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Avaliação do efeito da vacinação com BCG na prevenção da infecção por Mycobacterium tuberculosis em profissionais de saúde adultos no Brasil

Wed, 01 Jan 2025 00:00:00 GMT

Título: Avaliação do efeito da vacinação com BCG na prevenção da infecção por Mycobacterium tuberculosis em profissionais de saúde adultos no Brasil Abstract: The Bacillus Calmette-Guérin (BCG) vaccine is currently the only licensed vaccine for tuberculosis (TB), providing proven protection against severe forms of the disease in childhood. In addition, BCG is able to induce immunological memory in innate immunity, known as trained immunity, which may contribute not only to reducing the risk of illness from Mycobacterium tuberculosis but also to preventing infection itself. However, its effectiveness in adults remains uncertain and shows considerable variability among different populations. Healthcare workers are at higher risk of Mtb infection due to contact with patients, making them more exposed to the disease. Thus, the aim of this study was to evaluate the effectiveness of the protective response of BCG vaccination against Mycobacterium tuberculosis infection in adult healthcare workers in three Brazilian cities. This study is derived from a randomized controlled clinical trial, the BRACE study (NCT04327206). The study included healthcare professionals over 18 years of age from three locations in Brazil: Manaus/AM, Campo Grande/MS, and Rio de Janeiro/RJ, regardless of prior BCG vaccination. Eligible participants were randomized in a 1:1 ratio to receive the BCG vaccine or a placebo. The QuantiFERON-TB Gold Plus (QFT) test was used to assess TB infection before the intervention and at the 12th month post-vaccination. The primary outcome was QFT conversion (≥0.35 IU/mL) up to 12 months after BCG or placebo vaccination, among participants who were QFT negative at baseline. The secondary outcome was sustained conversion (two consecutive positive results), with a minimum interval of 6 months, among individuals with negative QFT at enrollment. Additional exploratory analyses included the use of alternative thresholds for QFT conversion (≥0.7; ≥2.0; and ≥4.0 IU/mL) and conversion up to 12 months in individuals with a baseline QFT value ≤0.2 IU/mL. Between October 2020 and April 2021, a total of 1,985 participants were enrolled in the study, 996 individuals (50.2%) in the BCG group and 989 (49.8%) in the placebo group. Of the participants, 1,475 (74.3%) were women, with a median age of 39 years (interquartile range: 32-47). During the first year, 34 (3.4%) of 996 participants in the BCG group had initial QFT conversion, compared to 32 (3.2%) of 989 in the placebo group (risk ratio [RR]: 1.09; p=0.791). Among those who converted QFT in the 12-month period, 49 underwent a subsequent test. In the BCG group, 15 (1.5%) showed sustained conversion, compared to 19 (1.9%) of the 989 in the placebo group (RR: 0.80; p=0.510). Using a threshold of 0.7 IU/mL or higher, conversions occurred in 15 (1.5%) BCG and 13 (1.3%) placebo participants (RR: 1.15; p=0.713). With a threshold of 2.0 IU/mL or higher, there were 6 (0.6%) BCG conversions and 5 (0.5%) placebo conversions (RR: 1.18; p=0.788). Among those with a baseline QFT of 0.2 IU/mL, conversion to 0.35 IU/mL occurred in 22 (2.3%) BCG group participants and 23 (2.4%) in the placebo group (RR: 0.96; p=0.903). BCG vaccination did not reduce the risk of initial and sustained QFT conversion among healthcare workers, even with the application of alternative thresholds, which showed no significant differences. These results reinforce the lack of evidence regarding the efficacy of BCG revaccination in adults for the prevention of TB, and therefore do not justify its use for this purpose. Tipo: Tese

Vigilância da raiva urbana em Campo Grande-MS (2021-2023): análise descritiva do serviço e percepção da população

Wed, 01 Jan 2025 00:00:00 GMT

Título: Vigilância da raiva urbana em Campo Grande-MS (2021-2023): análise descritiva do serviço e percepção da população Abstract: Human rabies is a serious and fatal viral disease when not treated immediately after exposure. The rabies virus, belonging to the Lyssavirus genus, primarily affects the central nervous system of mammals, including humans. According to data from the State Department of Health (MS), rabies is a significant epidemiological concern, with transmission occurring mainly through bites or scratches from dogs, cats and bats, which are the main hosts of the virus. The disease is prevalent in more than 150 countries, causing approximately 55,000 deaths annually, with the majority of occurrences in Asia and Africa. In Brazil, between 2010 and 2023, 47 cases of human rabies were recorded, with bats being the main culprits. In Mato Grosso do Sul, a fatal case of rabies was recorded in Corumbá in 2015. Urbanization and the destruction of natural habitats lead bats to adapt to urban environments, increasing the risk of rabies transmission. This cross-sectional, descriptive-exploratory, quantitative and qualitative research aimed to analyze data from telephone calls to the Campo Grande Zoonosis Control Center (CCZ) regarding bat capture, between January 2021 and May 2023, carried out by Endemic Disease Control and Control Agents. The secondary data were collected through calls from the population to the CCZ to collect bats. The primary data were collected through questionnaires: Population that contacted the CCZ (24 questions), and the CCZ Endemic Disease Control and Control Agents (16 questions). The data were collected from the "Bat Collection" (RM) forms, completed by the Endemic Disease Control and Control Agents. A total of 1,150 occurrences were confirmed, of which 451 were in 2021, 465 in 2022, and 234 in the first five months of 2023. Information was collected on the location, frequency, family of bats, description of age (baby, juvenile, and adult), and rabies virus positivity. The analysis revealed an increase in the demand for CCZ interventions, possibly due to the population's greater knowledge and access to information about bats and the health risks they pose. The survey involved 1,055 captured bats, of which 952 belonged to the Molossidae family, 53 to the Vespertilionidae family, and 47 to the Phyllostomidae family. Eleven bats tested positive for the rabies virus, representing a positivity rate of 1.0%, slightly higher than expected. The research highlights the importance of rabies surveillance in bats in Campo Grande - MS, and the crucial role of the CCZ in capturing and analyzing them. The increase in demand for the CCZ reflects the population's greater awareness, indicating the need to maintain and intensify education and prevention actions. The rate of bats testing positive for rabies (1.0%) reinforces the need for control measures, such as vaccinating domestic animals and investigating suspected cases, to prevent human rabies in the city. Tipo: Tese

Fatores de risco associados ao abandono do acompanhamento após acidentes com material biológico

Wed, 01 Jan 2025 00:00:00 GMT

Título: Fatores de risco associados ao abandono do acompanhamento após acidentes com material biológico Abstract: Introduction: Occupational accidents in healthcare involve various risk factors, with biological risk standing out due to frequent contact with biological materials and sharp instruments. Blood is the fluid with the highest potential for transmitting HIV and hepatitis B and C. Post-exposure follow-up is essential, but many professionals abandon it, compromising epidemiological surveillance and the adoption of effective preventive measures. This study analyzed factors associated with the abandonment of follow-up after occupational exposure in a hospital in the Midwest of Brazil. Materials and Methods: This is a retrospective, observational, and analytical epidemiological study. Data were collected from professionals who spontaneously sought care at the "Professora Esterina Corsini" HDIA Hospital between 2010 and 2023, using records from the "Biological Risk Project" stored in the REDCap system. Healthcare professionals aged ≥18 years exposed to blood or potentially contaminated fluids were included, excluding those whose exposure was non-occupational. Results: A total of 1,305 exposed professionals were evaluated between 2010 and 2023. Follow-up abandonment was 28%, being higher among professionals with more experience (37%), exposure to an unknown source patient (41%), use of PEP (40%), and complete hepatitis B vaccination (83%). Nursing staff and laboratory technicians had the highest number of exposures and abandonment rates. Discussion and Conclusion: The abandonment rate was lower than in other studies. Early-career professionals showed lower abandonment, suggesting higher motivation. Institutional strategies should reinforce adherence to follow-up, including improved case reporting, psychosocial support, and educational campaigns to reduce occupational infection risks and protect healthcare workers. Tipo: Dissertação

Estudo de associação dos genes do inflamassoma na COVID-19

Wed, 01 Jan 2025 00:00:00 GMT

Título: Estudo de associação dos genes do inflamassoma na COVID-19 Abstract: COVID-19, caused by the SARS-CoV-2 coronavirus, exhibits considerable clinical heterogeneity, with manifestations ranging from asymptomatic infections to severe respiratory syndromes, which are among the leading causes of severe complications and death related to the disease. Disease severity is strongly associated with dysregulation of the immune response, particularly the hypersecretion of pro-inflammatory cytokines such as IL-1β and IL-18. In this context, the NLRP3 inflammasome, activated during viral infection, plays a central role by inducing the release of these cytokines, promoting exacerbated inflammation and contributing to disease progression to more severe forms. The observed difference in the intensity of the inflammatory response among individuals suggests a potential genetic contribution. Single nucleotide variants (SNVs) have been identified as genetic alterations capable of influencing gene expression or function, potentially enhancing or disrupting biological mechanisms. However, data on the functional impact of these variants remain limited, especially in genetically diverse populations such as the Brazilian population. This study evaluated the association between SNVs in genes related to the inflammasome and COVID-19 severity through a case-control study involving 800 adults infected with SARS-CoV-2, equally distributed between mild/moderate and severe/critical cases. Genotyping was performed using qPCR for SNVs in the NLRP3 (rs7525979, rs35829419, rs10754558), CASP1 (rs572687), and IL1B (rs1143634, rs1143629) genes. No statistically significant associations were found between variants in the IL1B and CASP1 genes and disease severity. In contrast, gain-of-function variants in NLRP3 (rs35829419 and rs10754558) showed a significant association with a protective effect against progression to severe forms and mortality due to COVID-19 (p < 0.05). These findings reinforce the role of the NLRP3 inflammasome in the pathophysiology of the disease and suggest the potential of these variants as prognostic biomarkers of severity. Tipo: Tese