Telma Abdalla de Oliveira Cardoso

Viral infections in workers in hospital and research laboratory settings: a comparative review of infection modes and respective biosafety aspects

Summary Objectives To compare modes and sources of infection and clinical and biosafety aspects of accidental viral infections in hospital workers and research laboratory staff reported in scientific articles. Methods PubMed, Google Scholar, ISI Web of Knowledge, Scirus, and Scielo were searched (to December 2008) for reports of accidental viral infections, written in English, Portuguese, Spanish, or German; the authors’ personal file of scientific articles and references from the articles retrieved in the initial search were also used. Systematic review was carried out with inclusion criteria of presence of accidental viral infections cases information, and exclusion criteria of absence of information about the viral etiology, and at least probable mode of infection. Results One hundred and forty-one scientific articles were obtained, 66 of which were included in the analysis. For arboviruses, 84% of the laboratory infections had aerosol as the source; for alphaviruses alone, aerosol exposure accounted for 94% of accidental infections. Of laboratory arboviral infections, 15.7% were acquired percutaneously, whereas 41.6% of hospital infections were percutaneous. For airborne viruses, 81% of the infections occurred in laboratories, with hantavirus the leading causative agent. Aerosol inhalation was implicated in 96% of lymphocytic choriomeningitis virus infections, 99% of hantavirus infections, and 50% of coxsackievirus infections, but infective droplet inhalation was the leading mode of infection for severe acute respiratory syndrome coronavirus and the mucocutaneous mode of infection was involved in the case of infection with influenza B. For blood-borne viruses, 92% of infections occurred in hospitals and 93% of these had percutaneous mode of infection, while among laboratory infections 77% were due to infective aerosol inhalation. Among blood-borne virus infections there were six cases of particular note: three cases of acute hepatitis following hepatitis C virus infection with a short period of incubation, one laboratory case of human immunodeficiency virus infection through aerosol inhalation, one case of hepatitis following hepatitis G virus infection, and one case of fulminant hepatitis with hepatitis B virus infection following exposure of the workers conjunctiva to hepatitis B virus e antigen-negative patient saliva. Of the 12 infections with viruses with preferential mucocutaneous transmission, seven occurred percutaneously, aerosol was implicated as a possible source of infection in two cases, and one atypical infection with Macacine herpesvirus 1 with fatal encephalitis as the outcome occurred through a louse bite. One outbreak of norovirus infection among hospital staff had as its probable mode of infection the ingestion of inocula spread in the environment by fomites. Conclusions The currently accepted and practiced risk analysis of accidental viral infections based on the conventional dynamics of infection of the etiological agents is insufficient to cope with accidental viral infections in laboratories and to a lesser extent in hospitals, where unconventional modes of infection are less frequently present but still have relevant clinical and potential epidemiological consequences. Unconventional modes of infection, atypical clinical development, or extremely severe cases are frequently present together with high viral loads and high virulence of the agents manipulated in laboratories. In hospitals by contrast, the only possible association of atypical cases is with the individual resistance of the worker. Current standard precaution practices are insufficient to prevent most of the unconventional infections in hospitals analyzed in this study; it is recommended that special attention be given to flaviviruses in these settings.

Sistemas de indicadores de saúde e ambiente em instituições de saúde

This article presents a discussion on conceptual and methodological aspects involved in the establishment of a system of indicators for Health and Environment, with the purpose of integrating the management of research, education and health services institutes while also taking Biosafety into account. The initial task was the study of international indicator models, paying special attention to the World Health Organization model, more apropriate to this article, which was used in the process of collection, organization and synthesis of data. This work aims to create methodological instruments for the monitoring and evaluation of these procedures and support the decision making process.

Emerging and reemerging diseases in Brazil: data of a recent history of risks and uncertainties

This article discusses the emergence and reemergence of infectious diseases on the basis of a review of the literature. It shows the critical situations faced worldwide and in special Brazils susceptible position due to its complexity, mostly represented by the mega-biodiversity of the country and its socio-economic problems directly affecting public health. It approaches the discussions around the issue with emphasis to the recommended investments in the health sector, directed to surveillance and to strengthening the epidemiological, laboratorial and clinical bases and centered on preventive and control measures in the affected areas including Biosafety.

Bioterrorismo: dados de uma história recente de riscos e incertezas

Today, bioterrorism is a real threat in the whole world. Considering the actions of bioterrorism by using biological agents capable of promoting great epidemics and overload in the health systems of any city, state or country, the bioterrorism is not only a health professional concern, but government and military also. This article discusses a bibliographical review done in the LILACS, MEDLINE, SciELO and REPIDISCA databases, during the period of 1997 the 2007, the characteristics of related national publications to the bioterrorism, the type of biological agents studied, and the existing knowledge in the country to face a bioterrorism event, in order to feed with information the professionals who will act in first reply to the bioterrorism events and that are essential to reduce the number of victims.

Health surveillance, biosafety and emergence and re-emergence of infectious diseases in Brazil.

The present paper presents compulsory notification data for infectious diseases and epidemiologic ones recorded at the Center for Strategic Information and Health Surveillance (CIEVS) for the period of March 2006 to April 2007. Data is presented in accordance with geographic distribution, time and risk classification of the etiologic agents found, according to Ministry of Health regulations. The importance of this epidemiologic surveillance system is presented, debating the main topics required for quality improvement and information analysis. It is concluded, from the analysis of epidemiologic events and their relation to risk management, that the compulsory notification system in Brazil is incomplete, irregular, delayed and, in a large percentage of cases, notification cannot be completed and the agent may not be identified. Quality of data varies from one region to another and from county to county within the same region. There is a high proportion of cases in which the etiologic agent is unknown and, in such cases, a high lethality is expected, establishing a high risk exposure condition for those health professionals involved in health surveillance. From these data, the study points out the need to improve the surveillance system and strengthens the idea of building maximum containment laboratories.

Biossegurança no trabalho em frigoríficos: da margem do lucro à margem da segurança

The cold storage unit and meat production industry has made Brazil one of the leading suppliers and exporters of products of animal origin. The rapid expansion of the market has led to a rise in competitiveness from a capitalist standpoint, and in this respect corporate profit often leads to the need to adapt human actions to new functions in order to reduce costs and maximize production. These routine activities involve repetitive work, multi-tasking, long hours and operating machines with the use of sharp cutting tools, which is why the work is conducted wearing protective gear. Among the main hazards present, biological risks are the most important due to direct exposure to internal organs, blood, fecal matter, urine and placental or fetal fluids from slaughtered animals that may be infected with pathogens of zoonotic origin. This paper discusses the risks to which slaughterhouse-cold storage unit professionals are exposed, conducting a thorough bibliographical review of the literature that takes into consideration the conceptual framework of Biosafety, which contributes to improve the safety and health conditions of these workers.

Hospital seguro frente aos desastres: uma reflexão sobre biossegurança e arquitetura

One of the biggest challenges in todays society is facing adversity caused by disasters. Health facilities, especially hospitals, are considered essential in these situations. This article discusses the principles of architectural design of hospitals safe from disasters, as proposed by the World Health Organization and the Pan American Health Organization. Designing a safe hospital requires multidisciplinary efforts, involving administrators, architects, engineers, physicians, and nurses. The planning of each hospital demands the analysis of specific risks and safety concerns. The concept of biosafety should also be addressed in planning safe hospitals. The balance between architectural aspects and biosafety provides an understanding of work-associated risks, facilitating the adequate planning of spaces to support response actions to emergencies. In short, the planning of a safe hospital requires the synthesis of various types of expertise, including those relating to biosafety and architecture. These principles should support the appraisal of safe hospitals and architectural planning with a focus on preparing facilities to function at full capacity even in the face of adverse situations.

Contribuição de Oswaldo Paulo Forattini à saúde pública: análise da produção científica

I Programa de Pós-Graduação Saúde Materno-infantil. Faculdade de Medicina. Universidade Federal Fluminense. Niterói, RJ, Brasil II Escola Politécnica de Saúde Joaquim Venâncio. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil III Programa de Pós-Graduação em Sustentabilidade. Escola de Artes, Ciências e Humanidades. Universidade de São Paulo. São Paulo, SP, Brasil IV Núcleo de Biossegurança. Escola Nacional Saúde Pública. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, BrasilABSTRACT OBJECTIVE To analyze the main characteristics of the scientific production of Oswaldo Paulo Forattini, researcher and, for 40 years, editor of Revista de Saúde Pública. METHODS Descriptive study with bibliometric approach conducted in three steps. (1) identification of bibliographic records using the following search strategy: “Oswaldo Paulo Forattini” OR “Forattini OP” OR “Forattini” up information sources Google Scholar, Web of Science, and PubMed, in July 2016, which retrieved 867 records. (2) composition of research corpus, in which we included 351 bibliographic records of articles, books, book chapters, editorials, book reviews, informative notes and annual reports of the RSP and excluded 516 duplicates and acknowledgement notes, obituary notes, and nonretrievable citations. (3) data organization and analysis, in which we built databases for descriptive analysis and development of the MeSH coauthors and terms networks in VOSviewer software. For analysis of editorials, three reviewers read the full text of each editorial and categorized them according to subject, historical context and perspectives, relating them with historical milestones. RESULTS Forattini’s scientific production occurred from 1946 to 2009, most consisting of articles (n = 218; 62.1%), editorials (n = 43; 12.3%), and books (n = 13; 3.7%). The main subjects were Culicidae (36.8%), Triatominae (12.5%), and Epidemiology (10.0%). The coauthors of articles were his professors, colleagues of his generation, and graduate students. His editorials addressed critical reflections on the production of knowledge, research priorities, and factors that contributed to or hindered progress. The scope of subjects is broad, referring to socioeconomic and scientific development, public health issues in developed countries, or global health. CONCLUSIONS The analysis shows Forattini’s commitment with public health, research with vectors, training of researchers, and scientific communication.

Study of mortality from infectious diseases in Brazil from 2005 to 2010: risks involved in handling corpses

In the wake of disasters, the lack of information on how to handle and dispose of corpses leads the professionals involved in emergency operations to uncertainty about associated risks and safety precautions. The article seeks to establish the risks of the etiologic agents involved in Brazilian mortality due to infectious diseases and identify and discuss the main protection measures for professionals involved in handling of corpses in disaster situations. It involved a survey of deaths by infectious diseases in Brazil between 2005 and 2010, using data from the Mortality Information System. Of the 171,223 deaths analyzed, the pathogens leading to the greatest number of deaths were: HIV, Mycobacterium tuberculosis and Trypanosoma cruzi. 59% belonged to risk class 3 and 40.6% to risk class 2. Eight deaths were caused by risk class 4 pathogens, which represent high risk. The professionals involved in the handling of corpses may be exposed to chronic risks, such as viruses transmitted via blood, gastrointestinal infections and tuberculosis. These findings indicate the importance of investment in the preparation of measures to reduce the risk of infection associated with the handling of corpses.

Bacillus anthracis como ameaça terrorista

Apos 2001, a utilizacao de patogenos reforcou seu emprego como arma de guerra. Este estudo descritivo tem por objetivo discutir estrategias de contingenciamento em ataque por anthrax, auxiliando no reconhecimento precoce e estabelecimento de medidas de contencao. Profissionais de saude necessitam reconhecer a infeccao, pois em atentados, o elemento-chave e medico e nao militar. O anthrax por inalacao e a forma de atentado mais provavel com 100% de mortalidade, caso nao haja tratamento imediato. E altamente resistente; tem periodo de incubacao de um a seis dias; seus sintomas iniciais sao similares a influenza; so permite diagnostico em NB3; a vacina e aquela recomendada para ocupacoes de risco, de disponibilidade restrita; e requer profilaxia antibiotica longa.