Hometown is São José do Rio Preto
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FAMERP virologist Maurício Nogueira discusses the characteristics of the current epidemic and the need for the health system to prepare for more patients
Léo Ramos Chaves / Pesquisa FapespVirologist Dr
Maurício Lacerda Nogueira knows dengue well
For almost 20 years he has been studying the evolution of the virus
which occasionally sparks epidemics in Brazil
leaving hundreds of thousands of people bedbound for days on end
He himself has had dengue fever three times
Nogueira has a degree in medicine from the Federal University of Minas Gerais (UFMG)
where he also did a master&#8217;s degree and a doctorate
a town in the state of São Paulo where dengue fever and other diseases transmitted by the Aedes aegypti mosquito are endemic
At the São José do Rio Preto School of Medicine (FAMERP)
he established one of the laboratories of the Viral Genetic Diversity Network
and investigated factors behind the development of severe dengue fever and how immunity evolves after infection
he was head of a center at FAMERP that evaluated the dengue vaccine candidate developed by the Butantan Institute: Butantan-DV
In an interview given via videocall on January 31
Nogueira spoke about the effectiveness of the various dengue vaccines currently available and drew attention to the risk of the current epidemic being the largest ever experienced in Brazil
A total of 232,000 suspected cases of dengue were recorded in January
2.5 times the number recorded in January 2023
What should we expect in the coming months
I expect cases to rise significantly until April
cases have peaked between late March and mid-May
Then they drop sharply with the arrival of the first cold front
It is possible that 2024 could become the year with the highest number of suspected—and probably confirmed—cases in Brazil’s history
there were 15 confirmed deaths from dengue
Dengue behaves differently in Brazil than in Singapore
epidemics manifest in a more homogeneous way
we see multiple phenomena occurring at the same time
there is a strong presence of dengue virus serotypes 1 and 2
In the highly populated state of São Paulo
which causes similar clinical symptoms to dengue and can make the data a bit less clear
the serotype 2 virus in circulation is a cosmopolitan strain
while in São Paulo it is the Asian-American strain
We are also getting reports that serotype 3 is appearing in some places
On top of this complexity is the concern that some states in the Northeast that have historically been heavily affected by dengue are now relatively quiet
If the outbreak currently occurring in some areas of the country reaches this region
Is it possible to distinguish between the symptoms of dengue and Chikungunya
it is almost impossible [a doctor cannot know what the disease is based solely on the patient’s symptoms]
It’s so difficult to distinguish one from the other that the World Health Organization [WHO] recommends that suspected cases of dengue and Chikungunya both be treated as dengue
Dengue mortality drops significantly if it is diagnosed early and treated
is that everything ends up being reported as dengue
What might be the impact of the simultaneous circulation of four dengue serotypes
We are moving towards a situation of hyperendemicity
which is the simultaneous circulation of all four serotypes of the virus
but not aggressively—each serotype was predominant in a different region
with two at most circulating at the same time
where there was an epidemic of all four serotypes in 2010 and 2011
Léo Ramos Chaves / Pesquisa FapespA Technician at FAMERP&#8217;s Virology Research Laboratory performs rapid dengue testsLéo Ramos Chaves / Pesquisa Fapesp
What are the consequences of a hyperendemic disease
When a person is successively infected with different serotypes
which used to be known as hemorrhagic dengue
In the first six months after infection with one serotype
the patient is protected against all serotypes due to nonspecific antibodies that remain in the blood
Between nine months and two years after infection
and they can actually facilitate infection by other serotypes
This phenomenon is called antibody-dependent enhancement
which contributes to the occurrence of severe dengue
a previous infection neither protects against nor worsens the following one
The consequences of the simultaneous circulation of all four serotypes depends on the circumstances
If serotype 3 spreads in the area this year
there will be a major risk of more cases of hemorrhagic fever
consisting of hydration and medication for pain and fever
Due to increased permeability of the blood vessels
some of the liquid inside escapes from the patient’s circulatory system and accumulates in the surrounding tissue
This can lead to something known as hypovolemic shock
the heart is unable to pump enough of it to the organs
Do the serotypes cause different severities of the disease
the Asian-American lineage of serotype 2 that circulates in Brazil is more aggressive than the American lineage
And serotype 4 is typically less aggressive
If an individual is infected with dengue type 4 soon after a type 2 infection
ADE might occur and the case could become severe
A serotype 4 infection in a person who is obese or has diabetes can also be serious
it is important to know which strain is circulating
Doctors must follow the same treatment protocols
Butantan-DV protects against serotypes 1 and 2
but we do not know how it works against 3 and 4
Is it still possible to measure the efficacy against these serotypes before the end of the trial
The number of people being followed is small
I don&#8217;t see a problem with serotypes 3 and 4
The Butantan vaccine was formulated with live attenuated viruses
and 4 viruses they used were subject to genetic deletions that impair their ability to reproduce
Since this process didn’t affect the reproduction capacity of serotype 2
another approach was used: serotype 2 genes were introduced into the serotype 4 virus
The data from animal and human trials show that all four components multiply in the body
This does not occur with the other two vaccines approved for use in Brazil
only the dengue serotype 4 component multiplies
Sanofi&#8217;s vaccine does not protect against serotypes 1 and 2
while Takeda&#8217;s does not protect children against serotype 3 [probably because each vaccine uses a different technology]
but there was still excellent protection against this serotype
There is no reason to expect protection against dengue types 3 and 4 to be any worse
Whether regulatory agencies will accept the results is a matter that Butantan will have to deal with
How can they assess the efficacy against serotypes 3 and 4
which is developing a vaccine almost identical to Butantan’s
is carrying out a phase 3 clinical study in Asia
in which a person who has been given the vaccine is then deliberately exposed to the virus
Anna Durbin&#8217;s group at Johns Hopkins University
If the regulatory agencies accept the data
they could fast-track licensing of the Butantan vaccine
Is Butantan-DV expected to complement the role of the two existing vaccines or compete with them
The data available so far suggest that the Butantan vaccine is superior to the others
Brazil is a country of 200 million inhabitants
It’s not possible to manufacture that many vaccines in one year
Smart strategies are needed to immunize as many people as possible within an appropriate timeframe and with the resources available
Five million doses of Qdenga are expected to be available this year
which would be enough to vaccinate 2.5 million people
What impact could this have on the epidemic
The 2.5 million people who receive the vaccine would be protected
this is just 1% of the Brazilian population—it would not have a major impact on the ongoing epidemic
And I’m concerned about the Takeda vaccine’s lack of protection against dengue 3
We could eventually see a similar situation to Sanofi
The number of serotype 3 cases in the study was very small
as was the proportion of people who had not previously had dengue
This reduces the statistical reliability of the result in relation to this serotype
The team of experts from the WHO that evaluated the vaccine did not consider this a problem and recommended it for use in adolescents
just like the Brazilian Ministry of Health
Qdenga is a good vaccine with potential for use in the health system
It has only been approved for individual use by people who have already had dengue fever
An additional complication is that it requires three doses
All of these vaccines have potential for use in the public health system
But they must be used in an intelligent way
The major change on the horizon is the licensing of the Butantan vaccine
How many people would have to be vaccinated to see a protective effect in an epidemic
Vaccinated people are 80% less likely to get sick
I&#8217;ve had dengue fever three times and it&#8217;s a horrible illness
I didn&#8217;t have the severe form and I wasn’t hospitalized
If I could have gotten the vaccine at the time
It prevents a disease that has a huge personal impact and an indirect economic cost that we don&#8217;t usually measure in Brazil
millions of people take up to five days of sick leave from work every year
No dengue vaccines are available universally through Brazil’s public health system
but they are available in the private sector
Should people get it if they can afford to
That’s an individual decision that has to be made in consultation with a doctor
A review article published in the journal <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9127483/pdf/40259_2022_Article_531.pdf" target="_blank" rel="noopener">BioDrugs </a>in 2022 listed seven dengue vaccine candidates
The three most promising were those developed by Sanofi
There are several others in earlier stages of testing
Brazil did this until the middle of the last century
Nowadays it is impossible to eradicate the vector the way we did in the past
Two approaches used in the early twentieth century would not be accepted today
The first was the “foot in the door” policy adopted in campaigns to eradicate the Aedes aegypti mosquito
Health agents would enter your house with you
The public health merit of such an approach is worthy of discussion
The second was the use of pyrethroid insecticides and other highly toxic products
We have been talking about vector control ever since dengue epidemics returned in Brazil in 1986
But there is something that seems to show potential: controlling vectorial capacity
It is the mosquito&#8217;s ability to transmit the disease
It means rather than trying to eradicate the mosquito itself
we instead reduce its capacity to transmit the virus
This has been attempted by releasing mosquitoes intentionally infected with bacteria of the genus Wolbachia
which colonizes the mosquito&#8217;s digestive tract and prevents the dengue
and yellow fever viruses from infecting the intestinal cells and replicating
from where they are injected during a bite
One of the big advantages is that when the mosquitoes reproduce in nature
they transmit the bacteria to their offspring
There has been major investment in this approach by the World Mosquito Program
The Brazilian Ministry of Health and FIOCRUZ [Fundação Oswaldo Cruz] have also invested heavily
Some of the data from preliminary studies show that the method is effective
but we are still waiting for the results of a large
controlled study underway in Belo Horizonte
We divided the municipalities of Belo Horizonte
we are releasing mosquitoes infected with Wolbachia alongside the usual vector control protocols
we are only implementing normal vector controls
We are entering the fourth year of monitoring
but the results will only be released at the end of the experiment
Does this represent another potential strategy
If someone had asked me eight years ago whether we could control dengue
I would have given them a pessimistic answer
We now have a three-pronged approach to combating dengue
There are two licensed vaccines that despite their limitations
And we have a third one on the way that is probably better
The second strategy is the use of mosquitoes infected with Wolbachia
which plays the role of significantly reducing transmission
And the third is that there are at least three antiviral drugs specific to dengue undergoing phase 2 and 3 clinical trials
Dengue is a disease that can be caught at home
It is up to each of us to take care of that aspect
We shouldn’t wait for the State to take care of our own backyards
Since it isn’t possible to halt a dengue epidemic
what we have to do now that cases are rising is to prepare the health system for the high number of patients and raise awareness among the population about how to eliminate mosquito breeding grounds
 © Revista Pesquisa FAPESP - All rights reserved
but sometimes we want to get away from the hustle and bustle of the city
Here are the perfect destinations for that
Rio de Janeiro <a href="https://riodejaneirosecreto.com/coisas-para-fazer-no-rio-de-janeiro/" rel="noopener noreferrer" target="_self" class="shortcode-outbound-link" data-has-ga="true" data-ga-type="click" data-label="https://riodejaneirosecreto.com/coisas-para-fazer-no-rio-de-janeiro/" data-action="text_cta_0" data-category="click_internal">full of attractions</a> But we don&#8217;t always want to stay in the city
That&#8217;s why it&#8217;s worth taking a trip  to places that also have beautiful landscapes
historic buildings and are close to the capital of Rio de Janeiro
Check out 14 cities near Rio de Janeiro to visit
The imperial city is one of the favorite destinations for those looking for cities near Rio de Janeiro to visit and relax
Petrópolis is full of historical references and attractions
the Quitandinha Palace and the Santos Dumont House
Also in the mountainous region and neighboring Petrópolis
a quieter destination and perfect for spending a weekend or more
the city is a good choice for couples who want to get away from the routine
Another tip is to practice physical activity in its many landscapes, <a href="https://riodejaneirosecreto.com/en/amazing-viewpoints-rio-de-janeiro/" rel="noopener noreferrer" target="_self" class="shortcode-outbound-link" data-has-ga="true" data-ga-type="click" data-label="https://riodejaneirosecreto.com/en/amazing-viewpoints-rio-de-janeiro/" data-action="text_cta_3" data-category="click_internal">with breathtaking viewpoints</a>
Nova Friburgo &#8211; or just Friburgo &#8211; is one of the cities close to Rio de Janeiro that you can&#8217;t miss on your itinerary
If you want to get away from the hustle and bustle
it&#8217;s worth visiting this place with its many panoramic landscapes
Those who love shopping will also love this destination
as it is well known for selling quality underwear at a great price
take the opportunity to visit the districts near Friburgo
Saquarema has become a very popular tourist destination for those who love the sport
But even if you don&#8217;t have any familiarity with the board
a getaway to this town is also an alternative for relaxing by the sea
the small-town atmosphere prevails in Saquarema
ideal for strolling around at dusk and grabbing a bite to eat in the little squares
Cabo Frio is the largest city in the Lakes Region and therefore has an excellent infrastructure with hotels and inns for those who want to spend a few days off there
explore the historic neighborhoods &#8211; such as Bairro da Passagem &#8211; and even visit the famous São Mateus Fort lookout for a privileged view of the city
visiting Arraial do Cabo is like being in the Caribbean
It&#8217;s no wonder the city is so famous
paradisiacal waters enchant not only locals
That&#8217;s why the tip is to take advantage of the low season to relax and enjoy every corner of the city
To keep with the theme of popular destinations
the destination has just the right amount of bustle and peace and quiet
But beware: it is a historic region and a preserved area
there is a maximum number of visitors that the island can accommodate
it&#8217;s a delight to be in direct contact with nature
with lots of greenery and enjoying the meeting of fresh and salt waters
It&#8217;s impossible to resist the cobbled  streets
the colorful doors and  windows and the charms of Paraty
One of the cities close to Rio de Janeiro, on the <a href="https://riodejaneirosecreto.com/ilha-dos-cocos/" rel="noopener noreferrer" target="_self" class="shortcode-outbound-link" data-has-ga="true" data-ga-type="click" data-label="https://riodejaneirosecreto.com/ilha-dos-cocos/" data-action="text_cta_4" data-category="click_internal">State&#8217;s Green Coast</a> is a real practical lesson for those who want to dive in and learn more about Brazil&#8217;s history
It&#8217;s also a great destination for relaxing and has interesting options for all tastes &#8211; both for those who prefer a more urban atmosphere and for those who enjoy natural landscapes
If your type of trip is more rustic and you want to completely disconnect from the noise of the big city
This village is away from all the hustle and bustle and is one of the most popular destinations for those who like camping
you can also find very intimate hotels and inns
Waterfalls and a little music at the end of the day are part of the program
On the border between Rio de Janeiro and Minas Gerais
it&#8217;s worth taking a trip to Visconde de Mauá
this town has a great atmosphere for enjoying the restaurants and taking refuge in the mountains
you can explore the region&#8217;s green areas and bathe in its waterfalls
The town of Penedo is known as Little Finland and
This is because it was colonized by the Finns and to this day there is no shortage of references to the European country in its architecture and cuisine
Extra tip: don&#8217;t leave without trying the chocolates
<a href="https://riodejaneirosecreto.com/o-que-fazer-vassouras-rj/" rel="noopener noreferrer" target="_self" class="shortcode-outbound-link" data-has-ga="true" data-ga-type="click" data-label="https://riodejaneirosecreto.com/o-que-fazer-vassouras-rj/" data-action="text_cta_5" data-category="click_internal">Vassouras</a> is less than 3 hours from Rio and the town is the perfect route for those who want to escape the hustle and bustle of &#8220;errejota&#8221;
There are squares that have been the backdrops for soap operas
viewpoints and a host of tourist and gastronomic attractions for anyone to enjoy
Less than three hours from the capital, you&#8217;ll come across peaceful Macuco &#8211; <a href="https://riodejaneirosecreto.com/menor-cidade-do-rio-de-janeiro/" rel="noopener noreferrer" target="_self" class="shortcode-outbound-link" data-has-ga="true" data-ga-type="click" data-label="https://riodejaneirosecreto.com/menor-cidade-do-rio-de-janeiro/" data-action="text_cta_6" data-category="click_internal">the smallest town in Rio de Janeiro</a>
For those who love a country town atmosphere
the tip is to stop by Praça Professor João Brasil
a meeting point where the town&#8217;s events take place
If Macuco is the smallest town of all, São José do Vale do Rio Preto is <a href="https://riodejaneirosecreto.com/cidade-que-tem-o-maior-nome-rj/" rel="noopener noreferrer" target="_self" class="shortcode-outbound-link" data-has-ga="true" data-ga-type="click" data-label="https://riodejaneirosecreto.com/cidade-que-tem-o-maior-nome-rj/" data-action="text_cta_7" data-category="click_internal">the one with the biggest name in Brazil!</a>
However, like all the others, this is an option for those who want to get away from the hustle and bustle of Rio de Janeiro. That&#8217;s because São José do Vale do Rio Preto is a charming, historic town that&#8217;s perfect for a few days of relaxation!
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Fact checked by <a href="https://www.vax-before-travel.com/people/robert-carlson-md">Robert Carlson, MD</a>
So far this year, the mosquito-transmitted Chikungunya virus disease has caused <a href="https://www.precisionvaccinations.com/chikungunya-outbreaks">outbreaks</a> throughout the Region of the Americas
indicates that 161 Chikungunya-related deaths were reported in 2024
led by the Federative Republic of Brazil's 375,000 confirmed cases
while most of the Chikungunya cases have been reported in Brazil's mountainous regions
the country's Chikungunya hot spot could be in the state of São Paulo
The Municipality of São Paulo's Health Surveillance Coordination of the Health Department reported in mid-August that 29 locally acquired and 40 imported Chikungyna cases have occurred this year
Since São Paulo is the most populous city in Brazil
this data does not indicate a significant health risk
a recent study concluded Brazil's Chikungunya infection rate is significantly under-counted
The Lancet Infectious Diseases published results from a study in February 2024 investigating the risk of death in people infected with Chikungunya two years after the first symptoms of the disease
This study concluded Chikungunya virus disease is associated with an increased risk of death for up to 84 days after symptom onset
including deaths from cerebrovascular diseases
A separate analysis of the blood samples from São José do Rio Preto
showed that the number of chikungunya cases in proportion to the population rose from 0.35% in 2015 to 2.3% in 2019
These studies indicate that Chikungunya's actual health risk should be a primary concern to Sao Paulo's residents
about 11.8 million tourists arrived in Sao Paulo in 2023
For example, in September, the NFL will conduct a game in Sao Paulo to attract local and international fans for the <a href="https://www.nfl.com/international/games/saopaulo/event-info/corinthians-arena-faq">Eagles vs. Packers</a> game on September 6
From a risk-prevention option, there is now one U.S. FDA-approved Chikungyna vaccine, Valneva SE's <a href="https://www.precisionvaccinations.com/vaccines/ixchiq-chikungunya-vaccine-live">IXCHIQ®</a>
The travel vaccine IXCHIQ was approved in the U.S
Regulatory reviews in the United Kingdom and Brazil are ongoing
In the U.S., IXCHIQ is offered at travel vaccine clinics such as <a href="https://www.passporthealthusa.com/vaccinations/chikungunya/">Passport Health USA</a> and certain pharmacies
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Are you already planning your end-of-year getaway to enjoy the Christmas spirit away from the hustle and bustle of the capital
How about innovating and spending Christmas in the interior of São Paulo
many people take the opportunity to get away from the hustle and bustle of the big city
if you&#8217;re also thinking of taking the family on a trip over the festive period
is usually the favorite of São Paulo residents during the winter
the city becomes a veritable Christmas village
This year, the program will be even more special with <a href="https://saopaulosecreto.com/en/monicas-class-christmas-in-spain/" rel="noopener noreferrer" target="_self" class="shortcode-outbound-link" data-has-ga="true" data-ga-type="click" data-label="https://saopaulosecreto.com/en/monicas-class-christmas-in-spain/" data-action="text_cta_1" data-category="click_internal">Turma da Mônica&#8217;s Christmas</a>
Capivari Park will be in the Christmas mood to welcome visitors
who will be able to enjoy the program until December 30
the inland town is transformed into a magical setting
This year&#8217;s attractions include the Enchanted Forest
 the public can enjoy the Christmas atmosphere in the countryside with a light show and
the &#8221; ChristmasParade&#8221; and the &#8220;Snowfall&#8221; are among the main attractions for the public
 Another city that has already announced the official dates of its Christmas events is Serra Negra
Natal Luzes da Serra begins on November 14 and runs until December 28
That means there&#8217;s plenty of time to visit and admire all the special decorations
as well as Santa&#8217;s House and other attractions for the little ones
the tourist resort of Olímpia presents its traditional  Enchanted Christmas
with a special free program in the city center
there is no information on the official date for 2024
but we can guarantee the presence of Santa Claus and lots of lights
the city&#8217;s iconic Rubião Júnior Square hosts the special &#8216;Enchanted Botucatu&#8217; event
the official date is not yet known and should be announced in the next few days
this year-end São José do Rio Preto is hosting &#8220;Natal Luz 2024&#8221;
The program includes the traditional illuminated mini-trio parades
which take playful characters on a tour of the city
23 huge Christmas trees and 3 nativity scenes decorate the streets at various addresses
 The <a href="https://saopaulosecreto.com/en/train-rides-sao-paulo/" rel="noopener noreferrer" target="_self" class="shortcode-outbound-link" data-has-ga="true" data-ga-type="click" data-label="https://saopaulosecreto.com/en/train-rides-sao-paulo/" data-action="text_cta_5" data-category="click_internal">historic train ride between</a> the cities of Itu and Salto
the Republican Train offers its traditional themed route
 From December 1, 2024 to January 6, 2025, you can check out the  4th Illuminated Christmas Dream, whose theme this year will be Around the World. This year&#8217;s theme will be Around the World, and Novo Horizonte  will be home to monuments from different countries around the world designed with Christmas lights, using a total of more than 1 million bulbs!
        View this post on Instagram                        </a>  <a href="https://www.instagram.com/p/DCFmjmJRdtB/?utm_source=ig_embed&amp;utm_campaign=loading" style=" color:#c9c8cd; font-family:Arial,sans-serif; font-size:14px; font-style:normal; font-weight:normal; line-height:17px; text-decoration:none;" target="_blank">A post shared by Festival Luzes Que Encantam (@festivaluzesquencantam)</a> 
 You may already be aware that Barretos is the national rodeo capital
But did you know that it&#8217;s also a good option for those looking to spend Christmas in the interior of São Paulo
the famous Parque do Peão will also receive a Christmas decoration
with the presence of Santa Claus and much more
More than 15,000 meters of lights will fill the park with color and joy for the whole family
<a href="/articles/s41598-020-62151-3/metrics" data-track="click" data-track-action="view metrics" data-track-label="link" rel="nofollow">Metrics details</a>
Measles is an acute and highly contagious but vaccine-preventable infectious disease
Despite years of being considered eliminated
decreased vaccination rates have produced virus reemergence in several countries
Measles can be controlled through immunization programs
through which aim to achieve 95% coverage with two doses of the vaccine
Measles can also be controlled if suspected cases can be properly identified in order to contain outbreaks
This cross-sectional study determined the prevalence of measles antibodies and their correlation with rubella antibodies (resulting from the combination vaccine used in Brazil’s public immunization program) in individuals aged higher 10 years old in São José do Rio Preto
participants of a prospective cohort of arbovirosis surveillance before virus reemergence in the country
Our findings presented that 32.9% of individuals aged 10–40 years old had not antibodies against measles; 39.3% of total individuals with documented evidence of measles vaccination did not have anti-measles IgG
though only 20.2% of individuals with documented evidence of rubella vaccination lacked anti-rubella IgG
the most of measles cases reported in the city
following the virus spreading in the country
occurred especially in groups defined by us as susceptible
Because the combination MMR vaccine is part of Brazil’s national vaccine schedule
the possible reasons for this relatively high rate of seronegativity need to be investigated further
The Brazilian National Immunization Program (BNIP) also provides non-previously inoculated teenagers and adults with the vaccine at any time
Given the current global measles outbreaks and the threat of the continued spread of the disease
this study used data provided by an ongoing arbovirosis surveillance cohort to determine the prevalence of measles antibodies and to correlate the findings with demographic characteristics and data on immunization coverage in order to predict the risk of a local outbreak
The main objective of this study was described the population immunity status to measles in an epidemiological context before virus spreading in the city
*2: including previous immunization (documented history of vaccination)
The highest anti-measles IgG seroprevalence rates were found among individuals over 40 years of age (533/545; 97.8%)
while 32.9% (143/435) of individuals between 10 and 40 years of age were found to have no measles antibodies
individuals older than 30 years of age (651/686; 94.9%) were found to have higher seroprevalence than those between 10 and 30 years of age (260/294; 88.4%)
Individuals in the subcohort between 10 and 20 years of age represent Brazilians who were infants and children when the Brazilian immunization program included the MMR vaccine and who were therefore vaccinated and likely not seroconverted after natural infection
61.43% were found to have measles antibodies
and 87.86% were found to have rubella antibodies
showing a significant part of population susceptible to natural infection to rubella
</a>Correlations between documented history of vaccination and measles and rubella antibodies in the city of São José do Rio Preto
</a>Estimates for each infection that presented antibody prevalence above the herd immunity threshold* and the number of secondary cases that would occur in each age cohort if a single infectious individual had contact with the remaining susceptible individuals
*Basic reproduction numbers for measles and rubella assumed to be 15 and 6
This serological surveillance study has helped to identify the proportion of individuals susceptible to measles in a single
city-wide population in Brazil during a time in which the country is experiencing an outbreak
The highest measles seroprevalence rate was found in the subcohort older than 40 years if age
as older individuals have more chances of exposure to measles and vaccines as they age
the most remarkable finding was the high rate of non-reagent individuals between 10 and 40 years of age (32.9%)
a result which shows that this subcohort is susceptible to infection
39.3% and 20.2% had proven documentation of measles and rubella
but not serological evidence (non-reagent antibodies to measles and rubella)
The relatively high potential for measles to spread is supported by the expected numbers of secondary cases in the subcohorts younger than 40 years of age
recommend at least two doses in children and adolescents
the results on rubella immunity obtained herein are lower than but consistent with those; however
the findings on measles immunity in our population vary substantially from those of other studies and there is an important difference between measles and rubella immunization in our population in each age group
The quality and durability of measles vaccine-induced immunity is dependent upon a number of factors involving both the vaccine used
all 35 subjects who had been vaccinated against measles but who tested non-reagent were younger than 40
and only 2 had a chronic disease (one case of cognitive deficits and one case of vitiligo; neither used immunosuppressive drugs)
39.3% of individuals with documented evidence of measles vaccination did not have anti-measles IgG
while 20.2% of individuals with documented evidence of rubella vaccination lacked anti-rubella IgG
if we analyze only group 10–20 years (n = 140)
36 of them had measles and rubella vaccine report
being the 36 reagent to anti-rubella IgG and 24 to anti-measles IgG
Because most of these subjects were likely exposed to the viruses through the MMR vaccine rather than natural infection
the differences between the measles and rubella seroconversion rates seem to be the result of the components of the vaccine
These findings represent a real epidemiological context in a population in surveillance
Another limitation of this study was the subjects’ lack of documentation regarding their immunization history
These results raise questions about the efficacy of measles immunization in these individuals and
Although these findings are not necessarily representative of measles seroprevalence in Brazil as a whole
they are representative in the city once to reflect demographic profile and health care model used in other neighborhoods
the understanding of the dynamic of antibodies in the population may highlight to susceptibility profiles
particularly for diseases that have an impact on global health
the need for larger-scale serological studies in order to better to know the results of immunization program beyond the vaccine coverage
Informed consent was obtained from all adult subjects and from the parents and/or legal guardians of subjects under 18 years of age
This study and the larger cohort surveillance study have been approved by the Ethical Review Board from Faculdade de Medicina de São José do Rio Preto (Comissāo de Ética em Pesquisa em Seres Humanos da FAMERP – CEP/FAMERP) (ERB number 02078812.8.0000.5415)
All performed experiments in this study are according with relevant protocols and also approved by institutional ERB
Confidentiality was ensured by the encoding of questionnaires and samples before data entry and analysis
A total of 981 individuals were included in this study
When they were originally included in the cohort
in 2016 (before measles spreading in the country as reemergent virus responsible to recent outbreak)
all individuals had blood samples collected for the detection of anti-measles and anti-rubella Immunoglobulin G (IgG)
They also completed a questionnaire about demographic characteristics
Data on vaccination history were also collected from vaccination booklets from 112 individuals
Collected sera were frozen and later tested using a commercial enzyme-linked immunosorbent assay (ELISA Euroimmun AG
Tests were used for the detection and qualitative measurement of IgG antibodies to measles and rubella following the manufacturer’s instructions
IgG antibodies to measles or rubella were categorized based on index standard ratio (ISR) values: seronegative was defined as an ISR less than 0.8; indeterminate results were defined as an ISR between 0.8 and 1.1; and seropositive was defined as an ISR greater than 1.1
Indeterminate was considered as negative to final analyses
The individuals included in this study were randomly selected from the population and then organized into age-based subcohorts with subjects 10 to 20 years of age (born between 1996 and 2006)
21–30 years of age (born between 1995 and 1986)
31 to 40 years of age (born between 1985 and 1976)
41 to 50 years of age (born between 1975 and 1966)
and older than 50 (born in 1965 or earlier)
vaccination against measles in Brazil was introduced in 1967 as a single-dose schedule
This was changed to a two-dose schedule in 1992
and the MMR vaccine became part of the routine schedule in 2004
The age-based subcohort that included subjects older than 50 therefore included unvaccinated individuals who were born in the prevaccine era
while the subcohorts that included subjects between 21 and 40 years of age included both vaccinated and unvaccinated individuals
The subcohorts with subjects younger than 20 years of age included only individuals who were born after the MMR vaccine became routine in Brazil and were therefore likely to have been seroconverted only after immunization rather than natural infection
Because of the lack of previous studies on seroconversion after natural infection or immunization and of studies with data organized by age
which would be required to estimate the expected prevalence rate of antibodies
we considered the known population (10,815 individuals in the study area) and a tolerable sample error of 4% to establish the minimum sample number for this study
we calculated the number of secondary cases that would be produced in each age-based subcohort if a single infected individual had contact with the remaining susceptible individuals
Measles in Harrison’s principles of internal medicine (eds
and Bennett’s principles and practice of infectious diseases
rubella and varicella among staff of a hospital in Riyadh
WHO Guideline for Epemidemic Preparedness and Response to Measles Outbreak
mumps and rubella Antibodies in 18 months and 6.5 years old children: 6 months after measles-mumps-rubella (MMR) vaccination
Seroprevalence of rubella and immunogenicity following rubella vaccination in adolescent girls in India
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Epidmemiologia do sarampo no Brasil in Epidemiologia: contextos e pluralidade [online] (ed
National immunization program: vaccination
Revista do Instituto de Medicina Tropical de Sao Paulo 54(Suppl 18)
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Plano de Contingência para Resposta às Emergências de Saúde Pública: sarampo [recurso eletrônico] (ed
Departamento de Vigilância das Doenças Transmissíveis) (2016)
and congenital rubella syndrome elimination in the region of the Americas: final report (ed PAHO) (2016)
Spatial analysis of dengue transmission in a medium-sized city in Brazil
Clinical and laboratory profile of Zika virus infection in dengue suspected patients: A case series
Simultaneous infection by DENV-3 and SLEV in Brazil
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SMS. Boletim de Sarampo. Ano de primeiros sintomas: 2019. São José do Rio Preto, <a href="http://saude.riopreto.sp.gov.br/transparencia/boletim_sarampo_saude_" data-track="click_references" data-track-action="external reference" data-track-value="external reference" data-track-label="http://saude.riopreto.sp.gov.br/transparencia/boletim_sarampo_saude_">http://saude.riopreto.sp.gov.br/transparencia/boletim_sarampo_saude_ riopreto.php</a> (2020)
2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP)
and Rubella Antibodies in College Students in Mumbai
rubella and varicella antibodies in the United States population
mumps and rubella-containing vaccines in healthy young children: A 10-year follow-up
Measles vaccination in health care personnel: mandates
Gerência de Informações de Vigilância Sanitária
Secretaria de Saude de São Jose do Rio Preto
<a data-track="click" data-track-action="download citation references" data-track-label="link" rel="nofollow" href="https://citation-needed.springer.com/v2/references/10.1038/s41598-020-62151-3?format=refman&amp;flavour=references">Download references</a>
This study received financial support from the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) number 2013/21719-3 for MLN
São José do Rio Preto Medical School (FAMERP)
Nathalia Zini &amp; Mauricio Lacerda Nogueira
Clinical and Molecular Virology Laboratory
Edison Luís Durigon &amp; Daniele Bruna Leal Oliveira
M.L.N.: conceived the manuscript B.H.G.A.M.
N.Z.: conducted the experiments and laboratory tests C.F.E.
E.M.: analyzed the results All authors reviewed the manuscript and approved the submitted version
The authors declare no competing interests
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations
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São José do Rio Preto is one of the cities of the state of São Paulo
with the presence of the four dengue serotypes
Objectives: to calculate dengue seroprevalence in a neighbourhood of São José do Rio Preto and identify if socioeconomic and demographic covariates are associated with dengue seropositivity
A cohort study to evaluate dengue seroprevalence and incidence and associated factors on people aged 10 years or older
was assembled in Vila Toninho neighbourhood
The participant enrolment occurred from October 2015 to March 2016 (the first wave of the cohort study)
when blood samples were collected for serological test (ELISA IgG anti-DENV) and questionnaires were administrated on socio-demographic variables
We evaluated the data collected in this first wave using a cross-sectional design
We considered seropositive the participants that were positive in the serological test (seronegative otherwise)
We modelled the seroprevalence with a logistic regression in a geostatistical approach
The Bayesian inference was made using integrated nested Laplace approximations (INLA) coupled with the Stochastic Partial Differential Equation method (SPDE)
We found 986 seropositive individuals for DENV in 1322 individuals surveyed in the study area in the first wave of the cohort study
corresponding to a seroprevalence of 74.6% (95%CI: 72.2–76.9)
Between the population that said never had dengue fever
non-white and living in a house (instead of in an apartment)
were positively associated with dengue seropositivity
We adjusted for the other socioeconomic and demographic covariates
and accounted for residual spatial dependence between observations
Only one in four people aged 10 years or older did not have contact with any of the serotypes of dengue virus in Vila Toninho neighbourhood in São José do Rio Preto
race and type of house were associated with the occurrence of the disease
The use of INLA in a geostatistical approach in a Bayesian context allowed us to take into account the spatial dependence between the observations and identify the associated covariates to dengue seroprevalence
In countries where this strategy is being or will be considered
the development of seroepidemiological studies are or will be fundamental for the definition of the regions and population groups to be vaccinated
Considering the rarity of this type of study in Brazil
we highlight the present seroprevalence study carried out in the state of São Paulo
as part of a dengue prospective cohort study
to calculate the seroprevalence of dengue in a neighbourhood of the municipality of São José do Rio Preto and to identify if socioeconomic and demographic covariates are associated with the dengue seropositivy
</a>a: Municipality of São José do Rio Preto
South America; b: Vila Toninho neighborhood (study area) in the municipality of São José do Rio Preto
A cohort to investigate dengue seroprevalence and seroincidence and associated factors was assembled in the study area and the participants were enrolled between October 2015 and March 2016 (the cohort first wave)
the cohort includes more three waves to measure the seroincidences (one measure per year)
The present study is a cross-sectional analysis of the data collected during the cohort first wave
The eligibility criteria to participate of the cohort were to be 10 years or older and to be a resident of Vila Toninho neighbourhood
To obtain the sample size necessary for the development of the study
we estimated that 380 seronegative individuals would be necessary to measure a seroincidence of 10%
with an error margin of 3% and a significance level of 5%
by the fourth and final wave of the cohort
We established the initial sample initial size around 1400 individuals considering that we would also have seroincidences of 10% and annual losses of 10% in the first
second and third waves of the cohort and a seroprevalence of 50% in the first wave
We visited all households in the study area and
in those that were not closed during our visits
all residents aged 10 years or older were invited to participate in the cohort
After agreement and signature of the Informed Consent Form
the study participant answered a structured questionnaire about their sociodemographic characteristics and past dengue occurrence
The questionnaire also included questions on the knowledge of the disease
issues to be addressed in future publications
Two blood tubes were then collected from the participant
one for the collection of whole blood (with K2 EDTA 7.2 mg anticoagulant (BD Vacutainer®)) and another to obtain serum (SST™ BD Vacutainer® tubes)
The tubes were sent under refrigeration to the Laboratory of Virology of School of Medicine of São José do Rio Preto (FAMERP)
centrifuged at a rate of 2000 g for 10 min and stored in a freezer at − 80 °C until
The period we made these blood collections was before the Zika virus circulation in the city
Serum exams of the study participants were performed using the anti-DENV IgG ELISA method
using the commercial kit Human Anti-Dengue vírus IgG ELISA kit (Abcam®
United Kingdom) and following the manufacturer’s instructions
The optical density (OD) reading was performed at an absorbance of 450 nm with the equipment Spectramax Plus ELISA reader (Molecular Devices©) and the calculations were made according to the kit instructions
The residential addresses of the individuals enrolled in the study were geocoded using a georeferenced street map that was available by the São José do Rio Preto City Council
for each enrolled individual we obtained their plain Cartesian coordinates in meters in the UTM coordinate system
We attributed a code for each participant and its collected data (questionnaire
serological test result and Cartesian coordinates) were typed in a Microsoft Excel spreadsheet
The study dependent variable was the seropositivity for dengue (IgG)
a participant who presented a positive test for dengue in the anti-DENV IgG ELISA serological test and seronegative (IgG neg)
We considered the following categorical covariates as predictors: sex (male or female)
occupation (inside or outside); schooling (&lt;=7 or &gt; 7 years)
hours at home (&lt;=12 h or &gt; 12 h per day) and number of residents (&lt;=4 or &gt; 4 residents in the house)
We also considered the standardized continuous covariates age and income as predictors
The standardization consisted in subtracting from the values of these covariates the respective means
followed by the division by the respective standard deviations
To model the dengue seropositivity (IgG) we specified a Bernoulli probability distribution (eqs. <a data-track="click" data-track-label="link" data-track-action="equation anchor" href="/articles/10.1186/s12879-019-4074-4#Equ1">1</a> and <a data-track="click" data-track-label="link" data-track-action="equation anchor" href="/articles/10.1186/s12879-019-4074-4#Equ2">2</a>) in a Bayesian context:
where i = 1,...,N represents the ID of a particular individual; πi is the probability of a individual to be dengue seropositive; α is the intercept; β is the vector of P regression parameters for the predictors; X is the matrix of predictors
si are the Cartesian coordinates of the individual residential location and W(si) is a realization of a latent stationary Gaussian field (GF) that models the spatial dependence between the address locations of the participants (Cartesian coordinates):
We use the mice package to regress each variable (with missing) against all the others and obtain five imputed datasets. This was based on Rubin [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 44" title="Rubin DB. Multiple imputation for nonresponse in surveys. New York: John Wiley &amp; Sons; 1987." href="/articles/10.1186/s12879-019-4074-4#ref-CR44" id="ref-link-section-d326342365e1393">44</a>]
who concluded that m equal to five would be sufficient for multivariate imputation
For each imputed dataset we ran model (v) and (vi) described above and obtained the regression coefficients (betas) and their respective standard errors for each one of the covariates
We ran the six models and used the Deviance Information Criteria (DIC) [<a data-track="click" data-track-action="reference anchor" data-track-label="link" data-test="citation-ref" aria-label="Reference 45" title="Blangiardo M, Cameletti M. Spatial and Spatio-temporal Bayesian models with R-INLA. Chichester: John Wiley and Sons; 2015." href="/articles/10.1186/s12879-019-4074-4#ref-CR45" id="ref-link-section-d326342365e1433">45</a>] to compare their goodness of fit
in the results we focused on the imputed covariate spatial model (model vi) which was characterised by the lowest DIC (corresponding to the best fit); the other models are presented as Additional Materials
running model vi without considering interactive effects
we investigated these effects considering all possible interactions among the covariates that were associated with a positive serological result for dengue
</a>Vila Toninho neighborhood and the distribution of seropositive
seronegative and inconclusive dengue cases
Table <a data-track="click" data-track-label="link" data-track-action="table anchor" href="/articles/10.1186/s12879-019-4074-4#Tab1">1</a> also presents the distribution of cohort sample
among which we highlight that it was composed mainly by people of female sex (60.6%)
living in houses (83.6%) and only 7.2% with more than 12 years of schooling (upper secondary level of education)
Our study also showed that 62.6% (828/1322) of our study population said that never had dengue fever
The main difference between the crude and adjusted OR is the lack of importance of the covariate Occupation in the final model
The investigation of interactive effects in our final model showed that the best fitted model was the one without any interactions (lowest DIC). Also, all the CI 95% for the OR of the interaction terms tested included the unit. We present the DIC values for all fitted models in Additional file <a data-track="click" data-track-label="link" data-track-action="supplementary material anchor" href="/articles/10.1186/s12879-019-4074-4#MOESM3">3</a>
where is also possible to see that the models with spatial component presented lower DIC than those without this component and showed better goodness of fit
The spatial correlation of the models we run for the five imputed databases showed that the maximum distances to where the spatial dependence was present ranged from 848.1 to 919.9 m
The median was 866.1 m and corresponded to the first imputed database; then we show its spatial structure
We obtained a range of around 1000 m for the intercept spatial model (i.e.
showing that only part of the spatial dependence present in the data was explained by the considered covariates
</a>Posterior mean of the spatial random field of the final model (intercept, covariates and the spatial component for the imputed datasets), considering the first imputed database, Vila Toninho neighbourhood, São José do Rio Preto, state of São Paulo, Brazil, 2015–2016
</a>Values of the spatial random field related to the positive and negative dengue cases of the final model (intercept
covariates and the spatial component for the imputed datasets)
considering the first imputed database; red colour represents negative values and blue
positive values; Vila Toninho neighbourhood
The high seroprevalence that we founded in our study reveals a large burden of disease of DENV in São José do Rio Preto
The seroprevalence found in people aged 10–19 years
slightly lower than the seroprevalences for the other age groups
also reveals high rates of transmission in the recent past
These results can be seen as a consequence of events of the last five and four decades
both internal to Brazil as with Latin America and Southeast Asian countries
is related to similar epidemiological realities experienced by the localities considered
a hyperendemic condition with simultaneous circulation of three or four DENV serotypes
A hypothesis for the lack of association would be the low variability of these three variables in the study area: around 80% of the participants are characterised by income less than four minimum wages
around 80% of the cohort live in households with four or fewer people and a small proportion of people have reached a higher education
they considered this an intriguing result and related it to cultural determinants of the communities
including the specific pattern of human movement of the sites surveyed
These are different situations that also need to be considered by the control services
the rarity of seroepidemiological studies developed in Brazil should be discussed and reviewed
The development of this type of study should be encouraged
since they produce important information and knowledge to be used in structuring appropriate surveillance systems
effective control programs and in particular to define vaccination strategies
One of the limitations of this study is the fact that its population was not a random sample of the study area’s population but that people agreed to participate in the cohort study
This is related to the type of area chosen for its development
The fact that it was a relatively small and closed area (three of its frontiers are composed of forest
which would facilitate the development of the work and the interpretation of the results
especially the entomological part of the study (untreated here)
We also choose this area because its Basic Health Unit is linked to FAMERP
the educational institution that coordinates this research project
to serve as a foot hold for the development of the research
Even though the sample was not obtained randomly
this limitation is relieved by the fact that the households of the research participants present a distribution that covered almost all the blocks of the study area
Our sample also represented the internal distribution of households in most blocks of the study area
Only the blocks located at the southern end of the study area did not follow the spatial distribution described above
Among the strengths of this study should be mentioned that this is one of the few carried out
Another highlight is that the statistical model selected allowed the control of the spatial correlation between the individuals participating in the study so that the results obtained on the relationship between dengue seroprevalence and covariates were controlled by the geographical location of the individuals participating in the study
the fact that the methodology we used took into account the geographical location of the participants and allowed the identification of the extent of the spatial dependence present in the study reaffirms the hypothesis that exposure to DENV is also linked with human movements
The seropositive for dengue in the study area was equal to 74.6%
Among the individuals who claimed that they never had dengue fever
of a non-white ethnicity and living in a house (instead of in an apartment)
adjusted for the other socioeconomic and demographic covariates considered in our study
had higher risk of a positive serological result for dengue
Spatial dependence between observations occurred until 800 m
showing the necessity to consider the spatial component in the models
School of Medicine of São José do Rio Preto
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We would like to thank to the League of Infectious Diseases of FAMERP
This study was supported by the São Paulo Research Foundation (FAPESP) with grant numbers 2013/21719–3 and 2016/15012–1 for MLN
2015/12295–0 for ACBT and 2017/09671–6 for FCN
It is also supported by the National Institute of Science and Technology in Dengue (INCT em Dengue)
RAS was supported by the Coordination for the Improvement of Higher Education Personnel (CAPES) with grant
MLN and FCN are CNPq (National Council for Scientific and Technological Development) Research Fellows
The funding agencies did not play any role in the design of the study and collection
and interpretation of data and in writing the manuscript
The datasets generated and/or analysed during the current study are not publicly available due they have the geographical coordinates of the participants’ houses
information that allows the identification of participants
which goes against what has been established in our Informed Consent Form
This formulary ensures for each participant that he/she will not be identified and that the confidential nature of the information related to his/her privacy will be kept
these datasets are available from the corresponding author on reasonable request
Departamento de Doenças Dermatológicas Infecciosas e Parasitárias
Faculdade de Medicina de São José do Rio Preto (FAMERP)
Ana Carolina Bernardes Terzian &amp; Mauricio Lacerda Nogueira
Laboratório de Modelagens Matemática e Estatística em Medicina
Department of Epidemiology and Biostatistics
GFG and ACBT participated in the field data collection
RAS and NZ performed the laboratory assays
GCDS and CFE provided support with data management
EAF and MLN supervised the field data collection and the laboratory assays
MB and MLN wrote the original draft of this study
All authors made the critical reading and contributed to the elaboration of the final version of this manuscript
All authors read and approved the final manuscript
This project was submitted to and approved by Ethics and Research Committee of FAMERP (CAAE 32293014.0.0000.5415)
The residents aged 10 years or older of the study area were invited to participate of the study
The invitation was preceded by an explanation of the objectives
the duration of the study (4 years) and the need to answer questionnaires and perform annual blood collections
Residents of legal age (18 years or older) who agreed to participate in the study signed an Informed Consent Form
For the people aged less than 18 years old
we asked for their agreement as well as for their parents’
who signed the Informed Consent Form as their legal representatives
The authors declare that they have no competing interests
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations
Combination of the separate estimates obtained from the five imputed databases for the final model (intercept
R codes related to the analysis of the imputed data using R-INLA and a Bayesian Geostatistical approach
Deviance Information Criterion for the run models
covariates and the spatial component for the imputed datasets) (Imp) and the non-imputed covariate spatial model (Not imp)
covariates and the spatial component for the imputed datasets) (Spatial) and the imputed covariate non-spatial model (Non-spatial)
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The emergence of the Brazilian variant of concern
impacted the epidemiological profile of COVID-19 cases due to its higher transmissibility rate and immune evasion ability
We sequenced 305 SARS-CoV-2 whole-genomes and performed phylogenetic analyses to identify introduction events and the circulating lineages
we use epidemiological data of COVID-19 cases
and deaths to measure the impact of vaccination coverage and mortality risk
Here we show that Gamma introduction in São José do Rio Preto
was followed by the displacement of seven circulating SARS-CoV-2 variants and a rapid increase in prevalence two months after its first detection in January 2021
Gamma variant is associated with increased mortality risk and severity of COVID-19 cases in younger age groups
which corresponds to the unvaccinated population at the time
Our findings highlight the beneficial effects of vaccination indicated by a pronounced reduction of severe cases and deaths in immunized individuals
reinforcing the need for rapid and massive vaccination
virus lineages with a slightly different genetic material
we evaluated the introductions of SARS-CoV-2 lineages in a Brazilian city with the third-highest number of confirmed COVID-19 cases in the state of São Paulo
Our analyses revealed several SARS-CoV-2 lineages first detected in the city
but after the introduction of the Gamma lineage
the majority of them were replaced by this variant that became the most common
there was an increase in the number of infections
the age group that was not fully vaccinated at the time
Our findings further support the evidence that vaccination effectively decreases SARS-CoV-2 spread and transmission
little is known about its association with the severity of COVID-19 disease and mortality risk
which is crucial to better understand and mitigate the severe impact of the ongoing pandemic
the impact of slow vaccination rates on the circulation and spread of VOCs on the epidemiological profiles at the national and local level is still unclear
we report the rapid spread of the Gamma variant following its introduction and dissemination in São José do Rio Preto (SJdRP)
the municipality with the third-highest number of confirmed COVID-19 cases in São Paulo and where based Hospital de Base (HB)
the main responsible for SARS-CoV-2 diagnosis and one of the leading in COVID-19 care and treatment in the state
the new lineage introduction drove a clade replacement event
associated with a change in the epidemiological profile
with increased severe COVID-19 cases and deaths
São José do Rio Preto (SJdRP) is in the northeast region of the state of São Paulo (SP)
One of the largest and most important hospital complexes in the municipality is the Hospital de Base de São José do Rio Preto (HB)
The HB is a reference health center serving more than two million inhabitants of the 102 municipalities belonging to the 15th Regional Health Department (RHD XV)
The HB complex is one of the leading in COVID-19 care and treatment centers in SP state
having the second largest COVID-19 ICU in Brazil
with more than 180 beds and having received more than 5700 admissions so far
since the beginning of the COVID-19 pandemic
HB is the main health unit responsible for SARS-CoV-2 diagnosis for SJdRP and surrounding municipalities population
The hospital is linked to the Faculdade de Medicina de São José do Rio Preto (FAMERP)
an educational facility where Laboratório de Pesquisas em Virologia (LPV) is located and where this research was conducted
A time-trend analysis was performed using a seven-day moving average of notified cases
and deaths related to COVID-19 in SJdRP from March 2020 to May 2021
The data were retrieved from the Public Health System of SJdRP and received from the Reporting Disease Information System (SINAN)
using mild respiratory syndrome (e-SUS) and severe acute respiratory syndrome (SRAG) cases databases
The RT-qPCR was conducted in a QuantStudio 3 Real-Time PCR System (Thermo Fisher Scientific
USA) with the following conditions: 50 °C for 20 min for the reverse transcription
followed by 45 cycles of denaturation at 95 °C for 15 s
and annealing at 58 °C for 60 s The results were analyzed in QuantStudio 3 software v1.5.1 (Thermo Fisher Scientific
USA) and were interpreted as cycle quantification value (Cq) less or equal 40 as positive and Cq more than 40 as negative
included in the GeneFinder COVID-19 Plus RealAmp Kit (non-infectious DNA plasmids coding for the SARS-CoV-2 E gene and N gene)
The study was approved by the institutional review board (IRB) of the Ethics Committee of the Faculdade de Medicina de São José do Rio Preto (protocol number: CAE# 31588920.0.0000.5415)
given that all data were analyzed anonymously with the total confidentiality of each participant
Whole-genome sequencing was performed using Next-Generation Sequencing (NGS) technology
and library preparation were carried out following the instructions provided by Illumina CovidSeq Test (Illumina Inc
USA) and QIAseq SARS-CoV-2 Primer Panel (Qiagen
The quality and size of the libraries were verified by Agilent 4150 TapeStation (Agilent Technologies Inc
Libraries were pooled in equimolar concentrations
and the sequencing was implemented on the Illumina MiSeq System (Illumina Inc
using MiSeq Reagent Kit v2 (read length of 2 × 150 bp) (Illumina Inc
</a>Phylogenetic tree reconstructed using GTR + F + R2 as nucleotide substitution model
The reliability of branching patterns was tested using Ultrafast Bootstrap (UFBoot) combined with SH-like Approximate Likelihood-ratio test (SH-aLRT)
The analysis involved 272 complete genome sequences from SJdRP and 509 from five Brazilian regions
and the final tree was visualized and edited in FigTree v.1.4.4
Branches are colored according to SARS-CoV-2 lineages classified by Pangolin v.3.1.14
Tip nodes are colored according to the origin of the sequences (except the reference sequence from Wuhan)
which are from the study area of São José do Rio Preto (SJdRP) and all the Brazilian regions (North
Branch lengths are represented by a scale bar (labelled 0.2) at the bottom of the phylogenetic tree
</a>The Maximum-Likelihood tree was reconstructed based on the GTR + F + R3 nucleotide substitution model
The reliability of branching patterns was tested using the Ultrafast Bootstrap (UFBoot) combined with SH-like Approximate Likelihood-ratio test (SH-aLRT)
The analysis involved 272 complete genome sequences
Correlation between the sampling date of the most prevalent SARS-CoV-2 lineages detected in SJdRP and their genetic distance from the root (hCoV-19/Wuhan/WIV04/2019 - EPI_ISL_402124) based on the Maximum Likelihood phylogenetic tree (Correlation coefficient (Cc) = 0.84; R2 = 0.72
Branches are colored according to SARS-CoV-2 lineage classified by Pangolin v
Tip nodes are colored (except the reference sequence from Wuhan) according to the sampled month
Branch lengths are represented by a scale bar (labelled 0.3) at the bottom of the phylogenetic tree
</a>a COVID-19 deaths per 100,000 inhabitants (black line) from March 2020 to June 2021 (left y-axis) and proportion of Gamma (green line) and Zeta (lilac line) lineages detected (right y-axis)
b Percentage of COVID-19 deaths by population age (years)
The circles of different colors represent the IRR death per 25% increase in Gamma prevalence for each age group
b Change in the proportion of cases in each age group from before versus after vaccination
Circles show effective vaccine coverage (total doses divided by twice the population)
while diamonds show the percentage of people who have received both doses
along with the line of best fit and 95% confidence interval (shaded area) for each
d Change in proportions of severe cases and deaths
would imply that more than one death is averted per person vaccinated; this would be the case if
people who are vaccinated not only have significantly lower mortality rates if infected but if they also have lower rates of transmission
which preferentially reduces infection rates among unvaccinated people in the same age group (herd immunity)
Using a combination of whole-genome sequencing and epidemiological analysis
and dominance of SARS-CoV-2 Gamma lineage in SJdRP was associated with an increase of severe COVID-19 cases and deaths
the mortality risk related to Gamma infection largely depends on several factors
if efficient vaccination measures are taken rapidly
it is possible to lower the transmission rate and the mortality risk for all age groups
a rapid and efficient vaccination program is essential to reducing virus divergence
the emergence of new and more concerning SARS-CoV-2 variants can drive new clade replacement events
Further information on research design is available in the <a data-track="click" data-track-label="link" data-track-action="supplementary material anchor" href="/articles/s43856-022-00108-5#MOESM11">Nature Research Reporting Summary</a> linked to this article
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Pangolin: lineage assignment in an emerging pandemic as an epidemiological tool
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<a data-track="click" data-track-action="download citation references" data-track-label="link" rel="nofollow" href="https://citation-needed.springer.com/v2/references/10.1038/s43856-022-00108-5?format=refman&amp;flavour=references">Download references</a>
We acknowledge Rede Corona-Ômica BR MCTI/FINEP affiliated to RedeVírus/MCTI (FINEP = 01.20.0029.000462/20
CNPq fellowship = 382032/2020-9 to C.A.B.)
Multiuser Laboratory (L.M.U.) at São José do Rio Preto School of Medicine (FAMERP)
for their support with the use of equipment’s (MiSeqTM
Funding support is acknowledged from FAPESP-COVID Program (Grant #2020/04836-0 to M.L.N.)
Fundação Butantan (FAPESP Grant #2020/10127)
and partly by the Centers for Research in Emerging Infectious Diseases (CREID)
“The Coordinating Research on Emerging Arboviral Threats Encompassing the Neotropics (CREATE-NEO)” grant 1U01AI151807 awarded to N.V
by the National Institutes of Health (NIH/USA)
The funders had no role in the design of the study
These authors contributed equally: Cecília Artico Banho
Faculdade de Medicina de São José do Rio Preto
Cássia Fernanda Estofolete &amp; Mauricio Lacerda Nogueira
Leila Sabrina Ullmann &amp; João Pessoa Araújo Jr
Ana Carolina Boldrin &amp; Michela Dias Barcelos
Laboratório de Medicina Veterinária Preventiva Aplicada
Faculdade de Zootecnia e Engenharia de Alimentos
Nikos Vasilakis &amp; Mauricio Lacerda Nogueira
Center for Vector-Borne and Zoonotic Diseases
Center for Biodefense and Emerging Infectious Diseases
Institute for Human Infection and Immunity
and M.L.N conceived and designed the study
performed statistical and epidemiological analyses
carried out data analyses and interpretation
All authors approved the final version of the manuscript
All authors had full access to all the data used in this study and had final responsibility for the decision to submit for publication
Communications Medicine thanks Jinal Bhiman
reviewer(s) for their contribution to the peer review of this work
<a data-test="citation-link" data-track="click" data-track-action="download article citation" data-track-label="link" data-track-external="" rel="nofollow" href="https://citation-needed.springer.com/v2/references/10.1038/s43856-022-00108-5?format=refman&amp;flavour=citation">Download citation</a>
DOI: https://doi.org/10.1038/s43856-022-00108-5
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the building presents a curving concrete fa&ccedil;ade to the passing streets
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Bishop Tome Ferreira da Silva gave Pope Francis his resignation after images circulated online of the bishop seminude during a video call with another man
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The Vatican announced his resignation Wednesday
who has been investigated by the Vatican previously
has said the man in the video is indeed him
He said he believed it was released by someone he lives with
and he has reported the matter to local police
In 2018, the Vatican looked into allegations that Ferreira had ignored reports of sexual abuse in the dioceses &quot;and had exchanged sexual messages with an adolescent,&quot; the <a href="https://www.washingtonpost.com/world/brazilian-bishop-resigns-days-after-sexual-video-circulates/2021/08/18/30eac8bc-0044-11ec-87e0-7e07bd9ce270_story.html" target="_blank">Associated Press</a> notes
He then gave up his position as coordinator of the Ribeirao Preto archdiocese
He said his resignation as coordinator was due to personal considerations
he was &quot;accused of taking a large amount of money from the church and giving it to his driver
with whom he allegedly had a romantic relationship,&quot; according to the AP
The Vatican&#39;s process of removing bishops normally takes months or even years
but it acted swiftly in the case of Ferreira
likely because the video was &quot;the final straw&quot; after the previous allegations
The Catholic Church has often been accused of being too slow to take action on sexual abuse by clergy members
When hundreds of high-risk prisoners from the state of São Paulo in Brazil were transferred to maximum-security jails in May 2006
leaders of the notorious prison gang First Command of the Capital ordered their followers to rebel
one of the largest criminal organizations in the country
led simultaneous riots in more than half the state's prisons and caused mayhem on the streets of the city of São Paulo and its metropolitan area
that criminal groups working from prison clashed with state authorities
with violence spilling over to the general population
a rebellion - the worst ever - exposed the penitentiary system's weaknesses: corruption
There are 131,000 people in the São Paulo prison system and every month the number increases by 1,000
Most of them are low- or medium-risk offenders who are forced to share cells with violent professional criminals
living in such a hostile environment is hardly conducive to the offenders' successful reintegration into society
Not all prisons in São Paulo state face the same challenges and not all are run in the same way: 22 out of a total of 144 facilities are managed by the state in partnership with NGOs
the state remains in charge of security and discipline while NGOs are responsible for prison administration and the inmates' welfare
"the state should exercise effective oversight and ensure the services provided to detainees are adequate," says Maurício Kuehne
the Director-General of the National Penitentiary Department (DEPEN)
Professional criminals with a violent history are not allowed at the jointly managed centres
Inmates are provided with three meals a day
vocational training and educational programmes
They are also encouraged to develop the skills and resources necessary to become law-abiding citizens upon release
These and other measures introduced at the centres are in line with international standards on the treatment of prisoners and the management of institutions
despite Government attempts to improve conditions
regular facilities are often unable to guarantee detainees their fundamental human rights
Facilities in the co-administration programme stand out for other reasons
"Their resocialization and rehabilitation services are quite innovative in Brazil," says Dr
lecturer at the Department of Peace Studies at Britain's University of Bradford and former researcher for Amnesty International
She has not seen a similar partnership model anywhere else in the world
who has done extensive research on the Brazilian criminal justice system
NGO staff taking part in this programme are passionate about their work and often bring previous experience as human rights advocates and social workers
the man who started this prison management model in 1996
believes that everyone benefits from the stronger bonds forged between the community and the prisoners
While he was a juvenile court judge in the city of Bragança Paulista
he worked with people from the community in preventing drug use
violence and health problems among vulnerable groups
"I always listened to what they had to say," he recalls
The prison management alliance between civil society and the state was formalized in January 1996
The Bragança Paulista municipality trained people to start an NGO
which then signed a contract with the city's Public Security Department to manage its penitentiary
Furukawa was appointed São Paulo State Secretary for Prison Administration in 1999
he brought the idea along with him and extended it to other prisons
All the NGOs have close ties with the local community
Furukawa says civil society provides better treatment and care for inmates than the state does
improving their chances of giving up crime when they are released
"The rate of reoffending in regular prisons in São Paulo state is as high as 58 per cent
Under the resocialization centre model it is between 3 and 15 per cent."
The Brazilian co-management model also tackles the problem of under-funding
Macaulay says that state-run prisons cost US$ 458 a month per prisoner
Some cases of mismanagement have been identified
but DEPEN's Maurício Kuehne says these do not invalidate the model
"I cannot undermine the model because one or other NGO did not work out," he says
Jointly managed detention facilities have helped to make ends meet by involving the private sector
approximately 8,000 prisoners worked from jail for private companies in São Paulo
the largest and richest state in the country
Several resocialization centres have employment programmes
detainees work for office furniture suppliers
recycling plants and construction companies
female detainees assemble pneumatic valves for industrial and transportation companies
inmates sew children's and women's clothes
Employers pay inmates 75 per cent of the minimum wage and the resocialization institutions the remaining 25 per cent
which the centres use to cover expenses and reinvest in the programme
many inmates prefer to earn some money rather than none at all so they can help their families and buy essential products for themselves
An additional incentive is that sentences are reduced by one day for every three days of work
Some companies even hire the best upon their release from jail
"I visited the centre in Jaú [outside São Paulo]
where prisoners and their families were learning to produce footwear
and the prisoners were able to work after completing their sentences," says Macaulay
One of the 22 jointly managed centres currently operating in São Paulo is a small custodial facility in the city of São José do Rio Preto that houses up to 210 female inmates
Over 70 per cent of the women here were convicted of drug trafficking
The São José do Rio Preto centre has been managed by the state and the Group to Protect People Living with AIDS (known by its Portuguese acronym GADA) since 2004
GADA works with the national and municipal HIV/AIDS programmes and with UNODC to prevent drug use and HIV infection
attracting increasing community involvement and broadening the scope of its work
"We were once an NGO for people living with HIV
now we are an NGO for vulnerable populations," explains Julio Caetano Figueiredo
young women and inmates are among the groups they assist mainly through peer-to-peer education
In its management of the female penal institution in São José do Rio Preto
GADA relies on the extensive experience it has gained running community-based projects
The organization's staff and volunteers care for inmates in the same way they do for people living with HIV/AIDS
Just as they have always looked for the persons behind the term "HIV-positive," they now refuse to see individuals merely as "offenders" but
as human beings who deserve respect and often need special attention
The detainees testify to the success of this approach
24-year-old Ana spent time in a regular prison before being moved to this resocialization centre
which she prefers: "I feel that I have a real opportunity to change here
Today I know I can rebuild my life without repeating old mistakes."
Most inmates say they receive excellent treatment in São José do Rio Preto
The time does not hang too heavily as they are always involved in one activity or another - working
Alice's schedule illustrates how busy inmates are
puts on her yellow overalls and joins the others for breakfast
it becomes the classroom where the women conduct their primary school studies
The 35-year-old woman is serving a six-year term for drug trafficking
Although each prisoner costs $150 a month or about $5 a day
the institution can still afford to provide good quality food and to have a nutritionist on board
All prisoners have their own bed and share rooms with no more than 11 other women
Some work at the centre as assistants to doctors
dentists and teachers while others help out in the kitchen
Additional programmes include medical and psychological services
Six companies have signed agreements with the female centre to employ inmates
These include clothing manufacturers Yellow Bug
which produces children's clothes for export to Great Britain
which produces women's underwear that is sold in Brazil
enough to supplement their families' income and buy personal items available at cost prices in the prison shop
The shop was opened to minimize the time and costs of inspecting the goods female prisoners receive from visitors
São Paulo has an incarceration rate of 389 detainees per 100,000 inhabitants
partly because courts rarely give non-custodial sentences
Removing the non-violent people from jail would help to reduce over-crowding in mainstream prisons
"Imprisonment is not the solution to all security problems," says DEPEN chief Kuehne
So I did not think twice when I met a man who offered both of us a home
All I wanted was for death to come and save me
I decided to write a letter to the Female Resocialization Centre in São José do Rio Preto
sharing my story and asking them to take me in
There is a real opportunity to change here
Today I know I can rebuild my life without repeating old mistakes
This man was addicted to drugs and started selling them
I accepted the situation because I was in love
the police caught me selling and put me in jail
I am now serving a six-year sentence in a resocialization centre
study and learn to live with my limitations
I also long for justice to prevail because the man who attacked me is still free
He is not paying for the mistakes he has made
My mother is addicted to alcohol and drugs
I have four brothers who are also addicted to drugs
an old guy bought some beers for my mom and
he told her that he would take me for a walk
Only God knows how I feel when I think about this
Then I met a young man and thought I had found happiness
We had three kids and lived in peace for five years
he hit me in the mouth with a tile and I lost my front teeth
When I got out of jail a year and a half later
and went to live with my mother in a shantytown
I was arrested again and my kids went to a shelter
Copyright&copy;2025&nbsp;UNODC, All Rights Reserved, <a href="/newsletter/en/legal.html" class="legalnotice">Legal Notice</a>
Details: cache-fra-eddf8230085-FRA 1746455739 3864366647
As many as three people were killed when a plane crashed into a garden swimming pool in Brazil
The light aircraft came down in a residential backyard in Sao Jose do Rio Preto
Video footage shows the wreckage of the aircraft at the rear of a house with one wing inside the pool
the plane crashed 980ft from Professor Eribelto Manoel Reino airport
Warren Buffett still lives in same house in quiet neighbourhood of Omaha that he bought in 1958 for $31,500
Buffett’s success made him highly influential in business communities
earning him nickname "The Oracle of Omaha"
"This is more of a theatrical performance on his part," Zelensky says of Putin's three-day truce offer 
Zelenskiy refuses to provide safety guarantee for foreign dignitaries
Albanese´s leadership resonated at a time of global tumult
Devotees were witnessing religious ceremony
frenzy caused during the rituals triggered stampede
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the bishop of the Diocese of São José do Rio Preto
has previously been accused of sexual misconduct
mismanaging funds of the diocese and ignoring allegations of local priests abusing minors
Pope Francis has accepted the resignation of a Brazilian bishop who quit after an intimate video of him with another man leaked on social media
submitted his resignation on Saturday after acknowledging that he was the man seen in the explicit video
Bishop was Seen Caressing His Sexual Organ On Video Call with Another Man
According to Brazilian news outlet&nbsp;<a href="https://g1.globo.com/sp/sao-jose-do-rio-preto-aracatuba/noticia/2021/08/18/dom-tome-renuncia-a-diocese-de-rio-preto.ghtml">Globo</a>
exposing himself and caressing his sexual organ during a video call with another man and was allegedly engaged in an act of self-gratification
When asked to confirm the video&#8217;s authenticity by the newspaper Diario da Regiao
the bishop acknowledged that the images were of him but declined to comment on the alleged content
&#8220;I want to know how this video came out of my cell phone and into the Diario,&#8221; Ferreira&nbsp;<a href="https://www.diariodaregiao.com.br/cidades/regiao/bispo-de-rio-preto-dom-tome-tem-video-intimo-vazado-nas-redes-sociais-1.798515">told</a>&nbsp;the newspaper
&#8220;Who passed it on?&#8221; The bishop also initially threatened to make a report to the police over a potential breach of his privacy in regard to the video&#8217;s becoming public
Ferreira has now been replaced by Moacir Silva
&#8220;The Apostolic Nunciature informs that the Holy Father accepted the request today of resignation from the pastoral government of the Diocese of Sao Jose de Rio Preto
presented by His Excellency,&#8221; the statement says
Previous Allegations of Sexual Misconduct Against Ferreira de Silva
Ferreira has previously faced calls to resign and has also been the subject of Vatican investigations over allegations of sexual misconduct and failure to act against a local clergy accused of abusing minors
In 2015, Ferreira was&nbsp;<a href="https://g1.globo.com/sp/sao-jose-do-rio-preto-aracatuba/noticia/2018/09/24/bispo-de-rio-preto-investigado-pelo-vaticano-em-denuncias-de-abusos-sexuais-deixa-cargo-ligado-a-cnbb.ghtml">accused</a>&nbsp;of having an affair with a young man working as his driver
and of ignoring credible accusations of abuse of minors against local priests
The bishop was also faced allegations of financial mismanagement of the diocese
the Vatican launched an investigation against Ferreira but no further action was taken
this time following allegations that he failed to act after being given information about the sexual abuse of minors by local priests
That investigation was triggered by the 2017 arrest of a local priest who was found in possession of child pornography on his mobile phone
as well as personal information of local minors
The priest was arrested after a complaint by the mother of a 17-year-old boy
who was concerned about her son&#8217;s frequent stays at the priest&#8217;s residence
the investigation again concluded with no action taken against Ferreira
who reportedly claimed he was the victim of a smear campaign by conservative elements within the local presbyterate
Metropóles<a target="_top" class="mtech__logo" title="Ir para página inicial" aria-label="Ir para página inicial" href="https://www.metropoles.com"></a>
O documento cita como justificativa para a medida a “intensa estiagem” que atinge a cidade e a escassez hídrica
que “tem causado dificuldades no serviço de abastecimento de água e prejuízos econômicos privados expressivos
especialmente aos setores da agricultura e pecuária”
A Represa Municipal, responsável por 30% do abastecimento da cidade, está com o reservatório em nível crítico. Por isso, nessa terça-feira (24/9), o <a href="https://semae.riopreto.sp.gov.br/" target="_blank" rel="noopener">Serviço Municipal de Água e Esgoto</a> (SeMAE) iniciou um plano emergencial de monitoramento diário do sistema de captação de água
que opera no limite da capacidade de distribuição
Não há registro de chuvas significativas no município há cinco meses
A decisão de colocar a cidade em estado de emergência considera ainda “elevados índices de incêndios em vegetação” e o parecer favorável da <a href="https://www.riopreto.sp.gov.br/orgaos/defesa-civil" target="_blank" rel="noopener">Defesa Civil Municipal</a> em relação à medida
De acordo com a <a href="https://www.defesacivil.sp.gov.br/" target="_blank" rel="noopener">Defesa Civil</a> do estado
um dos 13 focos ativos de incêndio registrados no estado nesta sexta-feira (27/9) é na região de São José do Rio Preto
O SeMAE ainda reforçou o pedido à população para que faça uso consciente de água
O racionamento não está descartado – o objetivo do decreto é justamente evitar que isso ocorra
Sem chuva há quase quatro meses, a cidade de Barretos, a 96 km de Rio Preto, teve o <a href="https://www.metropoles.com/sao-paulo/sem-chuva-cidade-sp-colapso-falta-agua">decreto de situação de emergência e estado de calamidade pública confirmado</a> pelo governo estadual nessa quinta-feira
Os mais de 122 mil habitantes do município enfrentam uma grave crise hídrica desde maio. Alguns bairros ficaram sem água por mais de cinco dias e o abastecimento à população está próximo de entrar em colapso, segundo a <a href="https://barretos.sp.gov.br/" target="_blank" rel="noopener">Prefeitura de Barretos</a>
a cidade está com racionamento parcial de água
A Defesa Civil de São Paulo já enviou mais de 15 mil litros de água potável para serem distribuídos a escolas e hospitais
Fique por dentro do que acontece em São Paulo. Siga o <a href="https://www.instagram.com/metropoles.sp/" target="_blank" rel="noopener">perfil do Metrópoles SP no Instagram</a>
Faça uma denúncia ou sugira uma reportagem sobre São Paulo por meio do <a href="https://api.whatsapp.com/send?phone=5511994677776" target="_blank" title="WhatsApp do Metrópoles SP" rel="noopener">WhatsApp do Metrópoles SP: (11) 99467-7776</a>.
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O virologista Maurício Nogueira, da Famerp, fala das características da epidemia atual e da necessidade de o sistema de saúde se preparar para receber os doentes
Léo Ramos Chaves/Revista Pesquisa FAPESP</a> Maurício Nogueira
no campus da FamerpLéo Ramos Chaves/Revista Pesquisa FAPESP
O médico e virologista Maurício Lacerda Nogueira conhece bem a dengue
Há quase 20 anos ele estuda a evolução do vírus causador dessa doença que
deixa centenas de milhares de pessoas prostradas e com dores pelo corpo por vários dias
Ele próprio já foi infectado algumas vezes e
Nogueira formou-se em medicina na Universidade Federal de Minas Gerais (UFMG)
No retorno de um estágio de pós-doutorado nos Institutos Nacionais de Saúde (NIH) dos Estados Unidos em 2004
cidade do interior paulista onde a dengue e outras doenças transmitidas pelo mosquito Aedes aegypti
Sua missão era implantar na Faculdade de Medicina de São José do Rio Preto (Famerp) um dos laboratórios da Rede de Diversidade Genética de Vírus
Em um estudo que acompanhou parte da população da cidade ao longo de cinco anos
ele e seu grupo investigaram os fatores que levam ao desenvolvimento de quadros graves de dengue e como a imunidade evolui após a infecção
Também analisaram como ter tido dengue previamente influencia o quadro das enfermidades causadas pelos vírus das febres zika e chikungunya
Em uma entrevista concedida por videochamada em 31 de janeiro, Nogueira falou do desempenho das diferentes vacinas disponíveis contra a dengue e chamou a atenção para o risco de a epidemia atual ser a maior já vivida pelo país e para a necessidade de o sistema de saúde se preparar para atender os doentes, uma vez que, com os recursos disponíveis, não é possível frear uma epidemia em curso. A seguir, leia os principais trechos.
Em janeiro, foram registrados 232 mil casos suspeitos de dengue, 2,5 vezes o total de janeiro de 2023. O que se deve esperar para os próximos meses?  A expectativa é que os casos subam de modo significativo até abril. Nos últimos 20 anos, o pico de casos ocorre entre o final de março e meados de maio. Em seguida, eles caem abruptamente com a primeira frente fria. Talvez 2024 se torne o ano com o maior número de casos suspeitos, e provavelmente confirmados, da história do Brasil.
Por quê? Porque dengue mata. E mata rápido. Já a chikungunya evolui lentamente e raramente é letal. A mortalidade por dengue cai muito se os casos forem identificados no início e tratados. E o Brasil tem tradição em fazer isso bem. Uma consequência é que se acaba notificando tudo como dengue, principalmente em uma epidemia, quando nem sempre o diagnóstico laboratorial é feito. Tenho certeza de que um número significativo de casos de chikungunya estão sendo contabilizados como dengue neste ano.
Léo Ramos Chaves/Revista Pesquisa FAPESP</a> Pesquisador do Laboratório de Pesquisa em Virologia da Famerp realiza testes rápidos de detecção de dengueLéo Ramos Chaves/Revista Pesquisa FAPESP
O tratamento da dengue é paliativo, com hidratação e medicamentos para dor e febre. Por que é importante hidratar? Por causa do extravasamento vascular. Com o aumento da permeabilidade dos vasos sanguíneos, parte do líquido escapa do sistema circulatório e se acumula nos tecidos. Isso pode levar ao chamado choque hipovolêmico. Como o volume de sangue é menor, o coração não consegue bombeá-lo em quantidade suficiente para os órgãos, que entram em falência.
Léo Ramos Chaves / Revista Pesquisa FAPESP</a> Colônia de mosquito Aedes aegypti
zika e da febre amarelaLéo Ramos Chaves / Revista Pesquisa FAPESP
A Butantan-DV vai complementar o papel das duas vacinas em uso no país
Os dados disponíveis até o momento sugerem que a vacina do Butantan é superior às outras
O Brasil é um país de 200 milhões de habitantes
Não se produz essa quantidade de vacinas em um ano
A própria Takeda não teria condições de suprir
Seriam necessários 400 milhões de doses para vacinar toda a população
uma vez que a imunização com a Qdenga é em duas doses
São necessárias estratégias inteligentes para imunizar o máximo de pessoas em um prazo adequado e com os recursos disponíveis
Este ano devem chegar 5 milhões de doses da Qdenga
o que daria para imunizar 2,5 milhões de pessoas
Os 2,5 milhões que receberem a vacina devem ficar protegidos
isso é 1% da população brasileira e não deve causar impacto na epidemia em curso
Me preocupa a falta de proteção da vacina da Takeda contra a dengue 3
podemos ter uma situação semelhante à da Sanofi
a vacina não protege contra a infecção pelo vírus do sorotipo 3
o número de casos provocados pelo sorotipo 3 foi muito pequeno
assim como a proporção de pessoas que não tinham tido dengue previamente
Isso diminui a confiabilidade estatística do resultado com relação a esse sorotipo
O grupo de experts da OMS que avaliou a vacina não considerou isso um problema e recomendou o seu uso em uma faixa etária mais alta
que é a faixa para a qual o MS indica o uso
com um potencial de uso no sistema de saúde
A vacina da Sanofi também teria um potencial de uso
Ela foi aprovada para uso individual por pessoas que já tiveram dengue
Uma complicação adicional é que ela é administrada em três doses
Todas essas vacinas têm potencial de uso no SUS
que não exponha as pessoas a um eventual risco
Não podemos aceitar risco de forma nenhuma em vacina
Gostaria de enfatizar que a forma como o MS recomenda o uso da Qdenga não nos causa maior preocupação
Quantas pessoas teriam de ser vacinadas para se observar um efeito protetor em uma epidemia
Há um impacto fundamental que é o individual
As pessoas vacinadas terão risco 80% menor de adoecer
Evitaria uma doença que causa um impacto pessoal muito grande e tem um custo econômico indireto que não costumamos mensurar no Brasil
são milhões de pessoas afastadas do trabalho por até cinco dias todos os anos
Os norte-americanos costumam medir o chamado custo-efetividade
que é a pessoa sofrendo e é imensurável; o custo-efetividade
que é quanto o governo vai gastar comprando vacina
e economizar evitando tratamentos e internações
Tudo deve chegar à casa dos bilhões de reais por ano
A despesa hospitalar é alta no caso da dengue
O último dado a que tive acesso mostra que passa da casa de centena de milhões de reais por ano no país
aquele clínico geral que atua na atenção primária à saúde e é com quem se deveria discutir o assunto
Aqui as pessoas vão direto ao especialista
e estruturou um bom programa de vacinação do idoso
Mas falha no atendimento primário ao adulto
Talvez as camadas menos privilegiadas da sociedade tenham acesso melhor à vacinação porque em alguns lugares há o Programa de Saúde da Família
no qual o médico ou a enfermeira vai à casa da família e leva essa discussão
acabam procurando um especialista para resolver problemas específicos
É uma medicina fragmentada que não permite ter uma visão global da saúde
Um artigo de revisão publicado em 2022 na revista <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9127483/pdf/40259_2022_Article_531.pdf">BioDrugs</a> enumerava sete compostos candidatos a vacina contra a dengue
Os três mais promissores eram os da Sanofi
As vacinas de RNA devem caminhar rapidamente
a grande mudança de paradigma deve ocorrer se houver o licenciamento da vacina do Butantan
inserir uma vacina contra a zika nesse pacote
O Brasil fez isso até meados do século passado
Hoje é impossível repetir a forma como ocorreu a erradicação do vetor no passado
Dois processos que ocorreram até meados do século XX não seriam aceitos
O primeiro foi a estratégia do “pé na porta”
adotada em muitas campanhas para erradicar os focos do Aedes aegypti
O agente de saúde entrava na casa com você
Pode-se discutir o mérito disso na saúde pública
O segundo era a utilização de inseticidas piretroides e outros produtos muitos tóxicos
Desde que retornaram as epidemias de dengue em 1986 no Brasil
mas não conseguimos controlar vetor nenhum até hoje
Porém há algo que parece ter potencial: controlar a capacidade vetorial
É a capacidade de o mosquito transmitir a doença
mas diminuir sua capacidade de transmitir o vírus
Isso tem sido tentando com a liberação na natureza de mosquitos infectados propositalmente com uma bactéria do gênero Wolbachia
Essa bactéria coloniza o trato digestório do mosquito e impede que os vírus da dengue
chikungunya e febre amarela infectem as células dos intestinos e se multipliquem
Como os vírus não conseguem se multiplicar
eles não chegam em grande quantidade às glândulas salivares do inseto
Há um investimento grande do World Mosquito Program
um programa mundial que tem tentado utilizar o mosquito infectado com Wolbachia
A Fiocruz [Fundação Oswaldo Cruz] e o MS têm também investido bastante
Há alguns dados de estudos preliminares mostrando uma boa efetividade
mas ainda não temos os resultados de um grande estudo controlado que está em desenvolvimento em Belo Horizonte
É um programa financiado pelos NIH e pelas universidades Emory
Estamos fazendo um ensaio de cluster randomizado
Contagem e Betim em 36 clusters [conglomerados de pessoas] e em alguns deles estamos liberando mosquitos com Wolbachia e fazendo também o controle usual do vetor
fazemos apenas a intervenção de controle de vetor usual
Estamos indo para o quarto ano de acompanhamento dessa estratégia
mas só liberaremos os resultados ao final do experimento
Se alguém me perguntasse há oito anos se a dengue teria controle
A segunda perna do tripé é o uso de mosquitos infectados com Wolbachia
que cumpre o papel de diminuir de forma significativa a transmissão
A terceira parte é que há ao menos três medicamentos antivirais específicos para a dengue que estão em testes clínicos de fase 2 e 3
ao menos será possível mitigar de forma significativa os impactos da dengue
Há capacidade de produzir em grande escala mosquitos infectados com Wolbachia
Tem uma fábrica sendo construída em Belo Horizonte para isso
Também se tentou combater os mosquitos com a liberação de machos estéreis na natureza
Nunca vi o ensaio da Oxitec [a empresa que produzia os mosquitos estéreis]
os estudos têm de ser desenhados com muito cuidado
senão facilmente indicarão que diminuiu a ocorrência da doença
Não adianta esperar que o Estado vá tomar conta do nosso quintal
Temos de cuidar da própria casa e da vizinhança para diminuir os focos de mosquito
Como não é possível controlar uma epidemia de dengue
o que temos de fazer agora que os casos estão subindo é preparar o sistema de saúde para receber os doentes e conscientizar a população sobre como evitar criadouro de mosquito
Íntegra do texto publicado em versão reduzida na edição impressa, <a href="https://revistapesquisa.fapesp.br/wp-content/uploads/2024/02/042-045_Entr-Mauricio-Nogueira_337.pdf" target="_blank" rel="noopener">representada no pdf</a>
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Catanduva has very few earthquakes and most of them are very small (below magnitude 3)
Larger quakes with magnitudes above 3 might occur from time to time
Based on data from the past 55 years and our earthquake archive back to 1900
there are about 8.2 quakes on average per year in or near Catanduva
Catanduva has had at least 1 quakes above magnitude 4 since 2018
which suggests that larger earthquakes of this size occur infrequently
probably on average approximately every 5 to 10 years
The depth of the quake is unknown.The quake was felt widely in the area
Catanduva was shaken by 1 quake of magnitude 4.0
There have been also 3 quakes below magnitude 2.0 which people don't normally feel
2024 at around 8.22 pm local time (America/Sao Paulo GMT -3)
Details of the quake (if it is one) are so far unkown until confirmed by a seismic agency
We will update the status of the event on this page as soon as more information becomes available.