Fatima Marinho

Mapping global environmental suitability for Zika virus

Zika virus was discovered in Uganda in 1947 and is transmitted by Aedes mosquitoes, which also act as vectors for dengue and chikungunya viruses throughout much of the tropical world. In 2007, an outbreak in the Federated States of Micronesia sparked public health concern. In 2013, the virus began to spread across other parts of Oceania and in 2015, a large outbreak in Latin America began in Brazil. Possible associations with microcephaly and Guillain-Barré syndrome observed in this outbreak have raised concerns about continued global spread of Zika virus, prompting its declaration as a Public Health Emergency of International Concern by the World Health Organization. We conducted species distribution modelling to map environmental suitability for Zika. We show a large portion of tropical and sub-tropical regions globally have suitable environmental conditions with over 2.17 billion people inhabiting these areas. DOI: http://dx.doi.org/10.7554/eLife.15272.001

Global yellow fever vaccination coverage from 1970 to 2016: an adjusted retrospective analysis

Summary Background Substantial outbreaks of yellow fever in Angola and Brazil in the past 2 years, combined with global shortages in vaccine stockpiles, highlight a pressing need to assess present control strategies. The aims of this study were to estimate global yellow fever vaccination coverage from 1970 through to 2016 at high spatial resolution and to calculate the number of individuals still requiring vaccination to reach population coverage thresholds for outbreak prevention. Methods For this adjusted retrospective analysis, we compiled data from a range of sources (eg, WHO reports and health-service-provider registeries) reporting on yellow fever vaccination activities between May 1, 1939, and Oct 29, 2016. To account for uncertainty in how vaccine campaigns were targeted, we calculated three population coverage values to encompass alternative scenarios. We combined these data with demographic information and tracked vaccination coverage through time to estimate the proportion of the population who had ever received a yellow fever vaccine for each second level administrative division across countries at risk of yellow fever virus transmission from 1970 to 2016. Findings Overall, substantial increases in vaccine coverage have occurred since 1970, but notable gaps still exist in contemporary coverage within yellow fever risk zones. We estimate that between 393·7 million and 472·9 million people still require vaccination in areas at risk of yellow fever virus transmission to achieve the 80% population coverage threshold recommended by WHO; this represents between 43% and 52% of the population within yellow fever risk zones, compared with between 66% and 76% of the population who would have required vaccination in 1970. Interpretation Our results highlight important gaps in yellow fever vaccination coverage, can contribute to improved quantification of outbreak risk, and help to guide planning of future vaccination efforts and emergency stockpiling. Funding The Rhodes Trust, Bill & Melinda Gates Foundation, the Wellcome Trust, the National Library of Medicine of the National Institutes of Health, the European Unions Horizon 2020 research and innovation programme.

Reconstruction of Zika Virus Introduction in Brazil.

We estimated the speed of Zika virus introduction in Brazil by using confirmed cases at the municipal level. Our models indicate a southward pattern of introduction starting from the northeastern coast and a pattern of movement toward the western border with an average speed of spread of 42 km/day or 15,367 km/year.

Existing and potential infection risk zones of yellow fever worldwide: a modelling analysis

Summary Background Yellow fever cases are under-reported and the exact distribution of the disease is unknown. An effective vaccine is available but more information is needed about which populations within risk zones should be targeted to implement interventions. Substantial outbreaks of yellow fever in Angola, Democratic Republic of the Congo, and Brazil, coupled with the global expansion of the range of its main urban vector, Aedes aegypti, suggest that yellow fever has the propensity to spread further internationally. The aim of this study was to estimate the diseases contemporary distribution and potential for spread into new areas to help inform optimal control and prevention strategies. Methods We assembled 1155 geographical records of yellow fever virus infection in people from 1970 to 2016. We used a Poisson point process boosted regression tree model that explicitly incorporated environmental and biological explanatory covariates, vaccination coverage, and spatial variability in disease reporting rates to predict the relative risk of apparent yellow fever virus infection at a 5 × 5 km resolution across all risk zones (47 countries across the Americas and Africa). We also used the fitted model to predict the receptivity of areas outside at-risk zones to the introduction or reintroduction of yellow fever transmission. By use of previously published estimates of annual national case numbers, we used the model to map subnational variation in incidence of yellow fever across at-risk countries and to estimate the number of cases averted by vaccination worldwide. Findings Substantial international and subnational spatial variation exists in relative risk and incidence of yellow fever as well as varied success of vaccination in reducing incidence in several high-risk regions, including Brazil, Cameroon, and Togo. Areas with the highest predicted average annual case numbers include large parts of Nigeria, the Democratic Republic of the Congo, and South Sudan, where vaccination coverage in 2016 was estimated to be substantially less than the recommended threshold to prevent outbreaks. Overall, we estimated that vaccination coverage levels achieved by 2016 avert between 94 336 and 118 500 cases of yellow fever annually within risk zones, on the basis of conservative and optimistic vaccination scenarios. The areas outside at-risk regions with predicted high receptivity to yellow fever transmission (eg, parts of Malaysia, Indonesia, and Thailand) were less extensive than the distribution of the main urban vector, A aegypti, with low receptivity to yellow fever transmission in southern China, where A aegypti is known to occur. Interpretation Our results provide the evidence base for targeting vaccination campaigns within risk zones, as well as emphasising their high effectiveness. Our study highlights areas where public health authorities should be most vigilant for potential spread or importation events. Funding Bill & Melinda Gates Foundation.

Social Media as a Sentinel for Disease Surveillance: What Does Sociodemographic Status Have to Do with It?

Introduction: Data from social media have been shown to have utility in augmenting traditional approaches to public health surveillance. Quantifying the representativeness of these data is needed for making accurate public health inferences. Methods: We applied machine-learning methods to explore spatial and temporal dengue event reporting trends on Twitter relative to confirmed cases, and quantified associations with sociodemographic factors across three Brazilian states (São Paulo, Rio de Janeiro, and Minas Gerais) at the municipality level. Results: Education and income were positive predictors of dengue reporting on Twitter. In contrast, municipalities with a higher percentage of older adults, and males were less likely to report suspected dengue disease on Twitter. Overall, municipalities with dengue disease tweets had higher mean per capita income and lower proportion of individuals with no primary school education. Conclusions: These observations highlight the need to understand population representation across locations, age, and racial/ethnic backgrounds in studies using social media data for public health research. Additional data is needed to assess and compare data representativeness across regions in Brazil.

Novo século, novos desafios: mudança no perfil da carga de doença no Brasil de 1990 a 2010

OBJECTIVE to describe the burden of disease in Brazil from 1990 to 2010. METHODS analysis of the estimates of the Global Burden of Disease Study 2010 - Years of Life Lost due to premature mortality (YLL), Years Lost due to Disability (YLD), Disability-Adjusted Life Year (DALY=YLL+YLD) and risk factors. RESULTS there was a decrease in deaths due to diarrhea and an increase in deaths due to diabetes and kidney disease, whilst deaths due to homicides and traffic accidents remained stable; cardiovascular diseases continued to be the leading cause of death despite a 30% reduction; the largest increases in DALY were due to diabetes and musculoskeletal diseases in women and alcohol abuse and low back pain in men; the main risk factors were poor diet and high blood pressure; smoking, domestic pollution and insufficient breastfeeding were found to have reduced. CONCLUSION the rapid epidemiological transition highlights the need to control infectious diseases and invest in reducing violence and non-communicable diseases.Resumo OBJETIVO: descrever a carga de doenca no Brasil de 1990 a 2010. METODOS: analise das estimativas do Global Burden of Disease Study 2010 - anos de vida perdidos por morte prematura (YLL), anos vividos com incapacidade (YLD), anos de vida perdidos por morte ou incapacidade (DALY=YLL+YLD) e fatores de risco. RESULTADOS: a mortalidade por diarreia reduziu-se, aumentou por diabetes e doenca renal e estabilizou-se por homicidios e acidentes de transporte; doencas cardiovasculares persistiram como principal causa de morte, apesar da reducao de 30%; os maiores aumentos de DALY foram por diabetes e doencas osteomusculares em mulheres, e abuso do alcool e dor lombar em homens; os principais fatores de risco foram dieta inadequada e hipertensao; reduziram-se tabagismo, poluicao domestica e aleitamento materno insuficiente. CONCLUSAO: a rapida transicao epidemiologica alerta para a necessidade de controlar as doencas infecciosas e investir na reducao da violencia e de doencas nao transmissiveis.OBJETIVO: describir la carga de enfermedad en Brasil entre 1990 y 2010. METODOS: analizar las estimaciones del Global Burden of Disease Study 2010 - anos de vida perdidos por muerte prematura (YLL), anos de vida perdidos por discapacidad (YLD), anos de vida perdidos por muerte o discapacidad (DALY=YLL+YLD) y factores de riesgo. RESULTADOS: hubo reduccion de muertes por diarrea, aumento por diabetes y enfermedad renal, con estabilizacion para homicidios y accidentes de trafico; las enfermedades cardiovasculares siguen siendo la principal causa de muerte, a pesar de una reduccion de 30%; los mayores incrementos de DALY fueron por diabetes y enfermedades osteomusculares en mujeres y abuso del alcohol y dolor lumbar en hombres; los principales factores de riesgo son mala alimentacion e hipertension; hubo reduccion del tabaquismo, contaminacion domestica y lactancia materna inadecuada. CONCLUSION: la rapida transicion epidemiologica advierte la necesidad de controlar las enfermedades infecciosas e invertir en la reduccion de la violencia y enfermedades no transmisibles.

The burden of diabetes and hyperglycemia in Brazil-past and present: findings from the Global Burden of Disease Study 2015

BackgroundDiabetes, hyperglycemia, and their complications are a growing problem in Brazil. However, no comprehensive picture of this disease burden has yet been presented to date.MethodsWe used Global Burden of Disease 2015 data to characterize diabetes prevalence, incidence and risk factors from 1990 to 2015 in Brazil. Additionally, we provide mortality, years of life lost prematurely (YLL), years of life lived with disability (YLD) and disability-adjusted life years (DALYs) lost due to diabetes, as well as similar data for chronic kidney disease (CKD) due to diabetes and, as an overall summary measure, for hyperglycemia, the latter expressed as high fasting plasma glucose (HFPG).ResultsFrom 1990 to 2015 diabetes prevalence rose from around 3.6 to 6.1%, and YLLs, YLDs, and DALYs attributable to diabetes increased steadily. The crude diabetes death rate increased 90% while that of CKD due to diabetes more than doubled. In 2015, HFPG became Brazil’s 4th leading cause of disability, responsible for 65% of CKD, for 7.0% of all disability and for the staggering annual loss of 4,049,510 DALYs. Diabetes DALYs increased by 118.6% during the period, increasing 42% due to growth in Brazil´s population, 72.1% due to population ageing, and 4.6% due to the change in the underlying, age-standardized rate of DALY due to diabetes. Main risk factors for diabetes were high body mass index; a series of dietary factors, most notably low intake of whole grains and of nuts and seeds, and high intake of processed meats; low physical activity and tobacco use, in that order.ConclusionsOur study demonstrates that diabetes, CKD due to diabetes, and hyperglycemia produce a large and increasing burden in Brazil. These findings call for renewed efforts to control the joint epidemics of obesity and diabetes, and to develop strategies to deal with the ever-increasing burden resulting from these diseases.

Microcefalia no Brasil: prevalência e caracterização dos casos a partir do Sistema de Informações sobre Nascidos Vivos (Sinasc), 2000-2015

OBJECTIVE to describe the prevalence coefficients and characterize cases of microcephaly at birth in Brazil from 2000-2015. METHODS this is a descriptive study with data from the Information System on Live Births (Sinasc). The coefficients were calculated by region and characteristics of mothers and live births (LB). RESULTS the annual average number of microcephaly cases was 164 for the period 2000-2014, whilst in 2015, 1,608 cases were registered (54.6 cases per 100 thousand LB). Higher coefficients were observed among preterm babies (81.7; 95%CI 72.3;92.2), born from black-skinned (70.9; 95%CI 58.5;85.9) or to brown-skinned (71.5; 95%CI67.4;75.8) women, to women aged ≤19 (70.3; 95%CI 63.5;77.8) or ≥40 (62.1; 95%CI 46.6;82.6), with ≤3 years of study (73.4; 95%CI 58.2;92.4) and residents in the Northeast region (138.7; 95%CI 130.9;147.0). CONCLUSION the high number of microcephaly cases in 2015 reinforces the importance of Sinasc and the need to improve the surveillance of congenital anomalies.OBJETIVO: describir coeficientes de prevalencia y caracterizar casos de microcefalia al nacer en Brasil, en el periodo 2000-2015. METODOS: estudio descriptivo con datos del Sistema de Informaciones sobre Nacidos Vivos (Sinasc). Los coeficientes fueron calculados segun regiones, caracteristicas maternas y del nacido vivo (NV). RESULTADOS: el promedio anual de casos de microcefalia fue 164 en el periodo 2000-2014, mientras en 2015 fue 1.608 (54,6 casos por 100.000 NV). Coeficientes mas elevados fueron observados entre prematuros (81,7; IC95% 72,3-92,2), nacidos de madres negras (70,9; IC95% 58,5-85,9) o pardas (71,5; IC95% 67,4-75,8), con edades ≤19 (70,3; IC95% 63,5-77,8) o ≥40 anos (62,1; IC95% 46,6-82,6), ≤3 anos de estudio (73,4; IC95% 58,2-92,4), y residentes del Noreste (138,7; IC95% 130,9-147,0). CONCLUSION: el elevado numero de casos de microcefalia, en 2015, refuerza la importancia del Sinasc y necesidad de mejorias del sistema de vigilancia de anomalias congenitas.

PW 0695 Factors associated to mortality due to suicide among adults in brazil

Suicide is a complex phenomenon, influenced by several factors and, therefore, generalizations of risk factors are counterproductive. Thus, contextual analyses can point out situations of greater risk and contribute to the formulation of policies to prevent attempts and deaths due to this cause. In order to describe and analyze both the individual and context factors associated with suicide deaths among adults (twenty years old or over), in Brazil from 2010 to 2015, the model of social health determinants proposed by Dahlgren and Whitehead was adopted. Crude suicide mortality rates were calculated using data from the Mortality Information System, according to individual and context variables, and a hierarchical and multilevel approach was performed, with the crude mortality rate by suicide as the outcome variable. A total of 60 440 deaths due to suicide were recorded, with a mortality rate of 7.5 per 1 00 000 inhabitants. Hanging (4.6) was the main means used to commit suicide. Higher risks were observed among the elderly aged 70 or over (8.9), individuals with 0 to 3 years of schooling (7.7), and indigenous people (12.4). Individual factors significantly associated with suicide were: male sex (relative risk 1.34; 95% confidence interval 1.16–1.54); indigenous ethnicity/skin color (2.03; 1.90–2.16); 0 to 3 years of schooling (1.05; 1.03–1.07); agricultural/forestry/fishing workers (1.14; 1.12–1.16). Context factors were: average of less than three residents per household (1.21; 1.19–1.22); absence of Psychosocial Care Center (Caps) (1.14; 1,13–1,16); municipalities with lower urbanization rate (1.38; 1.32–1.44), lower Gini index (1.10; 1.07–1.14), small-sized population (1.86; 1.82–1.89), located in the South of the country (1.60; 1.56–1.64). Context-level characteristics may influence suicidal behaviors above and beyond individual-level effects, although it is difficult to determine how the characteristics of the context level exert such influence.