Rosa Teodósio

Background: The 2022 mpox outbreak spread rapidly beyond endemic regions, affecting multiple countries with broadly similar transmission patterns but different public health responses and surveillance systems. We compared laboratory-confirmed mpox infections reported during the first epidemic wave in Rio de Janeiro, Brazil, and Lisbon, Portugal, with particular attention to demographic characteristics, clinical presentation, transmission patterns, hospitalization, and the role of HIV status. Methods: We conducted a retrospective analysis of routinely collected, deidentified surveillance data from national notification systems in Brazil and Portugal. Adults with laboratory-confirmed mpox reported between May and December 2022 were included. Variables were harmonized across datasets, and missing data were retained without imputation. Descriptive analyses were performed by city and HIV status. Group comparisons used Pearson’s chi-square test, Fisher’s exact test, Mann-Whitney U test, and two proportion Z tests, as appropriate. Data completeness was also explored. Results: A total of 1,614 individuals were included: 960 from Rio de Janeiro and 654 from Lisbon. Mean age was similar in both cities (34.5 vs 34.9 years), but Lisbon had a higher proportion of males (99.4% vs 93.0%). The epidemic curves showed a similar rise-and-decline pattern, with an earlier peak in Lisbon (June 2022) and a later peak in Rio de Janeiro (August 2022). Skin or mucosal lesions were the most frequently reported manifestation in both settings, affecting more than 85% of individuals. Fever was reported more often in Rio de Janeiro, whereas adenopathy and asthenia were more commonly recorded in Lisbon. Within each city, symptom profiles were not significantly different between people living with HIV and those not living with HIV. Hospitalization rates were low overall in both cities (5.7% in Rio de Janeiro and 5.4% in Lisbon), although people living with HIV in Rio de Janeiro had higher odds of hospitalization than those without HIV. Data completeness was generally better in Rio de Janeiro than in Lisbon. Conclusions: Rio de Janeiro and Lisbon experienced similarly shaped first wave mpox epidemics, despite differences in timing, surveillance completeness, and health system context. HIV status did not appear to meaningfully modify acute clinical presentation, while hospitalization risk may have been influenced by differences in immune status and care pathways. These findings highlight the importance of harmonized, high-quality surveillance to support more accurate cross-country comparisons and better targeted public health responses.

Traveler’s diarrhea (TD) is one of the most common travel-related health problems, largely interfering with planned activities and potentially contributing to antimicrobial resistance. This study aimed to characterize the knowledge about TD among pre-travel consultation users of one Portuguese travel clinic and determine the impact of the consultation on knowledge levels. Using a quasi-experimental, separate-sample pretest–posttest design, participants were randomly assigned to two groups: control/pre-consultation group (CG) or experimental/post-consultation group (EG). An anonymous self-administered questionnaire was used. A total of 470 participants were analyzed (227 CG; 243 EG). The EG/post-consultation group showed significant improvement in knowledge, with correct answers increasing from 63% to 75% (p < 0.001). However, knowledge gaps persisted: over 50% were unaware of TD’s self-limited nature, 30% did not recognize loperamide as a symptom reliever, and 36% believed all travelers should take antibiotics to prevent TD. The educational level and previous travel outside Europe influenced baseline knowledge; previous travel medicine consultations and information on TD improved knowledge in both groups and made it easier to acquire knowledge on the subject. Thus, a pre-travel consultation effectively increased travelers’ TD knowledge. However, post-consultation knowledge levels remained suboptimal, indicating the need for targeted interventions to increase travelers’ literacy and optimize pre-travel consultations.

Vaccination is one of the main advancements in public health in the prophylaxis of infectious diseases. We intend to describe the general knowledge about vaccines/vaccination among Brazilian immigrants in Portugal, characterize their attitudes toward vaccination, and describe their knowledge of the yellow fever (YF) vaccine. A cross-sectional study was conducted using a self-completion questionnaire (face-to-face or remote). A total of 542 people participated in the study; the mean age was 36.81 years; 40.1% were male; 44.8% had their 12th year of schooling; and 27.0% had resided for ≥10 years in Portugal. Regarding general knowledge about vaccination, 53.8% answered at least 6/8 questions correctly. A total of 37.1% tended to have a favorable attitude toward vaccination. Concerning traveling, 76.7% attributed the risk of disease at the destination as the main reason for accepting vaccines. A total of 89.3% knew that there was a risk of YF in Brazil. A total of 40% answered correctly only one question about the YF vaccine; 21.6% did not answer any questions correctly. Thus, most of the Brazilian immigrants in this study have high general knowledge about vaccines/vaccination, few have a favorable attitude, and their knowledge about the YF vaccine is scarce. This could limit vaccination adherence when visiting Brazil, making health education actions necessary to increase knowledge and prevent YF risks.

Revista da Sociedade Portuguesa de Medicina Interna

Norovirus (NoV) and rotavirus group A (RVA) are major agents of acute gastroenteritis worldwide. This study aimed to investigate their epidemiological profile in Portuguese elderly living in long‐term care facilities and to assess the host genetic factors mediating infection susceptibility. From November 2013 to June 2015, 636 faecal specimens from 169 elderly, mainly asymptomatic, living in nursing homes in Greater Lisbon and Faro district, Portugal, were collected. NoV and RVA were detected by real‐time polymerase chain reaction and NoV genotyped by phylogenetic analysis. NoV detection rate was 7.1% (12 of 169). Three GI.3 and one GII.6 strains were genotyped. RVA detection rate was 3.6% (6 of 169), exclusively in asymptomatic individuals. Host genetic factors associated with infection susceptibility were described on 250 samples by saliva‐based enzyme‐linked immunosorbent assays. The Lewis‐negative phenotype was 8.8% (22 of 250) and the rate of nonsecretors was 16.8% (42 of 250). Association to NoV and RVA infection was performed in the subgroup of individuals (n = 147) who delivered both faecal and saliva samples. The majority of NoV‐ and RVA‐positive individuals (90.9% and 83.3%, respectively) were secretor‐positive, with Lewis B phenotype. In a subset of individuals, FUT2 and FUT3 genes were genotyped to assess mutations and validate the secretor and Lewis phenotypes. All sequenced nonsecretors were homozygous for FUT2 nonsense mutation G428A. In this study, low detection rates of NoV and RVA infections were found during two winter seasons. However, even in the absence of any outbreak, the importance of finding these infections in a nonepidemic situation in long‐term care facilities may have important implications for infection control.

The modification and release of insects to suppress or replace natural insect vectors constitutes a promising tool for vector control and disease prevention, facing the unprecedented global emergence of vector-borne diseases. Little is known regarding these innovative modification strategies and available evidence is not standardized turning it difficult to reflect on their actual efficacy and eventual effects. This work conducted a systematic review, gathering and analyzing research articles from PubMed and Biblioteca Virtual em Saúde databases whose results directly report efficacy and effects of the use of modified insects for disease prevention until 2016. Within more than 1500 publications that were screened a total of 349 where analyzed. A total of 12/3.4% reported field-based evidence, and 41/11.7% covered modification stretagies’ efficacy after insects’ release, their epidemiology impact or its long-term efficacy. Examples of successful results were the replacement of natural field populations by wolbachia-infected mosquitoes in 5 weeks, and the elimination of a population in laboratory cages after transgenic mosquitoes release over 10–20 weeks. Variability in the effective results were described (90/25.7%) questioning its reproducibility in different settings. We also found 38/10.9% publications reporting reversal outcomes, such as an increase of vector population after release. Ecological effects such as horizontal transfer events to non-target species (54/15.5%), and wolbachia-induced worsening pathogenesis on mammal filarial diseases (10/2.9%) were also reported. Present work revealed promising outcomes of both suppressing and replacing approaches. However, it also revealed a need of field-based evidence mainly regarding epidemiologic and long-term impact of insect modification strategies. It pointed out some eventual irreversible and important effects that must not be ignored when considering open-field releases, and that may constitute constraints to generate the missing field evidence. Moreover, the level of variability of existing evidence suggests the need of local/specific evidence in each setting of an eventual release.

Cases of transfusion-transmitted malaria have been described around the world and highlighted in some studies. Semi-immune individuals are more likely to transmit malaria as they may be asymptomatic. Some countries allow blood donations only based on epidemiological criteria while others reinforce their criteria with serological tests. However, little is known about the longevity of anti-Plasmodium spp. antibodies and its meaning in blood donation. Therefore, this study aims to assess the longevity of different subclasses of anti-Plasmodium spp. antibodies in individuals with previous stays in endemic areas, as well as to assess how those antibodies are related to personal features and travel characteristics. Based on those results, the suitability of the Portuguese blood donors screening method was addressed, i.e. the method to search for an eventual risk of transfusion–transmitted malaria among the population studied. Statistical associations were found between the presence of total anti-Plasmodium spp. antibodies and some travel characteristics, namely to be born in endemic area versus non endemic and previous episodes of malaria. The intersection between seropositive results and the last year of stay in endemic areas showed a longer longevity of anti-Plasmodium spp. antibodies than previously reported. Those results represented a considerable portion of the individuals having returned from their last stay in endemic areas more than 10 years before enrolment in this study. Considering the study population as potential blood donors, serological results also indicated that if epidemiological criteria alone were applied to screen blood donors, an important percentage of seropositive individuals would be approved for blood donation. Because the nature and meaning of those antibodies in the blood donation context is still not understood, those approved individuals could represent a risk for blood transfusion safety. The place of birth and past episodes of malaria seem to be related to the serological outcome. Epidemiological criteria to screen potential blood donors are insufficient to guarantee the safety of the blood, if applied alone.

We report the presence of SNPs in Plasmodium falciparum K13-propeller gene in two African countries, Angola and Mozambique, where malaria is a serious public health problem. Samples were collected before and after ACT introduction as first-line treatment. In each country 50 samples collected before and 50 after ACT introduction were analysed. A total of three different mutations (R471R and R575R in Angola and V494I in Mozambique) were identified in five samples, all collected after the introduction of ACT. The R471R mutation detected in Angola has already been reported in Africa (DR-Congo and Gabon). However, the mutations R575R (Angola) and V494I (Mozambique), have never been reported. V494I is adjacent to the known K13 resistance-associated mutation Y493H, although functional analysis did not predict a deleterious effect on protein function.