RESUMO
BACKGROUND: The rise in dengue fever cases and the absence of dengue vaccines will likely cause governments to consider various types of effective means for controlling the disease. Given strong public interests in potential dengue vaccines, it is essential to understand the private economic benefits of dengue vaccines for accelerated introduction of vaccines into the public sector program and private markets of high-risk countries. METHODOLOGY/PRINCIPAL FINDINGS: A contingent valuation study for a hypothetical dengue vaccine was administered to 400 households in a multi-country setting: Vietnam, Thailand, and Colombia. All respondents received a description of the hypothetical dengue vaccine scenarios of 70% or 95% effectiveness for 10 or 30 years with a three dose series. Five price points were determined after pilot tests in order to reflect different local situations such as household income levels and general perceptions towards dengue fever. We adopted either Poisson or negative binomial regression models to calculate average willingness-to-pay (WTP), as well as median WTP. We found that there is a significant demand for dengue vaccines. The parametric median WTP is $26.4 ($8.8 per dose) in Vietnam, $70.3 ($23.4 per dose) in Thailand, and $23 ($7.7 per dose) in Colombia. Our study also suggests that respondents place more value on vaccinating young children than school age children and adults. CONCLUSIONS/SIGNIFICANCE: Knowing that dengue vaccines are not yet available, our study provides critical information to both public and private sectors. The study results can be used to ensure broad coverage with an affordable price and incorporated into cost benefit analyses, which can inform prioritization of alternative health interventions at the national level.
Assuntos
Vacinas contra Dengue/economia , Dengue/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Colômbia/epidemiologia , Comércio , Humanos , Análise de Regressão , Inquéritos e Questionários , Tailândia/epidemiologia , Vietnã/epidemiologiaRESUMO
Rickettsial spotted fever is common in southeastern Brazil. Differential diagnosis of pathogens can be performed with proper laboratory methods. A traveler arriving from Portugal developed a fatal febrile hemorrhagic syndrome diagnosed as spotted fever rickettsiosis. We isolated the agent, which was identified as Rickettsia conorii conorii by sequencing rickettsial genes.
Assuntos
Febre Botonosa , DNA Bacteriano , Genes Bacterianos , Rickettsia conorii , Análise de Sequência de DNA/métodos , Animais , Febre Botonosa/epidemiologia , Febre Botonosa/microbiologia , Febre Botonosa/transmissão , Brasil/epidemiologia , Reservatórios de Doenças/microbiologia , Cães , Evolução Fatal , Humanos , Masculino , Pessoa de Meia-Idade , Portugal , Rickettsia conorii/genética , Rickettsia conorii/isolamento & purificação , Rickettsia conorii/patogenicidade , Homologia de Sequência do Ácido Nucleico , Tempo para o Tratamento , Viagem , Zoonoses/epidemiologia , Zoonoses/microbiologia , Zoonoses/transmissãoRESUMO
Brazilian spotted fever (BSF) caused by Rickettsia rickettsii is the most important rickettsiosis and the only reportable tick-borne disease in Brazil. In Brazil, the hard tick Amblyomma cajennense is the most important BSF vector; however, in São Paulo State, A. aureolatum was also recognized as a vector species in remaining Atlantic forest areas near the metropolitan area of São Paulo city. We analyzed clinical and epidemiological features of BSF cases from two distinct areas where A. cajennense (Area 1) and A. aureolatum (Area 2) are the incriminated vectors. The clinical features demonstrate the same severity pattern of BSF in both endemic areas. Differences in seasonality, patient characteristics (median age and gender), and epidemiological risk factors (animals host contact and vegetation characteristics) were observed and possibly could be attributed to the characteristics of each vector and their typical biological cycle (hosts and environment).
Assuntos
Doenças Endêmicas , Rickettsia rickettsii/isolamento & purificação , Febre Maculosa das Montanhas Rochosas/epidemiologia , Febre Maculosa das Montanhas Rochosas/patologia , Adolescente , Adulto , Idoso , Animais , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Ixodidae/microbiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Adulto JovemRESUMO
BACKGROUND: Dengue is a mosquito-borne viral disease with an increasing incidence worldwide. Thrombocytopenia is a common finding in dengue virus (DV) infection; however, the underlying mechanisms remain unknown. CASE REPORT: Here we provide the first evidence of a case of antibody formation against ADAMTS13 (ADAMTS13 inhibitor) in the course of a severe acute DV infection resulting in thrombotic microangiopathy (TMA). The patient presented with classical dengue symptoms (positive epidemiology, high fever, myalgia, predominantly in the lower limbs and lumbar region for 1 week) and, after 11 days of initial symptoms, developed TMA. Clinical and laboratorial investigation of dengue and TMA was performed. RESULTS: The patient presented with ADAMTS13 inhibitor (IgG) during the acute phase of the disease, without anti-platelet antibodies detectable. Dengue infection had laboratorial confirmation. There were excellent clinical and laboratory responses to 11 serial plasma exchanges. Anti-ADAMTS13 inhibitor disappeared after remission of TMA and dengue resolution. No recurrence of TMA symptoms was observed after 2-year follow-up. CONCLUSIONS: Although the real incidence of dengue-related TMA is unknown, this case provides the basis for future epidemiologic studies on acquired ADAMTS13 deficiency in DV infection. The prompt clinical recognition of this complication and early installment of specific therapy with plasma exchange are likely to improve the outcome of severe cases of dengue.
Assuntos
Proteínas ADAM/imunologia , Autoanticorpos/sangue , Dengue/imunologia , Microangiopatias Trombóticas/imunologia , Proteína ADAMTS13 , Doença Aguda , Plaquetas/imunologia , Dengue/sangue , Dengue/complicações , Humanos , Imunoglobulina G/sangue , Masculino , Pessoa de Meia-Idade , Troca Plasmática , Microangiopatias Trombóticas/etiologia , Microangiopatias Trombóticas/terapiaRESUMO
The study was done to evaluate the cost-effectiveness of a national rotavirus vaccination programme in Brazilian children from the healthcare system perspective. A hypothetical annual birth-cohort was followed for a five-year period. Published and national administrative data were incorporated into a model to quantify the consequences of vaccination versus no vaccination. Main outcome measures included the reduction in disease burden, lives saved, and disability-adjusted life-years (DALYs) averted. A rotavirus vaccination programme in Brazil would prevent an estimated 1,804 deaths associated with gastroenteritis due to rotavirus, 91,127 hospitalizations, and 550,198 outpatient visits. Vaccination is likely to reduce 76% of the overall healthcare burden of rotavirus-associated gastroenteritis in Brazil. At a vaccine price of US$ 7-8 per dose, the cost-effectiveness ratio would be US$ 643 per DALY averted. Rotavirus vaccination can reduce the burden of gastroenteritis due to rotavirus at a reasonable cost-effectiveness ratio.
Assuntos
Gastroenterite/economia , Infecções por Rotavirus/economia , Vacinas contra Rotavirus/economia , Brasil , Pré-Escolar , Estudos de Coortes , Análise Custo-Benefício/estatística & dados numéricos , Feminino , Gastroenterite/prevenção & controle , Humanos , Lactente , Masculino , Rotavirus/efeitos dos fármacos , Infecções por Rotavirus/prevenção & controleRESUMO
Many aspects of the human asymptomatic visceral leishmaniasis (VL) remain not elucidated, and moreover, almost all the data come from highly endemic areas. The recent appearance of American VL (AVL) in the northeastern region of the state of São Paulo, Brazil, offered a good opportunity for further understanding. We present the preliminary results from a seroprevalence study on AVL in humans in Araçatuba, São Paulo. This was a cross-sectional survey on a random sample of the population (one-stage simple random sampling) in two areas, using rK39 dipstick tests. The sex ratios and age distributions in the two areas were comparable. Detectable antibodies were found in 23 subjects (20%) in area A1 and in 6 subjects (4.8%) in area A2. There was no significant difference in age distribution of seropositivity between the areas. We observed a difference in asymptomatic infection rates between the two areas, possibly associated with socioeconomic levels and transmission intensity.
Assuntos
Anticorpos Antiprotozoários/sangue , Leishmania infantum/imunologia , Leishmaniose Visceral/epidemiologia , População Urbana , Adolescente , Adulto , Idoso , Animais , Antígenos de Protozoários/imunologia , Brasil/epidemiologia , Criança , Pré-Escolar , Estudos Transversais , Cães , Feminino , Humanos , Leishmaniose Visceral/imunologia , Masculino , Pessoa de Meia-Idade , Proteínas de Protozoários/imunologia , Estudos SoroepidemiológicosRESUMO
Brazilian spotted fever (BSF) is the most important tick-borne disease in Brazil and is caused by Rickettsia rickettsii and transmitted by the Ixodid tick Amblyomma cajennense, its main vector. We present epidemiologic aspects of a case series of patients admitted to the Hospital das Clínicas da UNICAMP from 1985 to 2003 with a confirmed diagnosis of BSF either by a fourfold rise in indirect immunofluorescence (IFA) titers of IgG antibodies reactive with R. rickettsii or isolation of R. rickettsii from blood or skin specimens. Seasonal variation of case occurrence seems to be associated with the life cycle of the tick. The recent reemergence of cases seems to be associated with the growing numbers of the capybara (Hydrochaeris hydrochaeris) and their expansion into urban areas.
Assuntos
Infecções por Rickettsia/epidemiologia , Febre Maculosa das Montanhas Rochosas/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Brasil/epidemiologia , Criança , Pré-Escolar , Técnica Indireta de Fluorescência para Anticorpo , Humanos , Incidência , Pessoa de Meia-Idade , Rickettsia rickettsii/isolamento & purificaçãoRESUMO
This case series study is based on a retrospective review of medical records and case notification files of patients admitted to The Hospital das Clínicas da UNICAMP from 1985 to 2003 with a confirmed diagnosis of BSF either by fourfold rise in indirect immunofluorescence assay (IFA) titers of IgG antibodies reactive with R. rickettsii or isolation of R. rickettsii from blood or skin specimens. A median lethality of 41.9 % was observed between 1985 and 2004. The case-fatality ratio of 30 % in our study, lower than the overall São Paulo state ratio, could be explained by a higher index of suspicion and a larger experience in our hospital, a regional referral center for BSF. The presence of the classical triad of fever, rash, and headache as described in RMSF was observed in fever than half (35.2%) of our patients.