EXPEDITO JOSE DE ALBUQUERQUE LUNA
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Medicina Preventiva, Faculdade de Medicina - Docente
LIM/38 - Laboratório de Epidemiologia e Imunobiologia, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/38 - Laboratório de Epidemiologia e Imunobiologia, Hospital das Clínicas, Faculdade de Medicina - Líder
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- The effectiveness of maternal pertussis vaccination in protecting newborn infants in Brazil: A case-control study(2019) FERNANDES, Eder Gatti; SATO, Ana Paula S.; VAZ-DE-LIMA, Lourdes R. A.; RODRIGUES, Marcela; LEITE, Daniela; BRITO, Cyro A. de; LUNA, Expedito J. A.; CARVALHANAS, Telma Regina M. P.; RAMOS, Maria Ligia Bacciote Nerger; SATO, Helena Keico; CASTILHO, Euclides A. de; SOUZA, Edna M. de; ATOBE, Jane H.; OLIVEIRA, Carmem A. F.; MORAES, Jose Cassio de; GASPAR, Jaqueline Correia; OLIVEIRA, Silvia Silva deIntroduction: In 2014, the Brazilian Ministry of Health (MoH) recommended Tdap to pregnant women in response to a significant increase in the incidence of pertussis among infants. The present study assessed the effectiveness of maternal immunization in preventing pertussis in infants. Methods: An unmatched case-control study was undertaken in Sao Paulo State, Brazil from February 2015 to July 2016. Cases were infants aged <8 weeks at onset of pertussis reported to the Surveillance System and confirmed by real-time polymerase chain reaction or culture. Four to six healthy infants were selected as controls per case from birth certificates in the Information System on Live Births database. General characteristics and mother's vaccination status were compared between cases and controls. The vaccine effectiveness (VE) was calculated as 1 - odds ratio (OR). For the adjusted VE, the OR was calculated using logistic regression analysis. Results: Forty-two cases and 248 controls were enrolled in the study. Mothers of 8 cases (19.1%) and 143 controls (57.4%) were vaccinated during pregnancy, resulting in an unadjusted VE of 82.6% (95% confidence interval [CI], 60.8-92.3%). The VE was unchanged after adjusting for maternal age and monthly household income. Conclusion: Maternal pertussis vaccination during pregnancy was effective in protecting infants aged <8 weeks from pertussis.
- Prevalence of Trachoma in Schoolchildren in Brazil(2016) LUNA, Expedito Jose de Albuquerque; LOPES, Maria de Fatima Costa; MEDINA, Norma Helen; FAVACHO, Joana; CARDOSO, Maria Regina AlvesPurpose: Trachoma was hyperendemic in Brazil until the 20th century. The prevalence has declined sharply in the past decades. The aim of this study was to estimate trachoma prevalence in schoolchildren in Brazilian municipalities with a Human Development Index (HDI) below the national mean. Methods: A cluster random sampling survey on trachoma prevalence was carried out. Brazilian municipalities with HDI below the national mean, within each of the 27 states, were stratified into three strata according to population size. In each stratum, schools were systematically selected to comprise a sample of 2400 schoolchildren, totaling 7200 per state. In each selected school, children enrolled from 1st to 4th grade were examined for trachoma. The simplified trachoma grading system was used. At a meeting held in each school, the study was explained to parents, and verbal consent sought. Results: A total of 185,862 children were enrolled in the selected schools. Of these, 171,973 (92.5%) participated in the study. The overall prevalence of trachomatous inflammation - follicular was 5.0% (95% confidence interval 4.7-5.3%), varying from 1.5% to 9.0% among the states. Prevalence was significantly associated with the sampling stratum (being higher in small municipalities), the zone in which the school was located (higher in rural schools), and with age (higher among younger children). Conclusion: Trachoma is still a public health problem in Brazil, although at a low level of endemicity. As the country advances towards the elimination of blinding trachoma, this survey provides a baseline for evaluation of ongoing and future elimination interventions.
conferenceObject DENGUE IN SOUTHEASTERN BRAZIL: A LARGE OUTBREAK FOLLOWED BY A THREE-YEAR LOW INCIDENCE PERIOD. OBSERVATIONS FROM A PROSPECTIVE COHORT STUDY(2018) LUNA, Expedito; FIGUEIREDO, Gerusa; LEVI, Jose; CAMPOS, Sergio; FIGUEIREDO, Walter; COSTA, Angela; FELIX, Alvina; SOUZA, Nathalia; PANNUTI, Claudio- Microbial Translocation Is Associated with Extensive Immune Activation in Dengue Virus Infected Patients with Severe Disease(2013) WEG, Cornelia A. M. van de; PANNUTI, Claudio S.; ARAUJO, Evaldo S. A. de; HAM, Henk-Jan van den; ANDEWEG, Arno C.; BOAS, Lucy S. V.; FELIX, Alvina C.; CARVALHO, Karina I.; MATOS, Andreia M. de; LEVI, Jose E.; ROMANO, Camila M.; CENTRONE, Cristiane C.; RODRIGUES, Celia L. de Lima; LUNA, Expedito; GORP, Eric C. M. van; OSTERHAUS, Albert D. M. E.; MARTINA, Byron E. E.; KALLAS, Esper G.Background: Severe dengue virus (DENV) disease is associated with extensive immune activation, characterized by a cytokine storm. Previously, elevated lipopolysaccharide (LPS) levels in dengue were found to correlate with clinical disease severity. In the present cross-sectional study we identified markers of microbial translocation and immune activation, which are associated with severe manifestations of DENV infection. Methods: Serum samples from DENV-infected patients were collected during the outbreak in 2010 in the State of Sao Paulo, Brazil. Levels of LPS, lipopolysaccharide binding protein (LBP), soluble CD14 (sCD14) and IgM and IgG endotoxin core antibodies were determined by ELISA. Thirty cytokines were quantified using a multiplex luminex system. Patients were classified according to the 2009 WHO classification and the occurrence of plasma leakage/shock and hemorrhage. Moreover, a (non-supervised) cluster analysis based on the expression of the quantified cytokines was applied to identify groups of patients with similar cytokine profiles. Markers of microbial translocation were linked to groups with similar clinical disease severity and clusters with similar cytokine profiles. Results: Cluster analysis indicated that LPS levels were significantly increased in patients with a profound pro-inflammatory cytokine profile. LBP and sCD14 showed significantly increased levels in patients with severe disease in the clinical classification and in patients with severe inflammation in the cluster analysis. With both the clinical classification and the cluster analysis, levels of IL-6, IL-8, sIL-2R, MCP-1, RANTES, HGF, G-CSF and EGF were associated with severe disease. Conclusions: The present study provides evidence that both microbial translocation and extensive immune activation occur during severe DENV infection and may play an important role in the pathogenesis.
conferenceObject DETECTION OF SCHISTOSOMA MANSONI SPOROCYST STAGE IN BIOMPHALARIA GLABRATA MOLLUSK IN EXPERIMENTAL CONDITIONS(2018) CASOTTI, Marcia; TUAN, Roseli; GOMES, Michele; LUNA, Expedito Albuquerque; DIAS-NETO, Emmanuel; PAULA, Fabiana; PINHO, Joao Rebello; CARRILHO, Flair; GRYSCHEK, Ronaldo Borges; ESPIRITO-SANTO, Maria- Survey of Trachoma within School Students in the State of Roraima, Brazil(2011) MEDINA, Norma Helen; LOPES, Maria de Fatima; DURKIN, Shane R.; CARDOSO, Maria Regina A.; LUNA, Expedito A.; KOIZUMI, Ines K.; BROCK, Karen Ruth; FREITAS, Helen Selma de Abreu; MAURICIO, Maria AngelaPurpose: Trachoma, a blinding conjunctivitis, is the result of repeated infection with Chlamydia trachomatis. There are no recent data for the state of Roraima, Brazil, where it was thought that trachoma no longer existed. These data are derived from school children sampled in this state, with additional data collected from the contacts of children with trachoma. Design: A population-based cross-sectional study with random sampling of students in grades 1 through 4 of all public schools within municipalities where the human development index was less than the national average in 2003. The sample was stratified according to population size. Participants: A sample size of 7200 was determined and a total of 6986 (93%) students were examined, along with an additional 2152 contacts. Methods: All students were examined for trachoma according to World Health Organization criteria. Demographic data and contact information also was collected. The family and school contacts of students with trachoma then were located and examined. Main Outcome Measures: Prevalence and grade of trachoma, age, gender, race, and municipality location. Results: The overall prevalence of trachoma was 4.5% (95% confidence interval [CI], 3.7%-5.3%), but there were municipalities within the state where the prevalence of inflammatory trachoma was more than 10%. The prevalence was greater in rural areas (4.9%; 95% CI, 3.7%-6.0%) compared with urban areas (3.9%; 95% CI, 2.9%-4.9%). Living in indigenous communities was associated with trachoma (odds ratio, 1.6; 95% CI, 0.9-2.6). An additional 2152 contacts were examined, and the overall trachoma prevalence was 9.3% (95% CI, 8.1-10.5). Conclusions: Trachoma continues to exist in Roraima, Brazil, where there are municipalities with a significant prevalence of disease. The indigenous population is highly mobile, crossing state and international borders, raising the possibility of trachoma in neighboring countries. Trachoma prevalence among the contacts of students with trachoma was higher than the school population, highlighting the importance of contact tracing. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Ophthalmology 2011;118:1938-1943 (C) 2011 by the American Academy of Ophthalmology.
conferenceObject MOLECULAR CHARACTERIZATION OF THE LARVAL PHASE OF SCHISTOSOMA MANSONI IN BIOMPHALARIA GLABRATA MOLLUSKS UNDER EXPERIMENTAL CONDITIONS(2017) CASOTTI, Marcia Oliveira; TUAN, Roseli Tuan; GOMES, Michele; DIAS-NETO, Emmanuel; PINHO, Joao Renato Rebello; PAULA, Fabiana Martins; CARRILHO, Flair Jose Carrilho Jose; LUNA, Expedito Jose Albuquerque; GRYSCHEK, Ronaldo Cesar Borges Borges; ESPIRITO-SANTO, Maria Cristina- Epidemiological profile of influenza-related mortality in children under five years old. Brazil, 2000-2015(2018) ROSSETTO, E.; LUNA, E.
- Pre-vaccination screening strategies for the use of the CYD-TDV dengue vaccine: A meeting report(2019) WILDER-SMITH, A.; SMITH, P. G.; LUO, R.; KELLY-CIRINO, C.; CURRY, D.; LARSON, H.; DURBIN, A.; CHU, M.; THARMAPHORNPILAS, P.; NG, L. C.; SARTORI, A. M. C.; LUNA, E. J. A.; GUBLERJ, D. J.; ESPANA, G.; YOON, I. K.; FLASCHE, S.The first licensed dengue vaccine, CYD-TDV (Dengvaxia) is efficacious in seropositive individuals, but increases the risk for severe dengue in seronegative persons about two years after administration of the first dose. For countries considering the introduction of Dengvaxia, WHO recommends a pre-vaccination screening strategy whereby only persons with evidence of a past dengue infection would be vaccinated. Policy-makers need to consider the risk-benefit of vaccination strategies based on such screening tests, the optimal age to introduce the vaccine, communication and implementation strategies. To address these questions, the Global Dengue and Aedes-transmitted diseases Consortium (GDAC) organized a 3-day workshop in January 2019 with country representatives from Asia and Latin America. The meeting discussions highlighted many challenges in introducing Dengvaxia, in terms of screening test characteristics, costs of such tests combined with a 3-dose schedule, logistics, achieving high coverage rates, vaccine confidence and communication; more challenges than for any other vaccine introduction programme. A screening test would require a high specificity to minimize individual risk, and at the same time high sensitivity to maximize individual and population benefit. The underlying seroprevalence dependent positive predictive value is the best indicator for an acceptable safety profile of a pre-vaccination screening strategy. The working groups discussed many possible implementation strategies. Addressing the bottlenecks in school-based vaccine introduction for Dengvaxia will also benefit other vaccines such as HPV and booster doses for tetanus and pertussis. Levels of public trust are highly variable and context specific, and understanding of population perceptions and concerns is essential to tailor interventions, monitor and mitigate risks.
conferenceObject ZIKA VIRUS INFECTION IN A COHORT STUDY TO ASSESS THE INCIDENCE OF DENGUE, STATE OF SAO PAULO, BRAZIL, 2015, 2016(2017) FIGUEIREDO, Gerusa M.; LUNA, Expedito J.; CARDOSO, Maria Regina; LEVI, Jose E.; FELIX, Alvina C.; SOUZA, Nathalia C. C.; SOUZA, Ana C.; CAMPOS, Sergio R. Campos R.; FIGUEIREDO, Walter M.; COSTA, Angela A.; PANNUTI, Claudio S.