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The objectives were to estimate incidence of congenital syphilis and verify factors associated with vertical transmission. A national hospital-based study was performed in 2011-2012 with 23,894 postpartum women using an in-hospital interview and data from patient charts and prenatal cards. Univariate logistic regression was performed to verify factors associated with congenital syphilis. Estimated incidence of congenital syphilis was 3.51 per 1,000 live births (95%CI: 2.29-5.37) and vertical transmission rate was 34.3% (95%CI: 24.7-45.4). Congenital syphilis was associated with lower maternal schooling, black skin color, higher rate of risk factors for prematurity, late initiation of prenatal care, fewer prenatal visits, and lower rate of prenatal serological testing. Fetal mortality was six times higher in congenital syphilis, and newborns with congenital syphilis showed higher hospital admission rates. Congenital syphilis is a persistent public health problem in Brazil and is associated with greater social vulnerability and gaps in prenatal care. © 2016, Fundacao Oswaldo Cruz. All Rights Reserved.

Domingues R.M.S.M.,Instituto Nacional Of Infectologia Evandro Chagas | Szwarcwald C.L.,Institute Comunicacao e Informacao Cientifica e Tecnologica em Saude | Junior P.R.B.S.,Institute Comunicacao e Informacao Cientifica e Tecnologica em Saude | Leal M.C.,Escola Nacional de Saude Publica Sergio Arouca
Revista de Saude Publica | Year: 2014

Objective: Determine the coverage rate of syphilis testing during prenatal care and the prevalence of syphilis in pregnant women in Brazil. Methods: This is a national hospital-based cohort study conducted in Brazil with 23,894 postpartum women between 2011 and 2012. Data were obtained using interviews with postpartum women, hospital records, and prenatal care cards. All postpartum women with a reactive serological test result recorded in the prenatal care card or syphilis diagnosis during hospitalization for childbirth were considered cases of syphilis in pregnancy. The Chi-square test was used for determining the disease prevalence and testing coverage rate by region of residence, self-reported skin color, maternal age, and type of prenatal and child delivery care units. Results: Prenatal care covered 98.7% postpartum women. Syphilis testing coverage rate was 89.1% (one test) and 41.2% (two tests), and syphilis prevalence in pregnancy was 1.02% (95%CI 0.84;1.25). A lower prenatal coverage rate was observed among women in the North region, indigenous women, those with less education, and those who received prenatal care in public health care units. A lower testing coverage rate was observed among residents in the North, Northeast, and Midwest regions, among younger and non-white skin-color women, among those with lower education, and those who received prenatal care in public health care units. An increased prevalence of syphilis was observed among women with < 8 years of education (1.74%), who self-reported as black (1.8%) or mixed (1.2%), those who did not receive prenatal care (2.5%), and those attending public (1.37%) or mixed (0.93%) health care units. Conclusions: The estimated prevalence of syphilis in pregnancy was similar to that reported in the last sentinel surveillance study conducted in 2006. There was an improvement in prenatal care and testing coverage rate, and the goals suggested by the World Health Organization were achieved in two regions. Regional and social inequalities in access to health care units, coupled with other gaps in health assistance, have led to the persistence of congenital syphilis as a major public health problem in Brazil.

Girianelli V.R.,Instituto Nacional Of Infectologia Evandro Chagas | Thuler L.C.S.,Rio de Janeiro State Federal University | Thuler L.C.S.,Instituto Nacional Of Cancer Inca | e Silva G.A.,State University of Rio de Janeiro
Revista Brasileira de Ginecologia e Obstetricia | Year: 2016

Purpose To compare the predictive capability of HPV and Pap smear tests for screening pre-cancerous lesions of the cervix over a three-year follow-up, in a population of users of the Brazilian National Health System (SUS). Methods This is a retrospective cohort study of 2,032 women with satisfactory results for Pap smear and HPV tests using second-generation hybrid capture,made in a previous study. We followed them for 36 months with data obtained from medical records, the Cervix Cancer Information System (SISCOLO), and the Mortality Information System (SIM). The outcome was a histological diagnosis of cervical intraepithelial neoplasia grade 2 or more advanced lesions (CIN2+). We constructed progression curves of the baseline test results for the period, using the Kaplan-Meier method, and estimated sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratios for each test. Results A total of 1,440 women had at least one test during follow-up. Progression curves of the baseline test results indicated differences in capability to detect CIN2+ (p < 0.001) with significantly greater capability when both tests were abnormal, followed by only a positive HPV test. The HPV test was more sensitive than the Pap smear (88.7% and 73.6%, respectively; p < 0.05) and had a better negative likelihood ratio (0.13 and 0.30, respectively). Specificity and positive likelihood ratio of the tests were similar. Conclusions These findings corroborate the importance of HPV test as a primary cervical cancer screening. © 2016 by Thieme Publicações Ltda, Rio de Janeiro, Brazil.

Girianelli V.R.,Instituto Nacional Of Infectologia Evandro Chagas | Gamarra C.J.,Iguacu University | Azevedo e Silva G.,State University of Rio de Janeiro
Revista de Saude Publica | Year: 2014

Objective: To analyze cervical and breast cancer mortality in Brazil according to socioeconomic and welfare indicators. Methods: Data on breast and cervical cancer mortality covering a 30-year period (1980-2010) were analyzed. The data were obtained from the National Mortality Database, population data from the Brazilian Institute of Geography and Statistics database, and socioeconomic and welfare information from the Institute of Applied Economic Research. Moving averages were calculated, disaggregated by capital city and municipality. The annual percent change in mortality rates was estimated by segmented linear regression using the joinpoint method. Pearson's correlation coefficients were conducted between average mortality rate at the end of the three-year period and selected indicators in the state capital and each Brazilian state. Results: There was a decline in cervical cancer mortality rates throughout the period studied, except in municipalities outside of the capitals in the North and Northeast. There was a decrease in breast cancer mortality in the capitals from the end of the 1990s onwards. Favorable socioeconomic indicators were inversely correlated with cervical cancer mortality. A strong direct correlation was found with favorable indicators and an inverse correlation with fertility rate and breast cancer mortality in inner cities. Conclusions: There is an ongoing dynamic process of increased risk of cervical and breast cancer and attenuation of mortality because of increased, albeit unequal, access to and provision of screening, diagnosis and treatment.

Rodrigues A.M.,Federal University of Sao Paulo | Fernandes G.F.,Federal University of Sao Paulo | Araujo L.M.,Federal University of Sao Paulo | Della Terra P.P.,Federal University of Sao Paulo | And 6 more authors.
PLoS Neglected Tropical Diseases | Year: 2015

Background Sporothrix schenckii and associated species are agents of human and animal sporotrichosis that cause large sapronoses and zoonoses worldwide. Epidemiological surveillance has highlighted an overwhelming occurrence of the highly pathogenic fungus Sporothrix brasiliensis during feline outbreaks, leading to massive transmissions to humans. Early diagnosis of feline sporotrichosis by demonstrating the presence of a surrogate marker of infection can have a key role for selecting appropriate disease control measures and minimizing zoonotic transmission to humans. Methodology We explored the presence and diversity of serum antibodies (IgG) specific against Sporothrix antigens in cats with sporotrichosis and evaluated the utility of these antibodies for serodiagnosis. Antigen profiling included protein extracts from the closest known relatives S. brasiliensis and S. schenckii. Enzyme-linked immunosorbent assays and immunoblotting enabled us to characterize the major antigens of feline sporotrichosis from sera from cats with sporotrichosis (n = 49), healthy cats (n = 19), and cats with other diseases (n = 20). Principal Findings Enzyme-linked immunosorbent assay-based quantitation of anti-Sporothrix IgG exhibited high sensitivity and specificity in cats with sporotrichosis (area under the curve, 1.0; 95% confidence interval, 0.94–1; P<0.0001) versus controls. The two sets of Sporothrix antigens were remarkably cross-reactive, supporting the hypothesis that antigenic epitopes may be conserved among closely related agents. One-dimensional immunoblotting indicated that 3-carboxymuconate cyclase (a 60-kDa protein in S. brasiliensis and a 70-kDa protein in S. schenckii) is the immunodominant antigen in feline sporotrichosis. Two-dimensional immunoblotting revealed six IgG-reactive isoforms of gp60 in the S. brasiliensis proteome, similar to the humoral response found in human sporotrichosis. © 2015 Rodrigues et al.

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