Prevalência de infecção pelos vírus dengue em parturientes e neonatos, Goiânia-Goiás, 2009-2010
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Data
2010-12-21
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Universidade Federal de Goiás
Resumo
The research about the epidemiology and the pathogeneses of dengue virus during the
gestational period is essential to the understanding of clinical dengue severity among
women and their offspring. It has been postulated that children born from women with
antidengue antibodies may develop severe dengue during the first viral dengue exposure.
The objectives were (a) to determine the prevalence and incidence of dengue infection in
pregnant women and their neonates in two public hospitals in the city of Goiania, Goias
State, Central Brazil, (b) to assess the percent of newborns with maternal IgG and DENV
vertical transmission, (c) to evaluate the association of maternal recent dengue infection
(IgM) with the characteristics of the delivery and neonates. A cross sectional study was
conducted to assess recent (IgM) and previous (IgG) markers of dengue infection among
pregnant women and newborns. The survey was conducted in two public hospitals in the
city of Goiania (~1.2 million inhabitants), Central Brazil, from December 2009 to May
2010. We recruited women after giving birth. Women were interviewed to collect data
about previous dengue infection, symptoms of dengue during gestational period, pregnancy
period, delivery mode and outcomes pregnancy. Blood samples were collected from
women and neonates (umbilical cord). Previous infection was defined by the positivity to
IgG serology (PAN BIO) and recent infection by IgM (PAN BIO). The detection of
NS1Ag and viral nucleic acid (RT-PCR) were performed in the subsample of participants
who reported specific symptoms of dengue fever ten days previous to the delivery time.
Prevalence and incidence estimates were calculated with 95% Confidence Intervals (95%
CI). The agreement between the positive and negative serological results of the pair of
women and their concepts was calculated (Kappa Index). Positive and Negative Predictive
values between the history of previous dengue and the results of serological markers were
calculated. A case-control analysis was performed to assess risk factors among IgM
positive women (cases) and the outcomes of pregnancy compared to the seronegative
women (controls). Analysis was performed using SPSS 17.0 e o Epi Info 6.04. The
investigation was approved by the regional Ethical Committee and all participants signed
informed consent according to the Brazilian regulation. A total of 505 women and 505
neonates were investigated. The mean age of women was 25.8 (SD = 6.4), 83.6% of
ABSTRACT
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deliveries were between 37 and 41 weeks of pregnancy. The prevalence of IgG dengue
antibody was 53.9% (95% IC 49.3% - 58.0%) among women. Maternal antibodies were
also found in 99.2% of the offspring (Kappa index = 0.96). NS1 antigen was negative
among women and one case of DENV-2 was detected. The incidence of recent dengue
infection (IgM positivity and RT-PCR) was 8.9% (95% CI 6.6% - 11.8%) among women
and 1.6% (95% IC 0.7%-3.2%) among children. Eight neonates had IgM antibodies with
evidence of vertical DENV transmission. The positive predictive value of the previous
history of dengue related to seropositivity (IgG) was 88%. The outcomes of pregnancy
were similar among seropositive and seronegative women in the case-control analysis. In
our setting, half of the pregnant women had dengue antibodies. There was high agreement
rates between the serological markers detected among the pair of women and their
concepts. Acute dengue infection among pregnant women was not associated with the
outcomes unfavorable of pregnancies.
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ARGOLO, A. F. L. T. Prevalência de infecção pelos vírus dengue em parturientes e neonatos, Goiânia-Goiás, 2009-2010. 2010. 81 f. Dissertação (Mestrado em Medicina Tropical e Saúde Publica)–Universidade Federal de Goiás, Goiânia, 2010.