SUMMARY OBJECTIVE: This study aimed to assess physicians’ knowledge about human papillomavirus infection and its prevention. METHODS: Descriptive web-based survey with 15 objective questions targeted to physicians affiliated with the Regional Council of Medicine from Rio de Janeiro state, Brazil. Participants were invited by e-mail and the Council social networks, between January and December 2019. RESULTS: The study sample had 623 participants, with a median age of 45 years, predominantly women (63%). The most frequent specialties were Obstetrics and Gynecology (21.1%), Pediatrics (11.2%), and Internists (10.5%). Concerning human papillomavirus knowledge, 27.9% of the participants were able to identify accurately all possible forms of transmission, and none of them could recognize all the risk factors of infection. Nevertheless, 95% recognized that asymptomatic infection could occur in both sexes. Regarding knowledge about clinical manifestations, diagnosis, and screening, only 46.5% were able to identify all human papillomavirus-related cancers, 42.6% were aware of the periodicity of Pap smears, and 39.4% indicated that serological test was not adequate for diagnosis. The recommended age group for human papillomavirus vaccination was recognized by 94% of the participants, as well as the need for a Pap smear and the use of condoms, even after vaccination. CONCLUSIONS: There is good knowledge about prevention and screening for human papillomavirus infections; many gaps were identified regarding transmission, risk factors, and associated diseases among physicians in Rio de Janeiro state.

Abstract INTRODUCTION: The Amazon tropical rainforest has the most dense and diverse ecosystem worldwide. A few studies have addressed rodent-borne diseases as potential hazards to humans in this region. METHODS: A retrospective survey was conducted using enzyme-linked immunosorbent assay for detecting mammarenavirus and orthohantavirus antibodies in 206 samples collected from rural settlers of the Brazilian Western Amazonian region. RESULTS: Six (2.91%) individuals in the age group of 16 to 36 years were found to possess antibodies against mammarenavirus. CONCLUSION: Evidence of previous exposure to mammarenavirus in the rural population points to its silent circulation in this region.

RESUMO OBJETIVO: O papilomavírus humano (HPV) é o vírus sexualmente transmissível mais prevalente no mundo, estando a infecção por este agente associada a um aumento do risco do câncer de colo uterino. A abordagem mais eficaz para o controle desse tipo de câncer continua sendo a triagem por meio do exame preventivo (Papanicolaou). Este estudo analisa o conhecimento de estudantes universitárias de cursos da área da saúde, bem como cursos de graduação de outras áreas do conhecimento com relação a questões importantes sobre o HPV. MÉTODO: Quatrocentas e setenta e três estudantes universitárias responderam a um questionário que avaliava os conhecimentos sobre a infecção pelo HPV, o câncer de colo do útero e o exame preventivo. Após análise descritiva, foi feita a análise multivariada por regressão logística para identificação dos fatores associados à informação sobre o HPV/câncer de colo do útero. RESULTADOS: O conhecimento das universitárias foi maior para questões simples relacionadas ao HPV e ao exame preventivo, mas foi menor para as correlações do HPV com verrugas genitais e com o câncer de colo do útero. Ser aluna da área da saúde e ter alta renda foram fatores associados ao maior conhecimento. Somente uma minoria das participantes reconheceu todas as situações que aumentavam o risco de infecção pelo HPV apresentadas no questionário. CONCLUSÃO: Os resultados evidenciam a necessidade de realização de campanhas educativas sobre a infecção pelo HPV, do seu potencial como agente de câncer do colo uterino e as formas de prevenção disponíveis.

SUMMARY OBJECTIVE: Human papillomavirus (HPV) is the most prevalent sexually transmitted virus in the world and is associated with an increased risk of cervical cancer. The most effective approach to cervical cancer control continues to be screening through the preventive Papanicolaou test (Pap test). This study analyzes the knowledge of university students of health science programs as well as undergraduate courses in other areas of knowledge on important questions regarding HPV. METHOD: Four hundred and seventy-three university students completed a questionnaire assessing their overall knowledge regarding HPV infection, cervical cancer, and the Pap test. A descriptive analysis is presented, and multivariate analysis using logistic regression identified factors associated with HPV/cervical cancer information. RESULTS: Knowledge was higher for simple HPV-related and Pap test questions but was lower for HPV interrelations with genital warts and cervical cancer. Being from the health science fields and having high income were factors associated with greater knowledge. Only the minority of the participants recognized all the situations that increased the risk of virus infection presented in the questionnaire. CONCLUSIONS: These findings highlight the need for educational campaigns regarding HPV infection, its potential as a cervical cancer agent and the forms of prevention available.

Resumo: Estudo do corte transversal, realizado entre agosto de 2011 e julho de 2012 em Campos dos Goytacazes, Rio de Janeiro, Brasil. Amostras de sangue capilar em papel de filtro foram coletadas de 919 indivíduos com idade entre 1 e 19 anos e testadas para anticorpos para o vírus da hepatite A (anti-HAV). A prevalência total foi de 20,7% e 94,7% das crianças abaixo de 5 anos foi suscetível a infecção pelo HAV. A prevalência de anti-HAV aumentou com a idade, alcançando 33,3% entre indivíduos com 15 a 19 anos, caracterizando este município com um nível baixo de endemicidade para hepatite A. Idade, cor da pele não-branca, hábito de nadar no rio e número de moradores na residência acima de 5 foram associados com o aumento de chance de ser positivo para anti-HAV. O nível educacional materno (médio ou superior) foi considerado como fator de proteção para a infecção pelo HAV. Os dados obtidos mostraram que uma grande parte das crianças de Campos dos Goytacazes estava sob risco de infecção pelo HAV, o que deve ser minimizado com o programa de vacinação contra hepatite A implantado em 2011 no município.

Abstract: This cross-sectional study was carried out between August 2011 and July 2012 in the city of Campos dos Goytacazes in Rio de Janeiro State, Brazil. Dried blood spot samples were collected on filter paper from 919 individuals between the ages of 1 and 19 and were tested for antibodies against the hepatitis A virus (anti-HAV). The total prevalence was 20.7%, while 94.7% of children under the age of 5 were found to be susceptible to HAV infection. The prevalence of anti-HAV increased with age, reaching 33.3% among individuals aged between 15 and 19, thereby indicating that this municipality has a low level of endemicity for hepatitis A. Age, non-white skin color, accustomed to swimming in the river and more than five people living at home were the factors that were associated with an increase in the chance of a positive anti-HAV result. Mother's education level (secondary or tertiary) was considered a protective factor for HAV infection. The data obtained showed that a large proportion of the children from Campos dos Goytacazes were at risk of HAV infection, which should be minimized with the introduction of the vaccination program against hepatitis A that was launched in the municipality in 2011.

Resumen: Estudio de corte transversal, realizado entre agosto de 2011 y julio de 2012 en Campos dos Goytacazes, Río de Janeiro, Brasil. Se recogieron muestras de sangre capilar en papel de filtro de 919 individuos con una edad entre 1 y 19 años y testadas para anticuerpos del virus de la hepatitis A (anti-HAV). La prevalencia total fue de un 20,7% y un 94,7% de los niños por debajo de los 5 años fue susceptible a la infección por el HAV. La prevalencia de anti-HAV aumentó con la edad, alcanzando un 33,3% entre individuos con 15 a 19 años, caracterizando este municipio con un nivel bajo de endemicidad para la hepatitis A. Edad, color de piel no-blanca, hábito de nadar en el río y un número de ocupantes en la residencia de más de 5 se asociaron con el aumento de oportunidad de ser positivo para anti-HAV. El nivel educacional materno (medio o superior) se consideró como un factor de protección para la infección por el HAV. Los datos obtenidos mostraron que una gran parte de los niños de Campos dos Goytacazes estaba bajo riesgo de infección por el HAV, lo que debe ser minimizado con el programa de vacunación contra la hepatitis A implantado en 2011 en el municipio.

Resumo: Estudo do corte transversal, realizado entre agosto de 2011 e julho de 2012 em Campos dos Goytacazes, Rio de Janeiro, Brasil. Amostras de sangue capilar em papel de filtro foram coletadas de 919 indivíduos com idade entre 1 e 19 anos e testadas para anticorpos para o vírus da hepatite A (anti-HAV). A prevalência total foi de 20,7% e 94,7% das crianças abaixo de 5 anos foi suscetível a infecção pelo HAV. A prevalência de anti-HAV aumentou com a idade, alcançando 33,3% entre indivíduos com 15 a 19 anos, caracterizando este município com um nível baixo de endemicidade para hepatite A. Idade, cor da pele não-branca, hábito de nadar no rio e número de moradores na residência acima de 5 foram associados com o aumento de chance de ser positivo para anti-HAV. O nível educacional materno (médio ou superior) foi considerado como fator de proteção para a infecção pelo HAV. Os dados obtidos mostraram que uma grande parte das crianças de Campos dos Goytacazes estava sob risco de infecção pelo HAV, o que deve ser minimizado com o programa de vacinação contra hepatite A implantado em 2011 no município.

Abstract: This cross-sectional study was carried out between August 2011 and July 2012 in the city of Campos dos Goytacazes in Rio de Janeiro State, Brazil. Dried blood spot samples were collected on filter paper from 919 individuals between the ages of 1 and 19 and were tested for antibodies against the hepatitis A virus (anti-HAV). The total prevalence was 20.7%, while 94.7% of children under the age of 5 were found to be susceptible to HAV infection. The prevalence of anti-HAV increased with age, reaching 33.3% among individuals aged between 15 and 19, thereby indicating that this municipality has a low level of endemicity for hepatitis A. Age, non-white skin color, accustomed to swimming in the river and more than five people living at home were the factors that were associated with an increase in the chance of a positive anti-HAV result. Mother's education level (secondary or tertiary) was considered a protective factor for HAV infection. The data obtained showed that a large proportion of the children from Campos dos Goytacazes were at risk of HAV infection, which should be minimized with the introduction of the vaccination program against hepatitis A that was launched in the municipality in 2011.

Resumen: Estudio de corte transversal, realizado entre agosto de 2011 y julio de 2012 en Campos dos Goytacazes, Río de Janeiro, Brasil. Se recogieron muestras de sangre capilar en papel de filtro de 919 individuos con una edad entre 1 y 19 años y testadas para anticuerpos del virus de la hepatitis A (anti-HAV). La prevalencia total fue de un 20,7% y un 94,7% de los niños por debajo de los 5 años fue susceptible a la infección por el HAV. La prevalencia de anti-HAV aumentó con la edad, alcanzando un 33,3% entre individuos con 15 a 19 años, caracterizando este municipio con un nivel bajo de endemicidad para la hepatitis A. Edad, color de piel no-blanca, hábito de nadar en el río y un número de ocupantes en la residencia de más de 5 se asociaron con el aumento de oportunidad de ser positivo para anti-HAV. El nivel educacional materno (medio o superior) se consideró como un factor de protección para la infección por el HAV. Los datos obtenidos mostraron que una gran parte de los niños de Campos dos Goytacazes estaba bajo riesgo de infección por el HAV, lo que debe ser minimizado con el programa de vacunación contra la hepatitis A implantado en 2011 en el municipio.

Age-related seroprevalence studies that have been conducted in Brazil have indicated a transition from a high to a medium endemicity of hepatitis A virus (HAV) infection in the population. However, most of these studies have focused on urban populations that experience lower incidence rates of HAV infection. In the current study, the prevalence of anti-HAV antibodies was investigated in children with a low socioeconomic status (SES) that live on the periphery of three capital cities in Brazil. A total of 1,162 dried blood spot samples were collected from individuals whose ages ranged from one-18 years and tested for anti-HAV antibodies. A large number of children under five years old (74.1-90%) were identified to be susceptible to HAV infection. The anti-HAV antibody prevalence reached ≥ 50% among those that were 10-14 years of age or older. The anti-HAV prevalence rates observed were characteristics of regions with intermediate level of hepatitis A endemicity. These data indicated that a large proportion of children with a low SES that live at the periphery of urban cities might be at risk of contracting an HAV infection. The hepatitis A vaccine that is currently offered in Brazil is only available for high-risk groups or at private clinics and is unaffordable for individuals with a lower SES. The results from this study suggest that the hepatitis A vaccine should be included in the Brazilian National Program for Immunisation.

This study was conducted to estimate the prevalence of hepatitis E antibodies (anti-HEV) among individuals exposed to swine in the rural areas of the state of Mato Grosso (MT) in Brazil. The study included 310 participants who had an average age of 39 years. Fifty-one per cent of the participants were female and 26 (8.4%) were anti-HEV-positive. Concomitantly, we studied 101 blood donors from the urban area of the state capital who had never lived in a rural area or handled swine. Four per cent (4%) of these individuals were anti-HEV-positive (p = 0.206). When we compared the anti-HEV-positive participants who had been exposed to swine with the anti-HEV-negative participants, we noticed associations between the presence of anti-HEV and increased age, a history of blood transfusions and contact with other farm animals. However, after a multivariate analysis was performed, this association was not confirmed. Finally, the ratio of anti-HEV-positive individuals who had been exposed to swine in rural MT was similar to that found in previous studies in Brazil. This prevalence did not characterise this type of exposure as a risk factor for HEV infection in this region.

Objetivamos discutir a vinculação do Sistema de Informações de Agravos de Notificação (SINAN) e do Censo Demográfico para conhecer o contexto sócio-ambiental da hepatite A, analisando a contribuição das variáveis ambientais e sócio-demográficas para ocorrência de casos notificados e confirmados da infecção. Também, com base nas informações individuais sobre os casos de hepatite A notificados e confirmados, obtidos no SINAN, discutimos o padrão de endemicidade no Município do Rio de Janeiro, Brasil. No estudo agregado, a unidade de análise foi o setor censitário e as informações do Censo 2000, associadas à localização dos 1.553 casos notificados e confirmados de hepatite A ocorridos na cidade entre 1999-2001. Observou-se um padrão epidemiológico entre alta e média endemicidades, indicando situação menos favorável do que a observada nos estudos soro-epidemiológicos. A média rank do número de domicílios com condições sócio-ambientais desfavoráveis foi maior nos setores censitários de sobre-risco para hepatite A (dois ou mais casos) com significância estatística pelo teste de Mann-Whitney. As variáveis sócio-demográficas mostraram ter maior influência do que as ambientais na ocorrência de casos: maior percentual de pobreza e de menores de cinco anos apresentou as maiores diferenças de médias rank.

This article discusses the linking of data from SINAN (the Reportable Diseases Database) and population census in Brazil to identify the socio-environmental context of hepatitis A, analyzing the contribution by environmental and socio-demographic variables to reported and confirmed cases of hepatitis A. Also, based on individual case data provided by SINAN, we discuss the pattern of hepatitis A endemicity in the city of Rio de Janeiro. At the aggregate level, the unit of analysis was the census tract and census data, associated with the location of 1,553 cases in the city from 1999 to 2001. The observed pattern was high to medium endemicity, indicating a less favorable situation than observed by sero-epidemiological studies. The mean rank of number of households with unfavorable conditions was higher in the census tracts with excess risk of hepatitis A (two or more cases), a statistically significant result according to the Mann-Whitney Test. Socio-demographic variables had more impact than environmental ones (poverty and children in the household less than 5 years of age showed the highest mean ranks).

Objetivamos discutir a vinculação do Sistema de Informações de Agravos de Notificação (SINAN) e do Censo Demográfico para conhecer o contexto sócio-ambiental da hepatite A, analisando a contribuição das variáveis ambientais e sócio-demográficas para ocorrência de casos notificados e confirmados da infecção. Também, com base nas informações individuais sobre os casos de hepatite A notificados e confirmados, obtidos no SINAN, discutimos o padrão de endemicidade no Município do Rio de Janeiro, Brasil. No estudo agregado, a unidade de análise foi o setor censitário e as informações do Censo 2000, associadas à localização dos 1.553 casos notificados e confirmados de hepatite A ocorridos na cidade entre 1999-2001. Observou-se um padrão epidemiológico entre alta e média endemicidades, indicando situação menos favorável do que a observada nos estudos soro-epidemiológicos. A média rank do número de domicílios com condições sócio-ambientais desfavoráveis foi maior nos setores censitários de sobre-risco para hepatite A (dois ou mais casos) com significância estatística pelo teste de Mann-Whitney. As variáveis sócio-demográficas mostraram ter maior influência do que as ambientais na ocorrência de casos: maior percentual de pobreza e de menores de cinco anos apresentou as maiores diferenças de médias rank.

This article discusses the linking of data from SINAN (the Reportable Diseases Database) and population census in Brazil to identify the socio-environmental context of hepatitis A, analyzing the contribution by environmental and socio-demographic variables to reported and confirmed cases of hepatitis A. Also, based on individual case data provided by SINAN, we discuss the pattern of hepatitis A endemicity in the city of Rio de Janeiro. At the aggregate level, the unit of analysis was the census tract and census data, associated with the location of 1,553 cases in the city from 1999 to 2001. The observed pattern was high to medium endemicity, indicating a less favorable situation than observed by sero-epidemiological studies. The mean rank of number of households with unfavorable conditions was higher in the census tracts with excess risk of hepatitis A (two or more cases), a statistically significant result according to the Mann-Whitney Test. Socio-demographic variables had more impact than environmental ones (poverty and children in the household less than 5 years of age showed the highest mean ranks).

A infecção pelo vírus da hepatite E (VHE) ainda não foi detectada entre suínos na região central do Brasil. Com o intuito de avaliar se o VHE circula entre suínos no estado de Mato Grosso, um estudo de soroprevalência foi realizado em suínos de 17 propriedades rurais, correspondentes a 13 municípios. Os animais foram escolhidos aleatoriamente em lotes no momento da chegada para abate em dois frigoríficos entre dezembro de 2002 e fevereiro de 2003. Amostras de soro foram coletadas e testadas para a presença de anticorpos de classe IgG contra o VHE (anti-VHE) por ensaio imuno-enzimático (EIE). Este EIE foi executado utilizando-se duas proteínas recombinantes como antígenos. Uma proteína mosaico (MP-II) e outra proteína contendo a região dos aminoácidos 452 a 617 da ORF2 da cepa Burma do VHE. 211 dos 260 animais examinados eram anti-VHE reativos. A soropositividade não variou com gênero e idade, mas variou entre 15% a 100% de uma propriedade para outra. Nossos resultados apontaram que o VHE parece circular entre suínos do estado de Mato Grosso, sugerindo que o vírus encontra-se disseminado na região, como verificado em outros países ao redor do mundo.

There is no information about evidence of hepatitis E virus (HEV) infection in swines in Central Brazil. In order to assess if HEV circulates in swines of the State of Mato Grosso, Central Brazil, a seroprevalence study was conducted including pigs from 17 farms, corresponding to 13 counties. The animals were randomly chosen among pigs arriving to two slaughterhouses between December 2002 and February 2003. Serum samples were collected and tested for IgG antibodies against HEV (anti-HEV) by enzyme immunoassay (EIA). This EIA uses two HEV recombinant proteins as antigens, a mosaic protein (MP-II) and a protein containing region 452-617 of the ORF2 of the HEV Burma strain as coating antigens. 211 out of 260 pigs (81.2%; 95CI = 75.7%, 85.6%) were anti-HEV reactive. The seropositivity did not vary with gender or age, but ranges from 15% to 100% among the farms. Our results point out that HEV seems to circulate among pigs in Mato Grosso State, suggesting that this virus is spread over the region, as seen in other countries worldwide.

We investigated the seroprevalence of hepatitis A virus (HAV) and hepatitis E virus (HEV) infection in subjects living in the community of Manguinhos, Rio de Janeiro, Brazil, and assisted at the Health Unit of Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz. After formal consent, individuals were submitted to an interview using a standardized questionnaire. Anti-HAV and anti-HEV antibodies were detected by ELISA. Statistical analysis was carried out using the Epi-Info 6.04b software, to investigate possible associations between serological markers and risk factors. Results were regarded as significant when p value < 0.05. Although a high prevalence of anti-HAV was observed (87%), almost 50% of subjects under the age of 10 were susceptible to HAV infection, an unexpected rate in endemic areas. This fact could be attributed to improvements in environmental sanitation, occurring in this area in the last years. The increasing proportion of susceptible people may result in outbreaks of HAV infection, since the virus still circulates in this area, as verified by the detection of anti-HAV IgM in some individuals. No statistical association was met between HAV infection and the risk factors here assessed. The anti-HEV IgG prevalence found in this population was 2.4%, consistent with the one found in non-endemic areas.

Foram desenvolvidos dois ensaios imunoenzimáticos (EIA) competitivos: no primeiro (COMP-1) colocou-se numa placa sensibilizada com anti-HAVIgG as amostras teste juntamente como antígeno HA Vea seguir o conjugado anti-HA VHRP; no segundo (COMP-2), as amostras teste e o conjugado anti-HAV HRP competem pelos epitopos do antígeno HAV previamente absorvido na placa sensibilizada do anti-HAV IgG. O substrato utilizado foi tetrametilbenzidina (TMB). Ambas as técnicas mostraram ser produtíveis e aplicáveis para fins de diagnóstico e pesquisa.

Two competitive enzyme immunoassays (EIA) techniques were developed: in the first (COMP-1), test sera were added together with HAV antigen on anti-HAV IgG-coated wells followed by an anti-HA VHRP conjugate; in the second (COMP-2), test sera and anti-HA VHRP conjugate competed for HAV epitopes previously adsorbed to anti-HA V IgG-coated wells. Both procedures used tetramethylbenzidine (TMB) as a substrate. Both competitive tests were shown to be reproducible and suitable for routine diagnosis and research purposes.