Folha de S.Paulo
Authors: Castilhos, Washington; Almeida, Carla
Abstract: O objetivo do estudo aqui apresentado foi analisar a cobertura da grande imprensa nacional sobre o aborto em caso de Zika e examinar se esta reforçou os discursos já associados à prática ou se ampliou e qualificou a discussão sobre o tema. Trata-se de pesquisa qualitativa realizada com base na análise de 43 notícias sobre Zika/microcefalia/aborto publicadas pelos jornais O Globo e Folha de S.Paulo entre novembro de 2015 e dezembro de 2016. Baseando-se em conceitos do Jornalismo e da Análise do Discurso, identificamos as fontes presentes na cobertura e analisamos os argumentos por elas usados para justificar suas posições, além de estratégias, saberes e valores mobilizados nesta argumentação. Constatamos que os dois jornais privilegiaram fontes especializadas - médicos na Folha de S.Paulo e advogados e juristas em O Globo - e silenciaram as vozes de mulheres diretamente afetadas. Quanto à argumentação, as fontes favoráveis ao direito ao aborto em caso de Zika denunciaram, sobretudo, as injustiças sociais, enquanto as contrárias à proposta reacionaram o discurso em defesa da vida. Observamos a predominância de saberes de crença e valores morais na arena discursiva analisada, marcada ainda por analogias carregadas de sentidos negativos nos dois polos do debate. Comparando nossos dados aos de outros estudos sobre o aborto na mídia, consideramos que a cobertura da grande imprensa sobre Zika/microcefalia/aborto desempenhou um papel relevante na reconfiguração do discurso midiático sobre o tema, caracterizada por um enfoque mais técnico, pela pluralidade de vozes e posicionamentos, e por maior espaço reservado a argumentos favoráveis baseados em princípios constitucionais.

Title: Yellow fever outbreak in a rural-urban mixed community of Espírito Santo, Brazil: epidemiological aspects
Authors: Moussallem, Tálib Moysés; Gava, Caroline; Ardisson, Karla Spandl; Marques, Clemilda Soares; Graceli, Giselle Calmon; Koski, Aline da Penha Valadares; Almada, Gilton Luiz; Silva, Alexandre Rodrigues da; Jesus, Fernando Antonio Alves de; Rodrigues, Gilsa Aparecida Pimenta; Silva, Theresa Cristina Cardoso da
Abstract: Objetivo. Descrever os aspectos epidemiológicos de um surto de febre amarela ocorrido no Estado de Espírito Santo, Brasil, no período de 1o de janeiro de 2017 a 31 de julho de 2017. Métodos. O estudo se baseou em um enfoque descritivo, quantitativo e retrospectivo para analisar dados secundários obtidos dos sistemas nacionais de notificação: Sistema de Informação de Agravos de Notificação (SINAN), sistema Gerenciador de Ambiente Laboratorial (GAL) e Secretaria de Estado da Saúde de Espírito Santo (SESA). Resultados. No período de 1o de janeiro de 2017 a 8 de julho de 2017, 824 casos foram notificados no Espírito Santo, sendo 307 (37%) confirmados como febre amarela. Ocorreram 95 casos de morte pela doença (30,9%). O sexo masculino foi o mais afetado, sendo registrados 244 casos (79,5%) no sexo masculino e 63 casos (20,5%) no sexo feminino. A taxa de incidência mais alta foi verificada na cidade de Santa Leopoldina, com 380,2 casos por 100 mil habitantes. O surto progrediu rapidamente e a resposta foi possível com a ação de um grupo multidisciplinar formado para combater o surto de febre amarela. Conclusões. Os dados foram obtidos e analisados com rapidez e a resposta, consistindo de tratamento imediato dos casos e uma estratégia de vacinação de bloqueio, visou deter a progressão desta doença fatal. Apesar dos esforços, a taxa de letalidade da febre amarela continuou alta.

Title: Uncertainty in times of medical emergency: knowledge gaps and structural ignorance during the Brazilian Zika crisis
Authors: Kelly, Ann H.; Lezaun, Javier; Löwy, Ilana; Matta, Gustavo Corrêa; Nogueira, Carolina de Oliveira; Rabello, Elaine Teixeira

Title: Discordant Zika Virus Findings in Twin Pregnancies Complicated by Antenatal Zika Virus Exposure: A Prospective Cohort
Authors: Sobhani, Nasim C.; Avvad-Portari, Elyzabeth; Nascimento, Aline C. M.; Machado, Heloisa N.; Lobato, Daniel S. S.; Pereira, Jose Paulo; Esquivel, Mikaela S.; Vasconcelos, Zilton C.; Zin, Andrea A.; Tsui, Irena; Adachi, Kristina; Brickley, Elizabeth B.; Fisher, Susan J.; Nielsen-Saines, Karin; Brasil, Patricia; Moreira, Maria E.; Gaw, Stephanie L.

Title: Patients with COVID-19 and neurological manifestations show undetectable SARS-CoV-2 RNA levels in the cerebrospinal fluid
Authors: Espíndola, Otávio de Melo; Siqueira, Marilda; Soares, Cristiane Nascimento; Lima, Marco Antonio Sales Dantas de; Leite, Ana Claudia Celestino Bezerra; Araujo, Abelardo Queiroz Campos; Brandão, Carlos Otávio; Silva, Marcus Tulius Teixeira

by Mahamud-ur Rashid, Ali Zahedi-Amiri, Kathleen K. M. Glover, Ang Gao, Michaela E. Nickol, Jason Kindrachuk, John A. Wilkins, Kevin M. Coombs

Zika virus (ZIKV), a neglected tropical disease until its re-emergence in 2007, causes microcephaly in infants and Guillain-Barré syndrome in adults. Its re-emergence and spread to more than 80 countries led the World Health Organization in 2016 to declare a Public Health Emergency. ZIKV is mainly transmitted by mosquitos, but can persist in infected human male semen for prolonged periods and may be sexually transmitted. Testicular Sertoli cells support ZIKV replication and may be a reservoir for persistent ZIKV infection. Electrical impedance analyses indicated ZIKV infection rapidly disrupted Vero cell monolayers but had little effect upon human Sertoli cells (HSerC). We determined ZIKV-induced proteomic changes in HSerC using an aptamer-based multiplexed technique (SOMAscan) targeting >1300 human proteins. ZIKV infection caused differential expression of 299 proteins during three different time points, including 5 days after infection. Dysregulated proteins are involved in different bio-functions, including cell death and survival, cell cycle, maintenance of cellular function, cell signaling, cellular assembly, morphology, movement, molecular transport, and immune response. Many signaling pathways important for maintenance of HSerC function and spermatogenesis were highly dysregulated. These included IL-6, IGF1, EGF, NF-κB, PPAR, ERK/MAPK, and growth hormone signaling. Down-regulation of the PPAR signaling pathway might impact cellular energy supplies. Upstream molecule analysis also indicated microRNAs involved in germ cell development were downregulated by infection. Overall, this study leads to a better understanding of Sertoli cellular mechanisms used by ZIKV during persistent infection and possible ZIKV impacts on spermatogenesis.

by Oscar M. Vidal, Jorge Acosta-Reyes, Jesús Padilla, Edgar Navarro-Lechuga, Elsa Bravo, Diego Viasus, Mauricio Arcos-Burgos, Jorge I. Vélez

Chikungunya virus (CHIKV), a mosquito-borne alphavirus of the Togaviridae family, is part of a group of emergent diseases, including arbovirus, constituting an increasing public health problem in tropical areas worldwide. CHIKV causes a severe and debilitating disease with high morbidity. The first Colombian autochthonous case was reported in the Colombian Caribbean region in September 2014. Within the next two to three months, the CHIKV outbreak reached its peak. Although the CHIKV pattern of clinical symptomatology has been documented in different epidemiological studies, understanding of the relationship between clinical symptomatology and variation in phenotypic response to CHIKV infection in humans remains limited. We performed a cross sectional study following 1160 individuals clinically diagnosed with CHIKV at the peak of the Chikungunya outbreak in the Colombian Caribbean region. We examined the relationship between symptomatology and diverse phenotypic responses. Latent Class Cluster Analysis (LCCA) models were used to characterize patients’ symptomatology and further identify subgroups of individuals with differential phenotypic response. We found that most individuals presented fever (94.4%), headache (73.28%) and general discomfort (59.4%), which are distinct clinical symptoms of a viral infection. Furthermore, 11/26 (43.2%) of the categorized symptoms were more frequent in women than in men. LCCA disclosed seven distinctive phenotypic response profiles in this population of CHIKV infected individuals. Interestingly, 282 (24.3%) individuals exhibited a lower symptomatic “extreme” phenotype and 74 (6.4%) patients were within the severe complex “extreme” phenotype. Although clinical symptomatology may be diverse, there are distinct symptoms or group of symptoms that can be correlated with differential phenotypic response and perhaps susceptibility to CHIKV infection, especially in the female population. This suggests that, comparatively to men, women are a CHIKV at-risk population. Further study is needed to validate these results and determine whether the distinct LCCA profiles are a result of the immune response or a mixture of genetic, lifestyle and environmental factors. Our findings could contribute to the development of machine learning and artificial intelligence approaches to characterizing CHIKV infection in other populations. Preliminary results show that the accuracy reached of some approaches reaches up to 92% overall, with substantial sensitivity, specificity and accuracy values per LCCA-derived cluster.

by Mansyur Arif, Patricia Tauran, Herman Kosasih, Ninny Meutia Pelupessy, Nurhayana Sennang, Risna Halim Mubin, Pratiwi Sudarmono, Emiliana Tjitra, Dewi Murniati, Anggraini Alam, Muhammad Hussein Gasem, Abu Tholib Aman, Dewi Lokida, Usman Hadi, Ketut Tuti Merati Parwati, Chuen-Yen Lau, Aaron Neal, Muhammad Karyana
Background Chikungunya virus (CHIKV) is often overlooked as an etiology of fever in tropical and sub-tropical regions. Lack of diagnostic testing capacity in these areas combined with co-circulation of clinically similar pathogens such as dengue virus (DENV), hinders CHIKV diagnosis. To better address CHIKV in Indonesia, an improved understanding of epidemiology, clinical presentation, and diagnostic approaches is needed. Methodology/Principal findings Acutely hospitalized febrile patients ≥1-year-old were enrolled in a multi-site observational cohort study conducted in Indonesia from 2013 to 2016. Demographic and clinical data were collected at enrollment; blood specimens were collected at enrollment, once during days 14 to 28, and three months after enrollment. Plasma samples negative for DENV by serology and/or molecular assays were screened for evidence of acute CHIKV infection (ACI) by serology and molecular assays. To address the co-infection of DENV and CHIKV, DENV cases were selected randomly to be screened for evidence of ACI. ACI was confirmed in 40/1,089 (3.7%) screened subjects, all of whom were DENV negative. All 40 cases initially received other diagnoses, most commonly dengue fever, typhoid fever, and leptospirosis. ACI was found at five of the seven study cities, though evidence of prior CHIKV exposure was observed in 25.2% to 45.9% of subjects across sites. All subjects were assessed during hospitalization as mildly or moderately ill, consistent with the Asian genotype of CHIKV. Subjects with ACI had clinical presentations that overlapped with other common syndromes, atypical manifestations of disease, or persistent or false-positive IgM against Salmonella Typhi. Two of the 40 cases were possibly secondary ACI. Conclusions/Significance CHIKV remains an underdiagnosed acute febrile illness in Indonesia. Public health measures should support development of CHIKV diagnostic capacity. Improved access to point-of-care diagnostic tests and clinical training on presentations of ACI will facilitate appropriate case management such as avoiding unneccessary treatments or antibiotics, early response to control mosquito population and eventually reducing disease transmission.

by Kathryn L. Schaber, Valerie A. Paz-Soldan, Amy C. Morrison, William H. D. Elson, Alan L. Rothman, Christopher N. Mores, Helvio Astete-Vega, Thomas W. Scott, Lance A. Waller, Uriel Kitron, John P. Elder, Christopher M. Barker, T. Alex Perkins, Gonzalo M. Vazquez-Prokopec

by Parveen Kaur, Laura Sandra Lello, Age Utt, Sujit Krishna Dutta, Andres Merits, Justin Jang Hann Chu

Chikungunya virus (CHIKV) is an alphavirus that causes a febrile illness accompanied by myalgia and arthralgia. Despite having re-emerged as a significant public health threat, there are no approved therapeutics or prophylactics for CHIKV infection. In this study, we explored the anti-CHIKV effects of proteasome inhibitors and their potential mechanism of antiviral action. A panel of proteasome inhibitors with different functional groups reduced CHIKV infectious titers in a dose-dependent manner. Bortezomib, which has been FDA-approved for multiple myeloma and mantle cell lymphoma, was further investigated in downstream studies. The inhibitory activities of bortezomib were confirmed using different cellular models and CHIKV strains. Time-of-addition and time-of-removal studies suggested that bortezomib inhibited CHIKV at an early, post-entry stage of replication. In western blot analysis, bortezomib treatment resulted in a prominent decrease in structural protein levels as early as 6 hpi. Contrastingly, nsP4 levels showed strong elevations across all time-points. NsP2 and nsP3 levels showed a fluctuating trend, with some elevations between 12 to 20 hpi. Finally, qRT-PCR data revealed increased levels of both positive- and negative-sense CHIKV RNA at late stages of infection. It is likely that the reductions in structural protein levels is a major factor in the observed reductions in virus titer, with the alterations in non-structural protein ratios potentially being a contributing factor. Proteasome inhibitors like bortezomib likely disrupt CHIKV replication through a variety of complex mechanisms and may display a potential for use as therapeutics against CHIKV infection. They also represent valuable tools for studies of CHIKV molecular biology and virus-host interactions.

by Crisanta Serrano-Collazo, Erick X. Pérez-Guzmán, Petraleigh Pantoja, Mariah A. Hassert, Idia V. Rodríguez, Luis Giavedoni, Vida Hodara, Laura Parodi, Lorna Cruz, Teresa Arana, Melween I. Martínez, Laura White, James D. Brien, Aravinda de Silva, Amelia K. Pinto, Carlos A. Sariol

Little is known about the contribution of virus-specific and cross-reacting antibodies (Abs) or the cellular immune response generated by a primary dengue (DENV) infection on the course of a secondary zika (ZIKV) infection in vivo. Here we show that the length of time between DENV/ZIKV infections has a qualitative impact on controlling early ZIKV replication. Depletion of DENV2-specific Abs in sera confirmed that those type-specific Abs do not contribute to ZIKV control. We show that the magnitude and durability of the neutralizing antibodies (nAbs) induced by a secondary ZIKV infection is modest compared to the response induced after a secondary heterologous DENV infection. Our in vivo results are showing a complex interplay between the cellular and innate immune responses characterized by a high frequency of plasmacytoid dendritic cells (pDC) correlating with an increase in the frequency of DENV antigen specific T cells and a significant control of ZIKV replication which is time dependent. Taken together, our results suggest that early after ZIKV infection other mechanisms such as the innate and cellular immune responses may play a predominant role in controlling ZIKV replication. Regardless of the time elapsed between infections there was no evidence of in vivo antibody-dependent enhancement (ADE) of ZIKV by DENV immunity. These findings have pivotal implications while interpreting ZIKV pathogenesis in flavivirus-experimented populations, diagnostic results interpretation and vaccine designs and schedules among others.

by Fulian Yin, Xinyu Xia, Nan Song, Lingyao Zhu, Jianhong Wu
Backgroud Effective communication of accurate information through social media constitutes an important component of public health interventions in modern time, when traditional public health approaches such as contact tracing, quarantine and isolation are among the few options for the containing the disease spread in the population. The success of control of COVID-19 outbreak started from Wuhan, the capital city of Hubei Province of China relies heavily on the resilience of residents to follow public health interventions which induce substantial interruption of social-economic activities, and evidence shows that opinion leaders have been playing significant roles in the propagation of epidemic information and public health policy and implementations. Methods We design a mathematical model to quantify the roles of information superspreaders in single specific information which outbreaks rapidly and usually has a short duration period, and to examine the information propagation dynamics in the Chinese Sina-microblog. Our opinion-leader susceptible-forwarding-immune (OL-SFI) model is formulated to track the temporal evolution of forwarding quantities generated by opinion leaders and normal users. Results Data fitting from the real data of COVID-19 obtained from Chinese Sina-microblog can identify the different contact rates and forwarding probabilities (and hence calculate the basic information forwarding reproduction number of superspreaders), and can be used to evaluate the roles of opinion leaders in different stages of the information propagation and the outbreak unfolding. Conclusions The parameterized model can be used to nearcast the information propagation trend, and the model-based sensitivity analysis can help to explore important factors for the roles of opinion leaders.

Title: Telemedicine as a tool for PrEP delivery during the COVID-19 pandemic in a large HIV prevention service in Rio de Janeiro-Brazil
Authors: Hoagland, Brenda; Torres, Thiago S.; Bezerra, Daniel R. B.; Geraldo, Kim; Pimenta, Cristina; Veloso, Valdilea G.; Grinsztejn, Beatriz
Description: Brief communication.

Title: De toda maneira tem que andar junto: ações intersetoriais entre saúde e educação para crianças vivendo com a síndrome congênita do vírus Zika
Authors: Sá, Miriam Ribeiro Calheiros de; Vieira, Ana Carolina Dias; Castro, Barbara S Madeira; Agostini, Olivia; Kuper, Hannah; Moreira, Maria Elisabeth Lopes; Moreira, Martha Cristina Nunes
Abstract: Com base na experiência de um programa de intervenção para famílias de crianças com a síndrome congênita do vírus Zika, que inclui múltiplas deficiências, em uma instituição de educação, foram observados os desafios e conquistas encontrados com a entrada dessas famílias no sistema escolar. O objetivo deste artigo foi explorar os achados de pesquisa realizada após a conclusão de um programa de intervenção mediante entrevistas semiabertas com profissionais da instituição, e as possíveis contribuições para a construção das relações intersetoriais visando à inclusão escolar de crianças com deficiência. É possível constatar uma mudança provocada pelo programa na relação entre as famílias e os profissionais da instituição de educação; as famílias tiveram espaço para elaborar seus receios e discutir o papel da escola na vida de crianças com deficiência. Dessa forma, os profissionais passaram a vê-las em uma posição mais ativa. Acredita-se que esta experiência possa favorecer outros serviços e municípios que busquem a inclusão escolar de crianças e adolescentes com deficiência assim como sua inclusão social e de suas famílias.
Description: Agradecimento à equipe do Centro de Atendimento Educacional Especializado por todo apoio e receptividade.