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Background Although leprosy is largely curable with multidrug therapy, incomplete treatment limits therapeutic effectiveness and is an important obstacle to disease control. To inform efforts to improve treatment completion rates, we aimed to identify the geographic and socioeconomic factors associated with leprosy treatment default in Brazil. Methodology/Principal findings Using individual participant data collected in the Brazilian national registries for social programs and notifiable diseases and linked as part of the 100 Million Brazilian Cohort, we evaluated the odds of treatment default among 20,063 leprosy cases diagnosed and followed up between 2007 and 2014. We investigated geographic and socioeconomic risk factors using a multivariate hierarchical analysis and carried out additional stratified analyses by leprosy subtype and geographic region. Over the duration of follow-up, 1,011 (5.0%) leprosy cases were observed to default from treatment. Treatment default was markedly increased among leprosy cases residing in the North (OR = 1.57; 95%CI 1.25–1.97) and Northeast (OR = 1.44; 95%CI 1.17–1.78) regions of Brazil. The odds of default were also higher among cases with black ethnicity (OR = 1.29; 95%CI 1.01–1.69), no income (OR = 1.41; 95%CI 1.07–1.86), familial income ≤ 0.25 times Brazilian minimum wage (OR = 1.42; 95%CI 1.13–1.77), informal home lighting/no electricity supply (OR = 1.53; 95%CI 1.28–1.82), and household density of > 1 individual per room (OR = 1.35; 95%CI 1.10–1.66). Conclusions The findings of the study indicate that the frequency of leprosy treatment default varies regionally in Brazil and provide new evidence that adverse socioeconomic conditions may represent important barriers to leprosy treatment completion. These findings suggest that interventions to address socioeconomic deprivation, along with continued efforts to improve access to care, have the potential to improve leprosy treatment outcomes and disease control., Author summary While the leprosy new case detection has been decreasing worldwide since the introduction of multidrug therapy (MDT) in the 1980s, treatment default remains an important risk factor for leprosy-associated disability and an obstacle to disease control and elimination. Treatment default occurs when an individual with leprosy does not take the prescribed number of doses required for treatment with MDT. We hypothesized that the frequency of defaulting may be influenced by geographic factors, especially as related to access to care, and socioeconomic factors, such as income, education, and household living conditions. To test this hypothesis, we investigated geographic and socioeconomic factors associated with leprosy treatment default among 20,063 new leprosy cases followed as part of the 100 Million Brazilian Cohort between 2007 and 2014. In total, 5.0% of the leprosy patients defaulted from MDT. Among the associated factors, we found that having residency in the North and Northeast of Brazil, black ethnicity, low familial income, lack of formal electricity, and a high household density were associated with higher odds of leprosy treatment default. Overall, these findings highlight the need for tailoring MDT strategies for vulnerable populations in high-burden communities and suggest that social policies aiming to alleviate poverty should be investigated as potential tools for improving leprosy treatment completion.

Extradomiciliary contacts have been overlooked in the study of TB transmission due to difficulties in identifying actual contacts in large populations. Complex network analysis provides a framework to model the structure of contacts, specially extradomiciliary ones. We conducted a study of incident sputum-positive TB cases and healthy controls occurring in a moderate TB burden city. Cases and controls were interviewed to obtain data regarding the usual locations of residence, work, study, and leisure. Mycobacterium tuberculosis isolated from sputum was genotyped. The collected data were used to build networks based on a framework of putative social interactions indicating possible TB transmission. A user-friendly open source environment (GraphTube) was setup to extract information from the collected data. Networks based on the likelihood of patient-patient, patient-healthy, and healthy-healthy contacts were setup, depending on a constraint of geographical distance of places attended by the volunteers. Using a threshold for the geographical distance of 300 m, the differences between TB cases and controls are revealed. Several clusters formed by social network nodes with high genotypic similarity were characterized. The developed framework provided consistent results and can be used to support the targeted search of potentially infected individuals and to help to understand the TB transmission.

Background Social protection can reduce poverty and act on the determinants of tuberculosis (TB). Objective To evaluate the impact of the Family Health Strategy (FHS) and the Bolsa Familia Programme on TB-related mortality in Brazil. Methods This was an ecological study in which the units of analysis were Brazilian municipalities between 2001 and 2012. The principal independent variables were the levels of coverage of the primary health care system and the conditional cash transfer programme. The dependent variable was TB mortality rate (obtained from national databases). Descriptive analysis and negative binomial regression based on panel data using fixed-effects models were performed. Crude and adjusted estimates were calculated for continuous and categorical variables. Results A high FHS coverage was significantly associated with a reduction in the TB mortality rate (RR 0.80, 95%CI 0.72-0.89). An increase in the coverage of the Brazilian cash transfer programme was significantly associated with a reduction in the TB mortality rate (RR 0.87, 95%CI 0.81-0.96). Conclusion FHS and the Bolsa Familia conditional cash transfer programme had a positive impact on the TB mortality rate in Brazil. Public policies should include economic support combined with health promotion.

Background: Poverty and other socio-environmental determinants may contribute to the occurrence of leprosy. However, there is no previous evidence on the effectiveness of cash transfer programmes in reducing leprosy case detection among children under 15 years old. Objective: This study aimed to assess the effect of the Brazilian conditional cash transfer programme (Bolsa Familia Programme, BFP) on the reduction of new case detection rates (NCDR) of leprosy in Brazilians under 15 years old. Methods: We performed a mixed ecological study with the Brazilian municipalities as units of analysis, during 2004–2015. The main independent variables were: BFP coverage of target population (poor and extremely poor families) and BFP coverage of the total population of the municipalities. Data were obtained from public databases. We included 1,120 (of 5,570) municipalities in the analysis, using fixedeffects negative binomial models for panel data, adjusted for the municipal coverages of the Brazilian primary health care programme (Family Health Strategy, FHS) and for a set of sociodemographic covariates. Results: We found an increasing trend in the median BFP coverages and a decreasing trend in the NCDR of leprosy in individuals under 15 years old. This indicator was significantly reduced in municipalities with higher BFP coverages of target population (RR = 0.75; CI 95% 0.63–0.88) and higher BFP coverages of the total population of the municipalities (RR = 0.85; CI 95% 0.79–0.93). Conclusions: During the study period, BFP was associated with a reduction of the NCDR of leprosy among Brazilians aged less than 15 years old, living in municipalities with a high risk of leprosy transmission.

Resumo Objetivo: analisar associação entre desfecho do tratamento da tuberculose, características sociodemográficas e benefícios sociais recebidos. Métodos: estudo de coorte desenvolvido em Salvador, Bahia, Brasil, no período 2014-2016; analisaram-se associações bivariadas entre desfecho do tratamento, características sociodemográficas e benefícios sociais. Resultados: foram acompanhados 216 indivíduos, dos quais 79,6% foram curados; maior proporção de cura associou-se com escolaridade >9 anos (87,5%; p=0,028), união conjugal (86,3%; p=0,031) e densidade domiciliar ≤2 pessoas/dormitório (84,1%; p=0,013); foram adotados como referência indivíduos com escolaridade ≤9 anos, sem união conjugal, e densidade domiciliar >2 pessoas/dormitório; maior proporção de cura também foi verificada entre indivíduos que recebiam benefícios governamentais e não governamentais (90,5%) ou somente benefícios diretos (81,6%). Conclusão: escolaridade >9 anos, união conjugal e densidade domiciliar ≤2 pessoas/dormitório associaram-se com maior proporção de cura; este desfecho foi mais frequente entre indivíduos que acumulavam benefícios governamentais e não governamentais ou recebiam somente benefícios diretos. Resumen Objetivo: analizar la asociación entre resultados del tratamiento de la tuberculosis, características sociodemográficas y los beneficios sociales recibidos. Métodos: estudio de cohorte en Salvador, Bahia, Brasil, en el período 2014-2016; se analizaron correlaciones bivariadas entre resultados del tratamiento, características sociodemográficas y beneficios. Resultados: participaron 216 individuos, de los cuales 79,6% fueron curados; una mayor proporción de cura se asoció con escolaridad >9 años (87,5%; p=0,028), unión conyugal (86,3%; p=0,031) y densidad domiciliaria ≤2 personas/dormitorio (84,1%; p=0,013); fueron adoptados como referencia escolaridad ≤9 años, solteros y densidad domiciliaria >2 personas/dormitorio; mayor curación también se verificó entre individuos que recibían beneficios gubernamentales y no gubernamentales (90,5%) o únicamente beneficios directos (81,6%). Conclusión: escolaridad >9 años, unión conyugal y densidad domiciliaria ≤2 personas/dormitorio se asociaron con curación; este resultado fue más frecuente entre los que acumulaban beneficios gubernamentales y no gubernamentales o recibían solamente beneficios directos. Abstract Objective: to analyze association between tuberculosis treatment outcome, sociodemographic characteristics and receipt of social benefits. Methods: this was a cohort study conducted in Salvador, Bahia, Brazil, in the period 2014-2016; we analyzed bivariate associations between treatment outcome, sociodemographic characteristics and social benefits. Results: 216 individuals were followed, of whom 79.6% were cured; higher cure proportion was associated with schooling >9 years (87.5%; p=0.028), marital union (86.3%; p=0.031), and household density ≤2 individuals/bedroom (84.1%; p=0.013); we took as our reference individuals with schooling ≤9 years, not in marital union, and housing density >2 people/bedroom; higher cure proportion was also found among recipients of government and non-government benefits (90.5%), and among those who only received direct benefits (81.6%). Conclusion: schooling >9 years, marital union, and household density ≤2 individuals/bedroom were associated with higher cure; this outcome was more frequent among individuals receiving government and non-government benefits, and among individuals receiving only direct benefits.

International audience; BACKGROUND: Social protection interventions might improve tuberculosis outcomes and could help to control the epidemic in Brazil. The aim of this study was to evaluate the independent effect of the Bolsa Familia Programme (BFP) on tuberculosis treatment outcomes in Brazil.METHODS: We prospectively recruited and followed up individuals (aged ≥18 years) who initiated tuberculosis treatment at 42 health-care centres across seven cities in Brazil, between March 1, 2014, and April 30, 2017. Patients were interviewed at health-care centres and information about individual characteristics, socioeconomic status, living conditions, lifestyle, and comorbidities was recorded. Patients were separated into two groups according to BFP beneficiary status: BFP (exposed) or non-BFP (not exposed). Treatment outcome (cure, dropout, death, or development of drug-resistant tuberculosis or treatment failure) was recorded after 6 months of therapy. Pearson's χ2 test and ANOVA were used to compare tuberculosis treatment outcomes between the two groups, and we estimated the propensity score of being a beneficiary of the BFP using a logit model. We used multinomial regression models to evaluate the effect of the BFP on tuberculosis treatment outcomes.FINDINGS: 1239 individuals were included in the study, of whom 196 (16%) were beneficiaries of the BFP and 1043 (84%) were not. After 6 months of treatment, 912 (87%) of 1043 patients in the non-BFP group and 173 (88%) of 196 patients in the BFP group were cured of tuberculosis, 103 (10%) patients in the non-BFP group and 17 (9%) patients in the BFP group had dropped out, and 25 (3%) patients in the non-BFP group and six (3%) patients in the BFP group had died. Three (

to analyze association between tuberculosis treatment outcome, sociodemographic characteristics and receipt of social benefits.this was a cohort study conducted in Salvador, Bahia, Brazil, in the period 2014-2016; we analyzed bivariate associations between treatment outcome, sociodemographic characteristics and social benefits.216 individuals were followed, of whom 79.6% were cured; higher cure proportion was associated with schooling9 years (87.5%; p=0.028), marital union (86.3%; p=0.031), and household density ≤2 individuals/bedroom (84.1%; p=0.013); we took as our reference individuals with schooling ≤9 years, not in marital union, and housing density2 people/bedroom; higher cure proportion was also found among recipients of government and non-government benefits (90.5%), and among those who only received direct benefits (81.6%).schooling9 years, marital union, and household density ≤2 individuals/bedroom were associated with higher cure; this outcome was more frequent among individuals receiving government and non-government benefits, and among individuals receiving only direct benefits.analisar associação entre desfecho do tratamento da tuberculose, características sociodemográficas e benefícios sociais recebidos.estudo de coorte desenvolvido em Salvador, Bahia, Brasil, no período 2014-2016; analisaram-se associações bivariadas entre desfecho do tratamento, características sociodemográficas e benefícios sociais.foram acompanhados 216 indivíduos, dos quais 79,6% foram curados; maior proporção de cura associou-se com escolaridade9 anos (87,5%; p=0,028), união conjugal (86,3%; p=0,031) e densidade domiciliar ≤2 pessoas/dormitório (84,1%; p=0,013); foram adotados como referência indivíduos com escolaridade ≤9 anos, sem união conjugal, e densidade domiciliar2 pessoas/dormitório; maior proporção de cura também foi verificada entre indivíduos que recebiam benefícios governamentais e não governamentais (90,5%) ou somente benefícios diretos (81,6%).escolaridade9 anos, união conjugal e densidade domiciliar ≤2 pessoas/dormitório associaram-se com maior proporção de cura; este desfecho foi mais frequente entre indivíduos que acumulavam benefícios governamentais e não governamentais ou recebiam somente benefícios diretos.analizar la asociación entre resultados del tratamiento de la tuberculosis, características sociodemográficas y los beneficios sociales recibidos.estudio de cohorte en Salvador, Bahia, Brasil, en el período 2014-2016; se analizaron correlaciones bivariadas entre resultados del tratamiento, características sociodemográficas y beneficios.participaron 216 individuos, de los cuales 79,6% fueron curados; una mayor proporción de cura se asoció con escolaridad9 años (87,5%; p=0,028), unión conyugal (86,3%; p=0,031) y densidad domiciliaria ≤2 personas/dormitorio (84,1%; p=0,013); fueron adoptados como referencia escolaridad ≤9 años, solteros y densidad domiciliaria2 personas/dormitorio; mayor curación también se verificó entre individuos que recibían beneficios gubernamentales y no gubernamentales (90,5%) o únicamente beneficios directos (81,6%).escolaridad9 años, unión conyugal y densidad domiciliaria ≤2 personas/dormitorio se asociaron con curación; este resultado fue más frecuente entre los que acumulaban beneficios gubernamentales y no gubernamentales o recibían solamente beneficios directos.

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2016-04-25T18:22:27Z No. of bitstreams: 1 Artigo per nac. Rosana aquino. 2015.pdf: 118061 bytes, checksum: a0bd2c2b3b9fd99b364af0d01d8dbfcc (MD5) Made available in DSpace on 2016-04-25T18:22:27Z (GMT). No. of bitstreams: 1 Artigo per nac. Rosana aquino. 2015.pdf: 118061 bytes, checksum: a0bd2c2b3b9fd99b364af0d01d8dbfcc (MD5) Previous issue date: 2015-01 O objetivo do presente estudo foi identificar fatores associados ao acesso geográfico aos serviços de saúde por portadores de tuberculose em três capitais do Nordeste do Brasil. A amostra foi composta por casos novos de tuberculose, notificados em 2007. Foram utilizados dados provenientes do Sistema de Informação sobre Agravos de Notificação, e do Cadastro Nacional de Estabelecimento de Saúde. Os endereços dos domicílios e das unidades de saúde foram georreferenciados e, utilizando a distância entre o domicílio e a unidade de atendimento de cada caso, foi considerado acesso dificultado quando esta distância foi maior do que 800 metros. Foram estimadas as razões de prevalência bruta e ajustada por meio de regressão de Poisson. Verificou-se que após ajuste com as variáveis estudadas, apenas a variável unidade básica, em Salvador, Bahia (RP = 0,75; IC95%: 0,720-0,794) e em Recife, Pernambuco (RP = 0,402; IC95%: 0,318-0,508), manteve associação com o acesso dificultado. O estudo concluiu que a descentralização do atendimento em unidade básica pode contribuir com a melhoria do acesso aos serviços de saúde. Rio de Janeiro

OBJECTIVE To evaluate the impact of the Brazilian cash transfer programme (Bolsa Familia Programme, BFP) on tuberculosis (TB) incidence in Brazil from 2004 to 2012. DESIGN We studied tuberculosis surveillance data using a combination of an ecological multiple-group and time-trend design covering 2458 Brazilian municipalities. The main independent variable was BFP coverage and the outcome was the TB incidence rate. All study variables were obtained from national databases. We used fixed-effects negative binomial models for panel data adjusted for selected covariates and a variable representing time. RESULTS After controlling for covariates, TB incidence rates were significantly reduced in municipalities with high BFP coverage compared with those with low and intermediate coverage (in a model with a time variable incidence rate ratio = 0.96, 95%CI 0.93-0.99). CONCLUSION This was the first evidence of a statistically significant association between the increase in cash transfer programme coverage and a reduction in TB incidence rate. Our findings provide support for social protection interventions for tackling TB worldwide.

BCG protection varies and in some places (nearest the equator) is low or absent. Understanding this variation can inform the efforts to develop new vaccines against tuberculosis. Two main hypotheses are used to explain this variation: under masking, new vaccines are unlikely to increase protection; under blocking new vaccines have a greater potential to be effective when BCG is not. We conducted a cluster randomized trial to explored the masking and blocking hypotheses by studying BCG vaccine efficacy of neonatal vaccination and when administered for the first or a second (revaccination) time at school age in two sites (Manaus close and Salvador further south from the equator). Seven hundred and sixty three state schools were matched on socio economic characteristics of the neighborhood and 239,934 children were randomized to vaccine (BCG vaccination at school age) or control group. Protection by first BCG vaccination at school age was high in Salvador (34%, 95% CI 7-53%, p=0.017) but low in Manaus (8%, 95% CI t0 39-40%, p=0.686). For revaccination at school age, protection was modest in Salvador (19%, 95% CI 3-33%, p=0.022) and absent in Manaus (1%, 95% CI to 27-23%, p=0.932). Vaccine efficacy for neonatal vaccination was similar in Salvador (40%, 95% CI 22-54%, p

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2018-08-08T13:02:52Z No. of bitstreams: 1 Samia Barreto et al. 2017.pdf: 872552 bytes, checksum: 514f102e15c6ff861c7e0d01d513c327 (MD5) Made available in DSpace on 2018-08-08T13:02:52Z (GMT). No. of bitstreams: 1 Samia Barreto et al. 2017.pdf: 872552 bytes, checksum: 514f102e15c6ff861c7e0d01d513c327 (MD5) Previous issue date: 2017 Introduction: This study compares the clinical and epidemiological features of patients with TB, with and without DM. Methods: New cases of active pulmonary TB that occurred in Salvador, Bahia, Brazil between 2008 and 2010 were included. DM was diagnosed by based on diagnostic criteria established by the American Diabetes Association. Results: Of the 323 cases of TB, 44 (13.6%) were diabetic. Patients with TB and DM were older (44.7%), with a high level of education (34.%); had slow wound healing (23.4%) and fatigue (61.7%). Conclusions: Clinical symptoms differed between patients with TB, with and without DM. Uberaba

The number of bronchiectasis diagnoses has increased in the last two decades due to several factors.Research carried out over the last years showed that an aetiological diagnosis could change the approach and treatment of a relevant percentage of patients and consequently the prognosis.Currently, systematic investigation into aetiology, particularly of those disorders that can be subject to specific treatment, is recommended.Given the complexity of the aetiological diagnosis, the Pulmonology Portuguese Society Bronchiectasis Study Group assembled a working group which prepared a document to guide and standardize the aetiologic investigation based on available literature and its own expertise. The goal is to facilitate the investigation, rationalize resources and improve the delivery of care, quality of life and prognosis of patients with bronchiectasis. Keywords: Bronchiectasis, Recommendations, Aetiological diagnosis

OBJECTIVE To test the association between diabetes and tuberculosis. METHODS It is a case-control study, matched by age and sex. We included 323 new cases of tuberculosis with positive results for bacilloscopy. The controls were 323 respiratory symptomatic patients with negative bacilloscopy, from the same health services, such as: ambulatory cases from three referral hospitals and six basic health units responsible for the notifications of new cases of tuberculosis in Salvador, Bahia. Data collection occurred between 2008 and 2010. The instruments used were structured interview, including clinical data, capillary blood glucose (during fasting or postprandial), and the CAGE questionnaire for screening of abusive consumption of alcohol. Descriptive, exploratory, and multivariate analysis was performed using conditional logistic regression. RESULTS The average age of the cases was 38.5 (SD = 14.2) years and of the controls, 38.5 (SD = 14.3) years. Among cases and controls, most subjects (61%) were male. In univariate analysis we found association between the occurrence of diabetes and tuberculosis (OR = 2.37; 95%CI 1.04–5.42), which remained statistically significant after adjustment for potential confounders (OR = 3.12; 95%CI 1.12–7.94). CONCLUSIONS The association between diabetes and tuberculosis can hinder the control of tuberculosis, contributing to the maintainance of the disease burden. The situation demands increasing early detection of diabetes among people with tuberculosis, in an attempt to improve disease control strategies. RESUMO OBJETIVO Testar a associação entre diabetes e tuberculose. MÉTODOS Trata-se de estudo caso-controle, pareado por idade e sexo. Foram incluídos 323 casos novos de tuberculose com resultados positivos à baciloscopia. Os controles foram 323 sintomáticos respiratórios com baciloscopia negativa, oriundos dos mesmos serviços de saúde dos casos: ambulatórios de três hospitais de referência e seis unidades básicas de saúde responsáveis pelas notificações dos casos novos de tuberculose em Salvador, Bahia. A coleta de dados ocorreu entre 2008 e 2010. Os instrumentos utilizados foram entrevista estruturada, incluindo dados clínicos, glicemia capilar (em jejum ou pós-prandial) e o questionário CAGE para triagem de consumo abusivo de álcool. Foi realizada análise descritiva, exploratória e multivariada utilizando-se de regressão logística condicional. RESULTADOS A média de idade dos casos foi 38,5 (DP = 14,2) anos e dos controles, 38,5 (DP = 14,3) anos. Tanto entre os casos quanto entre os controles, a maioria (61%) dos indivíduos era do sexo masculino. Na análise univariada, houve associação entre ocorrência de diabetes e de tuberculose (OR = 2,37; IC95% 1,04–5,42), que permaneceu estatisticamente significante após ajuste pelos potenciais confundidores (OR = 3,12; IC95% 1,12–7,94). CONCLUSÕES A associação entre diabetes e tuberculose pode dificultar o controle da tuberculose, contribuindo para manutenção da elevada carga da doença. A situação demanda intensificação da detecção precoce de diabetes entre pessoas com tuberculose, na tentativa de maior efetividade das estratégias de controle da doença.

This study constitutes a first attempt to describe the genetic population structure of Mycobacterium tuberculosis circulating in Salvador, Bahia State, Brazil. A total of 56 confirmed cases of pulmonary tuberculosis, identified between March and June 2008, were analyzed using restriction fragment length polymorphism (IS6110-RFLP). The study population was characterized by a predominance of males (71.43%) over 30 years of age (68.75%). Forty-one isolates were found to belong to a single pattern (73.2%), while 15 (26.7%) were found in group patterns, forming six clusters. The higher level of diversity observed is much more suggestive of endogenous reactivation than recent transmission. Este é o primeiro estudo realizado na Bahia, Brasil, visando à descrição da estrutura da população genética circulante do Mycobacterium tuberculosis na cidade de Salvador. Um total de 56 casos confirmados de tuberculose pulmonar, identificados entre março e junho de 2008, foi analisado pelo método Restriction Fragment Lenght Polymorphism (IS6110-RFLP). A população de estudo foi caracterizada como a maioria do sexo masculino (71,43 %), idade acima de 30 anos (68,75%). Quarenta e um isolados (73,21%) com padrão único, enquanto 15 (26,75%) apresentaram padrões agrupáveis, formando seis clusters. A alta taxa de diversidade das cepas de M. tuberculosis observada é mais sugestiva de reativação endógena do que transmissão recente.

p. 59-66 Submitted by Ana Valéria de Jesus Moura (anavaleria_131@hotmail.com) on 2011-08-14T14:02:01Z No. of bitstreams: 1 6492.pdf: 179218 bytes, checksum: e721eeffed70a7b18da64b6958fb3af3 (MD5) Made available in DSpace on 2011-08-14T14:02:01Z (GMT). No. of bitstreams: 1 6492.pdf: 179218 bytes, checksum: e721eeffed70a7b18da64b6958fb3af3 (MD5) Previous issue date: 2007 OBJETIVO: A vacina BCG é utilizada desde 1921, embora ainda apresente controvérsias e aspectos não esclarecidos. O objetivo do artigo foi analisar aspectos relacionados ao efeito protetor da primeira e segunda doses da vacina BCG e as políticas de vacinação adotadas. MÉTODOS: Foi realizada revisão sistemática da literatura publicada em inglês e espanhol, abrangendo o período compreendido entre 1948 e 2006, na base PubMed. Os principais descritores utilizados foram BCG vaccine, BCG effi cacy, BCG e tuberculosis. Os estudos foram agrupados por tipo de desenho, apresentando-se separadamente os principais resultados de ensaios clínicos, estudos de caso-controle e metanálises. RESULTADOS: O efeito protetor da primeira dose da vacina BCG contra a tuberculose na forma miliar ou na meningite é elevado. No entanto, os resultados são discordantes em relação à forma pulmonar, variando de ausência de efeito a níveis próximos a 80%. Estão sendo conduzidas pesquisas sobre novas vacinas candidatas a substituir a BCG ou serem utilizadas como reforço. CONCLUSÕES: Há evidências de que a segunda dose da BCG não aumenta o seu efeito protetor. Apesar de seus limites e da expectativa futura de nova vacina para tuberculose, a vacina BCG mantém-se como importante instrumento no controle dos efeitos danosos da doença, sobretudo em países com taxas de incidência médias e elevadas.

Summary Background Many countries offer a second BCG vaccination to prevent tuberculosis, although there is little evidence of whether this confers additional protection. BCG vaccination is routine in Brazil but BCG revaccination procedures vary by state. We studied revaccination efficacy in two Brazilian cities with tuberculosis prevalence representative of Brazil. Methods We did a cluster-randomised trial of the protection against tuberculosis from BCG revaccination in school-aged children who had had one BCG vaccination as infants. 767 schools in the cities of Salvador and Manaus, Brazil, participated; schools were the unit of randomisation. The study was open label with no placebo. Cases of tuberculosis were identified through record linkage to the Tuberculosis Control Programme. Revaccination status was masked during linkage and validation of cases. The incidence of tuberculosis was the primary outcome. Analysis was by intention to treat. Findings 386 schools (176 846 children) were assigned BCG revaccination and 365 (171 293 children) no revaccination. 42 053 children in the vaccine group and 47 006 in the control group were absent from school on the day of the visit and were excluded. 31 163 and 27 146, respectively were also excluded because they had no BCG scar, two or more scars, or a doubtful scar on assessment. The crude incidence of tuberculosis in the intervention group was 29·3 per 100 000 person years and in the control group 30·2 per 100 000 person-years (crude-rate ratio 0·97; 95% CI 0·76–1·28). The efficacy of BCG revaccination was 9% (−16 to 29%). Interpretation Revaccination given to children aged 7–14 years in this setting does not provide substantial additional protection and should not be recommended. Follow-up is ongoing and needed to assess the effect of other factors on revaccination efficacy: time since vaccination, age at vaccination, and high or low prevalence of environmental mycobacteria.

Texto completo: acesso restrito. p. 271-278 Submitted by Edileide Reis (leyde-landy@hotmail.com) on 2013-11-27T14:42:15Z No. of bitstreams: 1 Norma I. Soza Pineda.pdf: 99903 bytes, checksum: e1947a3e122e342e8537ca02c4fbb1dd (MD5) Approved for entry into archive by Rodrigo Meirelles (rodrigomei@ufba.br) on 2013-11-28T21:51:56Z (GMT) No. of bitstreams: 1 Norma I. Soza Pineda.pdf: 99903 bytes, checksum: e1947a3e122e342e8537ca02c4fbb1dd (MD5) Made available in DSpace on 2013-11-28T21:51:56Z (GMT). No. of bitstreams: 1 Norma I. Soza Pineda.pdf: 99903 bytes, checksum: e1947a3e122e342e8537ca02c4fbb1dd (MD5) Previous issue date: 2005 OBJETIVO: Identificar factores relacionados con el abandono (deserción) del tratamiento de la tuberculosis en centros de salud de los departamentos de Managua y Matagalpa, en Nicaragua. MÉTODOS: Se diseñó un estudio de casos y testigos pareados por edad y por municipio de tratamiento. Se seleccionaron como casos 251 pacientes mayores de 15 años que abandonaron el tratamiento antituberculoso y como testigos pacientes que concluyeron la farmacoterapia (razón 1:1) durante el periodo de enero de 1998 a diciembre de 2001. Se obtuvieron datos de aspectos demográficos y socioeconómicos, hábitos de vida y características de la atención. Las variables se seleccionaron y agruparon utilizando un modelo teórico jerarquizado. Por medio de un análisis de regresión logística condicional, se estimó la razón de posibilidades (odds ratio, OR), con un intervalo de confianza de 95% (IC95%). RESULTADOS: Son factores de riesgo de abandono de la farmacoterapia antituberculosa: sexo masculino (OR: 2,51; IC 95%: 1,63 a 3,94), residencia inestable o en la calle (OR: 3,08; IC95%: 1,57 a 6,49), cambio de domicilio durante el tratamiento (OR: 4,22; IC95%: 2,06 a 9,93), consumo de bebidas alcohólicas (OR: 5,25; IC95%: 2,43 a 12,94), uso de drogas ilícitas (OR: 5,25; IC95%: 2,43 a 12,94), dificultad de acceso a los servicios de salud (OR: 2,64; IC95%: 1,39 a 5,29) y un concepto negativo de la atención recibida (OR: 5,33; IC95%: 1,52 a 28,56). CONCLUSIÓN: Es indispensable establecer en los servicios de salud medidas que contribuyan a abatir el riesgo de abandono. Es importante recuperar la participación social del sector de la salud mediante acciones comunitarias.

A quimioprofilaxia da tuberculose constitui-se numa medida terapêutica para a prevenção da infecção pelo Mycobacterium tuberculosis ou para evitar o desenvolvimento da doença nos indivíduos infectados. Geralmente baseia-se na administração de isoniazida. Entretanto, o uso de rifampicina e pirazinamida vem sendo recentemente introduzido. Este trabalho tem como objetivo revisar os resultados dos principais estudos que avaliaram as indicações da quimioprofilaxia com isoniazida e sua associação com outras drogas, sua efetividade na prevenção da tuberculose considerando os diversos grupos de risco, e as alternativas do uso de outros esquemas. Procedeu-se à revisão sistemática da literatura, com ênfase em ensaios clínicos e meta-análises. Foram consultados também os documentos oficiais. Foram selecionados aqueles estudos que envolveram ensaios clínicos ramdomizados com uso de isoniazida, rifampicina ou pirazinamida em pacientes HIV positivos ou negativos. Concluiu-se que a isoniazida continua sendo efetiva na prevenção da tuberculose na população de indivíduos HIV negativos e de HIV positivos. A dose padrão de 5 a 15 mg/kg/dia tem mostrado proteção similar para períodos de tratamento de seis e doze meses. O risco de desenvolver hepatite foi menor que 1%, sendo recomendada sua utilização com acompanhamento nos indivíduos com idade superior a 35 anos e usuários de álcool. Os estudos com esquemas de tratamento utilizando outros medicamentos não foram conclusivos, sendo necessária a realização de novos estudos para avaliação da efetividade desses esquemas em populações de alto risco de desenvolver tuberculose.

This paper describes the design and baseline results of a large and simple randomized controlled trial of the protection against tuberculosis of a dose of Bacillus Calmette Guerin (BCG) vaccination given to school children in a population with a high coverage of neonatal BCG (The Brazilian BCG-REVAC trial). The study started in 1996 and is a pair-matched and stratified-cluster randomized controlled trial with no placebo. The study population consists of children aged 7-14 years enrolled in 763 state schools from the cities of Salvador and Manaus, Brazil. Schools were the unit of randomization. Identifying information was collected for 354,708 school children. The final study population, after exclusions on the basis of age, BCG scar readings and absence from school on the day of the study visit, consists of 242,401 children, of whom 125,403 are in intervention schools. Follow-up relies on ascertainment of cases diagnosed at the health services and notified to the tuberculosis control program surveillance system. Blindness is guaranteed during linkage and validation of cases. Analysis is planned for the next 12 months, where efficacy will be estimated by calculating incidence of tuberculosis in the vaccine and control groups, taking into consideration the cluster design. The intervention studied, a second BCG vaccination, is widely used, although the World Health Organization does not recommend it on the basis of absence of evidence of protection or lack of protection. The results of the trial will make it possible for BCG revaccination practice to be informed by evidence. This is an example of a large simple and relatively inexpensive effectiveness trial, resulting from good collaboration between academia and health and education services enabling developing countries to define policies that are relevant for their reality.

Background Social determinants can affect the transmission of leprosy and its progression to disease. Not much is known about the effectiveness of welfare and primary health care policies on the reduction of leprosy occurrence. The aim of this study is to evaluate the impact of the Brazilian cash transfer (Bolsa Família Program-BFP) and primary health care (Family Health Program-FHP) programs on new case detection rate of leprosy. Methodology/Principal Findings We conducted the study with a mixed ecological design, a combination of an ecological multiple-group and time-trend design in the period 2004–2011 with the Brazilian municipalities as unit of analysis. The main independent variables were the BFP and FHP coverage at the municipal level and the outcome was new case detection rate of leprosy. Leprosy new cases, BFP and FHP coverage, population and other relevant socio-demographic covariates were obtained from national databases. We used fixed-effects negative binomial models for panel data adjusted for relevant socio-demographic covariates. A total of 1,358 municipalities were included in the analysis. In the studied period, while the municipal coverage of BFP and FHP increased, the new case detection rate of leprosy decreased. Leprosy new case detection rate was significantly reduced in municipalities with consolidated BFP coverage (Risk Ratio 0.79; 95% CI = 0.74–0.83) and significantly increased in municipalities with FHP coverage in the medium (72–95%) (Risk Ratio 1.05; 95% CI = 1.02–1.09) and higher coverage tertiles (>95%) (Risk Ratio 1.12; 95% CI = 1.08–1.17). Conclusions At the same time the Family Health Program had been effective in increasing the new case detection rate of leprosy in Brazil, the Bolsa Família Program was associated with a reduction of the new case detection rate of leprosy that we propose reflects a reduction in leprosy incidence., Author Summary Leprosy is considered a poverty related disease. Not much is known about the effectiveness of welfare and primary health care policies on reduction of leprosy occurrence. We conducted a study to evaluate the impact of the Brazilian conditional cash transfer (Bolsa Família Program) and the Primary Health Care (Family Health Program) on the new case detection rate of leprosy in the period 2004–2011 in the Brazilian municipalities. All variables were obtained from national databases and a total of 1,358 municipalities were included in the analysis. The new case detection rate of leprosy was significantly reduced in municipalities with intermediate, high, and consolidated BFP coverage. There was a significant increase in new case detection rate of leprosy as Family Health Program coverage increased. We interpret this to mean that at the same time the primary health care had been effective increasing the new case detection rate of leprosy in Brazil, there is an impact of conditional cash transfer in the reduction of the new case detection rate of leprosy due to reduction in leprosy incidence. We expect that these results contribute with arguments to the discussion on the relationship between distributive social policies and health conditions of the population in developing countries worldwide.

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2015-06-01T12:42:28Z No. of bitstreams: 1 Conceição Costa 2014.pdf: 764727 bytes, checksum: 47fb9c8e5f2c7614aea57c86229d3a08 (MD5) Made available in DSpace on 2015-06-01T12:42:28Z (GMT). No. of bitstreams: 1 Conceição Costa 2014.pdf: 764727 bytes, checksum: 47fb9c8e5f2c7614aea57c86229d3a08 (MD5) Previous issue date: 2014-06 Introduction:Congenital syphilis is an important health problem in Brazil. This study assessed measures aimed at the prevention and control of syphilis in the State of Mato Grosso and its capital, Cuiabá. Methods: A descriptive study cross-sectional and of time trends assessing the congenital syphilis was performed in Cuiabá and Mato Grosso between 2001 and 2011. We compared maternal sociodemographic characteristics and health care utilization related to cases of congenital syphilis during the periods from 2001 to 2006 and from 2007 to 2011. We assessed the temporal trends in this disease’s incidence using a simple linear regression. Results: Between 2001 and 2006 in Mato Grosso, 86.8% of the mothers who had live births with congenital syphilis received prenatal care, 90.6% presented with a nontreponemal test reagent at delivery, 96.2% had no information regarding a treponemal confi rmatory test at delivery, and 77.6% received inadequate treatment for syphilis; additionally, 75.8% of their partners were not treated. There was a statistically signifi cant reduction in prenatal visits (p = 0.004) and an increase in the proportion of mothers reactive to nontreponemal tests at delivery (p = 0.031) between the two periods. No other variables were found to differ signifi cantly between the periods. In Cuiabá, we observed a similar distribution of variables. In the state and in the capital, the increasing trend of congenital syphilis was not statistically signifi cant. Conclusions: The high incidence of congenital syphilis in Mato Grosso and the low levels of health care indicators for pregnant women with syphilis suggest the need to improve the coverage and quality of prenatal care. Rio de Janeiro

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2015-06-15T13:46:35Z No. of bitstreams: 1 Santos Darci. 2014 et al.pdf: 184108 bytes, checksum: efe395c3ae5f3394885f78dd6758071d (MD5) Made available in DSpace on 2015-06-15T13:46:35Z (GMT). No. of bitstreams: 1 Santos Darci. 2014 et al.pdf: 184108 bytes, checksum: efe395c3ae5f3394885f78dd6758071d (MD5) Previous issue date: 2014 INTRODUCTION: Despite the availability of treatment and a vaccine, tuberculosis continues to be a public health problem worldwide. Mental disorders might contribute to the burden of the disease. OBJECTIVE: The objective of this study was to investigate the association between common mental disorders and tuberculosis. METHODS: A matched case-control study was conducted. The study population included symptomatic respiratory patients who attended three referral hospitals and six community clinics in the city of Salvador, Brazil. A doctor's diagnosis defined potential cases and controls. Cases were newly diagnosed tuberculosis cases, and controls were symptomatic respiratory patients for whom tuberculosis was excluded as a diagnosis by the attending physician. Cases and controls were ascertained in the same clinic. Data collection occurred between August 2008 and April 2010. The study instruments included a structured interview, a self-reporting questionnaire for the identification of common mental disorders, and a questionnaire for alcoholism. An univariate analysis included descriptive procedures (with chi-square statistics), and a multivariate analysis used conditional logistic regression. RESULTS: The mean age of the cases was 38 years, and 61% of the cases were males. After adjusting for potential confounders, the odds of tuberculosis were significantly higher in patients diagnosed with a common mental disorder (OR: 1.34; 95% CI 1.05-1.70). CONCLUSION: There appears to be a positive and independent association between common mental disorders and tuberculosis; further epidemiological studies are required to increase our understanding of the possible biological and social mechanisms responsible for this association. Independent of the direction of the association, this finding has implications for the provision of care for mental disorders and for tuberculosis. San Francisco

OBJECTIVE: To determine the prevalence of nutritional deficiency among patients with pulmonary tuberculosis. METHODS: This was a cross-sectional study using data obtained from the Brazilian Case Registry Database and from the medical records of patients diagnosed with pulmonary tuberculosis (15-59 years of age) residing in one of the municipalities that make up the 16th Regional Health District of the state of Bahia. We calculated the incidence, lethality, and mortality rates, as well as the prevalence of nutritional deficiency, as evaluated by body mass index. Demographic, social, clinical, and epidemiological data were collected. RESULTS: Of the 72 confirmed cases of tuberculosis, 59 (81.9%) were in males, and 21 (29.2%) of the patients were in the 40-49 year age bracket. The majority (85.3%) described themselves as Mulatto or Black; 55.2% reported using alcohol; and approximately 90% were treated as outpatients. In the district and age bracket studied, the incidence of pulmonary tuberculosis was 30.6/100,000 population. Among the 72 patients, data regarding nutritional status was available for 34. Of those, 50% and 25%, respectively, presented nutritional deficiency at the beginning and at the end of treatment. No statistically significant differences were found between normal-weight and malnourished patients regarding the characteristics studied. CONCLUSIONS: The prevalence of nutritional deficiency was high among our sample of patients with pulmonary tuberculosis. This underscores the importance of nutritional follow-up for the assessment of tuberculosis treatment in the decision-making process regarding therapeutic interventions. OBJETIVO: Determinar a prevalência de deficiência nutricional entre pacientes com tuberculose pulmonar. MÉTODOS: Estudo transversal tendo como fontes de dados o Sistema de Informação de Agravos de Notificação e prontuários médicos de pacientes diagnosticados com tuberculose pulmonar (15-59 anos de idade) residentes nos municípios da 16a Regional de Saúde do estado da Bahia. Foram calculados os coeficientes de incidência, letalidade e mortalidade por tuberculose e a prevalência de deficiência nutricional, avaliada pelo índice de massa corpórea. Informações sobre características demográficas, sociais e clínico-epidemiológicas foram coletadas. RESULTADOS: Dos 72 casos confirmados de tuberculose, 59 (81,9%) eram do sexo masculino, e 21 (29,2%) tinham 40-49 anos de idade. A maioria declarou-se como pardo ou preto (85,3%). O tratamento foi ambulatorial em aproximadamente 90% dos casos, e 55,2% referiram uso de álcool. A incidência de tuberculose pulmonar foi de 30,6/100.000 habitantes no distrito e faixa etária estudados. Dos 72 pacientes, 34 apresentavam dados relativos ao estado nutricional. Desses, 50% e 25%, respectivamente, apresentavam deficiência nutricional ao início e ao final do tratamento. Não houve diferenças estatisticamente significantes entre pacientes eutróficos e desnutridos quanto às características estudadas. CONCLUSÕES: A prevalência de deficiência nutricional foi elevada em nossa amostra de pacientes com tuberculose pulmonar. Isso reforça a importância do acompanhamento nutricional para a avaliação do tratamento da tuberculose para a tomada de decisão quanto a intervenções terapêuticas.

Human tuberculosis is an infectious disease caused by bacteria from the Mycobacterium tuberculosis complex (MTBC). Although spoligotyping and MIRU-VNTR are standard methodologies in MTBC genetic epidemiology, recent studies suggest that Single Nucleotide Polymorphisms (SNP) are advantageous in phylogenetics and strain group/lineages identification. In this work we use a set of 79 SNPs to characterize 1987 MTBC isolates from Portugal and 141 from Northeast Brazil. All Brazilian samples were further characterized using spolygotyping. Phylogenetic analysis against a reference set revealed that about 95% of the isolates in both populations are singly attributed to bacterial lineage 4. Within this lineage, the most frequent strain groups in both Portugal and Brazil are LAM, followed by Haarlem and X. Contrary to these groups, strain group T showed a very different prevalence between Portugal (10%) and Brazil (1.5%). Spoligotype identification shows about 10% of mis-matches compared to the use of SNPs and a little more than 1% of strains unidentifiability. The mis-matches are observed in the most represented groups of our sample set (i.e., LAM and Haarlem) in almost the same proportion. Besides being more accurate in identifying strain groups/lineages, SNP-typing can also provide phylogenetic relationships between strain groups/lineages and, thus, indicate cases showing phylogenetic incongruence. Overall, the use of SNP-typing revealed striking similarities between MTBC populations from Portugal and Brazil. Highlights: - We characterized MTBC populations from Portugal and Northeast Brazil; - We used a SNP-based Bayesian tree for identification of the MTBC isolates; Our approach allowed to define the usefulness of SNPs in strain identification; - MTBC populations from Portugal and Northeast Brazil presented striking similarities. The work was funded by the Portuguese Foundation for Science and Technology (FCT) and by the European Commission [grant EC-ICT-231807]. Data collection in Brazil was supported by National Counsel of Technological and Scientific Development (CNPQ) [Project Number 410498/2006-8] and Coordination of Improvement of Higher Education Personnel (CAPES) [Project Number 23038.005107/2011-83]. N/A

The study analyzed clinical, laboratory, and radiological characteristics of tuberculosis (TB) among adolescents from two Brazilian State capitals, according to the 2010 Updated Guidelines of the National TB Control Program (NTPC) through a descriptive, retrospective cross-sectional study of reported TB cases from Manaus and Salvador from 1996 to 2003. Patients were divided into two groups: 10 to 14 years and 15 to 19 years of age. Variables were studied through descriptive statistics; 1,781 adolescents were included; 928 (52.1%) were males. Median age was 16 years (SD = 2.3). Pulmonary TB (PTB) occurred in 1,447 patients (82.9%), pleural TB in 179 (10.3%), and peripheral adenopathy in 81 (4.6%). Cough was more frequent in the ≥ 15-year PTB group (p0.001). Chest x-rays were classified as: adult-type TB in 1,088 (98.6%) in the ≥-15 year group; 258 (98.1%) in the15-year group (p0.0001). Adult type bacteriological PTB increased in proportion to age.

INTRODUCTION: Bacterial meningitis has great social relevance due to its ability to produce sequelae and cause death. It is most frequently found in developing countries, especially among children. Meningococcal meningitis occurs at a high frequency in populations with poor living conditions. This study describes the temporal evolution of bacterial meningitis in Salvador, Brazil, 1995-2009, and verifies the association between its spatial variation and the living conditions of the population. METHODS: This was an ecological study in which the areas of information were classified by an index of living conditions. It examined fluctuations using a trend curve, and the relationship between this index and the spatial distribution of meningitis was verified using simple linear regression. RESULTS: From 1995-2009, there were 3,456 confirmed cases of bacterial meningitis in Salvador. We observed a downward trend during this period, with a yearly incidence of 9.1 cases/100,000 population and fatality of 16.7%. Children aged