Rui Moreira Braz

Caracterização das epidemias de malária nos municípios da Amazônia Brasileira em 2010

Epidemias de malaria ocorrem anualmente nos municipios da Regiao Amazonica, Brasil, no entanto os servicos de saude nao adotam, de maneira sistematica, instrumentos para deteccao e contencao oportunas desses eventos. O objetivo foi caracterizar as epidemias de malaria na regiao segundo duracao, especie de Plasmodium e vulnerabilidade das populacoes. Foi avaliado um sistema de monitoramento automatizado da incidencia da malaria, com base no diagrama de controle segundo quartis, para identificar as epidemias da doenca. Em 2010, ocorreram epidemias em 338 (41,9%) municipios da regiao. Houve epidemias por P. falciparum e por P. vivax, separadamente, e tambem por ambas as especies. Epidemias com duracao de um a quatro meses ocorreram em 58,3% dos municipios epidemicos; de cinco a oito meses, em 24,3%; e de nove a 12 meses, em 17,4%. O monitoramento automatizado da variacao da incidencia da malaria podera contribuir para deteccao precoce das epidemias e melhorar o seu controle oportuno.Malaria epidemics occur annually in various municipalities (counties) in the Brazilian Amazon. However, health services do not systematically adopt tools to detect and promptly control these events. This article aimed to characterize malaria epidemics in the Brazilian Amazon Region based on their duration, the Plasmodium species involved, and the populations degree of vulnerability. An automatic malaria incidence monitoring system based on quartiles was assessed for prompt identification of malaria epidemics. In 2010, epidemics were identified in 338 (41.9%) of the counties in the Brazilian Amazon. P. falciparum and P. vivax epidemics were detected, both singly and in combination. Epidemics lasted from 1 to 4 months in 58.3% of the counties, 5 to 8 months in 34.5%, and 9 to 12 months in 17.4%. Systematic monitoring of malaria incidence could contribute to early detection of epidemics and improve the effectiveness of control measures.

Epidemiology of malaria in the municipality of Cruzeiro do Sul, State of Acre, Brazil, in 2010: uses of a control chart at the local level

INTRODUCTION This study describes the uses of a control chart in the malaria surveillance at the local level, signaling whether there is a need to intensify or adapt control measures. METHODS The districts of Cruzeiro do Sul (n=14), State of Acre, Brazil, were classified into three groups: I) those with an incidence lower than expected; II) those with an incidence within the expected range; and III) those with an epidemic. RESULTS Thirteen of the fourteen districts had outbreaks of malaria at some point in 2010, and six districts showed persistent malaria epidemic throughout the year. CONCLUSIONS The control chart may help the malaria control at the local level.

Spatial dependence of malaria epidemics in municipalities of the Brazilian Amazon

Introduction: In 2010, there were 305 (37.8%) municipalities with malaria epidemics in the Brazilian Amazon. The epidemics spread can be explained by the spatial distribution pattern. Objective: To analyze the spatial dependence, autocorrelation, of the malaria epidemics in the municipalities of this region. Methods: An automated algorithm was used for the detection of epidemic municipalities in 2003, 2007 and 2010. Spatial dependence was analyzed by applying the global and local Moran index on the epidemic months proportion variable. The epidemic municipalities clusters were identified using the TerraView software. Results: The global Moran index values were 0.4 in 2003; 0.6 in 2007; and 0.5 in 2010 (p = 0.01), confirming the spatial dependence among the epidemic municipalities. Box Map and Moran Map identified inter-municipal, interstate and borders clusters with spatial autocorrelation (p < 0.05). There were 10 epidemic municipalities clusters in 2003; 9 in 2007 and 8 in 2010. Discussion: The epidemic municipalities clusters may be linked to the health facilities difficulties on acting together. The structural limitations of the health services can be overcome by territorial integration to support planning and control activities, strengthening the interventions. Conclusion: The routine analysis of the epidemic municipalities clusters with spatial and temporal persistence may provide a new indicator of planning and integrated control prioritization, contributing to malaria epidemics reducing in inter-municipal, interstate and borders areas.ABSTRACT: Introduction: In 2010, there were 305 (37.8%) municipalities with malaria epidemics in the Brazilian Amazon. The epidemics spread can be explained by the spatial distribution pattern. Objective: To analyze the spatial dependence, autocorrelation, of the malaria epidemics in the municipalities of this region. Methods: An automated algorithm was used for the detection of epidemic municipalities in 2003, 2007 and 2010. Spatial dependence was analyzed by applying the global and local Moran index on the epidemic months proportion variable. The epidemic municipalities clusters were identified using the TerraView software. Results: The global Moran index values were 0.4 in 2003; 0.6 in 2007; and 0.5 in 2010 (p = 0.01), confirming the spatial dependence among the epidemic municipalities. Box Map and Moran Map identified inter-municipal, interstate and borders clusters with spatial autocorrelation (p < 0.05). There were 10 epidemic municipalities clusters in 2003; 9 in 2007 and 8 in 2010.

Classificação de risco de transmissão de doenças imunopreveníveis a partir de indicadores de coberturas vacinais nos municípios brasileiros

Resumo OBJETIVO: descrever a classificacao de risco de doencas imunopreveniveis nos municipios brasileiros. METODOS: estudo epidemiologico descritivo com dados do Sistema de Informacoes do Programa Nacional de Imunizacoes (SI-PNI) para 2014; os indicadores de coberturas vacinais foram utilizados para classificar o risco de transmissao de doencas imunopreveniveis nos municipios. RESULTADOS: dos 5.570 municipios brasileiros, 12,0% foram classificados como de risco muito baixo, 29,6% de risco baixo, 2,2% de risco medio, 54,3% de risco alto e 1,8% de risco muito alto. Conclusao: a vigilância das coberturas vacinais permitiu identificar a maioria dos municipios em situacao de alto risco e a minoria das criancas vivendo em municipios com cobertura adequada; a vigilância das coberturas utilizando indicadores pactuados no Sistema Unico de Saude (SUS) oferece nova ferramenta para identificacao de areas prioritarias, onde as acoes poderao ter maiores chances de acerto pelos gestores e melhorar a qualidade e o sucesso do PNI.OBJETIVO: describir la clasificacion de riesgo de enfermedades prevenibles en municipios brasilenos. METODOS: estudio epidemiologico descriptivo con datos del Sistema de informaciones del programa nacional de inmunizaciones (PNI) de 2014; los indicadores de cobertura fueron utilizados para clasificar el riesgo de transmision de enfermedades prevenibles en los municipios. RESULTADOS: de los 5.570 municipios brasilenos, 12,0% fueron clasificados de muy bajo riesgo, 29,6% de bajo riesgo, 2,2% de riesgo medio, 54,3% de alto riesgo y 1,8% de riesgo muy alto. CONCLUSION: la vigilancia de la cobertura de vacunacion permitio identificar la mayoria de los municipios en situaciones de alto riesgo y la minoria de ninos que viven en municipios con una cobertura adecuada; la vigilancia de la cobertura de vacunacion segun indicadores acordados en el sistema de salud publica ofrece una nueva herramienta para la identificacion de areas prioritarias en las que la accion pueda tener mayores posibilidades de exito por los administradores de salud para mejorar la calidad y el exito del programa de inmunizacion.OBJECTIVE to describe the transmission risk classification of vaccine-preventable diseases in Brazilian municipalities. METHODS this was a descriptive epidemiologic study using 2014 data of the Brazilian National Immunization Program Information System; the vaccine coverage indicators were used to classify the transmission risk of vaccine-preventable diseases in the municipalities. RESULTS of the 5,570 Brazilian municipalities, 12.0% were classified as very low risk, 29.6% as low risk, 2.2% as medium risk, 54.3% as high risk and 1.8% as very high risk. CONCLUSION the vaccination coverage surveillance allowed to identify most of the municipalities in high risk situation and the minority of children living in municipalities with appropriate coverage; the vaccination coverage surveillance using indicators of the Brazilian National Health System (SUS) is a new tool for identifying priority areas where the actions can be more successful for health managers and improve the quality and the success of the immunizations program.

Avaliação da completude e da oportunidade das notificações de malária na Amazônia Brasileira, 2003-2012

OBJECTIVE to evaluate the completeness and timeliness of malaria case reporting, diagnosis and treatment in the Brazilian Amazon. METHODS this is a descriptive study using data from 23 fields of notification forms recorded on the Malaria Epidemiological Surveillance Information System (Sivep-Malaria) between 2003 and 2012. RESULTS data completeness was good in 86.0% of fields (≥90.0% filled in); there was timely recording of 40.6% of notifications at the Municipal Health Departments (0-7 days following notification) and 75.6% at the Ministry of Health (0-30 days following notification); timely diagnosis and timely treatment occurred in 44.6% and 45.4% of patients, respectively. CONCLUSION most notification forms had good completeness; timeliness in recording notifications was below international standards; timeliness of diagnosis and treatment was below the Ministry of Health recommendations.Objective: to evaluate the completeness and timeliness of malaria case reporting, diagnosis and treatment in the Brazilian Amazon. Methods: this is a descriptive study using data from 23 fields of notification forms recorded on the Malaria Epidemiological Surveillance Information System (Sivep-Malaria) between 2003 and 2012. Results: data completeness was good in 86.0% of fields ( ≥90.0% filled in); there was timely recording of 40.6% of notifications at the Municipal Health Departments (0-7 days following notification) and 75.6% at the Ministry of Health (0-30 days following notification); timely diagnosis and timely treatment occurred in 44.6% and 45.4% of patients, respectively. Conclusion: most notification forms had good completeness; timeliness in recording notifications was below international standards; timeliness of diagnosis and treatment was below Health Ministry recommendations.

Análise do Sistema de Informação da Vigilância de Eventos Adversos Pós-Vacinação no Brasil, 2014 a 2016

RESUMO Objetivo Descrever as características das notificações de eventos adversos pós-vacinação (EAPV) no Sistema de Informação da Vigilância de EAPV (SI-EAPV) on-line nos primeiros 2 anos de operação do sistema. Método Foi realizado um estudo descritivo dos registros de EAPV notificados no SI-EAPV entre julho de 2014 e junho de 2016. Resultados Durante o período do estudo, foram registradas 24 732 notificações. De 5 570 municípios brasileiros, 2 571 (46,2%) realizaram notificação de algum EAPV. Entretanto, somente 1 622 (6,6%) notificações estavam encerradas no momento do estudo; dessas, 89,9% não apresentaram gravidade. Entre as notificações encerradas, 19,7% não tiveram o preenchimento da variável “atendimento médico” e 98,7% não apresentaram registro de exames laboratoriais. As manifestações clínicas sistêmicas neurológicas foram as mais frequentes entre os eventos adversos graves encerrados, correspondendo a 59,5% dos sinais e sintomas. Em relação à idade, os maiores coeficientes de notificação foram registrados entre os menores de 4 anos. Conclusão O SI-EAPV mostra-se útil no monitoramento da segurança das vacinas. Contudo, os municípios precisam ampliar a adesão ao sistema, bem como realizar as investigações e notificações dos EAPV, preenchendo a ficha de notificação de forma adequada e oportuna. O conhecimento sobre EAPV pode ser aplicado na prática dos serviços de vigilância em saúde, melhorando a segurança de utilização dos imunobiológicos.

Characteristics of malaria epidemics in the municipalities of the Brazilian Amazon, 2010

Epidemias de malaria ocorrem anualmente nos municipios da Regiao Amazonica, Brasil, no entanto os servicos de saude nao adotam, de maneira sistematica, instrumentos para deteccao e contencao oportunas desses eventos. O objetivo foi caracterizar as epidemias de malaria na regiao segundo duracao, especie de Plasmodium e vulnerabilidade das populacoes. Foi avaliado um sistema de monitoramento automatizado da incidencia da malaria, com base no diagrama de controle segundo quartis, para identificar as epidemias da doenca. Em 2010, ocorreram epidemias em 338 (41,9%) municipios da regiao. Houve epidemias por P. falciparum e por P. vivax, separadamente, e tambem por ambas as especies. Epidemias com duracao de um a quatro meses ocorreram em 58,3% dos municipios epidemicos; de cinco a oito meses, em 24,3%; e de nove a 12 meses, em 17,4%. O monitoramento automatizado da variacao da incidencia da malaria podera contribuir para deteccao precoce das epidemias e melhorar o seu controle oportuno.Malaria epidemics occur annually in various municipalities (counties) in the Brazilian Amazon. However, health services do not systematically adopt tools to detect and promptly control these events. This article aimed to characterize malaria epidemics in the Brazilian Amazon Region based on their duration, the Plasmodium species involved, and the populations degree of vulnerability. An automatic malaria incidence monitoring system based on quartiles was assessed for prompt identification of malaria epidemics. In 2010, epidemics were identified in 338 (41.9%) of the counties in the Brazilian Amazon. P. falciparum and P. vivax epidemics were detected, both singly and in combination. Epidemics lasted from 1 to 4 months in 58.3% of the counties, 5 to 8 months in 34.5%, and 9 to 12 months in 17.4%. Systematic monitoring of malaria incidence could contribute to early detection of epidemics and improve the effectiveness of control measures.

Caracterización de las epidemias de malaria en los municipios de la Amazonia brasileña en 2010

Epidemias de malaria ocorrem anualmente nos municipios da Regiao Amazonica, Brasil, no entanto os servicos de saude nao adotam, de maneira sistematica, instrumentos para deteccao e contencao oportunas desses eventos. O objetivo foi caracterizar as epidemias de malaria na regiao segundo duracao, especie de Plasmodium e vulnerabilidade das populacoes. Foi avaliado um sistema de monitoramento automatizado da incidencia da malaria, com base no diagrama de controle segundo quartis, para identificar as epidemias da doenca. Em 2010, ocorreram epidemias em 338 (41,9%) municipios da regiao. Houve epidemias por P. falciparum e por P. vivax, separadamente, e tambem por ambas as especies. Epidemias com duracao de um a quatro meses ocorreram em 58,3% dos municipios epidemicos; de cinco a oito meses, em 24,3%; e de nove a 12 meses, em 17,4%. O monitoramento automatizado da variacao da incidencia da malaria podera contribuir para deteccao precoce das epidemias e melhorar o seu controle oportuno.Malaria epidemics occur annually in various municipalities (counties) in the Brazilian Amazon. However, health services do not systematically adopt tools to detect and promptly control these events. This article aimed to characterize malaria epidemics in the Brazilian Amazon Region based on their duration, the Plasmodium species involved, and the populations degree of vulnerability. An automatic malaria incidence monitoring system based on quartiles was assessed for prompt identification of malaria epidemics. In 2010, epidemics were identified in 338 (41.9%) of the counties in the Brazilian Amazon. P. falciparum and P. vivax epidemics were detected, both singly and in combination. Epidemics lasted from 1 to 4 months in 58.3% of the counties, 5 to 8 months in 34.5%, and 9 to 12 months in 17.4%. Systematic monitoring of malaria incidence could contribute to early detection of epidemics and improve the effectiveness of control measures.