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Introduction: Homeless people are a vulnerable group to sexually transmitted diseases (STD) with high prevalence of syphilis and hepatitis. Objectives: To estimate the prevalence of syphilis infection and its association with risky behaviors for STDs in a sample of homeless people, and to assess the feasibility of the use of rapid syphilis test (RST) in this population. Methods: Cross-sectional study, in a convenience sample of homeless people assisted in social support services of São Paulo, between 2006 and 2007. A structured questionnaire was applied and RST was performed. In addition, a blood sample for syphilis detection was also collected. The sensitivity and specificity of the RST was estimated using conventional laboratory diagnosis (VDRL + TPHA) as reference. Results: 1,405 volunteers were included in the study. The prevalence rate of syphilis was 7.0%, and was associated with homosexual practices (ORadj 4.9; 95%CI 2.6 - 9.4), prior history of STD (ORadj 2.6; 95%CI 1.7 - 4.0) and with self-referred non-white race (ORadj 1.9; 95%CI 1.1 - 3.4). The sensitivity and specificity of the RST for syphilis were, respectively, 81.4 and 92.1%. Conclusion: The high prevalence of syphilis infection among homeless people shows the need for actions for its control and the utilization of RST that can be considered an efficient strategy due to its sensitivity and specificity. Public Health policymakers must strengthen actions for syphilis control, with screening tests for syphilis and early treatment, decreasing morbidity with the improvement of sexual and reproductive health of the population in general and especially the most vulnerable.

OBJETIVO: Analisar a prevalência e o perfil de vulnerabilidade ao HIV de moradores de rua. MÉTODOS: Estudo transversal com amostra não probabilística de 1.405 moradores de rua usuários de instituições de acolhimento de São Paulo, SP, de 2006 a 2007. Foi realizado teste anti-HIV e aplicado questionário estruturado. O perfil de vulnerabilidade foi analisado pela frequência do uso do preservativo, considerando mais vulneráveis os que referiram o uso nunca ou às vezes. Foram utilizadas regressões logística e multinomial para estimar as medidas de efeito e intervalos de 95% de confiança. RESULTADOS: Houve predominância do sexo masculino (85,6%), média de 40,9 anos, ter cursado o ensino fundamental (72,0%) e cor não branca (71,5%). A prática homo/bissexual foi referida por 15,7% e a parceria ocasional por 62,0%. O número médio de parcerias em um ano foi de 5,4 e mais da metade (55,7%) referiu uso de drogas na vida, dos quais 25,7% relataram uso frequente. No total, 39,6% mencionaram ter tido uma doença sexualmente transmissível e 38,3% relataram o uso do preservativo em todas as relações sexuais. A prevalência do HIV foi de 4,9% (17,4% dos quais apresentaram também sorologia positiva para sífilis). Pouco mais da metade (55,4%) tinha acesso a ações de prevenção. A maior prevalência do HIV esteve associada a ser mais jovem (OR 18 a 29 anos = 4,0 [IC95% 1,54;10,46]), história de doença sexualmente transmissível (OR = 3,3 [IC95% 1,87;5,73]); prática homossexual (OR = 3,0 [IC95% 1,28;6,92]) e à presença de sífilis (OR = 2,4 [IC95% 1,13;4,93]). O grupo de maior vulnerabilidade foi caracterizado por ser mulher, jovem, ter prática homossexual, número reduzido de parcerias, parceria fixa, uso de drogas e álcool e não ter acesso a ações de prevenção e apoio social. CONCLUSÕES: O impacto da epidemia entre moradores de rua é elevado, refletindo um ciclo que conjuga exclusão, vulnerabilidade social e acesso limitado à prevenção.OBJETIVO: Analizar la prevalencia y el perfil de vulnerabilidad al VIH en personas que viven en la calle. MÉTODOS: Estudio transversal con muestra no probabilística de 1.405 personas que viven en la calle y que acuden a albergues de Sao Paulo, Sureste de Brasil, de 2006 a 2007. Se realizó prueba anti-VIH y se aplicó cuestionario estructurado. El perfil de vulnerabilidad fue analizado por la frecuencia de uso del preservativo, considerando más vulnerables a los que relataron no haberlo usado nunca o a veces. Se utilizaron regresiones logística y multinomial para estimar las medidas de efecto e intervalos de 95% de confianza. RESULTADOS: Hubo predominancia del sexo masculino (85,6%), promedio de 40,9 años, haber cursado educación primaria (72,0%) y no tener color blanco (71,5%). La práctica homo/bisexual fue relatada por 15,7% y la pareja ocasional por 62,0%. El número promedio de parejas en un año fue de 5,4 y más de la mitad (55,7%) narraron uso de drogas en la vida, de los cuales 25,7% lo hicieron de forma frecuente. En total, 39,6% mencionaron haber tenido una enfermedad sexualmente transmisible y 38,3% contaron el uso de preservativo en todas las relaciones sexuales. La prevalencia de VIH fue de 4,9% (17,4% de los cuales presentaron también serología positiva para sífilis). Poco más de la mitad (55,4%) tenía acceso a acciones de prevención. La mayor prevalencia del VIH estuvo asociada a ser más joven (OR 18 a 29 años = 4,0 [IC95% 1,54;10,46]), historia de enfermedad sexualmente transmisible (OR = 3,3 [IC95% 1,87;5,73]); práctica homosexual (OR = 3,0 [IC95% 1,28;6,92]) y a la presencia de sífilis (OR = 2,4 [IC95% 1,13;4,93]). El grupo de mayor vulnerabilidad fue caracterizado por ser mujer, joven, tener práctica homosexual, número reducido de parejas, pareja fija, uso de drogas y alcohol y no tener acceso a acciones de prevención y apoyo social. CONCLUSIONES: El impacto de la epidemia entre las personas que viven en la calle es elevado, reflejando un ciclo que conjuga exclusión, vulnerabilidad social y acceso limitado a la prevención.OBJECTIVE: To assess the prevalence and vulnerability of homeless people to HIV infection. METHODS: Cross-sectional study conducted with a non-probabilistic sample of 1,405 homeless users of shelters in the city of São Paulo, southeastern Brazil, from 2006 to 2007. They were all tested for HIV and a structured questionnaire was applied. Their vulnerability to HIV was determined by the frequency of condom use: those who reported using condoms only occasionally or never were considered the most vulnerable. Multinomial and logistic regression models were used to estimate effect measures and 95% confidence intervals. RESULTS: There was a predominance of males (85.6%), with a mean age of 40.9 years, 72.0% had complete elementary schooling, and 71.5% were non-white. Of all respondents, 15.7% reported being homosexual or bisexual and 62,0% reported having casual sex. The mean number of sexual partners in the last 12 months was 5.4. More than half (55.7%) of the respondents reported lifetime drug use, while 25.7% reported frequent use. Sexually-transmitted disease was reported by 39.6% of the homeless and 38.3% reported always using condoms. The prevalence of HIV infection was 4.9% (17.4% also tested positive for syphilis) and about half of the respondents (55.4%) had access to prevention programs. Higher HIV prevalence was associated with younger age (18-29 years, OR = 4.0 [95%CI 1.54;10.46]); past history of sexually-transmitted disease (OR = 3.3 [95%CI 1.87;5.73]); homosexual sex (OR = 3.0 [95%CI 1.28;6.92]); and syphilis (OR = 2.4 [95%CI 1.13;4.93]). Increased vulnerability to HIV infection was associated with being female; young; homosexual sex; having few partners or a steady partner; drug and alcohol use; not having access to prevention programs and social support. CONCLUSIONS: The HIV epidemic has a major impact on homeless people reflecting a cycle of exclusion, social vulnerability, and limited access to prevention.

A leishmaniose tegumentar americana adquiriu caráter epidêmico no Litoral Norte Paulista, desde a década de 1990. A partir de dados secundários, realizou-se estudo descritivo da doença no período de 1993 a 2005 nos quatro municípios que compõem a região e analisou-se a freqüência dos flebotomíneos capturados nos locais prováveis de transmissão. Foram notificados 689 casos autóctones de leishmaniose tegumentar, com casos isolados e agrupados, determinando uma distribuição espacial heterogênea, com sincronismo na manifestação e ciclicidade, em intervalo de seis a oito anos. Todas as faixas etárias foram acometidas, com ligeiro predomínio do sexo masculino, sem associação com uma ocupação. Capturou-se 2.758 flebotomíneos e a espécie Nyssomyia intermedia predominou (80,4%), no peri e intradomicílio. A doença apresentou perfil de transmissão peri e intradomiciliar, entre o periurbano e a mata, e no interior da mata. Neste caso, a transmissão estaria mais relacionada com os focos enzoóticos.American cutaneous leishmaniasis acquired epidemic characteristics on the northern coastline of the State of São Paulo beginning in the 1990s. From secondary data, a descriptive study of the disease in the four municipalities making up this region over the period from 1993 to 2005 was conducted. The frequency of phlebotomine capture in the probable transmission locations was analyzed. 689 autochthonous cases of cutaneous leishmaniasis were notified, with single and grouped cases, thus determining that the spatial distribution was heterogenous. There was synchronism and cyclicity of disease manifestation, at intervals of six to eight years. All ages were affected, with slight predominance among males, without association with any specific occupation. Among the 2,758 phlebotomines captured, Nyssomyia intermedia predominated (80.4%) inside homes and in areas surrounding them. The disease presented a transmission profile inside homes and in areas surrounding them, between the urban fringe and forests, and inside forests. In such cases, transmission would be more related to enzootic foci.

OBJETIVO: Analisar a prevalência e o perfil de vulnerabilidade ao HIV de moradores de rua. MÉTODOS: Estudo transversal com amostra não probabilística de 1.405 moradores de rua usuários de instituições de acolhimento de São Paulo, SP, de 2006 a 2007. Foi realizado teste anti-HIV e aplicado questionário estruturado. O perfil de vulnerabilidade foi analisado pela frequência do uso do preservativo, considerando mais vulneráveis os que referiram o uso nunca ou às vezes. Foram utilizadas regressões logística e multinomial para estimar as medidas de efeito e intervalos de 95% de confiança. RESULTADOS: Houve predominância do sexo masculino (85,6%), média de 40,9 anos, ter cursado o ensino fundamental (72,0%) e cor não branca (71,5%). A prática homo/bissexual foi referida por 15,7% e a parceria ocasional por 62,0%. O número médio de parcerias em um ano foi de 5,4 e mais da metade (55,7%) referiu uso de drogas na vida, dos quais 25,7% relataram uso frequente. No total, 39,6% mencionaram ter tido uma doença sexualmente transmissível e 38,3% relataram o uso do preservativo em todas as relações sexuais. A prevalência do HIV foi de 4,9% (17,4% dos quais apresentaram também sorologia positiva para sífilis). Pouco mais da metade (55,4%) tinha acesso a ações de prevenção. A maior prevalência do HIV esteve associada a ser mais jovem (OR 18 a 29 anos = 4,0 [IC95% 1,54;10,46]), história de doença sexualmente transmissível (OR = 3,3 [IC95% 1,87;5,73]); prática homossexual (OR = 3,0 [IC95% 1,28;6,92]) e à presença de sífilis (OR = 2,4 [IC95% 1,13;4,93]). O grupo de maior vulnerabilidade foi caracterizado por ser mulher, jovem, ter prática homossexual, número reduzido de parcerias, parceria fixa, uso de drogas e álcool e não ter acesso a ações de prevenção e apoio social. CONCLUSÕES: O impacto da epidemia entre moradores de rua é elevado, refletindo um ciclo que conjuga exclusão, vulnerabilidade social e acesso limitado à prevenção.

Resumo Objetivo: descrever a ocorrência da hepatite B entre gestantes, a realização de imunoprofilaxia e a transmissão vertical e perinatal nas crianças expostas ao vírus na rede de Atenção Primária à Saúde do estado de São Paulo, Brasil. Métodos: estudo transversal sobre registros de pré-natal de gestantes atendidas de janeiro a junho de 2012 e coorte dos recém-nascidos; foram descritas as frequências dos resultados e calculada a estimativa da ocorrência da hepatite B. Resultados: foram incluídas 6.233 gestantes, das quais 53,1% com 20 a 29 anos de idade, 58,7% com 8 a 11 anos de estudo, 53,3% brancas e 73,9% com companheiro; a ocorrência de hepatite B foi de 0,13% (IC95%: 0,04 a 0,21%); das oito crianças de mães com hepatite B crônica, seis tiveram esquema vacinal completo e não houve transmissão vertical ou perinatal. Conclusão: observou-se baixa ocorrência de hepatite B em gestantes e ausência de transmissão vertical ou perinatal.

Avian malaria parasites are widespread parasites transmitted by Culicidae insects belonging to different genera. Even though several studies have been conducted recently, there is still a lack of information about potential vectors of Plasmodium parasites, especially in Neotropical regions. Former studies with free-living and captive animals in São Paulo Zoo showed the presence of several Plasmodium and Haemoproteus species. In 2015, a pilot study was conducted at the zoo to collect mosquitoes in order to find out (i) which species of Culicidae are present in the study area, (ii) what are their blood meal sources, and (iii) to which Plasmodium species might they be potential vectors. Mosquitoes were morphologically and molecularly identified. Blood meal source and haemosporidian DNA were identified using molecular protocols. A total of 25 Culicidae species were identified, and 6 of them were positive for Plasmodium/Haemoproteus DNA. Ten mosquito species had their source of blood meal identified, which were mainly birds, including some species that were positive for haemosporidian parasites in the former study mentioned. This study allowed us to expand the list of potential vectors of avian malaria parasites and to improve our knowledge of the evolutionary and ecological relationships between the highly diverse communities of birds, parasites, and vectors present at São Paulo Zoo.

Non-human primates (NHPs) have been shown to be infected by parasites of the genus Plasmodium, the etiological agent of malaria in humans, creating potential risks of zoonotic transmission. Plasmodium brasilianum, a parasite species similar to P. malariae of humans, have been described in NHPs from Central and South America, including Brazil. The merozoite surface protein 1 (MSP1), besides being a malaria vaccine candidate, is highly immunogenic. Due to such properties, we tested this protein for the diagnosis of parasite infection. We used recombinant proteins of P. malariae MSP1, as well as of P. falciparum and P. vivax, for the detection of antibodies anti-MSP1 of these parasite species, in the sera of NHPs collected in different regions of Brazil. About 40% of the NHP sera were confirmed as reactive to the proteins of one or more parasite species. A relatively higher number of reactive sera was found in animals from the Atlantic Forest than those from the Amazon region, possibly reflecting the former more intense parasite circulation among NHPs due to their proximity to humans at a higher populational density. The presence of Plasmodium positive NHPs in the surveyed areas, being therefore potential parasite reservoirs, needs to be considered in any malaria surveillance program.

Aedes aegypti is an important vector in Brazil being the main vector of the dengue-fever. This paper employs survival curves to describe the time in days from larvae to adult forms of Aedes aegypti raised, individually and collectively, and compares it during winter and spring when positioned inside and outside a laboratory. The study was conducted in São Vicente, a coastal city in Southeastern Brazil. The lowest water temperature in winter and in spring was 20 °C and the highest was 26 °C in spring. Higher and more stable temperatures were measured in the intra compared to the peri in both seasons. Consequently, larvae positioned in the intra resulted in the lowest median time to develop in the individual and collective experiment (nine and ten days, respectively). At least 25% of the larvae positioned in the intra in the individual experiment in the spring took only seven days to reach adulthood. Sex ratios and the median time development by sex did not show significant differences. These results indicate that efforts to control Aedes aegypti must be continuous and directed mainly to prevent the intra-domiciliary sites that can be infested in a week in order to reduce the human-vector contact.

Introduction Vector seasonality knowledge is important for monitoring and controlling of vector-borne diseases. Lutzomyia longipalpis (Lu. longipalpis) is the main vector of Leishmania (Leishmania) infantum Nicolle, 1908, which is the causative agent of visceral leishmaniasis in the Americas. Methods Lu. longipalpis was monitored for 3 consecutive nights each month using light traps from the Centers for Disease Control in the peridomiciles and intradomiciles of 18 residences from January 2005 to December 2012 in the urban area of Dracena, a medium-sized city located in the western region of São Paulo, Brazil. Results A total of 54,820 Lu. longipalpis specimens were collected, and the proportion of positive samples was significantly higher in the peridomiciles than in the intradomiciles (p

The specimen distribution pattern of a species can be used to characterise a population of interest and also provides area-specific guidance for pest management and control. In the municipality of Dracena, in the state of São Paulo, we analysed 5,889 Lutzomyia longipalpis specimens collected from the peridomiciles of 14 houses in a sector where American visceral leishmaniasis (AVL) is transmitted to humans and dogs. The goal was to analyse the dispersion and a theoretical fitting of the species occurrence probability. From January-December 2005, samples were collected once per week using CDC light traps that operated for 12-h periods. Each collection was considered a sub-sample and was evaluated monthly. The standardised Morisita index was used as a measure of dispersion. Adherence tests were performed for the log-series distribution. The number of traps was used to adjust the octave plots. The quantity of Lu. longipalpis in the sector was highly aggregated for each month of the year, adhering to a log-series distribution for 11 of the 12 months analysed. A sex-stratified analysis demonstrated a pattern of aggregated dispersion adjusted for each month of the year. The classes and frequencies of the traps in octaves can be employed as indicators for entomological surveillance and AVL control.

OBJETIVO: Analisar a evolução do coeficiente de mortalidade infantil na região metropolitana de São Paulo, no período de 1980 a 2000, considerando suas diferenças espaciais, segundo idade e causa. MÉTODOS: Os municípios da região metropolitana de São Paulo, foram reunidos em cinco grupos formados a partir do coeficiente de mortalidade infantil (CMI) de 1980: CMI maior ou igual a 90‰ nv (grupo 1), CMI entre 70 e 89‰ nv (grupo 2), entre 50 e 69‰ nv (grupo 3) e abaixo de 50‰ nv (grupo 4). O grupo 5 foi formado pelo Município de São Paulo (CMI=51‰ nv). A análise das tendências foi feita por modelos de regressão exponencial. RESULTADOS: O CMI e seus componentes foram estatisticamente decrescentes (p

OBJETIVO: Analisar a evolução do coeficiente de mortalidade infantil na região metropolitana de São Paulo, no período de 1980 a 2000, considerando suas diferenças espaciais, segundo idade e causa. MÉTODOS: Os municípios da região metropolitana de São Paulo, foram reunidos em cinco grupos formados a partir do coeficiente de mortalidade infantil (CMI) de 1980: CMI maior ou igual a 90‰ nv (grupo 1), CMI entre 70 e 89‰ nv (grupo 2), entre 50 e 69‰ nv (grupo 3) e abaixo de 50‰ nv (grupo 4). O grupo 5 foi formado pelo Município de São Paulo (CMI=51‰ nv). A análise das tendências foi feita por modelos de regressão exponencial. RESULTADOS: O CMI e seus componentes foram estatisticamente decrescentes (p

This paper describes a methodological proposal based on secondary data and the main results of the HIV-Sentinel Study among childbearing women, carried out in Brazil during 2006. A probabilistic sample of childbearing women was selected in two stages. In the first stage, 150 health establishments were selected, stratified by municipality size (