Erenilde Marques de Cerqueira

Epidemiology of Chikungunya Virus in Bahia, Brazil, 2014-2015.

Chikungunya is an emerging arbovirus that is characterized into four lineages. One of these, the Asian genotype, has spread rapidly in the Americas after its introduction in the Saint Martin island in October 2013. Unexpectedly, a new lineage, the East-Central-South African genotype, was introduced from Angola in the end of May 2014 in Feira de Santana (FSA), the second largest city in Bahia state, Brazil, where over 5,500 cases have now been reported. Number weekly cases of clinically confirmed CHIKV in FSA were analysed alongside with urban district of residence of CHIKV cases reported between June 2014 and October collected from the municipality’s surveillance network. The number of cases per week from June 2014 until September 2015 reveals two distinct transmission waves. The first wave ignited in June and transmission ceased by December 2014. However, a second transmission wave started in January and peaked in May 2015, 8 months after the first wave peak, and this time in phase with Dengue virus and Zika virus transmission, which ceased when minimum temperature dropped to approximately 15°C. We find that shorter travelling times from the district where the outbreak first emerged to other urban districts of FSA were strongly associated with incidence in each district in 2014 (R2).

Epidemiological and ecological determinants of Zika virus transmission in an urban setting

The Zika virus has emerged as a global public health concern. Its rapid geographic expansion is attributed to the success of Aedes mosquito vectors, but local epidemiological drivers are still poorly understood. Feira de Santana played a pivotal role in the Chikungunya epidemic in Brazil and was one of the first urban centres to report Zika infections. Using a climate-driven transmission model and notified Zika case data, we show that a low observation rate and high vectorial capacity translated into a significant attack rate during the 2015 outbreak, with a subsequent decline in 2016 and fade-out in 2017 due to herd-immunity. We find a potential Zika-related, low risk for microcephaly per pregnancy, but with significant public health impact given high attack rates. The balance between the loss of herd-immunity and viral re-importation will dictate future transmission potential of Zika in this urban setting.

Epidemic establishment and cryptic transmission of Zika virus in Brazil and the Americas

Zika virus (ZIKV) transmission in the Americas was first confirmed in May 2015 in Northeast Brazil1. Brazil has the highest number of reported ZIKV cases worldwide (>200,000 by 24 Dec 20162) as well as the greatest number of cases associated with microcephaly and other birth defects (2,366 confirmed cases by 31 Dec 20162). Following the initial detection of ZIKV in Brazil, 47 countries and territories in the Americas have reported local ZIKV transmission, with 22 of these reporting ZIKV-associated severe disease3. Yet the origin and epidemic history of ZIKV in Brazil and the Americas remain poorly understood, despite the value of such information for interpreting past trends in reported microcephaly. To address this we generated 53 complete or partial ZIKV genomes, mostly from Brazil, including data generated by the ZiBRA project – a mobile genomics lab that travelled across Northeast Brazil in 2016. One sequence represents the earliest confirmed ZIKV infection in Brazil. Joint analyses of viral genomes with ecological and epidemiological data estimate that the ZIKV epidemic first became established in NE Brazil by March 2014 and likely disseminated from there, both nationally and internationally, before the first detection of ZIKV in the Americas. Estimated dates of the international spread of ZIKV from Brazil coincide with periods of high vector suitability in recipient regions and indicate the duration of pre-detection cryptic transmission in those regions. NE Brazil’s role in the establishment of ZIKV in the Americas is further supported by geographic analysis of ZIKV transmission potential and by estimates of the virus’ basic reproduction number. One Sentence Summary Virus genomes reveal the establishment of Zika virus in Northeast Brazil and the Americas, and provide an appropriate timeframe for baseline (pre-Zika) microcephaly in different regions.

Vigilância epidemiológica no sistema local de saúde

Se trata de un estudio calitativo, que procura analizar la organizacion de Vigilancia Epidemiologica (VE) en el sistema local de salud de Feira de Santana-BA, de 1997 a 2001, considerando: estructura organizacional, recursos disponibles (humanos y materiales), planeamiento, ejecucion de las acciones y articulacion intra, interinstitucional e intersectorial, teniendo en cuenta la insercion del municipio en la Gestion Plena de Atencion Basica La recogida de datos se realizo en 3 etapas: analisis documental, entrevistas semiestructuradas y observacion directa con el equipo de VE. Los resultados apuntan que la organizacion VE ha tenido cambios frecuentes de gestores y como la estructura se centra en la SMS da prioridad a programas de accion desarticulados de la red de servicios. Se notan avances en la infraestructura, aunque se carece de equipamientos y exista deficiencia en la capacitacion de los recursos humanos. La transformacion del modelo de atencion a la salud ocurrira cuando los profesionales de la salud, los gestores y los usuarios consoliden su voluntad politica de transformar la practica de los servicios de la salud.

Comprehensive health care: dilemmas and challenges in nursing

OBJECTIVE this article discusses comprehensive care as a guiding tenet of the Brazilian Unified Health System (SUS), outlining health care practices, especially nursing, and the relationships built by subjects in action by means of different knowledge. METHODS this is a theoretical reflection that aims to propose dimensions of analysis (access to services, reception, links, lines of care, accountability, and responsiveness), with an emphasis on the dilemmas and challenges of nursing. The proposed dimensions analyze the production of care and its political and technical aspects. CONCLUSION care should be the focus of all health care work, bearing in mind that intervention for technological action of each profession goes beyond the core of isolated knowledge, as is the case of nursing, which is connected to other professional practices, and can peruse other territories that operate through relational technologies, entering into the world of the needs of users and families.

Cuidado integral em saúde: dilemas e desafios da Enfermagem

OBJECTIVE this article discusses comprehensive care as a guiding tenet of the Brazilian Unified Health System (SUS), outlining health care practices, especially nursing, and the relationships built by subjects in action by means of different knowledge. METHODS this is a theoretical reflection that aims to propose dimensions of analysis (access to services, reception, links, lines of care, accountability, and responsiveness), with an emphasis on the dilemmas and challenges of nursing. The proposed dimensions analyze the production of care and its political and technical aspects. CONCLUSION care should be the focus of all health care work, bearing in mind that intervention for technological action of each profession goes beyond the core of isolated knowledge, as is the case of nursing, which is connected to other professional practices, and can peruse other territories that operate through relational technologies, entering into the world of the needs of users and families.

Cuidado integral en salud: dilemas y retos de la Enfermeria

OBJECTIVE this article discusses comprehensive care as a guiding tenet of the Brazilian Unified Health System (SUS), outlining health care practices, especially nursing, and the relationships built by subjects in action by means of different knowledge. METHODS this is a theoretical reflection that aims to propose dimensions of analysis (access to services, reception, links, lines of care, accountability, and responsiveness), with an emphasis on the dilemmas and challenges of nursing. The proposed dimensions analyze the production of care and its political and technical aspects. CONCLUSION care should be the focus of all health care work, bearing in mind that intervention for technological action of each profession goes beyond the core of isolated knowledge, as is the case of nursing, which is connected to other professional practices, and can peruse other territories that operate through relational technologies, entering into the world of the needs of users and families.

Epidemiological vigilance in the local health system

Se trata de un estudio calitativo, que procura analizar la organizacion de Vigilancia Epidemiologica (VE) en el sistema local de salud de Feira de Santana-BA, de 1997 a 2001, considerando: estructura organizacional, recursos disponibles (humanos y materiales), planeamiento, ejecucion de las acciones y articulacion intra, interinstitucional e intersectorial, teniendo en cuenta la insercion del municipio en la Gestion Plena de Atencion Basica La recogida de datos se realizo en 3 etapas: analisis documental, entrevistas semiestructuradas y observacion directa con el equipo de VE. Los resultados apuntan que la organizacion VE ha tenido cambios frecuentes de gestores y como la estructura se centra en la SMS da prioridad a programas de accion desarticulados de la red de servicios. Se notan avances en la infraestructura, aunque se carece de equipamientos y exista deficiencia en la capacitacion de los recursos humanos. La transformacion del modelo de atencion a la salud ocurrira cuando los profesionales de la salud, los gestores y los usuarios consoliden su voluntad politica de transformar la practica de los servicios de la salud.

Vigilancia epidemiológica en el sistema local de salud

Se trata de un estudio calitativo, que procura analizar la organizacion de Vigilancia Epidemiologica (VE) en el sistema local de salud de Feira de Santana-BA, de 1997 a 2001, considerando: estructura organizacional, recursos disponibles (humanos y materiales), planeamiento, ejecucion de las acciones y articulacion intra, interinstitucional e intersectorial, teniendo en cuenta la insercion del municipio en la Gestion Plena de Atencion Basica La recogida de datos se realizo en 3 etapas: analisis documental, entrevistas semiestructuradas y observacion directa con el equipo de VE. Los resultados apuntan que la organizacion VE ha tenido cambios frecuentes de gestores y como la estructura se centra en la SMS da prioridad a programas de accion desarticulados de la red de servicios. Se notan avances en la infraestructura, aunque se carece de equipamientos y exista deficiencia en la capacitacion de los recursos humanos. La transformacion del modelo de atencion a la salud ocurrira cuando los profesionales de la salud, los gestores y los usuarios consoliden su voluntad politica de transformar la practica de los servicios de la salud.