成人腹泻病人轮状病毒感染监测及分组分型研究

目的研究武汉市成人腹泻病人轮状病毒的感染状况及A组轮状病毒基因型的分布。方法收集2001—2002年度武汉市成人腹泻大便标本728份,用聚丙烯酰胺凝胶电泳进行轮状病毒检测,逆转录—聚合酶链反应进行A组轮状病毒基因型研究。结果和结论2001—2002年度武汉市成人腹泻病人A、B组轮状病毒检出率分别为7.83%和0.27%。A组轮状病毒以G3P[8]型为主。成人A组轮状病毒流行的季节和基因型别与婴幼儿的一致。     

An Overview of Neglected Orthobunyaviruses in Brazil

Dozens of orthobunyaviruses have been isolated in Brazil, and at least thirteen have been associated with human disease. The Oropouche virus has received most attention for having caused explosive epidemics with hundreds of thousands of cases in the north region between the 1960sand the 1980s, and since then has been sporadically detected elsewhere in the country. Despite their importance, little is known about their enzootic cycles of transmission, amplifying hosts and vectors, and biotic and abiotic factors involved in spillover events to humans. This overview aims to combine available data of neglected orthobunyaviruses of several serogroups, namely, Anopheles A, Anopheles B, Bunyamwera, California, Capim, Gamboa, Group C, Guama, Simbu and Turlock, in order to evaluate the current knowledge and identify research gaps in their natural transmission cycles in Brazil to ultimately point to the future direction in which orthobunyavirus research should be guided.     

Hepatitis E virus infection in north-east Italy: serological study in the open population and groups at risk

SUMMARY. Developed western countries are considered to be relatively free from endemic foci of hepatitis E virus (HEV) infections. The aim of this study was to assess the seroepidemiology of HEV in north-east Italy. Of the 2361 individuals studied 1889 were representative of the general population and 472 were from groups at high risk for viral infections: 279 drug users and 193 patients on chronic haemodialysis. All sera were tested for hepatitis C virus antibody (HCVAb), human immunodeficiency virus antibody (HIVAb) and for hepatitis B virus (HBV) serology. Two solid-phase enzyme-linked immunosorbent assays (ELISA) were used to study the seroepidemiology of HEV IgG, the first (using recombinant antigens) for screening, the second (using synthetic peptides) for confirmation of initially reactive samples. The prevalence of circulating hepatitis E virus antibody (HEVAb) was 2.6% in the open population, 5.4% among drug users and 9.3% among patients on chronic haemodialysis. In the open population a positive relationship between age and prevalence of HEVAb was observed. A relationship between presence of HEVAb and serological evidence of previous HBV or HCV infections was also observed in this study. It was concluded that HEV infections are present in north-east Italy and are more frequent among subjects at risk for blood-borne viral infections. The positive correlation, observed in the open population, between age and prevalence of HEVAb suggests the presence of a cohort effect.     

Predictable Chikungunya Infection Dynamics in Brazil

Chikungunya virus (CHIKV) was first imported into the Caribbean in 2013 and subsequently spread across the Americas. It has infected millions in the region and Brazil has become the hub of ongoing transmission. Using Seasonal Autoregressive Integrated Moving Average (SARIMA) models trained and validated on Brazilian data from the Ministry of Health’s notifiable diseases information system, we tested the hypothesis that transmission in Brazil had transitioned from sporadic and explosive to become more predictable. Consistency weighted, population standardized kernel density estimates were used to identify municipalities with the most consistent inter-annual transmission rates. Spatial clustering was assessed per calendar month for 2017–2021 inclusive using Moran’s I. SARIMA models were validated on 2020–2021 data and forecasted 106,162 (95%CI 27,303–200,917) serologically confirmed cases and 339,907 (95%CI 35,780–1035,449) total notifications for 2022–2023 inclusive, with >90% of cases in the Northeast and Southeast regions. Comparing forecasts for the first five months of 2022 to the most up-to-date ECDC report (published 2 June 2022) showed remarkable accuracy: the models predicted 92,739 (95%CI 20,685–195,191) case notifications during which the ECDC reported 92,349 case notifications. Hotspots of consistent transmission were identified in the states of Para and Tocantins (North region); Rio Grande do Norte, Paraiba and Pernambuco (Northeast region); and Rio de Janeiro and eastern Minas Gerais (Southeast region). Significant spatial clustering peaked during late summer/early autumn. This analysis highlights how CHIKV transmission in Brazil has transitioned, making it more predictable and thus enabling improved control targeting and site selection for trialing interventions.     

Effect of rotavirus infection on small gut pathophysiology in a mouse model

AIM: To study the effect of rotavirus infection on amino acid uptake in the small intestine in an experimental mouse model. METHODS: Infant mice (7-8 days of age) were orally infected with the EB serotype 3 strain of rotavirus and animals (both infected and control) were killed on days 0, 1, 3, 5, 7 and 10 post inoculation (PI) after recording their bodyweights. Gamma-glutamyltranspeptidase (GGT), leucine amino peptidase (LAP), glutathione (GSH) and leucine amino acid uptake in the jejunum and ileum were assessed. RESULTS: Infected animals showed significant reduction in their bodyweights and intestinal lengths on the third day PI compared with controls. Leucine amino peptidase, GGT, GSH and leucine uptake were significantly reduced in the ileum on the third and fifth day PI compared with controls while uptake in the jejunum was only reduced on third day PI. The LAP, GGTP, GSH and leucine uptake attained normal levels on the seventh day when diarrhoea stopped. Histology showed damage to the villi in the jejunum and prominent cytoplasmic vacuolation in the ileum of infected animals on the third and fifth day PI. CONCLUSION: Rotavirus affects amino acid uptake in the small intestine at the time of peak infection.     

Clinical features and associated morbidity of scabies in a rural community in Alagoas, Brazil

Objective To describe the clinical characteristics of scabies and the associated morbidity in an impoverished rural community in northeast Brazil. Method A door‐to‐door survey was made to examine twice the population of an endemic area; first at the end of the rainy season, and a second time in the dry season 4 months later. Results In total, 2005 individuals were examined. The overall prevalence of scabies was 9.8% (95% CI 8.5–11.2). Predilection sites with similar relative frequencies in all age groups were the abdomen (83.7%) and the inguinal area/inner part of the thighs (66.3%). Hands, feet, genitals and the scalp/neck/face were significantly more often affected in children <7 years (all P < 0.03). Fifty‐five per cent of the patients showed scabies lesions simultaneously at ≥12 distinct topographic areas. Papular lesions were most commonly found, followed by papular‐crusted lesions. Vesicles were significantly more often observed in children (P = 0.04). Sixty‐four per cent of the patients had three or more types of lesions. Local lymphadenopathy was present in 53.6% and superinfection in 36.7% of the cases. The number of topographic areas affected, as well as the proportion of superinfected lesions, was inversely correlated with age (rho = −0.22, P = 0.002 and rho = −0.358, P < 0.05, respectively). The quantity of skin surface infested, the proportion of superinfected lesions and the presence of a superinfected lesion distal to an enlarged lymphnode were predictors of lymphadenopathy. Seventy‐two per cent of the patients suffered from sleep disorders, mainly because of itching. Conclusion Scabies is associated with considerable morbidity in this endemic community. Predilection sites, clinical presentation, quantity of skin surface affected and proportion of secondary infected lesions show a dichotomy between children and adults.     

Synergistic associations between hookworm and other helminth species in a rural community in Brazil

OBJECTIVE: To identify possible synergistic associations of hookworm and other helminths. METHOD: Cross-sectional survey of all households within 10 km2 of Americaninhas, a rural community in Minas Gerais, Brazil. We determined the prevalence and intensity of single and multiple helminth species infection in an age-stratified sample of 1332 individuals from 335 households. RESULTS: Hookworm was the most prevalent helminth infection (68.2%), followed by Ascaris lumbricoides (48.8%) and Schistosoma mansoni (45.3%). Overall, 60.6% of individuals harboured mixed helminth infections. Multivariate analysis indicated significant positive associations for co-infection with hookworm and S. mansoni and for co-infection with hookworm and A. lumbricoides. Co-infections with hookworm and A. lumbricoides resulted in higher egg counts for both, suggesting a synergistic relationship between these species, although, we found important age differences in this relationship. However, the intensity of S. mansoni or A. lumbricoides co-infection did not differ from that of mono-infection. CONCLUSION: These results have implications for the epidemiology, immunology and control of multiple helminth infections. More research is needed to examine the rates of re-infection and immune responses after chemotherapy, and to what extent the effects of polyparasitism are altered by chemotherapy.     

Understanding uptake of community groundwater monitoring in rural Brazil

Resource monitoring is often cited as important for effective common pool resources management. In practice, not all monitoring interventions are successful, particularly when the resource, such as groundwater, is challenging to monitor and measure. We conducted a field experiment on groundwater monitoring in Ceará, Brazil, where communities are increasingly reliant on groundwater yet do not engage in monitoring. Despite careful implementation, uptake of monitoring within the 80 treatment communities was low. To unpack this low uptake, we conduct multimethods exploratory research. We find that uptake is less likely in communities facing high coordination costs, either within the community leadership or across the broader community. Uptake is also less likely when there are physical barriers to monitoring, when there are more substitutes for groundwater, and when there is lower variability in water availability. Our findings can inform future monitoring interventions in similar contexts worldwide.     

河南省2008-2014年5岁以下腹泻儿童A组轮状病毒病原学及流行病学特征研究

目的 分析2008-2014年河南省5岁以下腹泻儿童A组轮状病毒的感染状况及流行病学特征。方法 采集河南省两个监测哨点医院5岁以下儿童腹泻病例的粪便样本2 098份,双抗体夹心法ELISA检测A组轮状病毒,阳性样本抽提病毒RNA,两步巢式多重RT-PCR进行G-P基因分型,同时收集病例临床与流行病学信息进行分析。结果 2 098份腹泻样本共检出A组轮状病毒688份,总阳性率32.8%。年检出率最高46.4%(2013年),最低26.7%(2009年)。轮状病毒检出率的季节性特征显著,存在秋季和春季两个高峰。A组轮状病毒型别组合以G9P^[8]、G2P^[4]、G3P^[8]、G1P^[8]为主,还存在部分混合感染型别。感染病例集中于4个月到1岁,以无临床症状或轻症为主。结论 河南省5岁以下腹泻患儿中存在较高的A组轮状病毒感染率,病原体可分为多种基因型别,感染人群具有显著的流行病学特征。     

膜芯片检测人B组、C组轮状病毒的初步研究

目的建立检测人B组、C组轮状病毒（RV）的膜芯片。方法采用化学合成法合成B组、C组RV高度保守的核酸扩增区域,以地高辛标记上游引物,经半巢式PCR扩增B组、C组RV的保守检测区域,采用本实验室自行研制的膜芯片进行杂交检测。结果B组、C组RV的扩增产物同膜芯片上特异探针呈高度特异杂交。结论自制的膜芯片检测技术能够实现B组、C组RV的检测．并具有特异性好、高通量、平行性和简便快速的特点。     

Comparison of Patients Monoinfected with Hepatitis C Virus and Coinfected with Hepatitis B/C in the Amazon Region of Brazil

Hepatitis B and C are the most common causes of liver disease worldwide. The two infections share many similarities such as a global distribution, the same routes of transmission, hepatotropism, and the ability to cause chronic infection. The consequences of HBV/HCV coinfection are still being studied. The aim of this study is to describe and compare the epidemiological and laboratory profile and the degree of hepatic fibrosis between HCV-monoinfected and HBV/HCV-coinfected patients in the Brazilian Amazon region. ELISA tests were used for the investigation of HBV and HCV serological markers, and molecular tests were used for the detection and genotyping of these viruses. Additionally, transaminases were measured, and a FibroScan was performed for the analysis of liver function. A total of 328 patients with HCV participated in the study. The serological prevalence of HCV/HBV coinfection was 10.77%. A comparison of risk factors between the monoinfected and coinfected groups showed that illicit drug use, sharing sharp instruments, and tattooing/piercing are significantly associated with coinfection. The monoinfected patients had a higher HCV load than the coinfected patients. A viral interaction was observed in this study in which the presence of a coinfection with HBV appears to influence HCV replication. Further studies are necessary to better understand this interaction.     

Impact of rotavirus vaccination on diarrhoea mortality and hospital admissions in Brazil

Objective To analyse the data reported by the national surveillance system of Brazil, including data on diarrhoea mortality and hospital admissions before and after rotavirus vaccine introduction, and evaluate the impact of its widespread use under operational conditions. Method Retrospective analysis of routinely collected data was reported by several surveillance systems of Brazil, comprising an 8‐year period of all diarrhoea‐related hospitalisations and deaths in children <5 years old (2002–2009). Linear regressions were used to compare trends of diarrhoea hospitalisations and deaths before and after vaccine introduction (2002–2005 vs. 2006–2009). Results There was a long‐term reduction in hospitalisations that preceded the introduction of the vaccine. This reduction was more marked in <1‐year‐old than in 1– to 4‐year‐old children. All‐cause diarrhoea hospitalisations decreased further after vaccine introduction and the decrease was larger in <1‐year‐old (?35.6%) than in 1– to 4‐year‐old children (?12.3%). The number of deaths was decreasing before vaccine introduction, and the decrease also accelerated after vaccine introduction, with deaths halving in <1‐year‐old and decreasing by 32.9% in 1‐ to 4‐year‐old children. The linear relationships between hospitalisations and deaths were statistically different before and after vaccine introduction. Conclusions The data demonstrate a decreasing trend in all‐cause diarrhoea‐related hospitalisations and deaths in children <5 years of age. These reductions were steeper between 2006 and 2009, highlighting the potential beneficial effect of the rotavirus vaccine associated with all‐cause diarrhoeal disease.     

The First Two Cases of Monkeypox Infection in MSM in Bahia,Brazil, and Viral Sequencing

Monkeypox infection is rapidly spreading across the world. Despite the increasing number of cases, only a few reports have been published, and most are on people living without HIV. We report here the first two cases of monkeypox infection in Bahia, Brazil, one of them in a person living with HIV, on stable treatment. Both cases had a similar evolution, with a limited number of lesions and mild symptoms, with a complete recovery after 7–10 days. The potential route of transmission was via oral sex for the first case and was undefined for the second one. Both cases were confirmed through detection of the viral genome by PCR, and the partial sequence of the first case indicates the infection was caused by the West African clade. These cases confirm that monkeypox infection is currently being transmitted in Brazil and that people living with HIV on stable treatment are not likely to present a more severe form of monkeypox.     

Hepatitis C prevalence among men who have sex with men in Central Brazil

To assess the prevalence of hepatitis C virus infection among men who have sex with men (MSM) in Central Brazil, a cross-sectional study was conducted in the City of Goiânia, Central Brazil, using Respondent-Driven Sampling (RDS). All serum samples were tested for anti-HCV and also for alanine aminotransferase (ALT). Anti-HCV positive samples and/or those with elevated ALT were tested for HCV RNA and genotyped. Of the 522 participants, four were found to be anti-HCV positive, and one was also HCV RNA positive (active HCV infection). Elevated ALT was found in 14 individuals. Of these, one showed evidence of acute HCV infection (HCV RNA positive and anti-HCV negative). Therefore, five MSM were positive for either anti-HCV and/or HCV RNA, giving a crude overall HCV prevalence of 1.0%; 1.3% (95% CI: 0.3–5.5) after being weighted by RDSAT. All five individuals reported high-risk sexual behaviors, including two who showed evidence of active HCV infection (genotype 1, subtypes 1a and 1b). Although the study population reported high-risk sexual practices, HCV infection was not more frequent in MSM than in the general Brazilian population.     

Geriatrics in Brazil: a big country with big opportunities

Brazil has approximately 180 million inhabitants, of whom 15.2 million are aged 60 and older and 1.9 million are aged 80 and older. By 2025, the Brazilian elderly population is expected to grow to more than 32 million. Brazil has many problems related to its geographic and population size. Great distances between major cities, marked cultural and racial heterogeneity between the various geographic regions, high poverty levels, and decreasing family size all combine to put pressure on the medical and social services that can be made available to the elder population. Less than 500 Brazilian physicians are certified as geriatricians, translating into one geriatrician for every 37,000 elderly Brazilians. Beside 15 geriatric medicine residencies a larger number of fellowship programs exist, and these programs are in high demand, with more than 20 candidates per position, indicating new opportunities for growth in elder care. In addition, geriatric initiatives such as the annual elder vaccination program and the elder statute, recently approved by the Brazilian Congress, indicate that geriatric care in Brazil is entering a new era of growth and development. Although the challenges remain great, there are opportunities for Brazilian geriatrics and gerontology.     

Seroprevalence of hepatitis E virus in chronic hepatitis C in Brazil

Background and aims

Hepatitis E virus infection in patients with underlying chronic liver disease is associated with liver decompensation and increased lethality. The seroprevalence of hepatitis E virus in patients with chronic hepatitis C in Brazil is unknown. This study aims to estimate the seroprevalence of hepatitis E virus in patients with chronic hepatitis C and to describe associated risk factors.

南京地区2011-2012年度门诊婴幼儿轮状病毒腹泻的分子流行病学研究

目的 了解南京地区门诊婴幼儿轮状病毒腹泻的分子流行病学特征及轮状病毒的G/P分型状况。方法 2011年7月至2012年6月对门诊腹泻患儿标本进行轮状病毒胶体金检测,阳性标本通过巢式反转录聚合酶连反应进行G/P分型,同时测序得出亚型。 结果 在2 081例腹泻标本中共检出胶体金阳性标本165例,阳性率为7.9%。轮状病毒感染的高峰季节在10月到次年2月之间, 94%的感染患儿都在2岁以下,其中13～24月龄为高发年龄段。轮状病毒分型结果表明G1, G3, G9为主要G分型,而P\[8\]则是最常见的P分型。常见的G／P组合为：G1P\[8\](16.4%), G3P\[8\](13.9%), G9P\[8\](24.8%)。进一步VP7和VP4基因测序比对后发现G1和G3毒株各分属于一个亚型G1 Ic,G3 Ia,而G9毒株大部分属于G9 IV亚型,同时也有一小部分毒株属于G9 III亚型,P\[8\]型毒株主要为P\[8\] II亚型,少数为P\[8\] IV亚型。 结论 研究结果表明G9P\[8\]是最主要的流行型别,同时G1P\[8\]和G3P\[8\]也占较大比例。     

Prevalence of human immunodeficiency virus/hepatitis C virus co-infection in Brazil and associated factors: a review

The hepatitis C virus and human immunodeficiency virus share the same transmission routes, which makes co-infection an unfavorable condition for the natural history of both viral diseases. In this context, it should be highlighted that the knowledge of the extent of co-infection and associated risk factors is a vital tool for prevention and control over infectious diseases. The aim of this study was to review the literature, seeking to examine the prevalence of human immunodeficiency virus/hepatitis C virus co-infection reported in studies conducted in Brazil, and identify the main risk factors associated with co-infection.The electronic search was conducted in the Medline, Lilacs and SciELO databases. The following keywords were used: human immunodeficiency virus and Hepatitis C or hepatitis C virus and Brazil. The search led to 376 articles, of which 69 were selected for data extraction. We excluded animal studies, reports or case series, review articles, letters to the editor, other types of hepatitis and those studies in which co-infected patients were intentionally selected for comparison to single infected individuals. As a result, 40 articles were reviewed. The majority of the population in these studies was male (71%) and young adults, with a mean age of 26.7 years. The prevalence of hepatitis C virus co-infection among individuals living with human immunodeficiency virus in the studies conducted in Brazil ranged from 3.3% (serum samples) to 82.4% (drug users), with an average of 20.3%. The findings reveal that the prevalence of human immunodeficiency virus/hepatitis C virus co-infection is highly variable, depending on the characteristics of the study population. Risk factors associated with human immunodeficiency virus/hepatitis C virus co-infection were injection drug use and blood transfusion.