Spatial diffusion of the 2015-2016 Zika, dengue and chikungunya epidemics in Rio de Janeiro Municipality, Brazil.

Different countries, especially Brazil, that have faced recurrent dengue epidemics for decades and chikungunya epidemics since 2014, have had to restructure their health services to combat a triple epidemic of arboviruses - Zika, dengue and Chikungunya - transmitted by the same vector, mainly Aedes aegypti, in 2015-2016. Several efforts have been made to better understand these three arboviruses. Spatial analysis plays an important role in the knowledge of disease dynamics. The knowledge of the patterns of spatial diffusion of these three arboviruses during an epidemic can contribute to the planning of surveillance actions and control of these diseases. This study aimed to identify the spatial diffusion processes of these viruses in the context of the triple epidemic in 2015-2016 in Rio de Janeiro, Brazil. Two study designs were used: cross-sectional and ecological. Sequential Kernel maps, nearest-neighbour ratios calculated cumulatively over time, Moran global autocorrelation correlograms, and local autocorrelation changes over time were used to identify spatial diffusion patterns. The results suggested an expansion diffusion pattern for the three arboviruses during 2015-2016 in Rio de Janeiro. These findings can be considered for more effective control measures and for new studies on the dynamics of these three arboviruses.

Abusive alcohol consumption among adolescents: a predictive model for maximizing early detection and responses.

OBJECTIVE: To present a predictive model of alcohol abuse among adolescents based on prevalence projections in various population subgroups. STUDY DESIGN: Cross-sectional study. METHODS: The sample consisted of 785 adolescents enrolled in the second year of high school in Rio de Janeiro, Brazil. Alcohol consumption was assessed using the Alcohol Use Disorder Identification Test. Socio-economic, demographic, family, individuals, and school-related variables were examined as potential predictors. The logit model was used to estimate the prevalence projections. Model fitting was examined in relation to the observed data set, and in a subset, that was generated from 200 subsamples of individuals via a bootstrap process using general fit estimators, discrimination, and calibration measures. RESULTS: About 25.5% of the adolescents were classified as positive for alcohol abuse. Being male, being 17-19 years old, not living with mothers, presenting symptoms suggestive of binge eating, having used a strategy of weight reduction in the last 3 months, and, especially, being a victim of family violence were important predictors of abusive consumption of alcohol. While the model's prevalence projection in the absence of these features was 8%, it reaches 68% in the presence of all predictors. CONCLUSIONS: Knowledge of predictive characteristics of alcohol abuse is essential for screening, early detection of positive cases, and establishing interventions to reduce consumption among adolescents.

Uses of tuberculosis mortality surveillance to identify programme errors and improve database reporting.

BACKGROUND: In 2006, 848 persons died from tuberculosis (TB) in Rio de Janeiro, Brazil, corresponding to a mortality rate of 5.4 per 100 000 population. No specific TB death surveillance actions are currently in place in Brazil. SETTING: Two public general hospitals with large open emergency rooms in Rio de Janeiro City. OBJECTIVE: To evaluate the contribution of TB death surveillance in detecting gaps in TB control. METHODS: We conducted a survey of TB deaths from September 2005 to August 2006. Records of TB-related deaths and deaths due to undefined causes were investigated. Complementary data were gathered from the mortality and TB notification databases. RESULTS: Seventy-three TB-related deaths were investigated. Transmission hazards were identified among firefighters, health care workers and in-patients. Management errors included failure to isolate suspected cases, to confirm TB, to correct drug doses in underweight patients and to trace contacts. Following the survey, 36 cases that had not previously been notified were included in the national TB notification database and the outcome of 29 notified cases was corrected. CONCLUSION: TB mortality surveillance can contribute to TB monitoring and evaluation by detecting correctable and specific programme- and hospital-based care errors, and by improving the accuracy of TB database reporting. Specific local and programmatic interventions can be proposed as a result.

Under-reporting of tuberculosis in Praia, Cape Verde, from 2006 to 2012.

SETTING: According to World Health Organization (WHO) estimates, the under-reporting rate for tuberculosis (TB) in Cape Verde between 2006 and 2012 was 49%. However, the WHO recognises the challenges associated with this estimation process and recommends implementing other methods, such as record linkage, to combat TB under-reporting. OBJECTIVES: To estimate and analyse under-reporting of cases by TB surveillance health units and to evaluate TB cases retrieved from other TB diagnostic sources in Praia, Cape Verde, from 2006 to 2012. DESIGN: This cross-sectional study evaluated under-reporting using the following data: 1) the under-reporting index from TB reporting health units (RHUs), where the number of validated TB cases from RHUs was compared with data from the National Programme for the Fight against Tuberculosis and Leprosy (NPFTL); and 2) the under-reporting index among overall data sources, or a comparison of the number of all validated TB cases from all sources with NPFTL data. RESULTS: The TB under-reporting rate was 40% in Praia during the study period, and results were influenced by laboratory findings. CONCLUSION: The TB under-reporting rate was very similar to the rate estimated by the WHO. TB surveillance must be improved to reduce under-reporting.

Spatial distribution of tuberculosis in Manaus and its social determinants, 2008-2013.

SETTING: Brazil ranks eighteenth worldwide in annual numbers of new tuberculosis (TB) cases. The municipality of Manaus, Amazonas State, has the highest incidence of TB in Brazil. OBJECTIVE: To evaluate the quality of TB epidemiological surveillance, and to describe the spatial distribution pattern of TB incidence in Manaus and its social determinants. DESIGN: An ecological study was performed based on secondary data from TB epidemiological surveillance reports. RESULTS: An index was developed to classify neighborhoods in terms of the quality of surveillance and suspected underreporting. Based on data from neighborhoods with better surveillance performance, we observed that the average number of residents per room, the unemployment rate and the proportion of households connected to a sewage system were significant predictors of TB incidence. Seven neighborhoods in the south and west of the city had clusters of high TB transmission. CONCLUSION: Our results suggest that the association between TB and social vulnerability is obscured by the poor quality of TB surveillance data. We identified priority areas that require immediate TB control interventions and those where local surveillance efforts should be improved, and generated information useful for formulating more effective actions.

Estudo de obitos infantis por pneumonia por meio de inquerito domiciliar: Segunda fase de investigacao / Study of infantilis deaths by pneumonia by mean of inquiry domiciliary

Foi realizada uma investigacao domiciliar junto aos familiares de 154 criancas menores de 5 anos que morreram por pneumonia em Porto Alegre, entre abril de 1987 e marco de 1988; incluiu 91,67% dos obitos que ocorreram no periodo. Detectaram-se diferencas entre as informacoes constantes na Declaracao de Obito e as obtidas atraves das entrevistas. O numero de mortes domiciliares foi de 69 (44,80%) casos e 19 (12,34%) criancas morreram antes de 24 horas deinternacao. Ocorreram 66 (42,86%) obitos em hospital. Discutem-se as causas e suas possiveis associacoes entre elas para a ocorrencia da morte ser hospitalar ounao, fazendo uma extrapolacao a outros estados do pais .