GERUSA MARIA FIGUEIREDO
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
LIM/38 - Laboratório de Epidemiologia e Imunobiologia, Hospital das Clínicas, Faculdade de Medicina
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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- Population-Based Multicentric Survey of Hepatitis B Infection and Risk Factors in the North, South, and Southeast Regions of Brazil, 10-20 Years after the Beginning of Vaccination(2015) XIMENES, Ricardo A. A.; FIGUEIREDO, Gerusa M.; CARDOSO, Maria Regina A.; STEIN, Airton T.; MOREIRA, Regina C.; CORAL, Gabriela; CRESPO, Deborah; SANTOS, Alex A. dos; MONTARROYOS, Ulisses R.; BRAGA, Maria Cynthia; PEREIRA, Leila M. M. B.A population-based hepatitis survey was carried out to estimate the prevalence of hepatitis B virus (HBV) infection and its predictive factors for the state capitals from the north, south, and southeast regions of Brazil. A multistage cluster sampling was used to select, successively, census tracts, blocks, households, and residents in the age group 10-69 years in each state capital. The prevalence of hepatitis B surface antigen (HBsAg) was lower than 1% in the north, southeast, and south regions. Socioeconomic condition was associated with HBV infection in north and south regions. Variables related to the blood route transmission were associated with HBV infection only in the south whereas those related to sexual behavior were associated with HBV infection in the north and south regions. Drug use was associated in all regions, but the type of drug differed. The findings presented herein highlight the diversity of the potential transmission routes for hepatitis B transmission in Brazil. In one hand, it reinforces the importance of national control strategies of large impact already in course (immunization of infants, adolescents, and adults up to 49 years of age and blood supply screening). On the other hand, it shows that there is still room for further control measures targeted to different groups within each region.
- Mortality due to hepatocellular carcinoma associated with hepatitis B and C viruses in the state of São Paulo, Brazil(2022) CAVALCANTE, Débora Ferro; GARCIA, Érica Marvila; FARIAS, Norma Suely de Oliveira; KOIZUMI, Inês Kazue; FIGUEIREDO, Gerusa Maria; SATO, Ana Paula SayuriABSTRACT: Objective: This study aimed to describe and analyze the temporal and spatial distribution of deaths due to hepatocellular carcinoma (HCC) associated with hepatitis B (HBV) and C viruses (HCV) in the state of São Paulo. Methods: This is an ecological study of HCC deaths associated with HBV and HCV in the state of São Paulo, from 2009 to 2017, with data from the Mortality Information System (SIM). The temporal trend was analyzed by linear regression with Prais–Winsten estimation. Deaths were described according to sociodemographic characteristics by means of absolute and relative frequencies and were spatially distributed according to the regional health department. Results: It is found that 26.3% of deaths due to HCC were associated with HBV or HCV. A higher proportion of deaths due to HCC associated with HCV was observed (22.2%) when compared to HBV (3.9%). The mortality rate due to HCC associated with HBV showed a downward trend, and the mortality rate due to HCC associated with HCV showed a steady trend. Deaths of males, white individuals, those who aged from 50 to 59 years, and those who had 8–11 years of schooling predominated. Spatial analysis revealed a heterogeneous distribution of deaths in the state of São Paulo. Conclusions: The downward trend in mortality rates due to HCC associated with HBV shows an important advance in the disease control. However, the mortality rate due to HCC associated with HCV has remained stable throughout the study period. The spatial distribution of deaths may contribute to raise hypotheses for deeper knowledge of these diseases in the regions.
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.- Modelling the Force of Infection for Hepatitis A in an Urban Population-Based Survey: A Comparison of Transmission Patterns in Brazilian Macro-Regions(2014) XIMENES, Ricardo Arraes de Alencar; MARTELLI, Celina Maria Turchi; AMAKU, Marcos; SARTORI, Ana Marli C.; SOAREZ, Patricia Coelho de; NOVAES, Hillegonda Maria Dutilh; PEREIRA, Leila Maria Moreira Beltrao; MOREIRA, Regina Celia; FIGUEIREDO, Gerusa Maria; AZEVEDO, Raymundo Soares deBackground: This study aimed to identify the transmission pattern of hepatitis A (HA) infection based on a primary dataset from the Brazilian National Hepatitis Survey in a pre-vaccination context. The national survey conducted in urban areas disclosed two epidemiological scenarios with low and intermediate HA endemicity. Methods: A catalytic model of HA transmission was built based on a national seroprevalence survey (2005 to 2009). The seroprevalence data from 7,062 individuals aged 5-69 years from all the Brazilian macro-regions were included. We built up three models: fully homogeneous mixing model, with constant contact pattern; the highly assortative model and the highly assortative model with the additional component accounting for contacts with infected food/water. Curves of prevalence, force of infection (FOI) and the number of new infections with 99% confidence intervals (CIs) were compared between the intermediate (North, Northeast, Midwest and Federal District) and low (South and Southeast) endemicity areas. A contour plot was also constructed. Results: The anti-HAV IgG seroprevalence was 68.8% (95% CI, 64.8%-72.5%) and 33.7% (95% CI, 32.4%-35.1%) for the intermediate and low endemicity areas, respectively, according to the field data analysis. The models showed that a higher force of infection was identified in the 10- to 19-year-old age cohort (similar to 9,000 infected individuals per year per 100,000 susceptible persons) in the intermediate endemicity area, whereas a higher force of infection occurred in the 15-to 29-year-old age cohort (similar to 6,000 infected individuals per year per 100,000 susceptible persons) for the other macro-regions. Conclusion: Our findings support the shift of Brazil toward intermediate and low endemicity levels with the shift of the risk of infection to older age groups. These estimates of HA force of infection stratified by age and endemicity levels are useful information to characterize the pre-vaccination scenario in Brazil.
- Avaliação do processo de dispensação de medicamentos aos portadores de hepatite C crônica em farmácias de componentes especializados da Secretaria de Estado da Saúde de São Paulo, em 2010(2014) VENÂNCIO, Sônia Isoyama; BERSUSA, Ana Aparecida Sanches; MARTINS, Patrícia Nieri; FIGUEIREDO, Gerusa; AWAKAMATSU, Alda; ALVES, Venâncio Avancini FerreiraOBJECTIVE: to assess whether the medication dispensing procedures for chronic viral hepatitis C treatment follow Ministry of Health guidelines and to estimate possible costs of inadequate procedures. METHODS: this was a descriptive cross-sectional study of 643 medical records of patients with chronic viral hepatitis C registered in 2010 with four São Paulo State Health Department (SES/SP) Exceptional Drug Dispensing System pharmacies. RESULTS: relevant discrepancies regarding medication dispensing procedures were detected. Based on the histopathology reports it was estimated that only 64.5% of assessed patients actually met the guideline criteria for treatment and therefore R$ 1,096,132.32 was spent in nonconformity with the guidelines. CONCLUSION: a more rigorous standardization of procedures for dispensing medication for the treatment of chronic hepatitis C in SES/SP Public Health Services must be implemented.
- Prevalence of hepatitis A in the capitals of the States of North, Southeast and South regions of Brazil: decrease in prevalence and some consequences(2021) PEREIRA, Leila M. M. B.; STEIN, Airton T.; FIGUEIREDO, Gerusa Maria; CORAL, Gabriela Perdomo; MONTARROYOS, Ulisses R.; CARDOSO, Maria Regina Alves; BRAGA, Maria Cynthia; MOREIRA, Regina Celia; SANTOS, Alex A. Dos; XIMENES, Ricardo AlencarHepatitis A virus (HAV) infection has been considered one of the leading causes of acute hepatitis. The aim of the present study was to estimate the prevalence of HAV among children and adolescents in a population-based study in the capitals of the States of the North, Southeast and South of Brazil and identify predictive factors for the infection. A multi-stage sampling was used to select subjects aged between 5-9 and 10-19 years. Individual and household levels aside from the level of variables in the areas were collected. The outcome was the total IgG antibodies to HAV levels detected using a commercial Enzyme Immuno Assay (EIA). The associations between HAV and the independent variables were assessed using the odds ratio. A multilevel analysis was performed by GLLAMM using the Stata software. The prevalence of HAV infection in the 5-9 and 10-19 age groups was 28.7% and 67.5%, respectively for the North, 20.6% and 37.7%, for the Southeast and 18.9% and 34.5% for the South Region. The prevalence of HAV increased according to age in all sites. Variables related to education at the individual level (North and South), family and area level (South and Southeast) and family income level (Southeast and South) were independently associated with HAV infection. This emphasizes the need for individualized strategies to prevent the infection.
- Hepatitis E virus seroprevalence in patients with chronic hepatitis C at a university hospital in Brazil(2020) MAGRI, Mariana Cavalheiro; MANCHIERO, Caroline; DANTAS, Bianca Peixoto; NUNES, Arielle Karen da Silva; FIGUEIREDO, Gerusa Maria; BARONE, Antonio Alci; TENGAN, Fatima MitikoAim: We investigated the prevalence of anti-hepatitis E virus (HEV) antibodies in patients with chronic hepatitis C and the relationship with liver injury stage. Materials & methods: In total, 451 patients were included and the presence of anti-HEV antibodies was evaluated by ELISA. Results: Anti-HEV IgG antibodies were detected in 45 (10.0%) patients and anti-HEV IgM were detected in two IgG-positive patients (4.4%). The distributions of liver fibrosis, steatosis, inflammatory activity, homeostasis model assessment of insulin resistance and liver enzyme levels were similar between HEV-positive and HEV-negative patients. However, HEV-positive patients had a higher mean age (p = 0.030). The seroprevalence by age group increased from 2.2 (18-30 years) to 53.3% (>60 years). HEV infection was not related to advanced fibrosis. Conclusion: This investigation showed that the seroprevalence of HEV among patients with chronic hepatitis C is similar to that of blood donors in the same region.
- 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.
- Factors Associated with Spontaneous Clearance of Recently Acquired Hepatitis C Virus among HIV-Positive Men in Brazil(2023) FERRUFINO, Rosario Quiroga; RODRIGUES, Camila; FIGUEIREDO, Gerusa Maria; GLEISON, Daniel; YAPURA, Silvia; MATOS, Maria Laura Mariano de; WITKIN, Steven S. S.; MENDES-CORREA, Maria CassiaIntroduction: The objective of the present study was to describe the clinical and epidemiological aspects of recently acquired hepatitis C virus (HCV) infection and the frequency of its spontaneous clearance in a people living with the human immunodeficiency virus (PLWH) cohort. Methods: We reviewed the medical records from all PLWH at the human immunodeficiency virus (HIV) outpatient reference clinic affiliated with the University of Sao Paulo, Brazil, and identified, by immunoassays and RNA-PCR individuals who acquired HCV infection between January 2015 and December 2017. The factors associated with subsequent spontaneous clearance of the infection in this group were identified and analyzed. Results: Among 3143 PLWH individuals, 362 (11.5%) were coinfected with HCV. Forty-eight (13.2%) of these subjects first became HCV-positive between January 2015 and December 2017. Spontaneous HCV clearance was documented in 23 individuals (47.9%). The majority of this latter group were male (83.3%), and the median age was 31 years (23-39). The main risk group for HCV acquisition was men who had sex with men (MSM) (89.5%). In a multivariate analysis, only an elevated CD4+ T lymphocyte count at the time of seroconversion was found to be associated with subsequent HCV clearance (p = 0.025). Conclusions: In HIV-infected individuals in Sao Paulo, Brazil, most cases of recent HCV transmission were by sexual exposure. In PLWH, particularly in MSM, the individual's CD4+ T lymphocyte count is a determinant of whether an acquired HCV infection will be prolonged or will spontaneously clear.
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