Impact of previous macrolide use on invasive pneumococcal disease due to erythromycin-resistant serotypes in adults over 59 years of age

The major goals of the study were to describe the invasive pneumococcal disease (IPD) cases due to erythromycin-resistant serotypes and to evaluate the association between these cases and recent macrolide use in individuals aged over 59 years. We selected cases of IPD reported between 2007 and 2016 in persons aged over 59 years living in the Community of Madrid (CM). We followed the European Committee on Antimicrobial Susceptibility Testing (EUCAST). The explanatory variables (age, sex, year of onset of symptoms, clinical presentation, serotypes, vaccination status) were taken from the Mandatory Notification System for Infectious Diseases System and from the Vaccination Information System. The cases were classified as either included in the 13-valent pneumococcal conjugate vaccine (PCV13) or not (nonPCV13). Associations between cases due to erythromycin-resistant serotypes and previous macrolide use (total, long and short-term) were adjusted with a logistic regression multivariate analysis. A total of 1,831 cases were identified, of whom 408 were erythromycin-resistant serotypes. PCV13 cases were associated with previous macrolide use (OR: 5.07), particularly long-acting types (OR: 8.61). NonPCV13 cases were associated with the use of total macrolides (OR: 3.48) and long-acting macrolides (OR: 4.26) suggesting that PCV13 did not reduce the IPD cases in patients with previous use of macrolides. Our results confirmed that previous macrolide consumption was associated with the presence of IPD due to erythromycin-resistant serotypes. The risk was higher with the use of long-term macrolides.

Prevalence and risk factor analysis for HIV/HTLV 1/2 coinfection in Paraíba state, Brazil

Introduction: Human T-lymphotropic virus (HTLV) 1 and 2 infections can lead to neurological diseases, mainly in HIV/HTLV 1 coinfected. Furthermore, HTLV 1 infection in HIV/AIDS patients has also been associated with AIDS progression. Despite this, HTLV 1/2 infections are not of mandatory notification in Brazil. Here, we describe the prevalence of HTLV 1/2 in HIV/AIDS patients from Paraíba state, Brazil, as well as the sociodemographic characteristics of the coinfected individuals. Methodology: Information about HIV viral load and TCD4 lymphocyte count were obtained from patients’ records. Data on the patients’ sociodemographic characteristics were obtained by interview conducted after signing the informed consent form. The serological diagnosis for HTLV 1/2 was performed by Enzyme-Linked Immunosorbent Assay (ELISA) and Western Blot (WB). Results: A total of 401 HIV/AIDS patients participated in the study, of whom about 1.5% (6/401) were positive for antibodies against HTLV, specifically for HTLV 1, evaluated by both ELISA and WB. No risk factors were found associated with HIV/HTLV 1/2 coinfection. Conclusions: We report a 1.5% prevalence of HTLV 1 infection in HIV/AIDS patients from Paraíba state. Although we have not identified risk factors associated with HTLV 1, we describe the most observed sociodemographic characteristics in HIV/HTLV 1 coinfection.

Epidemiological Surveillance of Lyme Borreliosis in Bavaria, Germany, 2013–2020

Lyme borreliosis (LB) is the most common tick-borne disease in Germany. Mandatory notification of acute LB manifestations (erythema migrans (EM), neuroborreliosis (NB), and Lyme arthritis (LA)) was implemented in Bavaria on 1 March 2013. We aimed to describe the epidemiological situation and to identify LB risk areas and populations. Therefore, we analyzed LB cases notified from March 2013 to December 2020 and calculated incidence (cases/100,000 inhabitants) by time, place, and person. Overall, 35,458 cases were reported during the study period (EM: 96.7%; NB: 1.7%; LA: 1.8%). The average incidence was 34.3/100,000, but annual incidence varied substantially (2015: 23.2; 2020: 47.4). Marked regional differences at the district level were observed (annual average incidence range: 4–154/100,000). The Bavarian Forest and parts of Franconia were identified as high-risk regions. Additionally, high risk for LB was found in 5–9-year-old males and in 60–69-year-old females. The first group also had the highest risk of a severe disease course. We were able to identify areas and populations in Bavaria with an increased LB risk, thereby providing a basis for targeted measures to prevent LB. Since LB vaccination is currently not available, such measures should comprise (i) avoiding tick bites, (ii) removing ticks rapidly after a bite, and (iii) treating LB early/adequately.

Reports of Doses Administered and Adverse Reactions to Snake Antivenom Used in Uruguay in 2018

In Uruguay, around 60 cases of snakebite accidents occur every year that need to be treated with specific antivenom. They are caused by two snakes of Bothrops genus: Bothrops alternatus and Bothrops pubescens. Snakebite accidents are mandatory notification events, allowing the acquisition of an accurate registry and a fluent communication with the health care services. The aim of this study is to analyze and report the doses administered to achieve the neutralization of the venom and the adverse reactions caused by snake antivenoms used in Uruguay in 2018, when a change was made in the type of antivenom available. In this year, Uruguay started to use the BIOL® antivenom (lyophilized) and this use coexists with traditional antivenom liquid forms (Vital Brazil and Malbran). The number of patients treated with heterologous BIOL® antivenom were 28 and the ones treated with heterologous solutions Malbran and Vital Brazil antivenoms were 21. The initial dose of BIOL antivenom was 8 vials instead of 4 vials regularly used with the others antivenoms and it achieved the neutralization of most cases (27/28 cases). Early adverse reactions were detected in 4 patients (3 in children) treated with BIOL antivenom and there were no adverse reactions in those treated with Malbran or Vital Brazil antivenoms. Lyophilized antivenom BIOL is being used widely in Uruguay without major complications.

Human post exposure anti-rabies prophylactic assistance in the south of Brazil

Rabies is a zoonosis caused by Lyssavirus, with progressive development and a high lethality rate. In Brazil, rabies and accidents caused by animals potentially transmitting the disease are mandatory notification injuries. Exposure to rabies infection places a high financial burden on public health systems, especially for the care of people who are exposed and have a high risk of death. We aimed to define the epidemiological profile of human rabies post-exposure assistance in the municipality of Santa Maria, Rio Grande do Sul, Brazil, from 2010 to 2015. Data from Brazil’s Notifiable Diseases Information System were obtained and analyzed; these data were acquired by the completion of individual inquiry forms querying human anti-rabies assistance. A total of 55% (1,898/3,453) of anti-rabies assistance cases involved women and 45% (1,555/3,453) men. The highest occurrence (54.5%–1,882/3,453) was in the age group of 20–59 years. Most registered cases (87.5%–3,024/3.453) were caused by dogs, followed by cats (10.9%–378/3,453). The lower limb (22.1%–617/2,790) was the area of the body with the highest number of canine bites. We observed incorrect indications for the treatment. We suggest further training for health professionals involved in rabies post-exposure prophylaxis care, and dissemination of information aimed at educating users about the importance of animal-related injuries.

Socioeconomic Factors Associated With Reports of Domestic Violence in Large Brazilian Cities

Background: Domestic violence is a traumatic experience that can lead to physical consequences, mental disorders and financial damage. Over 18 cases per 100,000 inhabitants were reported in Brazil between 2013 and 2014. The ministry of health poses a mandatory notification of all cases of domestic violence, which is essential, bearing in mind its systemic relation to various social issues and the extensive regional differences and high socioeconomic inequalities present in Brazil.Aim: To analyze the characteristics of the notification rates of domestic violence and investigate the correlation of these with health and socioeconomic characteristics of large Brazilian cities.Methods: Retrospective data on notifications of domestic violence was collected from the National Information System for Notifiable Diseases for Brazil, 2017. Dependent variables were collected from the Brazilian Institute of Geography and Statistics and Ministry of Citizenship. Inclusion criteria were: cities larger than 100.000 habitants and that had at least 20 reports, totaling 68.313 reports in 259 cities. These were stratified by age, race and sex of victim, type of violence used, violence perpetrator, place of occurrence and means of aggression. Proportional number of notified cases was calculated for each city to expose different characteristics of reports. A multiple linear regression model was used to investigate the correlation between report rates and different socioeconomic and health variables.Results: The analysis showed a high proportion of repeated violence, use of body strength and over 50% were perpetrated by a partner or boyfriend. Report rates were higher for women, black individuals and children under four, highlighting subgroups of the population that were more vulnerable. Indeed, these groups were correlated differently with socioeconomic variables. Poverty, assessed as Bolsa Família investment, was correlated with domestic violence report rates across vulnerable groups.Conclusion: The study showed that black women and children are more vulnerable to domestic violence, highlighting deleterious effects of patriarchy and structural racism within Brazilian society. Altogether, we suggest that reducing poverty, patriarchy and structural racism could lead to fewer cases of domestic violence.

Meningitis: etiological and outcome panorama in Brazil in the 2019-2020 biennium

Background: Meningitis is the inflammation of the meninges. The outcome varies between etiologies. It is endemic in Brazil with mandatory notification. Objectives: To analyze the number of diagnoses and outcomes of meningitis in Brazil in the 2019-2020 biennium. Design and setting: Cross-sectional epidemiological study using DATASUS database realized by Neurology department of the University of Passo Fundo. Methods: Data from patients diagnosed with meningitis in the period from 2019 to 2020 were included, correlating them to the etiologies and their outcomes. Results: There was a 70.8% reduction in the absolute number of diagnosed meningitis in 2020 (4,713) compared to 2019 (16,155). The most prevalent specified cause was “viral meningitis”, corresponding to 49,1% in 2019 and 42% in 2020. There was no great variation in the percentage of etiologies. “Hospital discharge”, corresponding to 76.8% in 2019 and 68% in 2020. “Death” was the outcome of 14.8% of patients in 2020 and 12.9% in 2019. The most related option to “Death from meningitis” was “Bacterial meningitis”, responsible for 24% in 2020 and 21.3% in 2019. Conclusions: The number of diagnoses of meningitis fell in the 2019-2020 comparison. The context of under-diagnosis worries because it means late diagnoses and worse outcomes.

Surveillance of SARS-CoV-2 transmission in educational institutions, August to December 2020, Germany

This study aims at providing estimates on the transmission risk of SARS-CoV-2 in schools and day-care centres. We calculated secondary attack rates (SARs) using individual-level data from state-wide mandatory notification of index cases in educational institutions, followed by contact tracing and PCR-testing of high-risk contacts. From August to December 2020, every sixth of overall 784 independent index cases was associated with secondary cases in educational institutions. Monitoring of 14 594 institutional high-risk contacts (89% PCR-tested) of 441 index cases during quarantine revealed 196 secondary cases (SAR 1.34%, 0.99–1.78). SARS-CoV-2 infection among high-risk contacts was more likely around teacher-indexes compared to student-/child-indexes (incidence rate ratio (IRR) 3.17, 1.79–5.59), and in day-care centres compared to secondary schools (IRR 3.23, 1.76–5.91), mainly due to clusters around teacher-indexes in day-care containing a higher mean number of secondary cases per index case (142/113 = 1.26) than clusters around student-indexes in schools (82/474 = 0.17). In 2020, SARS-CoV-2 transmission risk in educational settings was low overall, but varied strongly between setting and role of the index case, indicating the chance for targeted intervention. Surveillance of SARS-CoV-2 transmission in educational institutions can powerfully inform public health policy and improve educational justice during the pandemic.

Meningitis: etiological and outcome panorama in Rio Grande do Sul in the 2019-2020 biennium

Background: Meningitis is the inflammation of the meninges and its outcome varies between etiologies. It is an endemic disease in Brazil with mandatory notification. Objectives: To analyze the number of diagnoses and outcomes of meningitis in Rio Grande do Sul (RS) in the 2019-2020 biennium. Design and setting: Cross-sectional epidemiological study using DATASUS database. Methods: Data from notified diagnosed meningitis in RS from 2019 to 2020 were included. The meningitis etiology was correlated with its outcome. Results: There was a 70% reduction in the absolute number of reported diagnoses of meningitis in the year 2020 (302) compared to 2019 (1,000). The most prevalent specified cause, in both years, was “viral meningitis”, corresponding to 29.9% in 2019 and 27.1% in 2020. There was no great variation in the incidence of etiologies from one year to another. Mortality was the outcome of 7% of patients in 2020 and 6.6% in 2019. Pneumococcus was the most related etiology to “death from meningitis”, responsible for 38% in 2020 and 28.7% in 2019. Conclusions: The number of meningitis diagnoses in RS fell from 2019 to 2020. The fall may be related to the COVID-19 pandemic. Besides that, even with the reduction in the number of diagnoses, mortality had increased.

Meningitis: etiological and outcome panorama in Brazil in the 2019-2020 biennium

Background: Meningitis is the inflammation of the meninges. The outcome varies between etiologies. It is endemic in Brazil with mandatory notification. Objectives: To analyze the number of diagnoses and outcomes of meningitis in Brazil in the 2019-2020 biennium. Design and setting: Cross-sectional epidemiological study using DATASUS database. Methods: Data from patients diagnosed with meningitis in the period from 2019 to 2020 were included, correlating them to the etiologies and their outcomes. Results: There was a 70.8% reduction in the absolute number of diagnosed meningitis in 2020 (4,713) compared to 2019 (16,155). The most prevalent specified cause was “viral meningitis”, corresponding to 49,1% in 2019 and 42% in 2020. There was no great variation in the percentage of etiologies. “Hospital discharge”, corresponding to 76.8% in 2019 and 68% in 2020. “Death” was the outcome of 14.8% of patients in 2020 and 12.9% in 2019. The most related option to “Death from meningitis” was “Bacterial meningitis”, responsible for 24% in 2020 and 21.3% in 2019. Conclusions: The number of diagnoses of meningitis fell in the 2019-2020 comparison. The context of under-diagnosis worries because it means late diagnoses and worse outcomes.