Background: Brazil has witnessed the co-circulation of dengue virus (DENV), Zika virus (ZIKV), and chikungunya virus (CHIKV), with outbreaks exacerbated by environmental factors, social determinants, and poor sanitation. The recent re-emergence of Oropouche virus (OROV) has added complexity to vector control strategies, emphasizing the need for integrated approaches to curb arboviruses spread. We aimed to analyze temporal trends and spatial distributions with national scope of these emerging arboviruses. Methods: An ecological study using data from the Brazilian Notifiable Diseases Information System the period from 2023 to 2024 was undertaken. Temporal trends were evaluated using Joinpoint regression, while spatial analysis was conducted using Moran’s I, and local indicators of spatial association. Results: Dengue fever cases increased by 322%, while Oropouche fever (OF) increased by 300%. The states of Amazonas and Espírito Santo reported increases in OF cases. Moran’s I test revealed spatial clustering of DENV and CHIKV. Two municipalities in the state of Mato Grosso do Sul showed cocirculation of DENV, CHIKV, and ZIKV. Conclusions: This study identified a surge in arbovirus cases between 2023 and 2024, with peak incidences from January to March and October to December, linked to favorable climatic conditions. Clustering patterns and co-circulation of arboviruses highlight the need for tailored control and prevention strategies and targeted interventions to mitigate their impact.

Chikungunya virus (CHIKV) vertical transmission occurs due to maternal viremia in the prepartum. Clinical presentation in neonates can be varied; however, the consequences of intrauterine exposure on the immune response are unclear. Thus, we aimed to analyze inflammatory alterations in children exposed to maternal CHIKV infection. This is a cross-sectional study that included children exposed to maternal CHIKV infection (confirmed by RT-qPCR and/or IgM). Circulant immune mediators were analyzed by a multiplex assay. RESULTS: We included 33 children, with a mean age of 3 ± 2.9 months-old, and 19 (57.6%) were male. Only one child presented neurological alterations. CHIKV-exposed infants showed elevated levels of MIP-1α, MIP-1β, and CCL-2 (p < 0.05). Pro-inflammatory cytokines such as TNFα, IL-6, and IL-7 (p < 0.0001) were also increased. In addition, lower levels of PDGF-BB and GM-CSF were observed in the same group (p < 0.0001). Principal component (PC) analysis highlighted a distinction in the inflammatory profile between groups, where PC explained 56.6% of the alterations. Our findings suggest that maternal exposure to CHIKV can affect the circulating levels of pro-inflammatory cytokines during the infants’ first year of life. The long-term clinical consequences of these findings should be investigated.

OBJECTIVE: To explore the spatial distribution of bacille Calmette-Guerin (BCG) vaccination coverage and tuberculosis cases in Brazilian children under the age of ten in the last two decades. METHODS: This is a population-based ecological study using data from the Sistema de Informação de Agravos de Notificação (SINAN – Information System for Notifiable Diseases) from January 2001 to December 2022. We investigated tuberculosis incidence and vaccination coverage in all Brazilian municipalities. Spatial dependence was analyzed by the Global Moran Index and Local Indicators of Spatial Association (LISA). Joinpoint regression was used to assess trends in tuberculosis and BCG rates over time. RESULTS: The results indicated 39,840 pediatric tuberculosis cases, with 60.65% in children under the age of five. The highest incidence rates were in the states of Amazonas, Mato Grosso, and Rio de Janeiro. Spatial analysis showed significant positive spatial autocorrelation in pediatric tuberculosis cases, with high-high clusters in several states and municipalities. Tuberculosis cases in children under five have been declining since 2000 but rose in 2020 (APC = 26.64; p-value = 0.032). An earlier increase was observed in children up to ten years old, starting six years prior. CONCLUSION: The study highlights the decline in BCG vaccination coverage below 90%, with the most significant drop in 2020, particularly in the Northeast. The findings underscore the need for high maintain vaccination coverage and robust public health policies to mitigate tuberculosis in children. Addressing these issues requires targeted public health interventions, especially in regions with higher tuberculosis burdens.

This study aimed to evaluate the hematological and coagulation parameters according to the clinical outcomes of coronavirus disease (COVID-19). We analyzed the hematological and coagulation parameters of hospitalized patients with COVID-19 at admission, and two and three weeks during hospitalization. To assess the performance of these parameters in predicting poor outcomes, receiver operating characteristic (ROC) curves were created. We studied 128 patients with COVID-19 (59.2±17.7 years, 56% male). Non-survivors (n=54, 42%) presented significant alterations in hematological and coagulation parameters at admission, such as increased in white blood cells (WBC), neutrophil, and band cell counts, as well as elevated prothrombin time (PT), activated partial thromboplastin time, and D-dimer levels. During follow-up, the same group presented a gradual increase in D-dimer and PT levels, accompanied by a reduction in PT activity, hemoglobin, and red blood cell count (RBC). ROC curves showed that WBC, neutrophil, and band cell counts presented the best area under the curve (AUC) values with sensitivity and specificity of >70%; however, a logistic regression model combining all the parameters, except for RBC, presented an AUC of 0.89, sensitivity of 84.84%, and specificity of 77.41%. Our study shows that significant alterations in hematological and coagulation tests at admission could be useful predictors of disease severity and mortality in COVID-19.

Objective: The aim of this study was to analyze the spatial and temporal distribution of systemic lupus erythematosus (SLE) cases in Brazil from 2008 to 2022.