LEWIS FLETCHER BUSS

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LIM/46 - Laboratório de Parasitologia Médica, Hospital das Clínicas, Faculdade de Medicina

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  • article 12 Citação(ões) na Scopus
    Epidemiology of COVID-19 after Emergence of SARS-CoV-2 Gamma Variant, Brazilian Amazon, 2020-2021
    (2022) NICOLETE, Vanessa C.; RODRIGUES, Priscila T.; FERNANDES, Anderson R. J.; CORDER, Rodrigo M.; TONINI, Juliana; BUSS, Lewis F.; SALES, Flavia C.; FARIA, Nuno R.; SABINO, Ester C.; CASTRO, Marcia C.; FERREIRA, Marcelo U.
    The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Gamma variant has been hypothesized to cause more severe illness than previous variants, especially in children. Successive SARS-CoV-2 IgG serosurveys in the Brazilian Amazon showed that agespecific attack rates and proportions of symptomatic SARS-CoV-2 infections were similar before and after Gamma variant emergence.
  • article 20 Citação(ões) na Scopus
    Spatial and temporal fluctuations in COVID-19 fatality rates in Brazilian hospitals
    (2022) BRIZZI, Andrea; WHITTAKER, Charles; SERVO, Luciana M. S.; HAWRYLUK, Iwona; JR, Carlos A. Prete; SOUZA, William M. de; AGUIAR, Renato S.; ARAUJO, Leonardo J. T.; BASTOS, Leonardo S.; BLENKINSOP, Alexandra; BUSS, Lewis F.; CANDIDO, Darlan; CASTRO, Marcia C.; COSTA, Silvia F.; CRODA, Julio; SANTOS, Andreza Aruska de Souza; DYE, Christopher; FLAXMAN, Seth; FONSECA, Paula L. C.; GEDDES, Victor E. V.; GUTIERREZ, Bernardo; LEMEY, Philippe; LEVIN, Anna S.; MELLAN, Thomas; BONFIM, Diego M.; MISCOURIDOU, Xenia; MISHRA, Swapnil; MONOD, Melodie; MOREIRA, Filipe R. R.; NELSON, Bruce; PEREIRA, Rafael H. M.; RANZANI, Otavio; SCHNEKENBERG, Ricardo P.; SEMENOVA, Elizaveta; SONNABEND, Raphael; SOUZA, Renan P.; XI, Xiaoyue; SABINO, Ester C.; FARIA, Nuno R.; BHATT, Samir; RATMANN, Oliver
    Analysis of individual-level patient records from Brazil reveals that the extensive shocks in COVID-19 mortality rates are associated with pre-pandemic geographic inequities as well as shortages in healthcare capacity during the pandemic. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Gamma variant of concern has spread rapidly across Brazil since late 2020, causing substantial infection and death waves. Here we used individual-level patient records after hospitalization with suspected or confirmed coronavirus disease 2019 (COVID-19) between 20 January 2020 and 26 July 2021 to document temporary, sweeping shocks in hospital fatality rates that followed the spread of Gamma across 14 state capitals, during which typically more than half of hospitalized patients aged 70 years and older died. We show that such extensive shocks in COVID-19 in-hospital fatality rates also existed before the detection of Gamma. Using a Bayesian fatality rate model, we found that the geographic and temporal fluctuations in Brazil's COVID-19 in-hospital fatality rates were primarily associated with geographic inequities and shortages in healthcare capacity. We estimate that approximately half of the COVID-19 deaths in hospitals in the 14 cities could have been avoided without pre-pandemic geographic inequities and without pandemic healthcare pressure. Our results suggest that investments in healthcare resources, healthcare optimization and pandemic preparedness are critical to minimize population-wide mortality and morbidity caused by highly transmissible and deadly pathogens such as SARS-CoV-2, especially in low- and middle-income countries.
  • article 4 Citação(ões) na Scopus
    Scale-free dynamics of COVID-19 in a Brazilian city
    (2023) POLICARPO, J. M. P.; RAMOS, A. A. G. F.; DYE, C.; FARIA, N. R.; LEAL, F. E.; MORAES, O. J. S.; PARAG, K. V.; PEIXOTO, P. S.; BUSS, L.; SABINO, E. C.; NASCIMENTO, V. H.; DEPPMAN, A.
    A common basis to address the dynamics of directly transmitted infectious diseases, such as COVID-19, are compartmental (or SIR) models. SIR models typically assume homoge-nous population mixing, a simplification that is convenient but unrealistic. Here we vali-date an existing model of a scale-free fractal infection process using high-resolution data on COVID-19 spread in Sao Caetano, Brazil. We find that transmission can be described by a network in which each infectious individual has a small number of susceptible con-tacts, of the order of 2-5. This model parameter correlated tightly with physical distancing measured by mobile phone data, such that in periods of greater distancing the model re-covered a lower average number of contacts, and vice versa. We show that the SIR model is a special case of our scale-free fractal process model in which the parameter that re-flects population structure is set at unity, indicating homogeneous mixing. Our more gen-eral framework better explained the dynamics of COVID-19 in Sao Caetano, used fewer parameters than a standard SIR model and accounted for geographically localized clusters of disease. Our model requires further validation in other locations and with other directly transmitted infectious agents.(c) 2023 Published by Elsevier Inc.
  • article 217 Citação(ões) na Scopus
    Epidemiological and clinical characteristics of the COVID-19 epidemic in Brazil
    (2020) SOUZA, William Marciel de; BUSS, Lewis Fletcher; CANDIDO, Darlan da Silva; CARRERA, Jean-Paul; LI, Sabrina; ZAREBSKI, Alexander E.; PEREIRA, Rafael Henrique Moraes; PRETE JR., Carlos A.; SOUZA-SANTOS, Andreza Aruska de; PARAG, Kris V.; BELOTTI, Maria Carolina T. D.; VINCENTI-GONZALEZ, Maria F.; MESSINA, Janey; SALES, Flavia Cristina da Silva; ANDRADE, Pamela dos Santos; NASCIMENTO, Vitor Heloiz; GHILARDI, Fabio; ABADE, Leandro; GUTIERREZ, Bernardo; KRAEMER, Moritz U. G.; BRAGA, Carlos K. V.; AGUIAR, Renato Santana; ALEXANDER, Neal; MAYAUD, Philippe; BRADY, Oliver J.; MARCILIO, Izabel; GOUVEIA, Nelson; LI, Guangdi; TAMI, Adriana; OLIVEIRA, Silvano Barbosa de; PORTO, Victor Bertollo Gomes; GANEM, Fabiana; ALMEIDA, Walquiria Aparecida Ferreira de; FANTINATO, Francieli Fontana Sutile Tardetti; MACARIO, Eduardo Marques; OLIVEIRA, Wanderson Kleber de; NOGUEIRA, Mauricio L.; PYBUS, Oliver G.; WU, Chieh-Hsi; CRODA, Julio; SABINO, Ester C.; FARIA, Nuno Rodrigues
    Brazil has one of the fastest-growing COVID-19 epidemics in the world. De Souza et al. report epidemiological, demographic and clinical findings for COVID-19 cases in the country during the first 3 months of the epidemic. The first case of COVID-19 was detected in Brazil on 25 February 2020. We report and contextualize epidemiological, demographic and clinical findings for COVID-19 cases during the first 3 months of the epidemic. By 31 May 2020, 514,200 COVID-19 cases, including 29,314 deaths, had been reported in 75.3% (4,196 of 5,570) of municipalities across all five administrative regions of Brazil. TheR(0)value for Brazil was estimated at 3.1 (95% Bayesian credible interval = 2.4-5.5), with a higher median but overlapping credible intervals compared with some other seriously affected countries. A positive association between higher per-capita income and COVID-19 diagnosis was identified. Furthermore, the severe acute respiratory infection cases with unknown aetiology were associated with lower per-capita income. Co-circulation of six respiratory viruses was detected but at very low levels. These findings provide a comprehensive description of the ongoing COVID-19 epidemic in Brazil and may help to guide subsequent measures to control virus transmission.
  • article 290 Citação(ões) na Scopus
    Three-quarters attack rate of SARS-CoV-2 in the Brazilian Amazon during a largely unmitigated epidemic
    (2021) BUSS, Lewis F.; JR, Carlos A. Prete; ABRAHIM, Claudia M. M.; JR, Alfredo Mendrone; SALOMON, Tassila; ALMEIDA-NETO, Cesar de; FRANCA, Rafael F. O.; BELOTTI, Maria C.; CARVALHO, Maria P. S. S.; COSTA, Allyson G.; CRISPIM, Myuki A. E.; FERREIRA, Suzete C.; FRAIJI, Nelson A.; GURZENDA, Susie; WHITTAKER, Charles; KAMAURA, Leonardo T.; TAKECIAN, Pedro L.; PEIXOTO, Pedro da Silva; OIKAWA, Marcio K.; NISHIYA, Anna S.; ROCHA, Vanderson; SALLES, Nanci A.; SANTOS, Andreza Aruska de Souza; SILVA, Martirene A. da; CUSTER, Brian; V, Kris Parag; BARRAL-NETTO, Manoel; KRAEMER, Moritz U. G.; PEREIRA, Rafael H. M.; PYBUS, Oliver G.; BUSCH, Michael P.; CASTRO, Marcia C.; DYE, Christopher; NASCIMENTO, Vitor H.; FARIA, Nuno R.; SABINO, Ester C.
    Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread rapidly in Manaus, the capital of Amazonas state in northern Brazil. The attack rate there is an estimate of the final size of the largely unmitigated epidemic that occurred in Manaus. We use a convenience sample of blood donors to show that by June 2020, 1 month after the epidemic peak in Manaus, 44% of the population had detectable immunoglobulin G (IgG) antibodies. Correcting for cases without a detectable antibody response and for antibody waning, we estimate a 66% attack rate in June, rising to 76% in October. This is higher than in Sao Paulo, in southeastern Brazil, where the estimated attack rate in October was 29%. These results confirm that when poorly controlled, COVID-19 can infect a large proportion of the population, causing high mortality.
  • article 6 Citação(ões) na Scopus
    Prolonged presence of replication-competent SARS-CoV-2 in mildly symptomatic individuals: A report of two cases
    (2021) CORREA, Maria C. Mendes; LEAL, Fabio E.; BOAS, Lucy S. Villas; WITKIN, Steven S.; PAULA, Anderson de; MENDONZA, Tania R. Tozetto; FERREIRA, Noely E.; CURTY, Gislaine; CARVALHO, Pedro S. de; BUSS, Lewis F.; COSTA, Silvia F.; CARVALHO, Flavia M. da Cunha; KAWAKAMI, Joyce; TANIWAKI, Noemi N.; PAIAO, Heuder; BIZARIO, Joao C. da Silva; JESUS, Jaqueline G. de; SABINO, Ester C.; ROMANO, Camila M.; GREPAN, Regina M. Z.; SESSO, Antonio
    It has been estimated that individuals with COVID-19 can shed replication-competent virus up to a maximum of 20 days after initiation of symptoms. The majority of studies that addressed this situation involved hospitalized individuals and those with severe disease. Studies to address the possible presence of SARS-CoV-2 during the different phases of COVID-19 disease in mildly infected individuals, and utilization of viral culture techniques to identify replication-competent viruses, have been limited. This report describes two patients with mild forms of the disease who shed replication-competent virus for 24 and 37 days, respectively, after symptom onset.
  • article 53 Citação(ões) na Scopus
    Higher risk of death from COVID-19 in low-income and non-White populations of SAo Paulo, Brazil
    (2021) LI, Sabrina L.; PEREIRA, Rafael H. M.; JR, Carlos A. Prete; ZAREBSKI, Alexander E.; EMANUEL, Lucas; ALVES, Pedro J. H.; PEIXOTO, Pedro S.; V, Carlos K. Braga; SANTOS, Andreza Aruska de Souza; SOUZA, William M. de; BARBOSA, Rogerio J.; BUSS, Lewis F.; MENDRONE, Alfredo; ALMEIDA-NETO, Cesar de; FERREIRA, Suzete C.; SALLES, Nanci A.; MARCILIO, Izabel; WU, Chieh-Hsi; GOUVEIA, Nelson; NASCIMENTO, Vitor H.; SABINO, Ester C.; FARIA, Nuno R.; MESSINA, Jane P.
    IntroductionLittle evidence exists on the differential health effects of COVID-19 on disadvantaged population groups. Here we characterise the differential risk of hospitalisation and death in SAo Paulo state, Brazil, and show how vulnerability to COVID-19 is shaped by socioeconomic inequalities.MethodsWe conducted a cross-sectional study using hospitalised severe acute respiratory infections notified from March to August 2020 in the Sistema de Monitoramento Inteligente de SAo Paulo database. We examined the risk of hospitalisation and death by race and socioeconomic status using multiple data sets for individual-level and spatiotemporal analyses. We explained these inequalities according to differences in daily mobility from mobile phone data, teleworking behaviour and comorbidities.ResultsThroughout the study period, patients living in the 40% poorest areas were more likely to die when compared with patients living in the 5% wealthiest areas (OR: 1.60, 95% CI 1.48 to 1.74) and were more likely to be hospitalised between April and July 2020 (OR: 1.08, 95% CI 1.04 to 1.12). Black and Pardo individuals were more likely to be hospitalised when compared with White individuals (OR: 1.41, 95% CI 1.37 to 1.46; OR: 1.26, 95% CI 1.23 to 1.28, respectively), and were more likely to die (OR: 1.13, 95% CI 1.07 to 1.19; 1.07, 95% CI 1.04 to 1.10, respectively) between April and July 2020. Once hospitalised, patients treated in public hospitals were more likely to die than patients in private hospitals (OR: 1.40%, 95% CI 1.34% to 1.46%). Black individuals and those with low education attainment were more likely to have one or more comorbidities, respectively (OR: 1.29, 95% CI 1.19 to 1.39; 1.36, 95% CI 1.27 to 1.45).ConclusionsLow-income and Black and Pardo communities are more likely to die with COVID-19. This is associated with differential access to quality healthcare, ability to self-isolate and the higher prevalence of comorbidities.
  • article 0 Citação(ões) na Scopus
    SARS-CoV-2 seropositivity and COVID-19 among 5 years-old Amazonian children and their association with poverty and food insecurity
    (2022) FERREIRA, Marcelo U.; GIACOMINI, Isabel; SATO, Priscila M.; LOURENCO, Barbara H.; NICOLETE, Vanessa C.; BUSS, Lewis F.; MATIJASEVICH, Alicia; CASTRO, Marcia C.; CARDOSO, Marly A.
    Background The epidemiology of childhood SARS-CoV-2 infection and COVID-19-related illness remains little studied in high-transmission tropical settings, partly due to the less severe clinical manifestations typically developed by children and the limited availability of diagnostic tests. To address this knowledge gap, we investigate the prevalence and predictors of SARS-CoV-2 infection (either symptomatic or not) and disease in 5 years-old Amazonian children. Methodology/Principal findings We retrospectively estimated SARS-CoV-2 attack rates and the proportion of infections leading to COVID-19-related illness among 660 participants in a population-based birth cohort study in the Jurua ' Valley, Amazonian Brazil. Children were physically examined, tested for SARS-CoV-2 IgG and IgM antibodies, and had a comprehensive health questionnaire administered during a follow-up visit at the age of 5 years carried out in January or June-July 2021. We found serological evidence of past SARS-CoV-2 infection in 297 (45.0%; 95% confidence interval [CI], 41.2-48.9%) of 660 cohort participants, but only 15 (5.1%; 95% CI, 2.9-8.2%) seropositive children had a prior medical diagnosis of COVID-19 reported by their mothers or guardians. The period prevalence of clinically apparent COVID19, defined as the presence of specific antibodies plus one or more clinical symptoms suggestive of COVID-19 (cough, shortness of breath, and loss of taste or smell) reported by their mothers or guardians since the pandemic onset, was estimated at 7.3% (95% CI, 5.4-9.5%). Importantly, children from the poorest households and those with less educated mothers were significantly more likely to be seropositive, after controlling for potential confounders by mixed-effects multiple Poisson regression analysis. Likewise, the period prevalence of COVID-19 was 1.8-fold (95%, CI 1.2-2.6-fold) higher among cohort participants exposed to food insecurity and 3.0-fold (95% CI, 2.8-3.5-fold) higher among those born to non-White mothers. Finally, children exposed to household and family contacts who had COVID-19 were at an increased risk of being SARS-CoV-2 seropositive and-even more markedly-of having had clinically apparent COVID-19 by the age of 5 years. Conclusions/Significance Childhood SARS-CoV-2 infection and COVID-19-associated illness are substantially under-diagnosed and underreported in the Amazon. Children in the most socioeconomically vulnerable households are disproportionately affected by SARS-CoV-2 infection and disease. Author summary The epidemiology of childhood COVID-19 in the tropics remains a relatively neglected research topic, in part because SARS-CoV-2 typically causes fewer severe illnesses, hospitalizations, and deaths in children than in adults. Here we show that 45% of 660 participants in a birth cohort study in the Brazilian Amazon had SARS-CoV-2 antibodies at the age of 5 years, although only 5% of them reported previously diagnosed COVID-19 episodes-implying that as many as 8 in 9 SARS-CoV-2 infections had remained undiagnosed in these young children. Only 16% of the seropositive children had reportedly experienced cough, shortness of breath, and/or loss of taste or smell. The most socioeconomically vulnerable participants were more likely to have experienced SARS-CoV-2 infection and overt COVID-19 by the age of 5 years. Importantly, children exposed to household food insecurity, which affects 54% of our study participants, had their COVID-19 risk increased by 76%.
  • article 9 Citação(ões) na Scopus
    Performance of a qualitative rapid chromatographic immunoassay to diagnose COVID-19 in patients in a middle-income country
    (2020) COSTA, Silvia Figueiredo; BUSS, Lewis; ESPINOZA, Evelyn Patricia Sanchez; JR, Jose Mauro Vieira; SILVA, Lea Campos de Oliveira da; SOUZA, Regina Maia de; NETO, Lauro Perdigao; PORTO, Ana Paula Matos; LAZARI, Carolina; SANTOS, Vera Aparecida dos; DUARTE, Alberto da Silva; NASTRI, Ana Catharina; LEITE, Gabriel Fialkovitz da Costa; MANULI, Erika; OLIVEIRA, Maura Salaroli de; ZAMPELLI, Daniella Bosco; PASTORE JUNIOR, Laerte; SEGURADO, Aluisio Cotrim; LEVIN, Anna S.; SABINO, Ester
    Objectives: We evaluated a rapid chromatographic immunoassay (IgG/IgM antibodies) and an ELISA assay to diagnose COVID-19 in patient sat two Brazilian hospitals. Methods: A total of 122 subjects with COVID-19 were included: 106 SARS-COV-2 RT-PCR-positive patients and 16 RT-PCR-negative patients with symptoms and chest computed tomography (CT) consistent with COVID-19. Ninety-six historical blood donation samples were used as controls. Demographic and clinical characteristics were retrieved from electronic records. Sensitivity and specificity were calculated, as were their 95% binomial confidence intervals using the Clopper-Pearson method. All analyses were performed in R version 3.6.3. Results: The sensitivity of the chromatographic immunoassay in all RT-PCR-positive patients, irrespective of the timing of symptom onset, was 85.8% (95% binomial CI 77.7% to 91.9%). This increased with time after symptom onset, and at >14 days was 94.9% (85.9% to 98.9%). The specificity was 100% (96.4% to 100%). 15/16 (94%) RT- PCR-negative cases tested positive. The most frequent comorbidities were hypertension and diabetes mellitus and the most frequent symptoms were fever, cough, and dyspnea. All RT-PCR-negative patients had pneumonia. The most frequent thoracic CT findings were ground glass changes (n = 11, 68%), which were bilateral in 9 (56%) patients, and diffuse reticulonodular infiltrates (n = 5, 31%). Conclusions: The COVID-19 rapid chromatographic immunoassay evaluated in this study had a high sensitivity and specificity using plasma, particularly after 14 days from symptom onset. ELISA and qualitative rapid chromatographic immunoassays can be used for the diagnosis of RT-PCR-negative patients.
  • article 16 Citação(ões) na Scopus
    Nucleoprotein-based ELISA for detection of SARS-COV-2 IgG antibodies: Could an old assay be suitable for serodiagnosis of the new coronavirus?
    (2021) TOZETTO-MENDOZA, Tania Regina; KANUNFRE, Kelly Aparecida; VILAS-BOAS, Lucy Santos; ESPINOZA, Evelyn Patricia Sanchez; PAIAO, Heuder Gustavo Oliveira; ROCHA, Mussya Cisotto; PAULA, Anderson Vicente de; OLIVEIRA, Maura Salaroli de; ZAMPELLI, Daniella Bosco; JR, Jose Mauro Vieira; BUSS, Lewis; COSTA, Silvia Figueiredo; SABINO, Ester Cerdeira; WITKIN, Steven S.; OKAY, Thelma Suely; MENDES-CORREA, Maria Cassia
    Objectives: We evaluated the performance of a nucleoprotein-based enzyme-linked immunosorbent assay (ELISA) for detection of IgG antibodies to SARS-CoV-2. Methods: The ELISA was based on serum IgG reactivity to a 46-kDa protein derived from the recombinant SARSCoV2 nucleoprotein. Assay sensitivity was assessed using serum samples from 134 COVID-19 confirmed cases obtained > 15 days after symptom onset. Specificity was determined by testing sera from 94 healthy controls. Cross-reactivity was evaluated with sera from 96 individuals with previous dengue or zika virus-confirmed infections, with 44 sera from individuals with confirmed infections to other respiratory viruses or with bacterial and fungal infections that cause pneumonia and with 40 sera negative for SARS-CoV-2 nucleoprotein by commercial ELISA kits. Results: The majority of subjects were male and >= 60 years old. Assay sensitivity was 90.3 % (95 % confidence interval 84.1 %-94.2 %) and specificity was 97.9 % (92.6 %-99.4 %). There was no cross-reactivity with sera from individuals diagnosed with dengue, zika virus, influenza virus, rhinovirus, adenovirus, respiratory syncytial virus, seasonal coronavirus, Mycobacterium tuberculosis, Staphylococcus (S. aureus and coagulase-negative), Streptococcus pneumoniae, Klebsiella pneumoniae and the fungus Aspergillus fumigatus. The level of concordance of our test with results from commercial ELISA kits was 100 %. Conclusion: The nucleoprotein-based ELISA was specific for detection of IgG anti-nucleoprotein antibodies to SARS-CoV-2. It utilizes a frequently employed low expense assay protocol and is easier to perform than other currently available commercial SARS-CoV2 antibody detection tests.