Epidemiological profile of tuberculosis in the prison population of Minas Gerais, Brazil

Introduction: Tuberculosis is the major cause of health problems among communicable diseases and predominates as an etiology in cases of death from a single infectious agent. In the prison environment, this is even more evident, as overcrowding, poor nutrition, drug consumption and the coexistence of other diseases, associated with the precariousness of the health service, favors the spread of the disease within the walls and to the families of inmates. Currently, it is estimated that the incidence of tuberculosis in the population deprived of liberty corresponds to approximately 11.2% of new cases in the country, and this group represents only 0.3% of the Brazilian population.  Methods: In this context, the present study aims to carry out an epidemiological analysis of tuberculosis in the prison population of the state of Minas Gerais, Brazil, based on secondary data from the Notifiable Diseases Information System (SINAN), in addition to identifying the main factors related to this type of involvement using measures of dispersion, central tendency and frequency, as well as Student’s T tests for independent samples and Mann-Whitney U tests in cases where the assumptions for parametric tests were not met, considering a 95 % confidence interval. Results: 1880 cases of tuberculosis were registered, with a monthly average of 22.38 notifications. The proximity of the factors brown ethnicity, male sex, age between 20 and 29 years to the center of case density and between the use of alcohol, other drugs and the abandonment of treatment was notable. Conclusion: Thus, the need for new prevention strategies in this context is highlighted due to the high incidence of tuberculosis, often related to negligence and misinformation.

Chronic Chagas cardiomyopathy: characterization of cases and possibilities of action in primary healthcare

Despite the drastic decrease in the incidence of Chagas disease in Brazil, past cases still greatly impact health services in the country. Thus, this study aimed to characterize Chagas disease cases regarding their cardiac staging and death prognosis and, based on that, to propose primary healthcare (PHC) case follow-ups. This is a cross-sectional study based on secondary data from the medical records of patients with chronic Chagas cardiomyopathy (CCC). A logistic regression was applied to estimate crude and adjusted odds ratios (OR). A total of 433 medical records were evaluated. More severe CCC cases were associated with a greater number of hospitalizations (OR = 3.41; 95%CI: 1.59-7.30) and longer hospitalization (OR = 3.15; 95%CI: 1.79-5.53). Cases with a higher risk of death were associated with a higher number of hospitalizations (OR = 1.92; 95%CI: 1.09-3.37), longer hospital stays (OR = 2.04; 95%CI: 1.30-3.18), and visits to the outpatient clinic (OR = 2.18; 95%CI: 1.39-3.41) and the emergency department of the assessed hospital (OR = 3.12; 95%CI: 1.27-7.66). Analyzing the medical records at two moments, 72.9% of the cases remained in the stages in which they were initially evaluated. Overall, 44.4% of cases were classified as mild to moderate risk of death and 68.3% as low ones. The cases classified in the most severe stages of CCC and with high or intermediate risk of death were associated with greater hospital dependence. However, most cases were classified as milder forms of the disease, with a low risk of death and clinical stability. These findings aim to promote the role of PHC as a protagonist in the longitudinal follow-up of CCC cases in Brazil.

Spotted Fever in the Morphoclimatic Domains of Minas Gerais State, Brazil

In Brazil, the tick-borne rickettsiosis known as Spotted Fever (SF) has been recorded from 59% of the Federative Units, however, the knowledge of the epidemiology and dynamics of human infection remains incipient in certain areas, complicating appropriate public health actions to inform the general population and control the disease. Here, we improved the interpretation of epidemiological information of SF cases recorded for an important endemic area. A descriptive epidemiological study was carried out based on records in the SINAN (Notifiable Diseases Information System) SF case databases. Data analysis was performed using Python programming language, Pandas library and Qgis map making. To evaluate the sociodemographic, clinical, assistance, laboratory and epidemiological characteristics, simple and relative nominal values of occurrences, means and standard deviations, and molecular analyzes were performed to identify the bioagent present in biological samples collected during each case investigation. Of the 298 confirmed cases, 98 resulted in death, the number of cases increased from 2011, and the disease scenario had 32.8% lethality. Overall, 207 cases involved men, and lethality was higher in this group. The most affected age group was 30 to 59 years old. The majority of patients reported having had contact with animals such as ticks, capybara and domestic animals such as dogs and cats. The results corroborate existing studies in areas of severe SF cases in Brazil. Despite reports of SF cases from the Cerrado Biome, analyses show that serious cases occur in anthropized areas of the Atlantic Forest biome, and in a transition area between this and the Cerrado. Complex, longitudinal, multidisciplinary studies, with an eco-epidemiological focus, should be carried out to allow the construction of algorithms capable of predicting, in time and space, the risk factors associated with severe cases and deaths from SF, with the aim of avoiding their expansion.

Políticas públicas de combate à infecção HIV/AIDS no Brasil:

Não se aplica - seção "Ponto de Vista"

ANÁLISE DE DADOS EPIDEMIOLÓGICOS DA INFLUENZA DURANTE A PANDEMIA DA COVID-19 NO BRASIL

Introdução/Objetivo

A pandemia da COVID-19 tem imposto grandes mudanças para o mundo, entre elas, o manejo e o diagnóstico de pacientes com essa enfermidade, que se tem mostrado um desafio ainda a ser superado, visto a alta transmissibilidade da COVID-19 e a similaridade dela com outras enfermidades como a Influenza. Dessa forma, o objetivo deste estudo é analisar variáveis como internações, mortalidade e gastos hospitalares referentes à Influenza no período da pandemia da COVID-19 e proporcionar medidas para se enfrentar essa e futuras pandemias.

Métodos

Com base no sistema de dados da plataforma DATASUS realizou-se um estudo epidemiológico descritivo, em que foram coletadas informações sobre o número de internações, taxa de mortalidade, óbitos por faixa etária e gastos totais com hospitalizações, por influenza, no Brasil, de janeiro a setembro dos anos de 2017, 2018, 2019 e 2020. Procedeu-se à análise percentual e média dos dados, comparando a média dos últimos três anos ao ano de 2020, ano de pandemia.

Resultados

Durante a pandemia da COVID-19, foram observadas 2147,11 internações, 6,59% de mortalidade nas internações e R$ 2.284.781,40 gastos com internações por gripe influenza. Esses números representam aumentos de 29,62%, 74,93% e 78,2%, respectivamente, nas médias de 1656,51 internações, de 3,77 % na taxa de mortalidade e do valor total de R$ 1.282.138,43 gastos com internações pela gripe influenza, os quais foram observados nos primeiros nove meses dos anos de 2017 a 2019. No ano de 2020, as faixas etárias de 80 anos ou mais, 70 a 79 anos e 60 a 69 anos obtiveram, 428, 329 e 258 óbitos, que representam, nessa ordem, aumentos de 72,85%, 179,6% e 268,57%, em comparação aos últimos três anos.

Conclusão

O atual estudo cumpriu seus objetivos, com o foco na análise da situação do vírus influenza, no período da pandemia em 2020 e os três anos anteriores, verificando o aumento das internações, taxa de mortalidade e dos gastos hospitalares. Também, buscou analisar as dificuldades no diagnóstico e de coinfecções com a influenza, juntamente com a pandemia da COVID-19, o que causou atraso nas notificações e confirmações dos casos que, consequentemente, resultou em mortes e piores desfechos dos casos clínicos. Embora seja uma pandemia da atualidade, foi possível analisar a necessidade de maiores preparos para esse cenário, com investigações e monitoramento de cepas virais, para haver posteriormente medidas de prevenção e controle.

A new focus of spotted fever caused by Rickettsia parkeri in Brazil

Spotted fever (SF) is a tick-borne zoonosis caused by bacteria of the genus Rickettsia . The disease varies in severity from mild clinical forms to severe cases. In Brazil, Rickettsia rickettsii SF is the most serious rickettsiosis and can result in death if not diagnosed and treated at the onset of symptoms. The SF mild form is caused by Rickettsia parkeri strain Atlantic Rainforest, and this etiological agent has been reported in the South, Southeast and Northeast regions of the country, in areas of preserved or little antropized Atlantic Rainforest. Amblyomma ovale is the proven vector and dogs are the hosts associated with the bioagent cycle. During a SF case investigation in Paraty municipality, Rio de Janeiro State, an Atlantic Rainforest biome area in Southeastern Brazil, the human pathogen R. parkeri strain Atlantic Rainforest was detected by PCR in a sample of human skin inoculation eschar and in a female A. ovale tick collected from a dog. These results expand the known area of occurrence of this mild form rickettsiosis in Brazil. In addition, the results of the present study indicate the importance of implementing programs to control canine ectoparasites and to raise awareness of the risks of infection, signs and symptoms of SF caused by R. parkeri strain Atlantic Rainforest.

Análise epidemiológica dos casos de Aids no Sudeste brasileiro de 2010 a 2019

Introdução: A epidemia de HIV e Aids representa um dos maiores problemas de saúde pública atualmente. No Brasil, estima-se que apenas 83 % das pessoas vivendo com HIV conhecem seu diagnóstico e somente 46 % possuem carga viral indetectável. Isso evidencia a necessidade de estudos voltados à compreensão do HIV e da Aids no Brasil, para a melhora das políticas públicas. Assim, o objetivo deste estudo é realizar um levantamento de dados sobre o perfil epidemiológico de pacientes portadores de Aids no Sudeste brasileiro. Métodos: Trata-se de um estudo epidemiológico descritivo, de caráter quantitativo. Os dados foram obtidos no SINAN. A análise restringiu-se ao período de janeiro de 2010 a junho de 2019. Resultados: No período analisado, o ano de 2017 apresentou a maior prevalência da doença (11,97 %). Além disso, observa-se uma tendência de crescimento no número de casos entre 2010 e 2014 e uma tendência decrescente nos últimos anos. O Rio de Janeiro foi o estado com maior número de novos casos (21,90 %) da Região Sudeste. Observou-se que os grupos com maior incidência de casos foram: sexo masculino (71,1 %), jovens e adultos (79,37 %), cor branca (46,67 %), ensino médio completo (19,71 %) e heterossexuais (46,94 %). Contudo, foi observado um aumento relativo da incidência entre homens homossexuais e entre os pardos. Além disso, a principal forma de transmissão foi via sexual (78,09 %). Conclusão: O estudo concluiu que são necessárias mais pesquisas acerca do tema, para acompanhar a epidemiologia da Aids e orientar medidas governamentais eficientes.

Dengue e COVID-19 em Minas Gerais

Este estudo objetiva realizar uma análise macrorregional dos casos, das internações, da infraestrutura de saúde e dos investimentos voltados à dengue e à COVID-19 no estado de Minas Gerais. Trata-se de estudo epidemiológico, descritivo e quantitativo pelo Sistema de Informação Hospitalar (SIH-SUS), Sistema de Informação de Agravos de Notificação (SINAN) e boletins epidemiológicos da COVID-19 da Secretaria de Estado de Saúde de Minas Gerais e do Ministério da Saúde entre janeiro de 2017 a maio de 2020. Registraram 845.352 casos de dengue com 15.366 internações, onerando R$6.247.580.00 às 14 macrorregiões do estado. O pico de incidência da dengue esteve entre janeiro a maio dos anos analisados. Para a COVID-19, nota-se aumento dos casos ao longo de 2020 gastando R$ 165.879.596.00 até o presente estudo. Destaque para a macrorregião Centro com maior número de casos por ambas doenças. A dengue, por si só, já prejudica a assistência hospitalar fornecida pelo SUS em Minas Gerais. Com a concomitância temporal da COVID-19 em 2020, o dispêndio ao sistema de saúde agravar-se-á, uma vez que ambas poderão sobrecarregá-lo. Portanto, deve-se focar na atenção primária para otimizar gastos. Palavras-chave: Dengue; COVID-19; atenção primária à saúde; vigilância em saúde.

Aspectos epidemiológicos da covid-19 sobre a enfermagem: uma análise retrospectiva

Objetivo: Analisar os aspectos epidemiológicos da COVID-19 nos profissionais de enfermagem brasileiros. Metodologia: Estudo transversal e quantitativo, com base em dados secundários de domínio público, do Observatório de Enfermagem do Conselho Federal de Enfermagem. Os dados foram coletados em novembro de 2020 e importados para a versão STATA 12.0. Foi realizada uma análise estatística descritiva, com números absolutos e medidas de freqüência. Resultados e discussão: 38.628 profissionais de enfermagem com suspeita de COVID-19 foram relatados, 52,4% com diagnóstico confirmado e predominantemente técnicos (62,9%). A faixa etária predominante entre os mortos era mais alta (41 a 60 anos) do que entre os infectados (31 a 40 anos), enquanto o sexo feminino era quantitativamente dominante em ambos, apesar da maior taxa de casos fatais entre os homens (4,5%). A mortalidade / 1.000 profissionais era alta no Amapá, Acre, Mato Grosso e Rondônia. O pico no número diário de casos novos (525) ocorreu em julho de 2020, enquanto que o número de mortes (18) ocorreu em setembro, mês em que houve uma tendência de queda na variação da taxa de crescimento da média móvel entre os casos novos, o que não é evidente na variável da média móvel entre as mortes. Este cenário tem uma forte relação com as condições precárias de trabalho, falta de EPI, sobrecarga física e emocional e os resultados da rápida contratação e qualificação para a gestão de pacientes com COVID-19. Conclusão: A compreensão da situação de vulnerabilidade experimentada por esses trabalhadores no contexto da pandemia revela a necessidade de concentrar ações de saúde eficazes voltadas para esse grupo.

A Vulnerability Analysis for the Management of and Response to the COVID-19 Epidemic in the Second Most Populous State in Brazil

The COVID-19 pandemic has the potential to affect all individuals, however in a heterogeneous way. In this sense, identifying specificities of each location is essential to minimize the damage caused by the disease. Therefore, the aim of this research was to assess the vulnerability of 853 municipalities in the second most populous state in Brazil, Minas Gerais (MG), in order to direct public policies. An epidemiological study was carried out based on Multi-Criteria Decision Analysis (MCDA) using indicators with some relation to the process of illness and death caused by COVID-19. The indicators were selected by a literature search and categorized into: demographic, social, economic, health infrastructure, population at risk and epidemiological. The variables were collected in Brazilian government databases at the municipal level and evaluated according to MCDA, through the Program to Support Decision Making based on Indicators (PRADIN). Based on this approach, the study performed simulations by category of indicators and a general simulation that allowed to divide the municipalities into groups of 1-5, with 1 being the least vulnerable and 5 being the most vulnerable. The groupings of municipalities were exposed in their respective mesoregions of MG in a thematic map, using the software Tabwin 32. The results revealed that the mesoregion of Norte de Minas stands out with more than 40% of its municipalities belonging to group 5, according to economic, social and health infrastructure indicators. Similarly, the Jequitinhonha mesoregion exhibited almost 60% of the municipalities in this group for economic and health infrastructure indicators. For demographic and epidemiological criteria, the Metropolitana de Belo Horizonte was the most vulnerable mesoregion, with 42.9 and 26.7% of the municipalities in group 5, respectively. Considering the presence of a population at risk, Zona da Mata reported 42.3% of the municipalities in the most vulnerable group. In the joint analysis of data, the Jequitinhonha, Vale do Mucuri and Vale do Rio Doce mesoregions were the most vulnerable in the state of MG. Thus, through the outlined profile, the present study proved how socioeconomic diversity affects the vulnerability of the municipalities to face COVID-19 outbreak, highlighting the need for interventions directed to each reality.

Needlestick-Associated Rocky Mountain Spotted Fever, Brazil

We report a fatal case of Rocky Mountain spotted fever (RMSF) in a man in Brazil without recent history of tick bites or environmental exposure. He received an accidental needlestick while working as a nurse. The nurse and his patient died. Both cases were confirmed as RMSF by molecular methods.

The impact of mastectomy on body image and sexuality in women with breast cancer: a systematic review

Objective: The study aims to evaluate the impact of mastectomy on body image and sexuality of women with breast cancer, as well as to provide a general understanding of their quality of life. Method: This review followed the PRISMA guidelines. The expression “Mastectomy AND (sexuality OR “body image”)” was searched in Lilacs, Scielo, Pubmed and Scopus databases. Articles published in English, Portuguese and Spanish between 2010 and 2020 were selected. The text analysis was carried out by peers. Results: 69.3% (43) of the studies presented mastectomy as a technique that worsens body image, sexual functioning and quality of life of women. Less radical procedures, such as breast-conserving surgery, showed lower impact on these indicators. Breast reconstruction is an alternative to mitigate breast surgery impacts. Conclusion: Mastectomy caused the major impacts on body image, sexual functioning and quality of life. These implications need to be considered during therapeutic choice.

Análise das tentativas de suicídio por intoxicações exógenas na região metropolitana de Goiânia, de 2012 a 2017

Objetivos: Descrever o perfil epidemiológico das vítimas de intoxicação exógena por suicídio na região metropolitana de Goiânia e propor medidas e propostas de intervenção para a problemática em questão. Método: Trata-se de um estudo transversal, descritivo e quantitativo, em que foram analisados dados do Sistema de Informação de Agravos de Notificação, referente à região metropolitana de Goiânia, abrangendo os casos notificados de intoxicação exógena relacionados ao suicídio no período entre os anos de 2012 a 2017.  Além disso, foram consultadas as plataformas Google Acadêmico e PUBMED e documentos do Ministério da Saúde para busca de referências bibliográficas para subsidiar uma proposta de intervenção. Resultados: No período analisado ocorreram 1830 intoxicações exógenas na região metropolitana de Goiânia, o que corresponde a uma média de 305 casos por ano, sendo o sexo feminino o mais atingido Discussão: Percebe-se que a intoxicação exógena por suicídio é um grave problema de saúde pública e que necessita de medidas eficazes para sua redução, voltadas para indivíduos de todas as localidades, sejam moradores de zonas rurais e urbanas. Medidas para redução dessas intoxicações também deve ser voltada para públicos específicos, de diferentes faixas etárias. Conclusão: Dessa forma, fica evidente a necessidade de construção de políticas públicas que sejam efetivas e que mitiguem as intoxicações exógenas.

Underreporting of Death by COVID-19 in Brazil's Second Most Populous State

The COVID-19 pandemic brings to light the reality of the Brazilian health system. The underreporting of COVID-19 deaths in the state of Minas Gerais (MG), where the second largest population of the country is concentrated, reveals government unpreparedness, as there is a low capacity of testing in the population, which prevents the real understanding of the general panorama of SARS-CoV-2 dissemination. The goals of this research are to analyze the causes of deaths in different Brazilian government databases (Civil Registry Transparency Portal and InfoGripe) and to assess whether there are sub-records showing an unexpected increase in the frequency of deaths from causes clinically similar to COVID-19. A descriptive and quantitative analysis of the number of deaths by COVID-19 and similar causes was performed in different databases. Our results demonstrate that different official sources had a discrepancy of 109.45% between these data referring to the same period. There was also a 758.57% increase in SARI deaths in 2020, when compared to the average of previous years. Finally, it was shown that there was an increase in the rate of pneumonia and respiratory insufficiency (RI) by 6.34 and 6.25%, respectively. In conclusion, there is an underreporting of COVID-19 deaths in MG due to the unexplained excess of deaths caused by SARI, respiratory insufficiency, and pneumonia compared to previous years.

Heterocontrole da fluoretação da água de abastecimento público em Uberlândia, Minas Gerais, Brasil

Este estudo teve como objetivo analisar os teores de flúor na água de abastecimento público do município de Uberlândia (MG) e, adicionalmente, comparar os valores encontrados com os dados do controle operacional e de um laboratório de referência. Durante seis meses coletaram-se 126 amostras, as quais foram analisadas pela técnica eletrométrica, inicialmente na Universidade Federal de Uberlândia e depois pelo laboratório de referência. Por meio do teste Generalized Estimating Equations, os dados foram comparados entre si e com os de controle operacional. Observou-se diferença estatística entre os laboratórios, entre os momentos avaliados e na interação entre laboratório e tempo. Mesmo com variabilidade entre os resultados, pôde-se concluir que o flúor está presente na água de abastecimento de Uberlândia com teores dentro dos padrões recomendados pelo Centro Colaborador do Ministério da Saúde em Vigilância da Saúde Bucal quanto à concentração de fluoretos e que a população tem sido assistida de forma segura.

Residência de Medicina de Família e Comunidade em uma Unidade Básica de Saúde Tradicional

Introdução: As Unidades Básicas de Saúde (UBS) desempenham papel central na garantia à população à serviços de saúde. Dotar estas unidades de condições para um atendimento de qualidade é um desafio. Relato: Residentes do primeiro ano de Medicina de Família e Comunidade (MFC)da Universidade Federal de Uberlândia foram direcionados em março de 2018 para uma UBS tradicional (constituída por clínico, pediatra e ginecologista). A partir da contratação de preceptoras especialistas em MFC, formou-se outra equipe, de estratégia básica, composta por elas e residentes. Foi feita territorialização e a distribuição de microáreas para cada residente e construídas planilhas com dados dos pacientes. Assim, foi possível conhecer o perfil da população, implementando diversas ações: grupos, visitas domiciliares, organização da agenda por meio do “acesso avançado”. Reuniões com esta equipe propiciaram espaço de educação permanente e formulação de Projetos Terapêuticos Singulares. A população demonstrou satisfação com as mudanças por meio da Ouvidoria de Saúde. Quantitativamente, os atendimentos aumentaram 17%, sendo que o clínico representou 86% do total desse aumento e houve 40% menos exames laboratoriais solicitados Discussão e considerações finais: A Residência de MFC ofereceu condições para alcançar melhorias no acesso e qualidade dos serviços ofertados pela UBS. A experiência foi bem-sucedida e deveria ser estimulada em outros cenários da Atenção Básica. Propõe-se que as esferas governamentais incentivem a seleção de especialistas em MFC para atuarem na APS e promovam transições de UBS tradicionais para equipes com a Estratégia de Saúde da Família.

Associação da Diabetes Mellitus com a gravidade da COVID-19 e seus potenciais fatores mediadores: uma revisão sistemática

Sabe-se que a gravidade da doença pelo novo coronavírus (COVID-19) é influenciada por comorbidades, como a Diabetes Mellitus (DM). Assim, esta revisão objetivou apresentar as evidências sobre a associação entre essa doença e a gravidade da COVID-19, bem como seus potenciais fatores mediadores. A busca de dados se deu no dia 21 de maio de 2020, utilizando as bases Scopus, Web of Science, LILACS, SciELO e PubMed, com os descritores: “Diabetes Mellitus” e “COVID-19”. Após aplicação dos critérios de exclusão, incluiu-se 13 estudos. Pela análise, os pacientes que evoluíram para maus prognósticos eram mais velhos (40-77 anos) e do sexo masculino (53,6% a 80,8%). Esse padrão foi reproduzido entre os infectados diabéticos, dentre os quais também se observou maior frequência de casos graves (31,8 a 61,9%) e maior letalidade (7,8 a 81,3%). Pela análise laboratorial, observou-se que há maior tendência à neutrofilia, leucocitose e linfopenia entre os diabéticos. Além disso, esses apresentaram maiores taxas de citocinas e marcadores inflamatórios, sugerindo o desenvolvimento de uma resposta imune desregulada e de um quadro inflamatório grave. Concluiu-se que a Diabetes Mellitus está associada com a maior gravidade da COVID-19, além de estar associada à suscetibilidade de seus portadores à doenças infecciosas.

Profilaxia antirrábica no município de Uberlândia, Minas Gerais

Objetivo: Caracterizar a profilaxia antirrábica no município de Uberlândia, Minas Gerais. Metodologia: baseou-se na utilização do tabulador de dados Tabwin 3.2 para avaliação das fichas de notificação do Sistema de Informação de Agravos de Notificações (SINAN), no período de 2008 a 2017. Resultados: No recorte temporal escolhido foram notificadas 23.090 profilaxias antirrábicas no município em 2018. Os mais acometidos foram homens 50,79%, e os principais responsáveis pelas agressões foram os cães 81,38%, gatos 11,16% e morcegos 0,71%. A observação de evolução clínica do animal é a principal conduta adotada 22,38%, e a maioria evolui de forma sadia 80,96%. Conclusão: O trabalho contribui para o acompanhamento do perfil epidemiológico da profilaxia antirrábica na cidade. Permite-se assim, diagnosticar condições de maior vulnerabilidade e a apresentação epidemiológica deste agravo a saúde, o que possibilita a melhoria desses atendimentos minimizando o risco da transmissão.

Perfil epidemiológico dos casos de sífilis congênita no estado de Minas Gerais no período de 2007 a 2017

O objetivo é analisar os casos de sífilis congênita confirmados no estado de Minas Gerais (MG), no período de 2007 a 2017. Trata-se de um estudo descritivo, transversal e quantitativo realizado por meio da análise de informações secundárias disponibilizadas no Sistema de Informação de Agravos de Notificação. Foram avaliadas um total de 9.646 casos em que se identificou um acelerado aumento na frequência das notificações, passando de 1,8% em 2007 para 25,3% em 2017. Em relação à variável idade da criança, ocorreram 9.598 (99,5%) dos casos na faixa etária menor de um ano. As características sociodemográficas maternas foram: 6.254 (64,8%) estavam na faixa etária entre 20 a 34 anos, com predominância da raça parda em 4.768 (49,4%) mulheres e para 1.552 (16,0%) a escolaridade era de 5° a 8° série incompleta do ensino fundamental. O pré-natal foi realizado por 85,5% das gestantes, em que 62,7% tiveram o diagnóstico de sífilis durante o pré-natal e 47,7% realizaram o tratamento inadequado. O esquema terapêutico prescrito para 29,4% (2.843) das crianças foi penicilina G cristalina. As características epidemiológicas dos casos de sífilis congênita são mulheres jovens, pardas, de baixa escolaridade, que realizam pré-natal, entretanto são diagnosticadas com a bactéria durante a gestação e não aderem ao tratamento adequado, transmitindo verticalmente a infecção para o concepto. As crianças diagnosticadas para a sífilis congênita estavam na faixa etária menor de um ano de idade. Medidas efetivas de diagnóstico, de adesão ao tratamento e educação em saúde são imprescindíveis para redução da prevalência alarmante desta Infecção Sexualmente Transmissível.

Situação epidemiológica das leishmanioses em Uberlândia, Minas Gerais

Objetivo: Descrever o perfil epidemiológico da leishmaniose visceral (LV) e da leishmaniose tegumentar (LT) no município de Uberlândia, Minas Gerais. Métodos: Este é um estudo descritivo, quantitativo e baseado em dados secundários do Sistema de Informação de Agravos de Notificação (SINAN), cujo período para análise foi de janeiro de 2008 a dezembro de 2017. Resultados: Foram notificados 23 casos confirmados de LV e 86 de LT, cujas incidências médias anuais foram, respectivamente, 0,36 e 1,33 casos por 100.000 habitantes. Ambas as doenças apresentaram acometimento mais frequente do sexo masculino, da população entre 50 e 64 anos e na zona urbana. Conclusão: Os achados justificam a necessidade de promoção de medidas afirmativas contrárias à expansão destas doenças e de estudos mais aprofundados sobre a realidade uberlandense.AbstractObjective: Describing the epidemiological profile of visceral leishmaniasis (LV) and tegumentary leishmaniasis (LT) in the city of Uberlândia, Minas Gerais. Methods: This is a descriptive, quantitative and secondary data-based study of the SINAN reporting system, whose period of analysis was from January 2008 to December 2017. Results: A total of 23 confirmed cases of LV and 86 of LT, whose annual average incidence was, respectively, 0.36 and 1.33 cases per 100,000 inhabitants. Both diseases had a more frequent involvement of males, of the population between 50 and 64 years old and in the urban zone. Conclusion: The findings justify the need to promote affirmative measures that are contrary to the expansion of these diseases and further studies on the reality of Uberlandia.

Spatiotemporal Dynamics of Hantavirus Cardiopulmonary Syndrome Transmission Risk in Brazil

BACKGROUND

Hantavirus disease in humans is rare but frequently lethal in the Neotropics. Several abundant and widely distributed Sigmodontinae rodents are the primary hosts of Orthohantavirus and, in combination with other factors, these rodents can shape hantavirus disease. Here, we assessed the influence of host diversity, climate, social vulnerability and land use change on the risk of hantavirus disease in Brazil over 24 years.

METHODS

Landscape variables (native forest, forestry, sugarcane, maize and pasture), climate (temperature and precipitation), and host biodiversity (derived through niche models) were used in spatiotemporal models, using the 5570 Brazilian municipalities as units of analysis.

RESULTS

Amounts of native forest and sugarcane, combined with temperature, were the most important factors influencing the increase of disease risk. Population at risk (rural workers) and rodent host diversity also had a positive effect on disease risk.

CONCLUSIONS

Land use change-especially the conversion of native areas to sugarcane fields-can have a significant impact on hantavirus disease risk, likely by promoting the interaction between the people and the infected rodents. Our results demonstrate the importance of understanding the interactions between landscape change, rodent diversity, and hantavirus disease incidence, and suggest that land use policy should consider disease risk. Meanwhile, our risk map can be used to help allocate preventive measures to avoid disease.

Human parasitism and toxicosis by Ornithodoros rietcorreai (Acari: Argasidae) in an urban area of Northeastern Brazil

The soft tick, Ornithodoros rietcorreai, is a parasite of the rodent, Kerodon rupestris, and, to a lesser extent, of bats living in rock cavities in Northeastern Brazil. This report describes the first recorded episodes of human parasitism by this argasid tick, reported to the Brazilian Ministry of Health in September 2017. We assessed outdoor environments, roofs, animal nests and chicken coops in five houses located in an urban area of Russas City, Ceará State, Brazil. Our results confirmed the presence of the tick in two of the assessed houses. The collected specimens were molecularly identified as O. rietcorreai. Of the ten individuals living in the investigated properties, three reported being parasitized by ticks. Although O. rietcorreai ticks were recovered from the evaluated houses, the primary hosts for the ticks were not identified. The retrospective medical records of parasitized individuals reported the following: local pruritus 3/3, malaise 3/3, local edema and erythema 3/3, local rash 3/3, local pain 3/3, slow lesion healing 3/3 and paresthesia 1/3. One of the individuals reported four parasitism episodes (March, June, July and August 2017) and required medical attention and the administration of anti-allergy and anti-inflammatory drugs. The aforementioned reports were the first to address human parasitism, with subsequent toxicosis, by this tick species in Brazilian urban areas. Attention was drawn to the potential consequences of such episodes to the health of previously exposed individuals.

Febre Maculosa por Rickettsia parkeri no Brasil: condutas de vigilância epidemiológica, diagnóstico e tratamento

Introdução: A febre maculosa (FM) é uma doença infecciosa, aguda, transmitida por carrapatos, e de gravidade variável. No Brasil, recentemente, tem sido descrita uma nova FM causada por Rickettsia parkeri, cujo perfil clínico, epidemiológico e laboratorial é diferente do perfil da FM causada por Rickettsia rickettsii. Metodologia: trata-se de uma revisão narrativa cujo objetivo é caracterizar a febre maculosa causada por Rickettsia parkeri no Brasil, discutindo as condutas de vigilância epidemiológica, diagnóstico e tratamento. Resultados: A febre maculosa por Rickettsia parkeri no Brasil é produzida, principalmente, pela R. parkeri cepa Mata Atlântica, presente no bioma Mata Atlântica das regiões Sul, Sudeste e Nordeste, onde o carrapato Amblyomma ovale figura como o principal vetor da doença. A suspeição clínica e epidemiológica deve considerar os pacientes que apresentam doença febril e presença da escara de inoculação, associadas à visita em área de mata e ou contatos com carrapatos. A coleta de material biológico (que inclua a escara de inoculação) deve ser realizada, oportunamente, para a caracterização do agente etiológico. O tratamento com antibioticoterapia deve ser iniciado já no início dos sintomas, e todos os casos devem ser notificados ao Ministério da Saúde e investigados imediatamente. A caracterização do ambiente de infecção é importante para melhor compreensão da ecoepidemiologia da doença e desencadeamento de medidas de prevenção e controle. Conclusão: Estabelecemos um protocolo para os profissionais de saúde com as condutas de vigilância epidemiológica, diagnóstico e tratamento para febre maculosa causada por Rickettsia parkeri no Brasil.

Magnitude and distribution of deaths due to hantavirus in Brazil, 2007-2015

OBJECTIVE

to describe the magnitude and temporal and spatial distribution of hantavirus cases and deaths in Brazil between 2007 and 2015.

METHODS

descriptive study with data from the Notifiable Diseases Information System (SINAN).

RESULTS

1,060 cases and 410 deaths were reported in the period; hantavirus lethality was 39.0%, varying according to month (from 28.6% in November to 50.7% in December), sex (37.4% in males and 42.6% in females), age (higher lethality in the elderly and children) and Brazilian regions (46.2% in the North, 32.9% in the South); most of the individuals who died lived in urban areas (58.3%) and were infected in rural area (70.2%).

CONCLUSION

high lethality in certain population groups, months of the year and regions of Brazil point to low clinical suspicion of the disease in groups with low exposure, which may compromise proper case management.

Rickettsia amblyommatis infecting Amblyomma pseudoconcolor in area of new focus of spotted fever in northeast Brazil

In Brazil, active infections of Rickettsia spp. is confirmed in all regions, involving various species of ticks. During investigation of a new focus of Spotted Fever (SF) incidence in the state of Pernambuco, northeastern Brazil, tick species Rhipicephalus sanguineus sensu lato (Latreille), and Amblyomma pseudoconcolor were collected from one Canis familiaris and four Euphractus sexcinctus, respectively, and analized for the presence of rickettsial genes. Ten A. pseudoconcolor ticks (90.9%) were found to be infected with Rickettsia, whereas no evidence of Rickettsia spp. was found in R. sanguineus s. l. Genetic analysis based of five rickettsial genes showed that the detected strain is most closely related to Rickettsia amblyommatis (formerly Candidatus Rickettsia amblyommii). R. amblyommatis was, for the first time, detected in Amblyomma pseudoconcolor and the results pointed to this tick like a potential vector in the enzootic cycle of R. amblyommatis in a typical semiarid Brazilian savannah region. In conclusion, despite the need for further studies to confirm if R. amblyommatis was responsible for the observed case in the state of Pernambuco, the presence of this bacterium during an SF focussed investigation should be a major concern in terms of public health due the capacity of SF for rapid and extensive dispersion within Brazilian territory.

Fatal case of spotted fever in a patient from Northeastern Brazil

Spotted fevers are diseases caused by bacterial agents belonging to the spotted-fever (SF) group of the genus Rickettsia. The first documented case of SF in Pernambuco State, Northeast Brazil, was reported here. Also, it is the first case described of fatal SF in Northeast region of Brazil. The patient was a resident of Arcoverde municipality and the probable site of infection lies in Sertania municipality, both in Pernambuco State, a semi-arid region of Brazil. The patient had not visited other areas where SF is endemic. The patient showed clinical manifestations and epidemiological exposure compatible with SF, and the infection was confirmed by molecular biology techniques.

Timeliness in the notification of spotted fever in Brazil: Evaluating compulsory reporting strategies and digital disease detection

Spotted fever is caused by rickettsia species, and is the most important tick-borne disease. In Brazil, it requires national compulsory notification to the Ministry of Health. Since 2007, all suspected cases of spotted fever have been integrated into the Notifiable Diseases Information System (SINAN). In this descriptive study we evaluate the timeliness (expressed in number of days between time of clinical suspicion and reporting) of the compulsory notification of spotted fever cases in SINAN and the strategy for digital disease detection (DDD). This study analysed the information from the SINAN and from the digital detection strategy used by ProMED-Português. Results show that detection by the SINAN system was more efficient than Promed-Português, reporting 90.4% of evaluated suspected cases 20.5days earlier. The surveillance strategy based on the mandatory case reporting using SINAN has proven to be more timely, but DDD can be considered as a complementary strategy providing a more disseminate epidemiological information to wide range readership globally.

Confirming Rickettsia rickettsii as the etiological agent of lethal spotted fever group rickettsiosis in human patients from Espírito Santo state, Brazil

Although Espírito Santo state is considered an endemic area for Brazilian spotted fever (BSF) with related lethal cases, it also constitutes the only state of southeastern Brazil that currently lacks a specific confirmation of the specific rickettsial agent. In an attempt to a species level confirmation of the etiological agent of fatal rickettsiosis cases in Espírito Santo state, in this study we tested human sera obtained between 2015 to 2017 by means of qPCR and subsequent conventional PCR protocols targeting gltA (citrate synthase) and ompA (190-kDA outer membrane protein) rickettsial genes. All samples were found to contain rickettsial DNA through the citrate synthase qPCR protocol. By conventional PCR, rickettsial gltA and ompA specific DNA fragments were detected in 25% (one sample) and 50% (2 samples) of the screened sera, respectively. Obtained consensuses for each gene partial sequences were 100% identical to Rickettsia rickettsii gltA and ompA genes. The present study confirms for the first time R. rickettsii as the etiological agent of a lethal spotted fever group rickettsiosis in human patients from Espírito Santo state.

Effect of piplartine and cinnamides on Leishmania amazonensis, Plasmodium falciparum and on peritoneal cells of Swiss mice

CONTEXT

Plants of the Piperaceae family produce piplartine that was used to synthesize the cinnamides.

OBJECTIVE

To assess the effects of piplartine (1) and cinnamides (2-5) against the protozoa responsible for malaria and leishmaniasis, and peritoneal cells of Swiss mice.

MATERIALS AND METHODS

Cultures of Leishmania amazonensis, Plasmodium falciparum-infected erythrocytes, and peritoneal cells were incubated, in triplicate, with different concentrations of the compounds (0 to 256 μg/mL). The inhibitory concentration (IC50) in L. amazonensis and cytotoxic concentration (CC50) in peritoneal cell were assessed by the MTT method after 6 h of incubation, while the IC50 for P. falciparum-infected erythrocytes was determined by optical microscopy after 48 or 72 h of incubation; the Selectivity Index (SI) was calculated by CC50/IC50.

RESULTS

All compounds inhibited the growth of microorganisms, being more effective against P. falciparum after 72 h of incubation, especially for the compounds 1 (IC50 = 3.2 μg/mL) and 5 (IC50 = 6.6 μg/mL), than to L. amazonensis (compound 1 = 179.0 μg/mL; compound 5 = 106.0 μg/mL). Despite all compounds reducing the viability of peritoneal cells, the SI were <10 to L. amazonensis, whereas in the cultures of P. falciparum the SI >10 for the piplartine (>37.4) and cinnamides 4 (>10.7) and 5 (= 38.4).

DISCUSSION AND CONCLUSION

The potential of piplartine and cinnamides 4 and 5 in the treatment of malaria suggest further pre-clinical studies to evaluate their effects in murine malaria and to determine their mechanisms in cells of the immune system.

Amblyomma ticks and future climate: Range contraction due to climate warming

Ticks of the Amblyomma cajennense species complex are important vectors of spotted fever in Latin America. Environmental conditions determine the geographic distribution of ticks, such that climate change could influence the distribution of tick-borne diseases. This study aimed to analyze the potential geographic distribution of A. cajennense complex ticks in a Brazil region under present-day and future climate models, assuming dispersal limitations and non-evolutionary adaptation of these tick populations to climate warming. Records of A. cajennense sensu stricto (s.s.) and Amblyomma sculptum were analyzed. Niche models were calibrated using Maxent considering climate variables for 1950-2000 and projecting models to conditions anticipated for 2050 and 2070 under two models of future climate (CCSM4 and HadGEM2-AO). Broad suitable areas for A. cajennense s.s. and A. sculptum were found in present-day climate models, but suitability was reduced when models were projected to future conditions. Our exploration of future climates showed that broad areas had novel climates not existing currently in the study region, including novel extremely high temperatures. Indeed, predicted suitability in these novel conditions would lead to biologically unrealistic results and therefore incorrect forecasts of future tick-distribution. Previous studies anticipating expansions of vectors populations due to climate change should be considered with caution as they assume that model extrapolation anticipates that species would evolve rapidly for adaptation to novel climatic conditions.

Rickettsia rickettsii infecting Rhipicephalus sanguineus sensu lato (Latreille 1806), in high altitude atlantic forest fragments, Ceara State, Brazil

In Brazil, Spotted Fever (SF) is caused by Rickettsia rickettsii and Rickettsia parkeri strain Atlantic Forest. In recent years, several human cases of a milder SF have been reported from the Maciço de Baturité region of Ceará State. Previous studies in this region found R. parkeri strain Atlantic Forest to be present in Rhipicephalus sanguineus sensu lato and Amblyomma ovale ticks. The present study isolated and identified the Rickettsia spp. present in this new endemic area in Brazil. In March 2015, R. sanguineus s.l. and A. ovale were collected in rural areas of the Maciço de Baturité region, and subjected to the isolation technique. A bacterium was isolated from one R. sanguineus s.l., which phylogenetic analysis clustered to the R. rickettsii group. In conclusion, R. rickettsii bacteria is circulating in the studied area and may in future have an impact on the clinical diagnoses and consequently cause changes in the profile of the disease in the region. In addition, we suggest the increase of epidemiological and environmental surveillance in the area, in order to prevent Brazilian Spotted Fever cases.

A fatal case of Brazilian spotted fever in a non-endemic area in Brazil: the importance of having health professionals who understand the disease and its areas of transmission

Brazilian spotted fever (BSF) is caused by the bacterium Rickettsia rickettsii. Because of its high case-fatality rate and apparent increase in areas of transmission, it is considered to be the rickettsial illness of primary public health interest. Cases of this disease have historically occurred in Southeastern Brazil. This article reports the first fatal case of BSF in Southern Brazil. This case high lights the importance of BSF to be considered as a differential diagnosis for acute hemorrhagic fever in areas where cases of BSF may not be expected.

Genetic identification of Rickettsia sp. strain Atlantic rainforest in an endemic area of a mild spotted fever in Rio Grande do Sul state, Southern Brazil

Rickettsia sp. strain Atlantic rainforest causes a less severe rickettsiosis, with two cases confirmed until now. The tick species Amblyomma ovale is appointed as the main vector of this bacterium. The southern region of Brazil has reported patients with spotted fever who have milder symptoms. In 2013, during an investigation of rickettsiosis cases, an A. ovale tick was found attached to a man in an area where there were two cases. The parasite was processed for molecular analysis and the rickettsial infection was confirmed based on phylogenetic analysis of genes ompA, ompB and geneD (sca4). In the present study the human pathogenic Rickettsia sp. strain Atlantic rainforest was identified in the state of Rio Grande do Sul, Southern Brazil. Since A. ovale, its main vector, is found frequently parasitizing dogs, animals that can cross international borders freely in southern Brazil, this bacteria can bring major concerns in terms of public health.

Avaliação dos conhecimentos e atitudes de prevenção sobre a febre maculosa entre profissionais de saúde no BrasilKnowledge and attitudes of prevention evaluation of spotted fever among health care professionals in Brazildoi:10.12662/2317-3076jhbs.v4i3.851.p152-159.2016

Introdução: A febre maculosa (FM) é uma doença transmitida por carrapatos, o que, no Brasil, preocupa as autoridades do Sistema Único de Saúde (SUS) por apresentar elevados coeficientes de letalidade. Objetivo: Descrever os conhecimentos e as atitudes de prevenção sobre a FM entre profissionais do SUS. Métodos: Foi realizado entre os meses de outubro a dezembro de 2015, um inquérito sobre os conhecimentos e as atitudes de prevenção sobre a FM entre os profissionais da saúde. Um questionário na plataforma FormSUS foi submetido a 426 profissionais de todo o Brasil que previamente já haviam participado de capacitações e atividades que envolviam o tema em questão. Vinte unidades federadas foram respondedoras da pesquisa (112/426). Foi possível verificar que a maioria dos profissionais de saúde conhece as condutas de notificação e de investigação epidemiológica. As incorporações recentes no programa de vigilância epidemiológica são de conhecimento da maioria dos respondentes. A rotatividade dos profissionais foi mencionada como principal dificultador das ações de vigilância da doença. Ações de fortalecimento dos programas de vigilância são realizadas de forma esporádica, somente no momento da ocorrência de casos de FM e não ocorrem de forma integral no âmbito do SUS. Conclusão: Cabe a cada segmento do SUS buscar seguir as diretrizes do sistema de vigilância epidemiológica da FM para que, de forma integral, se consiga reverter o panorama de morbimortalidade desta importante doença no Brasil.

An update on the epidemiological situation of spotted fever in Brazil

Background

Spotted fever is a tick-borne rickettsial disease. In Brazil, its notification to the Ministry of Health is compulsory. Since 2007, cases of spotted fever have been integrated to the Notifiable Diseases Information System, and epidemiological analyzes are part of the routines on surveillance programs.

Methods

This descriptive study updates epidemiological information on cases of spotted fever registered in Brazil between 2007 and 2015.

Results

In Brazil, 17,117 suspected cases of the disease were reported and 1,245 were confirmed in 12 states, mainly in São Paulo (550, 44.2 %) and Santa Catarina (276, 22.2 %). No geographic information was registered for 132 cases (10.6 %). Most of the infected people were men (70.9 %), mainly in rural areas (539, 43.3 %), who had contact with ticks (72.7 %). A higher number of suspected cases were registered between 2011 and 2015, but the number of confirmed cases and the incidence were relatively low. Moreover, 411 deaths were registered between 2007 and 2015, mainly in the southeastern region of the country, where the case-fatality rate was 55 %. Lack of proper filling of important fields of notification forms was also observed.

Conclusions

The results showed expansion of suspected cases of spotted fever and high case-fatality rates, which could be related to diagnostic difficulties and lack of prompt treatment. These factors may comprise limitations to the epidemiological surveillance system in Brazil, hence improvement of notification and investigation are crucial to reduce morbidity and mortality due to spotted fever in Brazil.

Vulnerability of Brazilian municipalities to hantavirus infections based on multi-criteria decision analysis

Background

Hantavirus infection is an emerging zoonosis transmitted by wild rodents. In Brazil, high case-fatality rates among humans infected with hantavirus are of serious concern to public health authorities. Appropriate preventive measures partly depend on reliable knowledge about the geographical distribution of this disease.

Methods

Incidence of hantavirus infections in Brazil (1993–2013) was analyzed. Epidemiological, socioeconomic, and demographic indicators were also used to classify cities’ vulnerability to disease by means of multi-criteria decision analysis (MCDA).

Results

From 1993 to 2013, 1752 cases of hantavirus were registered in 16 Brazilian states. The highest incidence of hantavirus was observed in the states of Mato Grosso (0.57/100,000) and Santa Catarina (0.13/100,000). Based on MCDA analysis, municipalities in the southern, southeastern, and midwestern regions of Brazil can be classified as highly vulnerable. Most municipalities in northern and northeastern Brazil were classified as having low vulnerability to hantavirus cardiopulmonary syndrome.

Conclusions

Although most human infections by hantavirus registered in Brazil occurred in the southern region of the country, a greater vulnerability to hantavirus was found in the Brazilian Midwest. This result reflects the need to strengthen surveillance where the disease has thus far gone unreported.