Shifting patterns of dengue three years after Zika virus emergence in Brazil.

In 2015, the Zika virus (ZIKV) emerged in Brazil, leading to widespread outbreaks in Latin America. Following this, many countries in these regions reported a significant drop in the circulation of dengue virus (DENV), which resurged in 2018-2019. We examine age-specific incidence data to investigate changes in DENV epidemiology before and after the emergence of ZIKV. We observe that incidence of DENV was concentrated in younger individuals during resurgence compared to 2013-2015. This trend was more pronounced in Brazilian states that had experienced larger ZIKV outbreaks. Using a mathematical model, we show that ZIKV-induced cross-protection alone, often invoked to explain DENV decline across Latin America, cannot explain the observed age-shift without also assuming some form of disease enhancement. Our results suggest that a sudden accumulation of population-level immunity to ZIKV could suppress DENV and reduce the mean age of DENV incidence via both protective and disease-enhancing interactions.

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.

[Epidemiologic surveillance in the local health system]. / Vigilância epidemiológica no sistema local de saúde.

This is a qualitative study, which aims at analyzing the organization of Epidemiological Vigilance (EV) in the local health system of Feira de Santana-BA, from 1997 to 2001 > in this study the following aspects were considered: organizational structure, resources available (human and material ones), planning, execution, intra and interinstitutional and intersectional articulations, considering the insertion of the city in the "Basic assistance Program". The collection of data was carried out in 3 stages: documental analysis, semi-structured interviews and direct observation with the VE. team. Results revealed that there are frequent changes in the management positions of VE. The structure, centralized in the SMS, prioritizes programmatic actions which are not articulated to the network of services offered. Advances can be noticed in the infrastructure, despite the lack of equipment and the deficiency in the qualification the human resources. The transformation of the model of health assistance is possible if health professionals, managers and users have political interest in changing it the practices in health services.