Eduardo Hage Carmo

Decline in Diarrhea Mortality and Admissions after Routine Childhood Rotavirus Immunization in Brazil: A Time-Series Analysis

A time series analysis by Manish Patel and colleagues shows that the introduction of rotavirus vaccination in Brazil is associated with reduced diarrhea-related deaths and hospital admissions in children under 5 years of age.

Prevalência e fatores associados às geo-helmintíases em crianças residentes em municípios com baixo IDH no Norte e Nordeste brasileiros

Stool surveys were conducted to estimate the prevalence and identify risk factors for geohelminth infections among children in ten Brazilian municipalities with low human development indices (HDI). Socioeconomic and environmental data were obtained from the childrens parents or guardians, and stool samples were examined. The proportion of geohelminth infections according to target variables was calculated. Risk factors were evaluated using multilevel logistic regression. Of the 2,523 children, 36.5% were infected with one or more geohelminths (Ascaris lumbricoides, 25.1%; hookworm, 15.3%; Trichuris trichiura, 12.2%). Overall prevalence of geohelminth infections was 45.7% in rural areas and 32.2% in urban areas. Low family income (OR = 1.75; 1.38-2.23), low maternal schooling (OR = 1.69; 1.39-2.06), presence of garbage near the home (OR = 1.50; 1.22-1.84), and number of individuals in the household (OR = 1.41; 1.17-1.71) were associated with infection. In conclusion, geohelminth infections were closely related to socioeconomic conditions, thus emphasizing the importance of targeted public interventions to improve living conditions as part of sustainable prevention.

Padrões de adoecimento e de morte da população brasileira: os renovados desafios para o Sistema Único de Saúde

No seculo XX, o Brasil passou por intensas transformacoes na sua estrutura populacional e no padrao de morbi-mortalidade. Este estudo tem o objetivo de apresentar uma reflexao sobre os grandes problemas de saude enfrentados pela populacao brasileira neste momento contemporâneo. Dentre as principais causas de obito e internacoes estao as doencas cronico-degenerativas, os acidentes e as diversas formas de violencia. Entretanto, as doencas infecciosas ainda se apresentam como problemas importantes de morbidade. A falta de solucao para problemas estruturais e basicos, a manutencao de condicoes e modo de vida inadequados, a insuficiencia dos mecanismos que regulam os danos ao meio ambiente ocasionam riscos a saude que se superpoem, em vez de se sucederem. Essa superposicao implica na manutencao de uma alta carga de morbidade e mortalidade na populacao que se mantem ao longo dos anos. A reducao desta carga representa um desafio para a definicao de politicas de saude. Portanto, e importante enfatizar a necessidade de acoes multissetoriais para a prevencao e controle das doencas e do sofrimento humano e para dar a cada individuo a garantia de atingir a sua plenitude fisica e mental. Estas acoes devem integrar nao so o setor saude, como tambem politicas economicas e sociais.

Zika Virus Infection and Associated Neurologic Disorders in Brazil

Zika virus has spread rapidly throughout the Americas and has been associated with fetal abnormalities and a variety of neurologic disorders. This report updates the epidemiologic findings over the past 2 years.

Infection-related microcephaly after the 2015 and 2016 Zika virus outbreaks in Brazil: a surveillance-based analysis

BACKGROUND On Nov 11, 2015, the Brazilian Ministry of Health declared a Public Health Emergency of National Concern in response to an increased number of microcephaly cases, possibly related to previous Zika virus outbreaks. We describe the course of the dual epidemics of the Zika virus infection during pregnancy and microcephaly in Brazil up to Nov 12, 2016, the first anniversary of this declaration. METHODS We used secondary data for Zika virus and microcephaly cases obtained through the Brazilian Ministry of Healths surveillance systems from Jan 1, 2015, to Nov 12, 2016. We deemed possible Zika virus infections during pregnancy as all suspected cases of Zika virus disease and all initially suspected, but later discarded, cases of dengue and chikungunya fever. We defined confirmed infection-related microcephaly in liveborn infants as the presence of a head circumference of at least 2 SDs below the mean for their age and sex, accompanied by diagnostic imaging consistent with an infectious cause, or laboratory, clinical, or epidemiological results positive for Zika virus or STORCH (infectious agents known to cause congenital infection, mainly syphilis, toxoplasmosis, cytomegalovirus, and herpes simplex virus). We excluded cases of congenital anomalies or death without microcephaly. We analyse the spatial clustering of these diseases in Brazil to obtain the kernel density estimation. FINDINGS Two distinct waves of possible Zika virus infection extended across all Brazilian regions in 2015 and 2016. 1 673 272 notified cases were reported, of which 41 473 (2·5%) were in pregnant women. During this period, 1950 cases of infection-related microcephaly were confirmed. Most cases (1373 [70·4%]) occurred in the northeast region after the first wave of Zika virus infection, with peak monthly occurrence estimated at 49·9 cases per 10 000 livebirths. After a major, well documented second wave of Zika virus infection in all regions of Brazil from September, 2015, to September, 2016, occurrence of microcephaly was much lower than that following the first wave of Zika virus infection, reaching epidemic levels in all but the south of Brazil, with estimated monthly peaks varying from 3·2 cases to 15 cases per 10 000 livebirths. INTERPRETATION The distribution of infection-related microcephaly after Zika virus outbreaks has varied across time and Brazilian regions. Reasons for these apparent differences remain to be elucidated. FUNDING None.

Schistosomiasis mansoni in Bahia, Brazil: historical trends and control measures

In order to aid the development of new approaches to schistosomiasis control, changes were analyzed in prevalence at the county level in the State of Bahia from the 1950s to the 1990s, as were determinants and the effect of community-based chemotherapy. In general, no substantial changes were observed in the basic pattern of spatial distribution of the prevalence of infection. However, during the period studied, there was an overall reduction in prevalence from 15.6% to 9.5% and an increase in prevalence rates in some counties from the western, southeastern, and northern areas of Bahia, indicative of new transmission areas. The effect of mass chemotherapy was analyzed. In the Paraguaçu Basin, where this control measure was used on a large scale, there was a reduction in prevalence similar to areas where this measure was not used. Correlation and regression analysis also failed to show links between mass chemotherapy and long term reduction in prevalence. The most powerful variables to explain these changes were those related with population dynamics. These findings strongly suggest that the reduction in prevalence observed in some areas of the State must be attributed to factors related with the spatial organization of this territory, causing a general decrease in the transmission rate, secondary to mass chemotherapy. At the same time, the incomplete form and the spatial inequalities that characterized the urbanization process created favorable conditions for the spread of schistosomiasis mansoni and the establishment of new foci.

Infectious diseases epidemiology

In this glossary the authors have reviewed old and new terms contemporarily used in the infectious disease epidemiology. Many of these concepts were established throughout the 19th century and at the beginning of the 20th century (classic terms), however, the meanings of old terms have been revised and new terms are continually being added. This glossary has therefore reviewed the classic and the more recently established terminology defining the most relevant terms contemporarily used in this field.

Influência do aumento do acesso à atenção básica no comportamento da taxa de detecção de hanseníase de 1980 a 2006

Brazilian Hansens disease detection rate rose during the 80s and 90s of the 20th century. The Brazilian health system reform happened during the same period. Detection rate is a function of the real incidence of cases and the diagnostic agility of the health system. Coverage of BCG immunization in infants was used as a proxy variable for primary healthcare coverage. A log-normal regression model of detection rate as a function of BCG coverage, time and time square was adjusted to data. The detection rate presents an upward trend throughout the period and with a downturn beginning in 2003. The model showed a statistically significant positive regression coefficient for BCG coverage, suggesting that detection rate behavior reflects the improvement of access to health care. The detection rate began a trend towards decline in 2003, indicating a new phase of Hansens disease control.

Emergências de saúde pública: conceito, caracterização, preparação e resposta

during recent years, international concern about the spread of diseases or agents from infections and chemical or radio-nuclear sources has increased. aiming to adapt the concepts and measures to prevent or reduce the risk of this spread, countries have adopted the new concept of “public health emergency of international concern” under the IHR (2005), and implemented new strategies for strengthening activities to prepare for and respond to such emergencies. Based on contextualized risk analysis of health events that can spread internationally, the aim is to be able to fall back on more appropriate tools for the timely identification of and intervention in these events. the adaptation of this concept for the purpose of national health surveillance and health care services in Brazil has allowed for a better management of health events that may pose a risk of disease-spread or injury/death in national territory and provide a more timely response. the analysis of these events presented herein shows that the occurrence of environmental disasters, even if in lower number than infectious events, poses a greater threat to the public and causes more widespread damage. on the other hand, infectious events, which usually occur as outbreaks or epidemics, affect a larger number of municipalities and reap a higher death toll. the measures adopted in the country to improve the health surveillance system in terms of detection, preparedness and response to public health emergencies are described here, as are the main challenges faced in managing the system.

Hantavirus pulmonary syndrome: Prognostic factors for death in reported cases in Brazil

Hantavirus pulmonary syndrome (HPS) was described for the first time in Brazil in 1993 and has occurred endemically throughout the country. This study analysed clinical and laboratory aspects as well as death-related factors for HPS cases in Brazil from 1993 to 2006. The investigation comprised a descriptive and exploratory study of the history of cases as well as an analytical retrospective cohort survey to identify prognostic factors for death due to HPS. A total of 855 Brazilian HPS cases were assessed. The majority of cases occurred during spring (33.5%) and winter (27.6%), mainly among young male adults working in rural areas. The global case fatality rate was 39.3%. The mean interval between the onset of symptoms and hospitalisation was 4 days and that between hospitalisation and death was 1 day. In the multiple regression analysis, adult respiratory distress syndrome and mechanical respiratory support were associated with risk of death; when these two variables were excluded from the model, dyspnoea and haemoconcentration were associated with a higher risk of death.