Effect of vaccination against Covid-19 one year after its introduction in Brazil.

BACKGROUND: Worldwide, several efforts have been made to develop, distribute and administer safe and effective vaccines to reduce morbidity and mortality and control the Covid-19 pandemic. This study aimed to analyze the effect of vaccination against Covid-19, one year after its introduction in Brazil. METHODS: An ecological study that analyzed the general effect of vaccination against Covid-19 on disease morbidity and mortality indicators among the Brazilian population aged 18 years or older per epidemiological week (EW), comparing the pre and postvaccination period. Morbidity and mortality indicators were calculated from secondary databases (hospitalization rate, severity, case fatality rate and mortality) and vaccination coverage by age groups (18 to 59 years and 60 years or older). Morbimortality trends were estimated using the JoinPoint model and their association with vaccine coverage using the Poisson model. RESULTS: The average weekly percentage change (AWPC) of morbidity and mortality indicators reduced after the introduction of Covid-19 vaccination: hospitalization rate (from 15.3% to -6.0%), severity (from 0.4% to -0.2%), case fatality rate (from 0.3% to -0.2%) and mortality (from 20.5% to -4.3%). The following indicators were inversely associated with the increase in vaccine coverage against Covid-19: hospitalization (IRR: 0.974), mortality (IRR: 0.975) and lethality for people aged 60 years or older (IRR: 0.997). CONCLUSIONS: In spite of the three epidemic waves and the circulation of variants of concern, the general effect of vaccination against Covid-19 in reducing the trend of morbidity and mortality from the disease in Brazil was demonstrated. These findings contribute to a better understanding of the mass vaccination program against Covid-19 and may inform future public health policies.

[Prevalence and intensity of geohelminths infection characterizing the socio-cultural and environmental factors that affect the infection of school children, Paraguay, 2015]. / Prevalencia e intensidad de infección por geohelmintos, caracterizando los factores socio culturales y ambientales que inciden en la infección de escolares, Paraguay, 2015.

INTRODUCTION: Currently, Paraguay has no data on the prevalence of soil-transmitted geohelminth infection in schoolchildren aged 6 to 12 years. AIM: To determine the prevalence and intensity of infection by Ascaris lumbricoides, Trichuris trichiura and hookworms and the socio-cultural-environmental characteristics of the affected population. METHODS: Descriptive, cross-sectional study, in three semi-tropical climatic zones: continental, semi steppe and humid. A total of 1,404 schoolchildren from 20 schools in eight departments were selected from the country's three climate zones. Copro-parasitological exams were analyzed in situ with the Kato-Katz method. RESULTS: The national prevalence for geohelminthiasis was 3.73% (95% CI = 2.8-4.8). The risk factors found were consumption of well water OR: 2.88 (95% CI = 1.64-2.07), ground floor in housing OR: 2.56 (95% CI = 1.45-4.50) and lack of flushing water baths in households OR: 2.29 (95% CI = 1.23-4.28). CONCLUSION: Although the national prevalence of geohelminthiasis was low, it is recommended to promote good hygienic practices, use of footwear, and safe water consumption, as well as designing interventions with all relevant sectors to improve access to safe water and improved basic sanitation facilities.

[Cases of acute pesticide poisoning in Colonia Puerto Pirapó, Itapúa, Paraguay, February, 2014].

In Paraguay, pesticides are the causative agent in 13.7% of poisonings, especially organophosphorus compounds. Such poisoning produces the inhibition of acetylcholinesterase generating three possible clinical conditions: acute poisoning, intermediate syndrome or late neurotoxicity. We present 15 cases of acute poisoning, ten women and five men from a rural community between 5 and 67 years of age, whose symptoms began after using water contaminated by pesticides from the community network. The most common symptoms were nausea and vomiting, followed by abdominal pain, headache, fever, itching, red eyes and sweating. Five patients underwent blood tests for blood count, renal and liver function and serum cholinesterase, with results within the reference values; just one patient had high liver enzymes.In two samples from the community water supply network the active compound detected was profenophos. It is essential to train primary health care personnel to identify cases of acute pesticide poisoning in a timely manner to provide appropriate treatment, especially in rural areas. Additionally, it is necessary that responsible institutions monitor compliance with environmental regulations in these areas to avoid such incidents.

[Seroprevalence of leptospirosis and associated factors in workers of the urban cleaning service of the Municipality of Asuncion, Paraguay]. / Seroprevalencia de leptospirosis y factores asociados en trabajadores del servicio de aseo urbano de la Municipalidad de Asunción, Paraguay.

INTRODUCTION: Leptospirosis is a serious infectious disease that has been linked to occupational activities such as farmers, sewer workers, garbage collectors, butchers and veterinarians. It is acquired through contact with major reservoirs like rodents, pets, or the environment contaminated by their urine. In Paraguay, there are no published reports on the seroprevalence of leptospirosis related to work activity. OBJECTIVE: To determine the seroprevalence and factors associated with transmission of leptospirosis in urban sanitation workers. METHODOLOGY: Descriptive transversal study. The study included workers from the Department of Urban Cleanliness of the City of Asuncion, who had completed at least one month on the job and who agreed to particípate in the study. Sampling was stratified and proportional to the number of workers. After informed consent was obtained, participants were surveyed and a blood sample was taken for detection of Leptospira IgG antibodies by ELISA. RESULTS: Leptospirosis seroprevalence was 8.6% (29/339), all positive cases were male and prevalence was statistically higher in workers of the collection area than in those of other work areas. CONCLUSION: We found a lower than expected seroprevalence. However, conditions observed at work and at home are conducive to transmission of infection. We recommend the improvement of prevention strategies and health promotion in this population.

Brote en simultáneo de Pseudomona aeruginosa y Klebsiella pneumoniae BLEE en una Unidad de Cuidados Intensivos Neonatal de Asunción, Paraguay / Simultaneous outbreak of Pseudomonas Aeruginosa and ESBL producing-Klebsiella Pneumoniae in a Neonatal Intensive Care Unit of Asunción, Paraguay

Las Infecciones Asociadas a las Atenciones Sanitarias (IAAS), constituyen un serio problema de salud pública. Se describe un brote de IAAS en una Unidad de Cuidados Intensivos Neonatales de Asunción y las medidas de control implementadas. Estudio descriptivo de serie de casos, entre el 26 de marzo y el 18 de abril del 2013. Fueron utilizados datos secundarios como historias clínicas, registros de enfermería, certificados de defunción, resultados de bacteriología, registros de control de IAAS. El universo estuvo constituido por 12 neonatos, en cuatro se aislaron Pseudomona aeruginosa y en tres Klebsiella pneumoniae BLEE. Predomino el sexo masculino (6/7), la media de edad de 2 días (rango:2-45 días), la mayoría prematuros (5/7). Todos con procedimientos invasivos durante la hospitalización. La tasa global de ataque fue 58% (7/12), con una tasa de ataque para P. aeruginosa de 33 % (4/12) y para K. pneumoniae BLEE de 38 % (3/12). La mortalidad global fue 29% (2/12) y la tasa de la letalidad atribuible a la infección por P. aeruginosa fue del 50% (2/4). Las medidas de control del brote fueron el aislamiento de los pacientes infectados, una enfermera por paciente, se intensifico los cuidados de bioseguridad para procedimientos invasivos y lavado de manos; suspensión de pacientes remitidos hasta que se asegurar el corte de transmisión. Se confirmó dos brotes simultáneos con agentes etiológicos diferentes, P. aeruginosa y K. pneumoniae BLEE. Es necesario reforzar las medidas de control de infecciones y lavado correcto de manos, de manera a prevenir brotes de IAAS en la UCIN(AU)

Brote de varicela en una escuela militar originada en una comunidad de Paraguay

Introducción: La varicela es una enfermedad infectocontagiosa de distribución mundial, producida por la infección primaria del virus varicela zoster (VVZ), es característica de la edad infantil. El ser humano es el único reservorio conocido. En climas tropicales el patrón no es tan evidente, el virus circula con menos frecuencia y la enfermedad se adquiere en edades más tardías. En mayo del 2013, a raíz de la notificación de cuatro casos de varicela a la Dirección General de Vigilancia de la Salud en una escuela militar se realizó la investigación. Objetivo: Confirmar el brote y proponer recomendaciones de prevención y control. Materiales y Método: Estudio descriptivo de corte transverso. Se realizó la búsqueda activa retrospectiva según la siguiente definición: persona de la Escuela Militar (EM) que consultó por lesiones de piel, fiebre o dolor de garganta entre las semanas epidemiológicas 14 y 21. Los casos sospechosos fueron entrevistados utilizando un cuestionario semi estructurado. Resultados: Además de los cuatro ya notificados, se identificaron 12 casos sospechosos que posteriormente fueron descartados. Los casos fueron todos varones entre 20-24 años de edad, sin historia previa de varicela, uno requirió hospitalización y tratamiento antiviral, cuatro presentaron lesiones en la piel, tres con fiebre y uno con dolor de garganta. Conclusión: Se confirmó el brote en una institución cerrada, la cual tuvo su origen en comunidad del distrito de Quiindy. Todos los casos estaban temporalmente relacionados con el primer caso encontrado en la comunidad. La medida de prevención para los cadetes (alumnos) fue el aislamiento domiciliario por lo que se evitó el contagio en los demás alumnos de la EM. Se recomendó la inmunización contra la varicela en los brotes, intensificar la vigilancia en los servicios de salud de modo que el sistema sea lo suficientemente sensible para responder en forma más oportuna a este tipo de eventos y el aislamiento domiciliario tanto en las poblaciones cerradas como también en la comunidad.

Abstract Introduction: Chickenpox is an infectious disease of worldwide distribution, caused by primary infection of varicella zoster virus (VZV), is characteristic of childhood. Man is the only known reservoir. In tropical climates, the pattern is not so obvious, the virus circulates less frequently and the disease are acquired at later ages. In May 2013, following the notification of four cases of chickenpox to the Directorate General of Health Surveillance in a military school, research was conducted. Objective: To confirm the outbreak and to propose recommendations for prevention and control. Materials and Methods: Cross sectional descriptive study. Were conducted Active retrospective search according to the following definition: a person from the Military School (MS) who presented with skin lesions, fever or sore throat between epidemiological weeks 14 and 21. Suspected cases was interviewed using a semi-structured questionnaire. Results: In addition to the four cases already reported, we identified 12-suspected cases more, but they were discarded later. The cases were all males aged 20-24 years old, with no history of varicella, one required hospitalization and antiviral treatment, four had skin lesions, three had fever and one had sore throat. Conclusion: The outbreak was confirmed in a closed institution, which originated in a community of Quiindy district. All cases were temporally related to the first case found in the community. The preventive measure for cadets (students) was the home insulation so that contagion was prevented in other students of MS. Immunization against chickenpox outbreaks recommended, intensify surveillance in health services so that the system is sensitive enough to respond in a more timely manner to such events and home insulation both in closed populations as well in the community.

Seroprevalencia de leptospirosis y factores asociados en trabajadores del servicio de aseo urbano de la Municipalidad de Asunción, Paraguay / Seroprevalence of leptospirosis and associated factors in workers of the urban cleaning service of the Municipality of Asuncion, Paraguay

Introduction: Leptospirosis is a serious infectious disease that has been linked to occupational activities such as farmers, sewer workers, garbage collectors, butchers and veterinarians. It is acquired through contact with major reservoirs like rodents, pets, or the environment contaminated by their urine. In Paraguay, there are no published reports on the seroprevalence of leptospirosis related to work activity. Objective: To determine the seroprevalence and factors associated with transmission of leptospirosis in urban sanitation workers. Methodology: Descriptive transversal study. The study included workers from the Department of Urban Cleanliness of the City of Asuncion, who had completed at least one month on the job and who agreed to particípate in the study. Sampling was stratified and proportional to the number of workers. After informed consent was obtained, participants were surveyed and a blood sample was taken for detection of Leptospira IgG antibodies by ELISA. Results: Leptospirosis seroprevalence was 8.6% (29/339), all positive cases were male and prevalence was statistically higher in workers of the collection area than in those of other work areas. Conclusion: We found a lower than expected seroprevalence. However, conditions observed at work and at home are conducive to transmission of infection. We recommend the improvement of prevention strategies and health promotion in this population.

Introducción: La leptospirosis es una enfermedad infecciosa grave que ha sido vinculada con actividades ocupacionales, en los agricultores, trabajadores de alcantarillas, recolectores de basura, carniceros y veterinarios; se adquiere a través del contacto con sus principales reservorios como roedores, animales domésticos o ambiente contaminado por su orina. En Paraguay no se tiene reportes publicados sobre la seroprevalencia de leptospirosis relacionados a la actividad laboral. Objetivo: Determinar la seroprevalencia y factores laborales asociados a la transmisión de la leptospirosis en trabajadores de aseo urbano. Metodología: Estudio descriptivo de corte transversal, en el que fueron incluidos trabajadores del Departamento de Aseo Urbano de la Municipalidad de Asunción, con una antigüedad mínima de un mes y que aceptaron participar del estudio. El muestreo fue probabilístico estratificado, proporcional al número de trabajadores. Previo consentimiento informado, los participantes fueron encuestados, y se extrajo una muestra de sangre para la detección de anticuerpos del tipo IgG anti Leptospira por el método de ELISA. Resultados: La seroprevalencia de leptospirosis fue de 8,6% (29/339), todos los casos positivos fueron del sexo masculino, los trabajadores del área de recolección tuvieron una prevalencia estadísticamente mayor que aquellos de otras áreas de trabajo. Conclusión: Se encontró una seroprevalencia menor a la esperada. Sin embargo, a pesar de la prevalencia relativamente baja, las condiciones observadas, tanto en el trabajo como en el hogar, son propicias para la transmisión de la infección por lo que se recomienda mejorar las medidas preventivas y de promoción de la salud en esta población.