ArboAlvo: stratification method for territorial receptivity to urban arboviruses / ArboAlvo: método de estratificação da receptividade territorial às arboviroses urbanas

ABSTRACT OBJECTIVE To present the urban arboviruses (dengue, zika and chikungunya) stratification methodology by the territorial receptivity Index, an instrument for the surveillance and control of these diseases, which considers the heterogeneity of an intra-municipal territory. METHODS Ecological study that uses as unit of analysis the areas covered by health centers in Belo Horizonte. For the development of a territorial receptivity index, indicators of socio-environmental determination of urban arboviruses were selected in order to integrate the analysis of main components. The resulting components were weighted by the analytic hierarchy process and combined via map algebra. RESULTS The territorial receptivity index showed great heterogeneity of urban infrastructure conditions. The areas classified with high and very high receptivity correspond to approximately 33% of the occupied area and are mainly concentrated in the administrative planning regions of East, Northeast, North, West, and Barreiro, especially in areas surrounding the municipality. When the density of dengue cases and Aedes eggs, from 2016, were superimposed with the stratification by the index of territorial receptivity to urban arboviruses, areas of very high receptivity had a high density of cases and Aedes eggs - higher than that observed in other areas of the city, which corresponds to a very small percentage of the municipal territory (13.5%). CONCLUSION The analyses indicate the need for the development of adequate surveillance and control actions for each context, overcoming the logic of homogeneous allocation throughout the territory.

RESUMO OBJETIVO Apresentar a metodologia de estratificação das arboviroses urbanas (dengue, zika e chikungunya) pelo índice de receptividade territorial, instrumento de vigilância e controle dessas doenças que considera a heterogeneidade territorial intramunicipal. MÉTODOS Estudo ecológico que utiliza como unidade de análise as áreas de abrangência dos centros de saúde de Belo Horizonte (MG). Para a construção do índice de receptividade territorial foram selecionados indicadores de determinação socioambiental das arboviroses urbanas a fim de integrar à análise de componentes principais. As componentes resultantes foram ponderadas por análise de processos hierárquicos e agregadas por meio de álgebra de mapas. RESULTADOS O índice de receptividade territorial evidenciou grande heterogeneidade das condições de infraestrutura urbana. As áreas classificadas como alta e muito alta receptividade correspondem a aproximadamente 33% da área ocupada e se concentram sobretudo nas regiões de planejamento administrativo Leste, Nordeste, Norte, Oeste e Barreiro, principalmente em áreas limítrofes do município. Quando sobrepostas à densidade de casos de dengue e de ovos de Aedes em 2016, a estratificação pelo índice de receptividade territorial às arboviroses urbanas demonstra que áreas de muito alta receptividade apresentam uma densidade de casos, bem como de ovos de Aedes superior àquela observada nas demais áreas da cidade, o que corresponde a um percentual bastante reduzido do território municipal (13,5%). CONCLUSÕES As análises indicam a necessidade do desenvolvimento de ações de vigilância e controle adequadas para cada contexto, superando, assim, a lógica de alocação homogênea em todo o território.

Surveillance of hemorrhagic fever and/or neuroinvasive disease: challenges of diagnosis

ABSTRACT OBJECTIVE To evaluate the performance of post mortem laboratory analysis in identifying the causes of hemorrhagic fever and/or neuroinvasive disease in deaths by arbovirus infection. METHODS Retrospective cross-sectional study based on the differential analysis and final outcome obtained in patients whose samples underwent laboratory testing for arboviruses at the Pathology Center of the Adolfo Lutz Institute, in São Paulo, Brazil. RESULTS Of the 1355 adults clinically diagnosed with hemorrhagic fever and/or neuroinvasive disease, the most commonly attributed cause of death and the most common final outcome was dengue fever. Almost half of the samples tested negative on all laboratory tests conducted. CONCLUSION The failure to identify the causative agent in a great number of cases highlights a gap in the diagnosis of deaths of unknown etiology. Additional immunohistochemical and molecular assessments need to be added to the post-mortem protocol if all laboratory evaluations performed fail to identify a causative agent. While part of our findings may be due to technical issues related to sample fixation, better information availability when making the initial diagnosis is crucial. Including molecular approaches might lead to a significant advancement in diagnostic accuracy.

Severe hemorrhage in a patient with dengue hemorrhagic fever after insertion of orthodontic mini-implants. A case report / Hemorragia severa em paciente com dengue hemorrágica após instalação de miniimplante ortodôntico

The objective of this paper is to report a clinical case of a patient who after installing an orthodontic mini-implant returned to the dental office seven days later with a severe hemorrhage where it was inserted. Because of the severe character of the hemorrhage, the mini-implant was removed, local compression was performed, medication to control bleeding was given and some lab tests were requested. The patient returned in 24 hours with diagnosis of dengue hemorrhagic fever (DHF). The patient was referred to the specialized hematology service where the diagnosis was confirmed. Past the critical period, a new mini-implant was inserted to continue the orthodontic treatment. It can be concluded from this account that despite the mini-implants being devices of simple installation and easy removal, it is important that the patient's systemic conditions are optimal for their overall effectiveness (AU)

The objective of this paper is to report a clinical case of a patient who after installing an orthodontic mini-implant returned to the dental office seven days later with a severe hemorrhage where it was inserted. Because of the severe character of the hemorrhage, the mini-implant was removed, local compression was performed, medication to control bleeding was given and some lab tests were requested. The patient returned in 24 hours with diagnosis of dengue hemorrhagic fever (DHF). The patient was referred to the specialized hematology service where the diagnosis was confirmed. Past the critical period, a new mini-implant was inserted to continue the orthodontic treatment. It can be concluded from this account that despite the mini-implants being devices of simple installation and easy removal, it is important that the patient's systemic conditions are optimal for their overall effectiveness (AU)

Influência dos determinantes sociais e ambientais na distribuição espacial da dengue no município de natal-rn / Influence of environmental and social determinants in spatial distribution of Dengue Fever in Natal, RN-Brazil

Introdução: a reemergência da dengue está relacionada às condições sociais e ambientais que tornam os ambientes propícios à dinâmica de transmissão da doença. Objetivos: identificar o padrão de distribuição espacial da dengue no município de Natal-RN e quantificar a influência dos determinantes sociais e ambientais nessa distribuição. Métodos: foram construídos mapas temáticos e de correlação (LISA) para verificação dedependência espacial e modelos de regressão linear bivariada espacial entre a incidência de dengue e as variáveis sociais. Para observar a associação entre ocorrência de dengue e índices pluviométricos, foi aplicado o teste de Correlação de Pearson. Resultados: no período de 2008 a 2012, as maiores incidências de dengue foram observadas nos bairros de Quintas, Alecrim, e Cidade Alta. O índice de Moran Global (I) foi de 0,31702 (p=0.05). Na análise bivariada pelo Moran Local, as variáveis taxa de crescimento populacional (-0.2349) e proporção de terrenos baldios (-0.2094) apresentaram correlação espacial negativa e fraca com a taxa de incidência de dengue. A precipitação pluviométrica mensal e incidência mensal de dengue no município de Natal apresentou correlação fraca (r=0,399). Conclusão: a análise mostrou que, no município de Natal, a dengue não está autocorrelacionada nem apresenta correlação com os indicadores sociais e ambientais

Introduction: dengue re-emergence is related to social and environmental conditions that make environmentsconducive to transmission dynamics of the disease. Objective: To identify the pattern of spatial distribution ofdengue in the city of Natal-RN and quantify the influence of social and environmental determinants in thisdistribution. Methods: thematic maps were constructed and correlation (LISA) to spatial dependency checking and models of spatial bivariate linear regression between the incidence of dengue and social variables. To observe the association between the occurrence of dengue and rainfall, the Pearson correlation test was used. Results: from2008 to 2012, the highest dengue incidence were observed in the districts of Quintas, Alecrim, and Cidade Alta.The Global Moran index (I) was 0.31702 (p = 0.05). In the bivariate analysis by the Local Moran, the population growth rate variables (-0.2349) and proportion of vacant lots (-0.2094) showed a negative and poor spatial correlation with dengue incidence rate. The monthly rainfall and monthly incidence of dengue in Natal had a weak correlation (r=0.399). Conclusions: The analysis showed that, in Natal, dengue is not autocorrelated nor is correlated with social and environmental indicators

Perfil epidemiológico da dengue no município de natal e região metropolitana no período de 2007 a 2012 / Epidemiological profile of dengue in the city of Natal and metropolitan region in period from 2007 to 2012

Introdução: A dengue é uma doença febril aguda, de notificação compulsória e considerada um sério problema desaúde pública. É responsável por 50 a 100 milhões de casos em todo o mundo e causadora de epidemias que sãodetectadas, principalmente, em muitos centros urbanos. Objetivo: Traçar um perfil epidemiológico da dengue, noperíodo de 2007 a 2012. Métodos: Trata-se de um estudo descritivo, com abordagem quantitativa e comtendências temporais da ocorrência e distribuição dos casos de dengue em Natal e sua região metropolitana. Osdados foram coletados no Sistema de Informação de Agravos de Notificação (SINAN) do Banco de Dados doSistema Único de Saúde (DATASUS). A análise foi feita a partir da estatística descritiva. Resultados: No períodoestudado foram notificados 60.676 casos, sendo Natal o município de maior incidência e de maior número decasos que evoluíram para óbito. O sexo com maior predominância foi o feminino e a faixa etária mais acometidafoi a de adultos jovens (15 a 39 anos). A ausência de notificações em alguns municípios pode predizer aocorrência de subnotificação. Conclusões: O comportamento epidemiológico da doença permitiu caracterizar o período estudado como de perfil endêmico, que pode estar diretamente relacionado aos problemas na infraestrutura dos centros urbanos, entre outros problemas

Introduction: Dengue is an acute febrile disease, reportable and considered a serious public health problem. Itaccounts for 50 to 100 million cases worldwide and causing epidemics that are detected, particularly in many urbanareas. Objective: Draw an epidemiological profile of dengue, from 2007 to 2012. Methods: This is a descriptive study with a quantitative approach and temporal trends in the occurrence and distribution of dengue cases in Natal and its metropolitan area. Data were collected on the System for Notifiable Diseases Information System (SINAN) Database of the Unified Health System (DATASUS). The analysis was made from the descriptive statistics.Results: During the study period were 60,676 reported cases and Natal, the city with the highest incidence andhighest number of deaths. The sex with predominance of cases were female and the most affected age group wasthat of young adults (15-39 years). The lack of notifications in some in some municipalities may predict theoccurrence of underreporting. Conclusions: The epidemiological behavior of the disease characterized the period studied as endemic profile, which is directly related to problems in the infrastructure of urban centers, among other problems

Identificação do biomarcador NS1 na saliva como diagnóstico da dengue / NS1 biomarker identification on saliva for dengue diagnosis

Muitas ferramentas de diagnóstico da dengue tornaram-se disponíveis, porém requerem coleta de sangue como amostra para análise. Um método não invasivo de confirmar a infecção por dengue seria de importância considerável para os estudos clínicos e epidemiológicos. Testes de saliva podem encorajar os pacientes a serem mais receptivos para o diagnóstico da dengue. Possíveis problemas com o uso de sangue incluem a exigência de consentimento e a cooperação do paciente. Em muitos casos, flebotomia em indivíduos com fobia de agulhas, portadores de deficiências e discrasias sanguíneas e, especialmente em bebês e crianças, ou ainda devido a razões sociais, religiosas, à necessidade de um enfermeiro treinado e à necessidade de se separar o soro do plasma antes do teste. Objetivo deste trabalho foi identificar RNA viral em amostras de saliva de pacientes infectados com dengue durante o período febril; avaliar o teste rápido para identificar NS1 em amostra de saliva; identificar a presença de NS1 em amostras de saliva por meio do teste ELISA. Foram coletas amostras de saliva de pacientes durante o período febril com e sem dengue. Todos diagnósticos foram confirmados por exame de sangue para IgM/IgG. Foi feito o teste da Reação em Cadeia da Polimerase em Tempo Real em 10 amostras de pacientes com dengue. Em 44 amostras foram testados as tiras de diagnóstico rápido da dengue e ao teste ELISA NS1, para a detecção da proteína NS1. Esse estudo ressaltou a importância da busca pelo diagnóstico laboratorial rápido, prático e financeiramente acessível de doenças febris agudas com sintomas inespecíficos, principalmente em áreas de ocorrência de dengue. Nesse estudo foi encontrada alta especificidade (94%) e média sensibilidade (73%) nos resultados da identificação da proteína NS1 nas amostras de saliva em estágios precoces da infecção por dengue. Esse método, se aprimorado para saliva, poderá ter resultados ainda melhores, por isso mais estudos são necessários.

This study brings a literature review about the current dengue status worldwide and in Brazil followed by a systematic review that highlights the dengue diagnosis through saliva. A prospective study was also made, which evaluated the dengue virus infection diagnosis accuracy through the NS1 antigen detection in saliva samples using ELISA assays. The NS1-ELISA results in saliva were compared to the IgM-ELISA and IgG-ELISA serology. A total of 44 saliva samples were obtained from November 2012 to February 2013. The results showed that de NS1-ELISA presented a sensibility of 0.73, specificity of 0.94, Positive Predictive Value of 0.95, Negative Predictive Value of 0.70, Positive Likelihood Ratio of 13.15, Negative Likelihood Ratio of 0.28. Having these findings in mind, it is possible to suggest that the NS1 detection in saliva may be an important diagnostic tool in special cases, such as people that fear needles, with blood dyscrasias, babies, children, as well as to quickly monitor epidemics and their dissemination.

Epidemiological study of Dengue infections in patients attended in a Public General Hospital, in Rio de Janeiro City, Brazil, during the outbreak of 2001-2002

From November of 2001 until April of 2002, a total of 1124 blood samples were collected from patients suspected of dengue infection attendedin the Hospital Municipal Paulino Werneck (HMPW), Ilha do Governador, Rio de Janeiro, Brazil. The samples were used for anti-dengue IgM and IgG detection, virus isolation, RT-PCR and Real time PCR. From those samples tested, 13.1 por cento (147/1124) were positive by IgM capture enzyme-linked immunosorbent assay. From these, 95 (64.6 por cento) presented only IgM and 52 (35.4 por cento) showed the presence of anti-dengue IgG. Considering the rate between IgM and IgG > 1.5 as an indicative of primary infection, from the 147 infections by the dengue virus, 102 (69 por cento) cases were characterized as primary infection and 45 (31 por cento) as secondary infection. Among the seropositive patients the proportion of females, young adults and individuals residing in Ilha do Governador was higher. The population most affected was white without predominance of a specific gender, age and location of residence. The most significant clinical manifestations observed were rash and itching and leukopenia, lymphocytosis and thrombocytopenia constituted the main hematological profile observed in the patients with dengue infection. The epidemic occurred during the hottest months of the year where elevated temperatures and high pluvial index are common. A higher seropositivity was observed in serum samples collected between the 4th and 8th day after the onset of the disease. The virus serotype virus responsible for the epidemic belongs to serotype 3 and Real time PCR demonstrated to be more sensitive than the conventional technique used to detect the infecting serotype.