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.
- 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.
- Population Prevalence of Trachoma in Nine Rural Non-Indigenous Evaluation Units of Brazil(2023) SZWARCWALD, Celia Landmann; LOPES, Maria de Fatima Costa; SOUZA JUNIOR, Paulo Roberto Borges de; GOMEZ, Daniela Vaz Ferreira; LUNA, Expedito Jose de Albuquerque; ALMEIDA, Wanessa da Silva de; DAMACENA, Giseli Nogueira; FAVACHO, Joana da Felidade Ribeiro; FRIAS, Paulo Germano de; BUTCHER, Robert; BOYD, Sarah; BAKHTIARI, Ana; WILLIS, Rebecca; JIMENEZ, Cristina; HARDING-ESCH, Emma; SABOYA-DIAZ, Martha Idali; SOLOMON, Anthony W.Purpose: To assess the contemporary prevalence of trachoma in Brazil's non-indigenous population, surveys of those thought to be at greatest risk of disease were conducted. Methods: Rural census tracts of non-indigenous population from nine mesoregions were selected to compose the survey evaluation units (EUs) by considering previously endemic municipalities at greatest risk of trachoma. In each of the nine EUs, we conducted a population-based prevalence survey. Every resident of selected households aged >= 1 year was examined for trachomatous inflammation - follicular (TF) and trachomatous trichiasis (TT). Additionally, data were collected on household-level access to water, sanitation, hygiene (WASH) and education. Results: A total of 27,962 individuals were examined across nine EUs. The age-adjusted TF prevalence in 1-9-year-olds was <5% in each EU. The age- and gender-adjusted prevalence of 7 unknown to the health system in >= 15-year-olds was <0.2% in eight EUs; in one EU, it was 0.22%. The median number of households surveyed per EU with access to an improved drinking water source within a 30-minute roundtrip of the house was 66%. School attendance was >99% of surveyed children. Conclusions: The prevalence of TF was well below the target for elimination as a public health problem in all EUs. Because EUs surveyed were selected to represent the highest-risk non-indigenous areas of the country, TF prevalence is unlikely to be >= 5% in non-indigenous populations elsewhere. In one EU, the prevalence of 7 was above the target threshold for elimination. Further investigation and possibly improvement in 7 surgical provision are required in that EU.
- Data on dengue incidence in South-eastern Brazil, 2014-2018(2020) LUNA, Expedito; FIGUEIREDO, Gerusa; LEVI, Jose; CAMPOS, Sergio; FELIX, Alvina; SOUZA, Nathalia; FIGUEIREDO, Walter; COSTA, Angela; CARDOSO, Maria; PANNUTI, ClaudioData from the routine surveillance systems have been extensively used to estimate the incidence of dengue. However, routine surveillance data frequently underestimate the diseases' incidence. Underreporting of dengue cases is related to the varying spectrum of its clinical presentation, with a large proportion of mild and asymptomatic infections, to its unspecific signs and symptoms, to the limitations of access to health care, and to the performance of the surveillance system itself [1-3]. In order to obtain accurate figures on dengue incidence, a cohort of children and adolescents was set up and followed during four years. The incidence of reported cases was used as a reference for the sample size calculation, which was stratified by age groups. A two-stage procedure was used to select the participants: census tracts were randomly selected, and within each one, a pre-determined number of children of each age group was randomly selected. The parents or legal guardians of the participating children and adolescents provided a written informed consent. In the first home visit, they responded to a questionnaire containing data on socio-demographic characteristics, housing, access to water, sewage, and garbage collection. Also, during the first visit a blood sample of the participating child/adolescent was collected for dengue baseline serology. Beginning in the week after the enrolment, the parent or legal guardian that was designated in the first visit received weekly phone calls for fever surveillance. If the child/adolescent had fever during the week, a nurse was dispatched to the family's home to collect more detailed data on the fever episode and collect a blood sample for dengue diagnosis (IgG, IgM, NS1 and PCR). If the dengue diagnosis was confirmed, a medical appointment was scheduled, and another blood sample for confirmatory tests was collected. It was also agreed that in every anniversary of their participation, they would receive another visit for a blood collection for dengue serology, regardless if they had a fever episode or a confirmed dengue diagnosis during the previous year. This article contains the description of the cohort's dataset. It is associated with the article published in Acta Tropica, under the title ""A cohort study to assess the incidence of dengue, Brazil, 2014-2018"" [4]. The associated article focused on the seroprevalence and incidence of dengue, and explored some associations between both outcomes and some explanatory variables. (C) 2020 The Authors.
- Clinical aspects of influenza A(H1N1)pdm09 cases reported during the pandemic in Brazil, 2009-2010(2015) ROSSETTO, Érika Valeska; LUNA, Expedito José de AlbuquerqueABSTRACT Objective: To describe the clinical aspects of cases of influenza A(H1N1)pdm09 in Brazil. Methods: A descriptive study of cases reported in Sistema de Informação de Agravos de Notificação (SINAN), 2009-2010. Results: As the final classification, we obtained 53,797 (56.79%) reported cases confirmed as a new influenza virus subtype, and 40,926 (43.21%) cases discarded. Fever was the most common sign, recorded in 99.74% of the confirmed and 98.92% of the discarded cases. Among the confirmed cases, the presence of comorbidities was reported in 32.53%, and in 38.29% of the discarded cases. The case fatality rate was 4.04%; 3,267 pregnant women were confirmed positive for influenza A new viral subtype and 2,730 of them were cured. The case fatality rate of pregnant women was 6.88%. Conclusion: The findings suggested concern of the health system with pregnant women, and patients with comorbidities and quality of care may have favored a lower mortality. We recommend that, when caring for patients with severe respiratory symptoms, with comorbidities, or pregnant women, health professionals should consider the need for hospital care, as these factors make up a worse prognosis of infection by the pandemic influenza virus.
- Saúde nas metrópoles - Doenças infecciosas(2016) SEGURADO, Aluisio Cotrim; CASSENOTE, Alex Jones; LUNA, Expedito de AlbuquerqueUrbanization is an irreversible global process and the number of people living in cities is estimated to reach 67% of the world population by 2050. In low- and middle-income countries, 30% to 40% of the population currently lives in slum areas, under risk of several diseases. Even though 84.3% of the Brazilian population already lived in urban areas in 2010, no consistent initiatives have been implemented to address urban health issues. We discuss here the epidemiological features of communicable diseases that are relevant to public health (dengue, HIV/aids, leptospirosis, leprosy and tuberculosis) in Brazil's 17 metropolitan areas since 2000 to help clarify the current role of infections in the context of Brazilian urban health.
- Advancing towards the elimination of trachoma as a cause of blindness in two cities in Sao Paulo State, Southeastern Brazil(2022) MEDINA, Norma Helen; JOSEPH, Vera Helena; KOIZUMI, Ines Kazue; PEREIRA, Renata Piffer; SILVA, Miria Lazzarin da; LUNA, ExpeditoThe World Health Organization recommends conducting prevalence surveys to validate the elimination of trachoma as a public health problem by the year 2030. The recommendation specifies that the surveys should be directed to previous endemic poor rural areas. Brazil is an endemic country for trachoma and has experienced a large internal migration from the rural areas to the outskirts of the major cities. This study aimed to determine the prevalence of trachoma in children aged 1 to 9 years old in two of the poorest municipalities on the outskirts of Sao Paulo to test the hypothesis of whether internal migration brought trachoma with it. A household survey was conducted between 2013 and 2014. The field teams went door-to-door to collect data on households with children of the selected age group and their members. The trachoma prevalence in this group was 1.5% (79/5,393). In the 10 to 19 years old group, the trachoma prevalence was significantly higher among girls 3.2% (47/1,448) than among boys 1.5% (20/1,361). This result adds evidence to the elimination of trachoma as a public health problem and will be included in the supporting material to validate its elimination in Brazil.
- Trachoma in Indigenous Settlements in Brazil, 2000-2008(2016) FREITAS, Helen Selma de Abreu; MEDINA, Norma Helen; LOPES, Maria de Fatima Costa; SOARES, Oscar Espellete; TEODORO, Marco Tulio Costa; RAMALHO, Karen Ruth Brock; CALIGARIS, Ligia Santos Abreu; MORSCHBACHERF, Ricardo; MENEZES, Maria Nazare Correia de; LUNA, Expedito Jose de AlbuquerquePurpose: Trachoma, caused by the bacterium Chlamydia trachomatis, is a chronic, recurrent inflammatory disease that affects the cornea and conjunctiva. Trachoma is the leading infectious cause of avoidable blindness worldwide. Its prevalence is higher among individuals of low socioeconomic status, and trachoma is common in indigenous communities. The present study presents aspects of the epidemiological profile of trachoma in indigenous communities in Brazil. Methods: We analyzed data from two databases collected during trachoma screening activities among the population of indigenous settlements in Brazil between 2000 and 2008. Trachoma cases were detected by ocular examination in accordance with the World Health Organization simplified trachoma grading system. Results: According to the surveillance database, a total of 9582 individuals in six different states were examined. Among children aged 1-9 years, the prevalence of follicular trachomatous inflammation (TF) was 35.2%. In individuals aged 15 years, the prevalence of trachomatous trichiasis (TT) was 1.2% in individuals and the sex-specific prevalence was 0.8% in males and 1.6% in females (p = 0.02). In a survey of two states, 2301 indigenous schoolchildren were examined. In the age bracket 5-9 years, the prevalence of TF was 4.9 (95% confidence interval 3.8-6.0%). Conclusion: In Brazil, trachoma appears to be a serious public health problem in indigenous settlements, which should therefore be given priority in programs aimed at the elimination of trachoma in the country.
- A case-control study to determine the effectiveness of a tetravalent dengue vaccine in the state of Parana, Brazil(2022) MORAES, Jose Cassio de; RIEDIGER, Irina Nastassja; CROSEWSKI, Fernanda; GARRETT, Denise Oliveira; FANTINATO, Francieli Fontana; RIBEIRO, Karina Braga; LUNA, Expedito Jose de AlbuquerqueBackground The Brazilian state of Parana conducted a mass vaccination campaign against dengue with the tetravalent attenuated vaccine CYD-TDV. The campaign targeted thirty endemic municipalities. The objective of this study was to assess the effectiveness of CYD-TDV in preventing symptomatic virologically confirmed dengue cases according to specific age groups in five of the municipalities. Methods A case-control study was carried out in the five most populous municipalities targeted by the vaccination, with a vaccine uptake of 25%. Symptomatic dengue cases were identified by the municipal health departments. The age groups targeted were 15-18 and 19-27 in four municipalities and 9-14 and 28-44 in one municipality. All cases were confirmed by real time reverse transcription quantitative polymerase chain reaction (RT-qPCR). For each case, two controls were selected: a neighbourhood control and a workplace or school/college control, matched by age group. A conditional logistic regression model was used to determine the odds ratio for vaccination and the vaccine effectiveness. Findings Study participants included 618 RT-qPCR-confirmed dengue cases and 1,236 matched controls (with a non-reactive dengue IgM serologic test). Vaccine effectiveness against dengue due to any serotype was 11.1% (95% CI: -19.0%; 33.6%). Effectiveness against DENV-1 was 33.3% (95% CI: -5.0%; 57.6%) and against DENV-2 was -56.7% (95% CI: -142.2%; -5.0%). No DENV-3 was detected. The vaccine was significantly effective in the prevention of DENV-4 cases (VE = 93.3%; 95% CI: 47.7%; 99.2%). Interpretation CYD-TDV was effective in the prevention of symptomatic cases due to DENV-4, but not due to any serotype. The low dengue seroprevalence in the target population could possibly be related to these results.