Seroprevalence of HIV, HTLV-I/II and other perinatally-transmitted pathogens in Salvador, Bahia

Santos, Jairo Ivo dos; Lopes, Maria Aparecida de Araújo; Deliège-Vasconcelos, Elizabeth; Couto-Fernandez, José Carlos; Patel, Balmukund Niljay; Barreto, Maurício Lima; Ferreira Jr., Orlando C; Galvão-Castro, Bernardo

doi:10.1590/S0036-46651995000400010

Abstracts

Generation of epidemiological data on perinatally-transmitted infections is a fundamental tool for the formulation of health policies. In Brazil, this information is scarce, particularly in Northeast, the poorest region of the country. In order to gain some insights of the problem we studied the seroprevalence of some perinatally-transmitted infections in 1,024 low income pregnant women in Salvador, Bahia. The prevalences were as follow: HIV-1 (0.10%), HTLV-I/II (0.88%), T.cruzi (2.34%). T.pallidum (3.91%), rubella virus (77.44%). T.gondii IgM (2.87%) and IgG (69.34%), HBs Ag (0.6%) and anti-HBs (7.62%). Rubella virus and T.gondii IgG antibodies were present in more than two thirds of pregnant women but antibodies against other pathogens were present at much lower rates. We found that the prevalence of HTLV-I/II was nine times higher than that found for HIV-1. In some cases such as T.cruzi and hepatitis B infection there was a decrease in the prevalence over the years. On the other hand, there was an increase in the seroprevalence of T.gondii infection. Our data strongly recommend mandatory screening tests for HTLV-I/II, T.gondii (IgM), T.pallidum and rubella virus in prenatal routine for pregnant women in Salvador. Screening test for T.cruzi, hepatitis and HIV-1 is recommended whenever risk factors associated with these infections are suspected. However in areas with high prevalence for these infections, the mandatory screening test in prenatal care should be considered.

Pregnant women; Perinatally-transmitted pathogens; HIV; HTLV-I/II; Seroprevalence

A obtenção de dados epidemiológicos é de fundamental importância para o estabelecimento de políticas em Saúde Pública. No Brasil, essas informações são escassas, principalmente na região Nordeste. Para se obter alguns destes dados, avaliamos a soroprevalência de algumas infecções de transmissão perinatal, em cerca de 1024 gestantes de baixa renda, em Salvador, Bahia. Os resultados encontrados foram os seguintes: HIV-1 (0,10%), HTLV-I/II (0,88%), T.cruzi (2,34%), T.pallidum (3,91%), vírus da rubéola (77,44%), IgM e IgG para T.gondii (2,87% e 69,34%, respectivamente), e antígenos e anticorpos de superfície (HBs Ag e anti-HBs) do vírus da hepatite B (0,6% e 7,62%, respectivamente). A prevalência de HTLV-I/II foi nove vezes maior do que aquela observada para o HIV-1. Constatou-se um decréscimo na prevalência das infecções causadas pelos T.cruzi e o vírus da hepatite B, em relação a anos anteriores, enquanto na infecção pelo T.gondii houve um aumento. Em função dos dados encontrados recomendamos que em Salvador, testes de triagem para HTLV-I, IgM, para T.gondii, T.pallidum e o vírus da rubéola, sejam feitos como rotina prenatal, e que triagens para T.cruzi, hepatite B e HIV-1 sejam feitas quando estiverem presentes fatores de risco associados a estas infecções. Entretanto, em áreas com altas taxas de prevalência para estas infecções, a triagem no prenatal deve ser considerada.

EPIDEMIOLGY

Seroprevalence of HIV, HTLV-I/II and other perinatally-transmitted pathogens in Salvador, Bahia

Soroprevalência do HIV, HTLV-I/II e outros patógenos de transmissão perinatal em Salvador, Bahia

Jairo Ivo dos Santos^I,II; Maria Aparecida de Araújo Lopes^III; Elizabeth Deliège-Vasconcelos^I; José Carlos Couto-Fernandez^I; Balmukund Niljay Patel^I; Maurício Lima Barreto^IV; Orlando C. Ferreira Jr.^V; Bernardo Galvão-Castro^I

^ILaboratório Avançado de Saúde Pública, CPqGM, FIOCRUZ, Salvador, Ba, Brasil

^IIPresent address: Departamento de Análises Clínicas, Centro de Ciências da Saúde, UFSC, Florianópolis, SC, Brasil

^IIILaboratório Central de Saúde Pública, SESAB, Salvador, Ba, Brasil

^IVInstituto de Saúde Coletiva, UFBA, Salvador, Ba, Brasil

^VInstituto de Infectologia Emílio Ribas, São Paulo, SP, Brasil

^{Correspondence to} Correspondence to: B. Galvão-Castro, MD LASP/CPqGM/FIOCRUZ Rua Waldemar Falcão 121, Brotas 40295-001 Salvador, Bahia, Brazil

SUMMARY

Generation of epidemiological data on perinatally-transmitted infections is a fundamental tool for the formulation of health policies. In Brazil, this information is scarce, particularly in Northeast, the poorest region of the country.

In order to gain some insights of the problem we studied the seroprevalence of some perinatally-transmitted infections in 1,024 low income pregnant women in Salvador, Bahia.

The prevalences were as follow: HIV-1 (0.10%), HTLV-I/II (0.88%), T.cruzi (2.34%). T.pallidum (3.91%), rubella virus (77.44%). T.gondii IgM (2.87%) and IgG (69.34%), HBs Ag (0.6%) and anti-HBs (7.62%). Rubella virus and T.gondii IgG antibodies were present in more than two thirds of pregnant women but antibodies against other pathogens were present at much lower rates. We found that the prevalence of HTLV-I/II was nine times higher than that found for HIV-1. In some cases such as T.cruzi and hepatitis B infection there was a decrease in the prevalence over the years. On the other hand, there was an increase in the seroprevalence of T.gondii infection.

Our data strongly recommend mandatory screening tests for HTLV-I/II, T.gondii (IgM), T.pallidum and rubella virus in prenatal routine for pregnant women in Salvador. Screening test for T.cruzi, hepatitis and HIV-1 is recommended whenever risk factors associated with these infections are suspected. However in areas with high prevalence for these infections, the mandatory screening test in prenatal care should be considered.

Keywords: Pregnant women; Perinatally-transmitted pathogens; HIV; HTLV-I/II; Seroprevalence

RESUMO

A obtenção de dados epidemiológicos é de fundamental importância para o estabelecimento de políticas em Saúde Pública. No Brasil, essas informações são escassas, principalmente na região Nordeste. Para se obter alguns destes dados, avaliamos a soroprevalência de algumas infecções de transmissão perinatal, em cerca de 1024 gestantes de baixa renda, em Salvador, Bahia. Os resultados encontrados foram os seguintes: HIV-1 (0,10%), HTLV-I/II (0,88%), T.cruzi (2,34%), T.pallidum (3,91%), vírus da rubéola (77,44%), IgM e IgG para T.gondii (2,87% e 69,34%, respectivamente), e antígenos e anticorpos de superfície (HBs Ag e anti-HBs) do vírus da hepatite B (0,6% e 7,62%, respectivamente). A prevalência de HTLV-I/II foi nove vezes maior do que aquela observada para o HIV-1. Constatou-se um decréscimo na prevalência das infecções causadas pelos T.cruzi e o vírus da hepatite B, em relação a anos anteriores, enquanto na infecção pelo T.gondii houve um aumento. Em função dos dados encontrados recomendamos que em Salvador, testes de triagem para HTLV-I, IgM, para T.gondii, T.pallidum e o vírus da rubéola, sejam feitos como rotina prenatal, e que triagens para T.cruzi, hepatite B e HIV-1 sejam feitas quando estiverem presentes fatores de risco associados a estas infecções. Entretanto, em áreas com altas taxas de prevalência para estas infecções, a triagem no prenatal deve ser considerada.

Full text available only in PDF format.

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ACKNOWLEDGEMENTS

We would like to thank Dr. Achilea Bittencourt and Dr. Michael Hendry for the critical reading of the manuscript. This work was partially supported by the Brazilian National Research Council (CNPq) processo nº 520932/93-5

Recebido para publicação em 10/03/1995

Aceito para publicação em 28/06/1995

1. ARAÚJO, A.Q.; ALI, A.; NEWELL, A.; DALGLEISH, A.G. & RUDGE, P. - HTLV-I infection and neurological disease in Rio de Janeiro. J. Neurol. Neurosurg. Psychiat., 55: 153-155, 1992.
2. AZEVEDO, E.S.; FORTUNA, C.M.M.; SILVA, K.M.C. et al. - Spread and diversity of human populations in Bahia, Brazil. Hum. Biol., 54: 329-341, 1982.
3. BIGGAR, R.J.; SAXINGER, C; GRADINER, C. et al. - Type-1 HTLV antibody in urban and rural Ghana, West Africa. Int. J. Cancer, 34: 215-219, 1984.
4. BITTENCOURT, A.L.; MOTA, E.; RIBEIRO-FILHO, R. et al. - Incidence of congenital Chagas' disease in Bahia, Brazil. J. trop. Pediat., 31: 242-248, 1985.
5. CAVALCANTI, M.; FERREIRA, O.C.; PUCCION, M.; NOVIS, S. & SCHECHTER, M.- HTLV-I associated neurologic manifestation in four generations of a Brazilian family. J. Acquir. Immune Defic. Syndr., 6: 213-217, 1993.
6. CHIN, J. - Current and future dimensions of the HIV/AIDS pandemic in women and children. Lancet, 336: 225-236, 1990.
7. CORTES, E.; DETELS, R.; ABOULAFIA, D. et al. - HIV-1, HIV-2 and HTLV-I infection in high-risk groups in Brazil. New Engl. J. Med., 320: 953-958, 1989.
8. COUTINHO, S.G.; GARCIA, A.P.; AMENDOEIRA, M.R.; ASSUNÇĂO, M.R. & ALBANO, N. - Detection of newborn infants at risk for congenital toxoplasmosis in Rio de Janeiro, Brazill. Rev. Inst. Med. trop. S. Paulo, 25: 25-30, 1983.
9. DELAPORTE, E.; DUPONT, A.; PEETERS, M. et al. - Epidemiology of HTLV-I in Gabon (Western Equatorial Africa). Int. J. Cancer, 42: 687-689, 1988.
10. DELAPORTE, E.; PEETERS, M.; DURAND, J.P. et al. - Seroepidemiological survey of HTLV-I infection among randomized populations of Western Central African countries. J. Acquir. Immune Defic. Syndr., 2: 410-413, 1989.
11. DESMONTS, G. & COUVREUR, J. - Toxoplasmosis in pregnancy and its transmission to the fetus. Bull. N.Y. Acad. Med., 50: 146-159, 1974.
12. DUMAS, M.; HOUINATO, D.; VERDIER, M. et al. - Seroepidemiology of human T-cell lymphotropic virus type I/II in Benin (West Africa). AIDS Res. Hum. Retrovir., 7: 447-451, 1991.
13. GABBAI, A.A.; BORDIN, J.O.; VIEIRA-FILHO, J.B.P. et al. - Selectivity of human lymphotropic virus type 1 (HTLV-1) and HTLV-2 infection among different populations in Brazil. Amer. J. trop. Med. Hyg., 49: 664-671, 1993.
14. GOEMAN, J.; MEHEUS, A. & PIOT, P. - L'Epidémiologie des maladies sexuellement transmissibles dans les pays en voie de développement ŕ l'čre du SIDA. Ann. Soc. belge Méd. trop., 71: 81-113, 1991.
15. HIRA, S.K.; BHAT, G.J.; PATEL, J.B. et al. - Early congenital syphilis: clinicoradiologic features in 202 patients. Sex. transm. Dis., 12: 177-183, 1985.
16. HUNSMANN, G.; BAYER, H.; SCHNEIDER, J. et al. - Antibodies to ATLV-HTLV-I in Africa. Med. Microbiol. Immunol., 173: 167-170, 1984.
17. IVO-DOS-SANTOS, J.; COUTO-FERNANDEZ, J.C.; SANTANA, A.J. et al. - Prevalence of HIV-1 antibodies in selected groups of a Brazilian city with African socio-demographic characteristics. J. Acquir. Immune Defic. Syndr., 4: 448-449, 1991.
18. KIRE, C.F. - Hepatitis B infection in Sub-Saharan Africa. The African regional group. Vaccine, 107-112: 134-138, 1990.
19. KRUGMAN, S. - Hepatites B virus and the neonate. Ann. N.Y. Acad. Sci., 549: 129-134, 1988.
20. LALLEMANT, M.; LALLEMANT-LE COEUR, S.L.; CHEYNIER, D. et al. - Characteristics associated with HIV-1 infection in pregnant women in Brazzaville, Congo. J. Acquir. Immune Defic. Syndr., 5: 279-285, 1992.
21. LEE, H.; ANDERSON, E.; ALLAIN, J.P. & GONZAGA, A. - HTLV-I infection in Brazil. Blood,73: 1742, 1989
22. MALONEY, E.M.; MURPHY, E.L.; FIGUEIROA, J.P. et al.- Human T-lymphotropic virus type I (HTLV-I) seroprevalence in Jamaica. Amer. J. Epidem., 133: 1114-1124, 1991.
23. MATUTES, E.; SCHULZ, T.; ANDRADE-SERPA, M.J.; CAMPOS-ARAUJO, A.Q. & POMBO-DE-OLIVEIRA, M.S. - Report of the Second International Symposium on HTLV in Brazil. Leukemia, 8: 1092-1094, 1994.
24. MEIRELES, A.; MOREIRA Jr., E.D.; MORENO-CARVALHO, O.A.; BADARÓ, R. & MELO, A. - HTLV-I associated myelopathy in Salvador (Northeastern Brazil). Arq. Neuropsiquiat., 50: 189-190, 1992.
25. MOREIRA, L.M.O. - Sorologia para toxoplasmose em uma populaçăo de gestantes da cidade de Salvador, Bahia. Salvador, 1988. (Tese de Doutoramento - Faculdade de Medicina da Universidade Federal da Bahia).
26. MOREIRA, L.M.O.; SILVA, J.; GOES, A. & TAVARES NETO, A. - Nível sorológico para rubéola era uma populaçăo de gestantes da cidade de Salvador. J. bras. Ginec., 92: 333-334, 1982.
27. MOREIRA Jr., E.D.; RIBEIRO, T.T.; SWANSON, P. et al. - Seroepidemiology of human T-cell lymphotropic virus type I/II in Northeastern Brazil. J. Acquir. Immune Defic. Synd., 6: 959-963, 1993.
28. MORENO-CARVALHO, O.A.; SANTOS, J.I.; DICREDICO, G. & GALVĂO-CASTRO, B. - Evidence of preferential female prevalence of HTLV-I associated tropical spastic paraparesis in Bahia, Brazil. Arq. Neuro-psiquiat., 50: 183-188, 1992.
29. MUELLER, N. - The epidemiology of HTLV-I infection. Cancer Causes Control, 2: 37-52, 1991.
30. PAPE, J.W.; LIAUTAUD, B.; THOMAS, F. et al. - Risk factors associated with AIDS in Haiti. Amer. J. med. Sci., 29: 4-7, 1986.
31. PECKHAM, C.S.; SENTURIA, Y.D. & ADES, A.E. - Obstetric and perinatal consequences of human immunodeficiency virus (HIV) infection: a review. Brit. J. Obstet. Gynaec, 94: 403-407, 1987.
32. POMBO-DE-OLIVEIRA, M.S.; MATUTES, E.; FAMA-DAS, L.C. et al. - Adult T cell leukemia/lymphoma in Brazil and its relation to HTLV-1. Lancet, 336: 987-990, 1990.
33. QUATTARA, S.A.; GODY, M. & DE THÉ, G.- Prevalence of HTLV-I compared to HIV-1 and HIV-2 antibodies in different groups in the Ivory Coast (West Africa). J. Acquir. Immune Defic. Syndr., 2: 481-485, 1989.
34. QUINN, T.C.; MANN, J.M.; CURRAN, J.W. & PIOT, P. - AIDS in Africa: an epidemiologic paradigm. Science, 234: 955-963, 1986.
35. SANTOS, C.; SAMPAIO, E.; SANTANA, I. et al.- Evidence for sexual transmission of HTLV-I/II in Brazil. In: INTERNATIONAL CONFERENCE AIDS/ INTERNATIONAL CONFERENCE STD, 10., Yokohama, 7-12 August, 1994. Abstract PCO 600. v. 2, p.303.
36 . SCHULZ, K.F.; CATES Jr. W. & O'MARA, P.R. - Pregnancy loss, infant death and suffering: legacy of syphilis and gonorrhoea in Africa. Genitourin. Med., 63: 326-328, 1987.
37. SERENO, A.; GALVĂO-CASTRO, B.; PROIETTI, F. et al. - HTLV-I/II differential geographical distribution in Brazil. In: INTERNATIONAL CONFERENCE AIDS/ INTERNATIONAL CONFERENCE STD, 10., Yokohama, 7-12 August, 1994. Abstract PCO 603. v. 2, p.304.
38. SILVA, L.R. - Transmissăo vertical do vírus da hepatite B em Salvador, Bahia. Salvador, 1985. (Dissertaçăo de Mestrado - Faculdade de Medicina da Universidade Federal da Bahia).
39. SOUTH, M.A. & SEVER, J.L. -Teratogen update: the congenital rubella syndrome. Teratology, 31: 297-307, 1985.
40. STD/AIDS. Brazilian Ministry of Health Epidemiological Bulletin, 9: 2-4, 1992.
41. VERDIER, M.; DENIS, F.; SANGARÉ, A. et al. - Prevalence of antibody to human T cell leukemia virus type I (HTLV-I) in population of Ivory Coast, West Africa. J. infect. Dis., 160: 363-370, 1989.
42. VIGGIANO, M.G.C.; MORAES FILHO, J.T.; OLIVEIRA, S.A.; AMARAL, W.N. & XIMENES, Y.R. - Toxoplasmose congęnita. A segunda infecçăo mais importante da síndrome Storch. J. bras. Ginec, 101: 293-302, 1991.
43. ZANCHETTA, N.; VIGANANO, P.; FERRARIO, M.P. et al. - B and delta hepatitis virus infection in a population of West Africa. Rev. Inst. Med. trop. S. Paulo, 32: 36-40, 1990.

Correspondence to:

B. Galvão-Castro, MD

LASP/CPqGM/FIOCRUZ

Rua Waldemar Falcão 121, Brotas

40295-001 Salvador, Bahia, Brazil

Publication Dates

Publication in this collection
21 Sept 2006
Date of issue
Aug 1995

History

Accepted
28 June 1995
Received
10 Mar 1995

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. ARAÚJO, A.Q.; ALI, A.; NEWELL, A.; DALGLEISH, A.G. & RUDGE, P. - HTLV-I infection and neurological disease in Rio de Janeiro. J. Neurol. Neurosurg. Psychiat., 55: 153-155, 1992.

[2] 2. AZEVEDO, E.S.; FORTUNA, C.M.M.; SILVA, K.M.C. et al. - Spread and diversity of human populations in Bahia, Brazil. Hum. Biol., 54: 329-341, 1982.

[3] 3. BIGGAR, R.J.; SAXINGER, C; GRADINER, C. et al. - Type-1 HTLV antibody in urban and rural Ghana, West Africa. Int. J. Cancer, 34: 215-219, 1984.

[4] 4. BITTENCOURT, A.L.; MOTA, E.; RIBEIRO-FILHO, R. et al. - Incidence of congenital Chagas' disease in Bahia, Brazil. J. trop. Pediat., 31: 242-248, 1985.

[5] 5. CAVALCANTI, M.; FERREIRA, O.C.; PUCCION, M.; NOVIS, S. & SCHECHTER, M.- HTLV-I associated neurologic manifestation in four generations of a Brazilian family. J. Acquir. Immune Defic. Syndr., 6: 213-217, 1993.

[6] 6. CHIN, J. - Current and future dimensions of the HIV/AIDS pandemic in women and children. Lancet, 336: 225-236, 1990.

[7] 7. CORTES, E.; DETELS, R.; ABOULAFIA, D. et al. - HIV-1, HIV-2 and HTLV-I infection in high-risk groups in Brazil. New Engl. J. Med., 320: 953-958, 1989.

[8] 8. COUTINHO, S.G.; GARCIA, A.P.; AMENDOEIRA, M.R.; ASSUNÇĂO, M.R. & ALBANO, N. - Detection of newborn infants at risk for congenital toxoplasmosis in Rio de Janeiro, Brazill. Rev. Inst. Med. trop. S. Paulo, 25: 25-30, 1983.

[9] 9. DELAPORTE, E.; DUPONT, A.; PEETERS, M. et al. - Epidemiology of HTLV-I in Gabon (Western Equatorial Africa). Int. J. Cancer, 42: 687-689, 1988.

[10] 10. DELAPORTE, E.; PEETERS, M.; DURAND, J.P. et al. - Seroepidemiological survey of HTLV-I infection among randomized populations of Western Central African countries. J. Acquir. Immune Defic. Syndr., 2: 410-413, 1989.

[11] 11. DESMONTS, G. & COUVREUR, J. - Toxoplasmosis in pregnancy and its transmission to the fetus. Bull. N.Y. Acad. Med., 50: 146-159, 1974.

[12] 12. DUMAS, M.; HOUINATO, D.; VERDIER, M. et al. - Seroepidemiology of human T-cell lymphotropic virus type I/II in Benin (West Africa). AIDS Res. Hum. Retrovir., 7: 447-451, 1991.

[13] 13. GABBAI, A.A.; BORDIN, J.O.; VIEIRA-FILHO, J.B.P. et al. - Selectivity of human lymphotropic virus type 1 (HTLV-1) and HTLV-2 infection among different populations in Brazil. Amer. J. trop. Med. Hyg., 49: 664-671, 1993.

[14] 14. GOEMAN, J.; MEHEUS, A. & PIOT, P. - L'Epidémiologie des maladies sexuellement transmissibles dans les pays en voie de développement ŕ l'čre du SIDA. Ann. Soc. belge Méd. trop., 71: 81-113, 1991.

[15] 15. HIRA, S.K.; BHAT, G.J.; PATEL, J.B. et al. - Early congenital syphilis: clinicoradiologic features in 202 patients. Sex. transm. Dis., 12: 177-183, 1985.

[16] 16. HUNSMANN, G.; BAYER, H.; SCHNEIDER, J. et al. - Antibodies to ATLV-HTLV-I in Africa. Med. Microbiol. Immunol., 173: 167-170, 1984.

[17] 17. IVO-DOS-SANTOS, J.; COUTO-FERNANDEZ, J.C.; SANTANA, A.J. et al. - Prevalence of HIV-1 antibodies in selected groups of a Brazilian city with African socio-demographic characteristics. J. Acquir. Immune Defic. Syndr., 4: 448-449, 1991.

[18] 18. KIRE, C.F. - Hepatitis B infection in Sub-Saharan Africa. The African regional group. Vaccine, 107-112: 134-138, 1990.

[19] 19. KRUGMAN, S. - Hepatites B virus and the neonate. Ann. N.Y. Acad. Sci., 549: 129-134, 1988.

[20] 20. LALLEMANT, M.; LALLEMANT-LE COEUR, S.L.; CHEYNIER, D. et al. - Characteristics associated with HIV-1 infection in pregnant women in Brazzaville, Congo. J. Acquir. Immune Defic. Syndr., 5: 279-285, 1992.

[21] 21. LEE, H.; ANDERSON, E.; ALLAIN, J.P. & GONZAGA, A. - HTLV-I infection in Brazil. Blood,73: 1742, 1989

[22] 22. MALONEY, E.M.; MURPHY, E.L.; FIGUEIROA, J.P. et al.- Human T-lymphotropic virus type I (HTLV-I) seroprevalence in Jamaica. Amer. J. Epidem., 133: 1114-1124, 1991.

[23] 23. MATUTES, E.; SCHULZ, T.; ANDRADE-SERPA, M.J.; CAMPOS-ARAUJO, A.Q. & POMBO-DE-OLIVEIRA, M.S. - Report of the Second International Symposium on HTLV in Brazil. Leukemia, 8: 1092-1094, 1994.

[24] 24. MEIRELES, A.; MOREIRA Jr., E.D.; MORENO-CARVALHO, O.A.; BADARÓ, R. & MELO, A. - HTLV-I associated myelopathy in Salvador (Northeastern Brazil). Arq. Neuropsiquiat., 50: 189-190, 1992.

[25] 25. MOREIRA, L.M.O. - Sorologia para toxoplasmose em uma populaçăo de gestantes da cidade de Salvador, Bahia. Salvador, 1988. (Tese de Doutoramento - Faculdade de Medicina da Universidade Federal da Bahia).

[26] 26. MOREIRA, L.M.O.; SILVA, J.; GOES, A. & TAVARES NETO, A. - Nível sorológico para rubéola era uma populaçăo de gestantes da cidade de Salvador. J. bras. Ginec., 92: 333-334, 1982.

[27] 27. MOREIRA Jr., E.D.; RIBEIRO, T.T.; SWANSON, P. et al. - Seroepidemiology of human T-cell lymphotropic virus type I/II in Northeastern Brazil. J. Acquir. Immune Defic. Synd., 6: 959-963, 1993.

[28] 28. MORENO-CARVALHO, O.A.; SANTOS, J.I.; DICREDICO, G. & GALVĂO-CASTRO, B. - Evidence of preferential female prevalence of HTLV-I associated tropical spastic paraparesis in Bahia, Brazil. Arq. Neuro-psiquiat., 50: 183-188, 1992.

[29] 29. MUELLER, N. - The epidemiology of HTLV-I infection. Cancer Causes Control, 2: 37-52, 1991.

[30] 30. PAPE, J.W.; LIAUTAUD, B.; THOMAS, F. et al. - Risk factors associated with AIDS in Haiti. Amer. J. med. Sci., 29: 4-7, 1986.

[31] 31. PECKHAM, C.S.; SENTURIA, Y.D. & ADES, A.E. - Obstetric and perinatal consequences of human immunodeficiency virus (HIV) infection: a review. Brit. J. Obstet. Gynaec, 94: 403-407, 1987.

[32] 32. POMBO-DE-OLIVEIRA, M.S.; MATUTES, E.; FAMA-DAS, L.C. et al. - Adult T cell leukemia/lymphoma in Brazil and its relation to HTLV-1. Lancet, 336: 987-990, 1990.

[33] 33. QUATTARA, S.A.; GODY, M. & DE THÉ, G.- Prevalence of HTLV-I compared to HIV-1 and HIV-2 antibodies in different groups in the Ivory Coast (West Africa). J. Acquir. Immune Defic. Syndr., 2: 481-485, 1989.

[34] 34. QUINN, T.C.; MANN, J.M.; CURRAN, J.W. & PIOT, P. - AIDS in Africa: an epidemiologic paradigm. Science, 234: 955-963, 1986.

[35] 35. SANTOS, C.; SAMPAIO, E.; SANTANA, I. et al.- Evidence for sexual transmission of HTLV-I/II in Brazil. In: INTERNATIONAL CONFERENCE AIDS/ INTERNATIONAL CONFERENCE STD, 10., Yokohama, 7-12 August, 1994. Abstract PCO 600. v. 2, p.303.

[36] 36 . SCHULZ, K.F.; CATES Jr. W. & O'MARA, P.R. - Pregnancy loss, infant death and suffering: legacy of syphilis and gonorrhoea in Africa. Genitourin. Med., 63: 326-328, 1987.

[37] 37. SERENO, A.; GALVĂO-CASTRO, B.; PROIETTI, F. et al. - HTLV-I/II differential geographical distribution in Brazil. In: INTERNATIONAL CONFERENCE AIDS/ INTERNATIONAL CONFERENCE STD, 10., Yokohama, 7-12 August, 1994. Abstract PCO 603. v. 2, p.304.

[38] 38. SILVA, L.R. - Transmissăo vertical do vírus da hepatite B em Salvador, Bahia. Salvador, 1985. (Dissertaçăo de Mestrado - Faculdade de Medicina da Universidade Federal da Bahia).

[39] 39. SOUTH, M.A. & SEVER, J.L. -Teratogen update: the congenital rubella syndrome. Teratology, 31: 297-307, 1985.

[40] 40. STD/AIDS. Brazilian Ministry of Health Epidemiological Bulletin, 9: 2-4, 1992.

[41] 41. VERDIER, M.; DENIS, F.; SANGARÉ, A. et al. - Prevalence of antibody to human T cell leukemia virus type I (HTLV-I) in population of Ivory Coast, West Africa. J. infect. Dis., 160: 363-370, 1989.

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