Epidemiology and costs of dengue in Brazil: a systematic literature review.

OBJECTIVES: Dengue infection is a growing public health problem, with the number of reported cases increasing in the Americas and worldwide. This review characterized the epidemiological and economic burden of dengue in Brazil. METHODS: Embase, MEDLINE, evidence-based review databases, and gray literature sources were searched for published literature and surveillance reports on epidemiology (between 2000 and 2019) and costs (between 2009 and 2019) of dengue in Brazil. Studies were included if they reported data on incidence, seroprevalence, serotype distribution, expansion factors, hospitalization, mortality, or costs. Data were summarized descriptively and reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: A total of 344 publications were included (167 peer-reviewed and 177 gray literature). Dengue outbreaks increased in incidence and frequency, with the highest incidence observed in 2015 at 807 cases per 100,000 population. Outbreaks were related to alternating predominant serotypes. Dengue was more frequent in young adults (aged 20-39 years) and in the Midwest. Cost and societal impacts are substantial and varied across regions, age, and public/private delivery of healthcare services. CONCLUSION: The burden of dengue in Brazil is increasing and likely underestimated. Therefore, developing and implementing new strategies, including vaccination, is essential to reduce the disease burden.

Validation of Embedded State Estimator Modules for Decentralized Monitoring of Power Distribution Systems Using IoT Components.

Recent theoretical studies demonstrate the advantages of using decentralized architectures over traditional centralized architectures for real-time Power Distribution Systems (PDSs) operation. These advantages include the reduction of the amount of data to be transmitted and processed when performing state estimation in PDSs. The main contribution of this paper is to provide lab validation of the advantages and feasibility of decentralized monitoring of PDSs. Therefore, this paper presents an advanced trial emulating realistic conditions and hardware setup. More specifically, the paper proposes: (i) The laboratory development and implementation of an Advanced Measurement Infrastructure (AMI) prototype to enable the simulation of a smart grid. To emulate the information traffic between smart meters and distribution operation centers, communication modules, that enable the use of wireless networks for sending messages in real-time, are used, bridging concepts from both IoT and Edge Computing. (ii) The laboratory development and implementation of a decentralized architecture based on Embedded State Estimator Modules (ESEMs) are carried out. ESEMs manage information from smart meters at lower voltage networks, performing real-time state estimation in PDSs. Simulations performed on a real PDS with 208 buses (considering both medium and low voltage buses) have met the aims of this paper. The results show that by using ESEMs in a decentralized architecture, both the data transit through the communication network, as well as the computational requirements involved in monitoring PDSs in real-time, are reduced considerably without any loss of accuracy.

Prevention and control of Aedes transmitted infections in the post-pandemic scenario of COVID-19: challenges and opportunities for the region of the Americas.

The coronavirus disease of 2019 (COVID-19) pandemic challenges public health systems around the world. Tropical countries will face complex epidemiological scenarios involving the simultaneous transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with viruses transmitted by Aedes aegypti. The occurrence of arboviral diseases with COVID-19 in the Latin America and the Caribbean (LAC) region presents challenges and opportunities for strengthening health services, surveillance and control programs. Financing of training, equipment and reconversion of hospital spaces will have a negative effect on already the limited resource directed to the health sector. The strengthening of the diagnostic infrastructure reappears as an opportunity for the national reference laboratories. Sharing of epidemiological information for the modeling of epidemiological scenarios allows collaboration between health, academic and scientific institutions. The fear of contagion by COVID-19 is constraining people with arboviral diseases to search for care which can lead to an increase in serious cases and could disrupt the operation of vector-control programs due to the reluctance of residents to open their doors to health personnel. Promoting intense community participation along with the incorporation of long lasting innovations in vector control offers new opportunities for control. The COVID-19 pandemic offers challenges and opportunities that must provoke positive behavioral changes and encourage more permanent self-care actions.

Prevention and control of Aedes transmitted infections in the post-pandemic scenario of COVID-19: challenges and opportunities for the region of the Americas

The coronavirus disease of 2019 (COVID-19) pandemic challenges public health systems around the world. Tropical countries will face complex epidemiological scenarios involving the simultaneous transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with viruses transmitted by Aedes aegypti. The occurrence of arboviral diseases with COVID-19 in the Latin America and the Caribbean (LAC) region presents challenges and opportunities for strengthening health services, surveillance and control programs. Financing of training, equipment and reconversion of hospital spaces will have a negative effect on already the limited resource directed to the health sector. The strengthening of the diagnostic infrastructure reappears as an opportunity for the national reference laboratories. Sharing of epidemiological information for the modeling of epidemiological scenarios allows collaboration between health, academic and scientific institutions. The fear of contagion by COVID-19 is constraining people with arboviral diseases to search for care which can lead to an increase in serious cases and could disrupt the operation of vector-control programs due to the reluctance of residents to open their doors to health personnel. Promoting intense community participation along with the incorporation of long lasting innovations in vector control offers new opportunities for control. The COVID-19 pandemic offers challenges and opportunities that must provoke positive behavioral changes and encourage more permanent self-care actions.

How Does the Adjustment of Training Task Difficulty Level Influence Tactical Behavior in Soccer?

Purpose: This study aimed to investigate if player tactical skill level and age category influence team performance and player exploratory behavior in tasks with different difficulty levels. Method: In total, 48 youth male soccer players participated in the study (U15, n = 24, mean age = 13.06 ± 1.53 years; U17, n = 24, mean age = 16.89 ± 0.11 years). Player tactical skills were evaluated through the System of Tactical Assessment in Soccer (FUT-SAT), allowing them to be organized into three groups according to tactical efficiency: Higher tactical skill level (Group 01), Intermediate tactical skill level (Group 02), and Lower tactical skill level (Group 03). Next, Group 01 and Group 03 of both categories performed six Small-Sided and Conditioned Games (SSCG) each, namely three High difficulty SSCGs and three Low difficulty SSCGs. Team performance and players' exploratory behavior were analyzed through the Offensive Sequences Characterization System and Lag Sequential Analysis, respectively. Results: We found that team performance and players' exploratory behavior were influenced both by the age and tactical skill level of the players, as well as by task difficulty level. Conclusion: Therefore, in an attempt to improve player performance, practitioners must carefully manipulate key task constraints to adapt training task difficulty levels to player age and tactical skill level.

Chikungunya surveillance in Brazil: challenges in the context of Public Health. / Vigilância de chikungunya no Brasil: desafios no contexto da Saúde Pública.

OBJECTIVE: to describe the challenges in implementing the chikungunya surveillance and prevention system in Brazil. METHODS: this was a descriptive study of suspected cases of the disease based on records held on the Notifiable Diseases Information System (Sinan) for the period 2014-2016. RESULTS: more than 100,000 probable chikungunya cases were notified in Brazil in this period, with the largest concentration in the Northeast states (83.3% between 2014 and 2015; 91.0% in 2016); Sinan provided an excellent opportunity for closing records of cases occurring between 2014 and 2015 (85%) and high completeness of obligatory variables. CONCLUSION: given the imminence of the introduction of chikungunya in Brazil in 2014, advance public health preparation took place in order to minimize its effects on society; implementation of the surveillance system improved collection of information regarding the disease, however many challenges can be seen in practice, in view of increasing case incidence. This requires greater handling capacity in this sector.

Time series analysis of dengue surveillance data in two Brazilian cities.

The aim of the study was to evaluate the temporal patterns of dengue incidence from 2001 to 2014 and forecast for 2015 in two Brazilian cities. We analysed dengue surveillance data (SINAN) from Recife, 1.6 million population, and Goiania, 1.4 million population. We used Auto-Regressive Integrated Moving Average (ARIMA) modelling of monthly notified dengue incidence (2001-2014). Forecasting models (95% prediction interval) were developed to predict numbers of dengue cases for 2015. During the study period, 73,479 dengue cases were reported in Recife varying from 11 cases/100,000 inhab (2004) to 2418 cases/100,000 inhab (2002). In Goiania, 253,008 dengue cases were reported and the yearly incidence varied from 293 cases/100,000 inhab (2004) to 3927 cases/100,000 inhab (2013). Trend was the most important component for Recife, while seasonality was the most important one in Goiania. For Recife, the best fitted model was ARIMA (1,1,3)12 and for Goiania Seasonal ARIMA (1,0,2) (1,1,2)12. The model predicted 4254 dengue cases for Recife in 2015; SINAN registered 35,724 cases. For Goiania the model predicted 33,757 cases for 2015; the reported number of cases by SINAN was 74,095, within the 95% prediction interval. The difference between notified and forecasted dengue cases in Recife can be explained by the co-circulation of dengue and Zika virus in 2015. In this year, all cases with rash were notified as "dengue-like" illness. The ARIMA models may be considered a baseline for the time series analysis of dengue incidence before the Zika epidemic.

Febre Chikungunya um desafio para o sistema de vigilância sanitária em saúde: revisão sistemática / Chikungunya Fever, a challenge for the health surveillance system: a systematic review

Introdução: No cenário internacional, o vírus Chikungunya é importante causa de morbidade. Por dispersar-se rapidamente para locais em que são encontrados os mosquitos Aedes aegypti e Aedes albopictus, tornou-se um desafio para a vigilância em saúde mundial. Objetivos: Revisar a literatura científica sobre a ocorrência da Febre do Chikungunya e a resposta da vigilância em saúde frente a surtos e epidemias. Métodos: Revisão sistemática de estudos primários publicados no período de 2005 a 2015, pesquisados nas bases de dados MEDLINE, SCOPUS, Web of Science, TripDatabase e BVS, com estratégia de busca que utilizou descritores em saúde referentes ao vírus Chikungunya e à vigilância em saúde. Resultados: Foram selecionados 13 artigos sobre o tema proposto. Conclusão: Evidenciou-se a necessidade de potencializar a integração das redes de vigilância, instituições de saúde, laboratórios de diagnóstico e ações de combate ao vetor, para acelerar a detecção de casos importados e de transmissão autóctone, bem como eliminação do vetor competente

Introduction: The Chikungunya virus is an important cause of morbidity in the international scene. It rapidly disperses to the sites where the Aedes aegypti and Aedes albopictus mosquitoes are found. Because this, it is a challenge for global health surveillance. Objectives: To review the scientific literature about Chikungunya fever's incidence and the health surveillance response to outbreaks and epidemics. Methods: Systematic review of primary studies published between 2005 and 2015, searched in databases (MEDLINE, SCOPUS, Web of Science, TripDatabase and BVS) using a strategy with Medical Subject Headings about Chikungunya virus and health Surveillance. Results: Were found 13 articles about the proposed theme of study. Conclusion: It is necessary to strengthen the integration of surveillance networks, health institutions, diagnostic laboratories and anti-vector actions in order to facilitate the early detection of imported cases and autochthonous transmission, and the elimination of the vector

Vigilância de chikungunya no Brasil: desafios no contexto da Saúde Pública / Vigilancia de chikungunya en Brasil: desafíos en el contexto de la Salud Pública / Chikungunya surveillance in Brazil: challenges in the context of Public Health

Objetivo: descrever os desafios da implantação do sistema de vigilância e prevenção de chikungunya no Brasil. Métodos: estudo descritivo dos casos suspeitos da doença notificados no Sistema de Informação de Agravos de Notificação (Sinan) entre 2014 e 2016. Resultados: no período estudado, foram notificados mais de 100 mil casos prováveis de chikungunya no país, com maior concentração nos estados do Nordeste (83,3% entre 2014 e 2015; 91,0% em 2016); o Sinan apresentou excelente oportunidade de encerramento dos casos entre 2014 e 2015 (85%) e alta completitude das variáveis obrigatórias. Conclusão: com a introdução de chikungunya no Brasil em 2014, houve um preparo prévio em termos de Saúde Pública para minimizar seus efeitos na sociedade; a implantação do sistema de vigilância ampliou a coleta de informações da doença, embora muitos desafios mostrem-se evidentes na prática, haja vista a incidência crescente de casos, demandando maior capacidade operante desse setor.

Objetivo: describir los desafíos de la implantación del sistema de vigilancia y prevención de chikungunya en Brasil. Métodos: estudio descriptivo de los casos sospechosos notificados en el Sistema de Notificación de Enfermedades Obligatorias (Sinan) entre 2014 y 2016. Resultados: en el período estudiado se notificaron más de 100 mil casos probables de chikungunya con mayor concentración en los estados del Nordeste (83,3% entre 2014 y 2015 y el 91,0% en 2016); el Sinan presentó una excelente oportunidad de cierre de los casos entre 2014 y 2015 (85%) y alta completitud de las variables obligatorias. Conclusión: con la introducción de chikungunya en Brasil hubo una preparación previa para minimizar sus efectos en la sociedad; la implantación del sistema de vigilancia ha ampliado la recolección de información sobre la enfermedad, sin embargo, muchos desafíos son evidenciados en la práctica, pues la incidencia de casos es creciente, necesitando de mayor capacidad operante de ese sector.

Objective: to describe the challenges in implementing the chikungunya surveillance and prevention system in Brazil. Methods: this was a descriptive study of suspected cases of the disease based on records held on the Notifiable Diseases Information System (Sinan) for the period 2014-2016. Results: more than 100,000 probable chikungunya cases were notified in Brazil in this period, with the largest concentration in the Northeast states (83.3% between 2014 and 2015; 91.0% in 2016); Sinan provided an excellent opportunity for closing records of cases occurring between 2014 and 2015 (85%) and high completeness of obligatory variables. Conclusion: given the imminence of the introduction of chikungunya in Brazil in 2014, advance public health preparation took place in order to minimize its effects on society; implementation of the surveillance system improved collection of information regarding the disease, however many challenges can be seen in practice, in view of increasing case incidence. This requires greater handling capacity in this sector.

Dengue em gestantes: caracterização dos casos no Brasil, 2007-2015 / Dengue en embarazadas: caracterización de casos en Brasil, 2007-2015 / Dengue in pregnant women: characterization of cases in Brazil, 2007-2015

OBJETIVO: caracterizar os casos prováveis de dengue em gestantes notificados no Brasil, de 2007 a 2015. MÉTODOS: estudo descritivo das características sociodemográficas, epidemiológicas, clínicas e laboratoriais, com dados do Sistema de Informação de Agravos de Notificação (Sinan). RESULTADOS: a incidência anual de dengue em gestantes variou de 3,3 (2009) a 816,6 (2010) casos por 100 mil nascidos vivos; dos 43.772 casos prováveis de dengue em gestantes, 81,6% foram investigados, 34,1% confirmados laboratorialmente e 1,7% graves; as taxas de hospitalização e letalidade foram de 5,4% e 1,6‰, respectivamente; o risco de óbito por dengue foi maior na população de gestantes do que na população de mulheres em idade fértil não gestantes (razão=3,95; intervalo de confiança de 95% ou IC95%=3,07;5,08), superior no terceiro trimestre da gestação (razão=8,55; IC95%=6,08;12,02). CONCLUSÃO: os resultados evidenciam a carga da dengue entre gestantes, sua vulnerabilidade ao agravamento e óbito pela doença.

OBJETIVO: caracterizar los casos probables de dengue en las mujeres embarazadas reportados en Brasil entre 2007 y 2015. MÉTODOS: estudio descriptivo de los datos de las enfermedades de declaración obligatoria del Sistema de Información (Sinan). RESULTADOS: la incidencia anual de dengue osciló entre 3,3 (2009) a 816,6 (2010) casos por cada 100 mil nacidos vivos; de los 43.772 casos probables de dengue, el 81,6% fueron investigados, 34,1% confirmados en laboratorio y 1,7% grave; las tasas de hospitalización y letalidad fueron 5,4% y 1,6%, respectivamente; el riesgo de muerte por dengue fue mayor en embarazadas que en mujeres en edad fértil no embarazadas (ratio=3,95 [IC95%=3,07;5,08]), y mayor en el tercer trimestre (ratio=8,55; [IC95%=6.08;12.02]). CONCLUSIÓN: los resultados muestran la carga de dengue en embarazadas y la vulnerabilidad de éstas al agravamiento y muerte por esta enfermedad.

OBJECTIVE: to characterize the probable cases of dengue in pregnant women reported in Brazil, from 2007 to 2015. METHODS: descriptive study of sociodemographic, epidemiological, clinical and laboratory characteristics, with data from the Information System for Notifiable Diseases (Sinan). RESULTS: the annual incidence of dengue in pregnant women ranged from 3.3 (2009) to 816.6 (2010) cases per 100 thousand live births; of the 43,772 probable cases of dengue in pregnant women, 81.6% were investigated, 34.1% were confirmed by laboratory tests, and 1.7% were severe cases; hospitalization and fatality rates were of 5.4% and 1.6‰, respectively; the risk of death due to dengue was higher in pregnant women than in the population of non-pregnant women at reproductive age (ratio=3.95; 95%CI=3.07;5.08), and higher in the third trimester of pregnancy (ratio=8.55; 95%CI=6.08;12.02). CONCLUSION: the results show the burden of dengue in pregnant women and their vulnerability to worsening of the disease and death.

A Fatal Hantavirus Pulmonary Syndrome Misdiagnosed as Dengue: An Investigation into the First Reported Case in Rio de Janeiro State, Brazil.

We report the results of an investigation into a fatal case of hantavirus pulmonary syndrome (HPS) in Rio de Janeiro State, Brazil, where the disease had not been reported previous to 2015. Following the notification of an HPS case, serum samples were collected from the household members and work contacts of the HPS patient and tested for antibody to hantaviruses. Seroprevalence of 22% (10/45) was indicated for hantavirus out of 45 human samples tested. Blood and tissue samples were collected from 72 rodents during fieldwork to evaluate the prevalence of hantavirus infection, by using enzyme-linked immunosorbent assay IgG, and to characterize the rodent hantavirus reservoir(s), by reverse transcription polymerase chain reaction and sequencing. Antibody prevalence was 6.9%. The circulation of a single genotype, the Juquitiba hantavirus, carried by two rodent species, black-footed pigmy rice rat (Oligoryzomys nigripes) and cursor grass mouse (Akodon cursor), was shown by analysis of the nucleotide sequences of the S segment. Juquitiba hantavirus circulates in rodents of various species, but mainly in the black-footed pigmy rice rat. HPS is a newly recognized clinical entity in Rio de Janeiro State and should be considered in patients with febrile illness and acute respiratory distress.

Estimativa de custos diretos do Programa Municipal de Controle da Dengue de Goiânia-GO / Costs of the Municipal Dengue Control Program of Goiânia, Brazil / Costos directos del Programa Municipal de Control de Dengue de Goiânia-GO, Brasil

OBJETIVO: estimar os custos do Programa Municipal de Controle da Dengue de Goiânia-GO, Brasil. MÉTODOS: estudo de custo de programa considerando períodos epidêmico (outubro/2009-abril/2010) e endêmico (maio-setembro/2010) de transmissão da doença, na perspectiva do Sistema Único de Saúde (SUS); os componentes de custo analisados foram recursos humanos, capacitação, infraestrutura, equipamentos de escritório, transporte, equipamentos de proteção individual, material de campo, material laboratorial, inseticidas e mobilização social; custos de capital (investimento) e recorrentes foram considerados. RESULTADOS: a média mensal de custos recorrentes foi de R$1.355.760 (US$814,075) e R$981.100 (US$589,108) nos períodos epidêmico e endêmico respectivamente; o custo de capital anual foi estimado em R$683.315 (US$410,301); cerca de 82%, 15% e 3% do custo total referem-se, respectivamente, às fontes de recurso municipal, federal e estadual. CONCLUSÃO: o custo adicional resultante das epidemias de dengue fornece subsídios para um melhor planejamento das atividades de prevenção e controle da infecção.

OBJECTIVE: to estimate the cost of the Municipal Program for Dengue Control in Goiânia, GO, Brazil. METHODS: Costs of program considering epidemic (October/2009-April/2010) and endemic (May-September/2010) periods of dengue transmission, from the perspective of the National Unified Health System (SUS); cost components considered were human resources, training, infrastructure, office equipment, transportation, personal protective equipment, field equipment, laboratory equipment, insecticides and social mobilization; capital (investment) and recurring costs were considered. RESULTS: average monthly recurring costs were R$1,355,760 (US$814,075) and R$981,100 (US$589,108), for the epidemic and endemic periods, respectively; annual capital cost was R$683,315 (US$410,301); approximately 82%, 15% and 3% of the total cost were from municipal, federal and state level funding sources, respectively. CONCLUSION: estimated incremental costs resulting from dengue epidemics provide information to support planning of dengue prevention and control activities.

OBJETIVO: estimar los costos del Programa Municipal de Control de Dengue en el municipio de Goiânia-GO, Brasil. MÉTODOS: estudio de costos del programa teniendo en cuenta períodos epidémicos (octubre/2009-abril/2010) y endémicos (mayo-septiembre/2010) de la transmisión de dengue; dentro de la perspectiva del Sistema Único de Salud (SUS); los componentes de los costos analizados fueron recursos humanos, capacitación, infraestructura, equipo de oficina, transporte, equipo de protección personal, equipo de campo, materiales de laboratorio, insecticidas y movilización social, teniendo en cuenta los costos de capital (inversión) y recurrentes. RESULTADOS: el valor mensual de costos recurrentes fue R$1.355.760 (US$814,075) y R$981.100 (US$589,108), en los períodos epidémicos y endémicos, respectivamente; los costos de capital durante el periodo de estudio fueron R$683,315 (US$410,301); alrededor de 82%, 15% y 3% de los costos totales fueron de fuente municipal, federal y estatal, respectivamente. CONCLUSIÓN: el conocimiento de los costos adicionales resultantes de las epidemias de dengue puede apoyar a una mejor planificación de las actividades de prevención y control del dengue.

Avaliação da qualidade dos dados, valor preditivo positivo, oportunidade e representatividade do sistema de vigilância epidemiológica da dengue no Brasil, 2005 a 2009* / Evaluation of the Dengue Epidemiological Surveillance System data quality, positive predictive value, timeliness and representativeness, Brazil, 2005-2009

Avaliar a qualidade dos dados, o valor preditivo positivo (VPP), a oportunidade e a representatividade do sistema de vigilância epidemiológica da dengue no Brasil entre 2005 e 2009. Métodos: estudo de avaliação, com análise dos dados de dengue do Sistema de Informação de Agravos de Notificação (Sinan) conforme atributos selecionados da metodologia do Centers for Disease Control and Prevention (Atlanta/GA, Estados Unidos da América). Resultados: houve melhora na qualidade dos dados quanto a sua consistência; o VPP dos casos de dengue variou de 34 a 65 por cento; o sistema apresentou uma mediana de oportunidade para notificação dos casos de 3 dias e revelou-se representativo, permitindo conhecer a situação da doença no país. Conclusão: o sistema de vigilância da dengue no Brasil mostrou-se consistente, com valor preditivo positivo expressivo, oportuno para notificação de casos e representativo, capaz de detectar tendência de mudança no perfil epidemiológico da doença...

To evaluate the dengue surveillance system data quality, positive predictive value (PPV), timeliness and representativeness in Brazil from 2005 to 2009. Methods: this was an observational, descriptive and cross-sectional study with analysis of data on dengue held on the Notifiable Diseases Information System (Sinan), based on the methodology proposed by the Centers for Disease Control and Prevention. Results: improvement in the quality of the data with regard to consistency; dengue case PPV ranged from 34 per cent to 65 per cent; the system showed a median time of three days for case notification and was found to be representative, providing knowledge of the disease’s status in the country. Conclusion: the dengue surveillance system in Brazil proved to be consistent, with significant positive predictive value, timely case reporting, as well as being representative and able to detect trends of change in the disease’s epidemiological profile...

Avaliação dos atributos de aceitabilidade e estabilidade do sistema de vigilância da dengue no estado de Goiás, 2011 / An evaluation of the acceptability and stability of the Dengue Surveillance System in Goiás state, Brazil, 2011

Objetivo: avaliar os atributos de aceitabilidade e estabilidade do sistema de vigilância da dengue no estado de Goiás, Brasil, em 2011. Métodos: estudo descritivo utilizando o método do Centers for Disease Control and Prevention (CDC/USA), com aplicação de questionário a profissionais envolvidos na vigilância da dengue. Resultados: 134 profissionais participaram do estudo, representando 41,5 por cento (102/246) dos municípios goianos; dificuldades para o encerramento dos casos graves foram referidas por 34,5 por cento dos coordenadores de vigilância; aproximadamente 70 por cento dos participantes informaram desconhecer a existência de um plano de contingência para o enfrentamento de epidemias de dengue e 59 por cento responderam que todos os casos suspeitos de dengue deveriam ser confirmados laboratorialmente, independentemente da ocorrência de epidemias; para 75 por cento dos entrevistados, a digitação das fichas de notificação/investigação foi realizada sem intercorrências. Conclusão: o sistema de vigilância da dengue apresentou funcionamento estável; porém, as limitações observadas remetem à necessidade de seu aprimoramento.

Objective: to evaluate the acceptability and stability of the dengue surveillance system in Goiás State, Brazil. Methods:descriptive study based on the Centers for Disease Control and Prevention (CDC) method using a questionnaire applied to professionals involved in dengue surveillance in 2011. Results: 134 professionals participated in the study, representing 41.5 per cent (102/246) of the municipalities in Goiás. Difficulties in closing severe cases were reported by 34.5 per cent of epidemiological surveillance coordinators, some 70 por cent of participants were unaware of the existence of a contingency plan for dengue outbreaks and 59 per cent responded that all suspected cases should be laboratory confirmed, regardless of the occurrence of epidemics. 75 per cent of respondents reported having no difficulty in inputting data on the Surveillance Information System. Conclusion: despite the stability of the dengue surveillance routines, the limitations observed indicate the need for system enhancement.

Th1 immune response to H. pylori infection varies according to the age of the patients and influences the gastric inflammatory patterns.

To compare children and adults in respect to the effect of H. pylori infection on the gastric concentrations of cytokines linked to innate and Th1 immune response, as well as to investigate the changes in the gastric concentrations of the studied cytokines according to the age. We studied 245 children (142 H. pylori-negative and 103 H. pylori-positive) and 140 adults (40 H. pylori-negative and 100 H. pylori-positive). The gastric concentrations of cytokines representative of the innate and Th1 response were higher in the H. pylori-positive than in the -negative children and adults. The gastric concentrations of IL-1α and TNF-α were significantly higher, while those of IL-2, IL-12p70 and IFN-γ were lower in the infected children than in the infected adults. In the infected children, the gastric concentration of IL-1α, IL-2, IL-12p70 and IFN-γ increased, whereas in adults, the gastric concentrations of IFN-γ and IL-12p70 decreased with the aging. Increased gastric concentration of Th1 associated cytokines correlated with increased degree of gastritis that is the background lesion for the development of the H. pylori associated severe diseases. Concluding, Th1 response to H. pylori infection varies according to the age and seems to have determinant implication in the H. pylori infection outcomes.

Fatores associados à dor pós-operatória na recuperação pós-anestésica em pacientes submetidos à gastroplastia laparoscópica / Factors associated to postoperative pain in the post-anesthetic care unit in patients submitted to laparoscopic gastroplasty

JUSTIFICATIVA E OBJETIVOS: A dor pós-operatória em pacientes obesos é um evento prejudicial para sua recuperação, retardando a alta e aumentando a chance de complicações. O objetivo deste estudo foi determinar a frequência de dor na sala de recuperação pós-anestésica e averiguar os fatores associados à ocorrência de dor moderada ou intensa em obesos submetidos a gastroplastia, relacionando-os a possíveis complicações. MÉTODOS: Estudo observacional prospectivo incluindo 84 pacientes submetidos a anestesia geral com sevoflurano para gastroplastia laparoscópica. Na sala de recuperação pós-anestésica, os pacientes foram avaliados quanto à intensidade da dor pela escala numérica e verbal, sedação (escala de Ramsay), ocorrência de náuseas, vômitos e complicações respiratórias. O modelo de regressão logística foi utilizado para determinar as variáveis independentes associadas à dor. RESULTADOS: Na sala de recuperação pós-anestésica, a ausência de dor na admissão ocorreu em 61,63% dos pacientes. Na análise multivariada, o uso do opioide fentanil em comparação ao sufentanil foi o único fator independentemente associado à dor (RR 3,07 - IC95% 1,17-6,4). Não houve diferença entre o tipo de opioide utilizado e a ocorrência de náuseas e vômitos (p>0,05). Os escores da escala de Ramsay não diferiram entre os tipos de opioides utilizados no intraoperatório (p>0,05). CONCLUSÃO: O único fator independentemente associado à dor na sala de recuperação pós-anestésica foi o tipo de opioide utilizado na indução anestésica. A dor pós-operatória ainda é um evento frequente que acomete a maioria dos pacientes e protocolos de analgesia precisam ser implementados para minimizar os efeitos que a dor subtratada pode causar.

BACKGROUND AND OBJECTIVES: Postoperative pain in obese patients is a noxious event for their recovery delaying hospital discharge and increasing the chance of complications. This study aimed at determining pain frequency in the post-anesthetic care unit and at investigating factors associated to moderate to severe pain in obese patients submitted to gastroplasty, relating them to potential complications. METHODS: This is an observational and prospective study including 84 patients submitted to general anesthesia with sevoflurane for laparoscopic gastroplasty. Patients were evaluated in the post-anesthetic care unit for pain intensity by the verbal and numerical scale (Ramsay scale), presence of nausea, vomiting and respiratory complications. Logistic regression model was used to determine pain-related independent variables. RESULTS: There has been no pain at admission to the post-anesthetic care unit in 61.63% of patients. In the multivariate analysis, fentanyl as compared to sufentanil was the only independent factor associated to pain (OR 3.07 - IC95% 1.17 - 6.4). There has been no difference between the type of opioid used and the presence of nausea and vomiting (p>0.05). Ramsay scale scores were not different between opioids used in the intraoperative period (p>0.05). CONCLUSION: The only independent factor associated to pain in the post-anesthetic care unit was the type of opioid used for anesthetic induction. Postoperative pain is still a frequent event affecting most patients, and analgesic protocols have to be implemented to minimize the effects that undertreated pain may induce.

Prevalence and incidence of dengue virus and antibody placental transfer during late pregnancy in central Brazil.

BACKGROUND: Maternal dengue antibodies are considered to play a significant role in dengue pathogenesis among infants. Determining the transplacental specific antibody transfer is invaluable for establishing the optimal vaccination age among infants in endemic regions. METHODS: We conducted a cross-sectional study among pairs of maternal and corresponding umbilical cord blood samples in public hospitals. The prevalence and incidence of dengue infection were determined in 505 pairs of pregnant women and neonates during a large outbreak (2009-2010) in central Brazil. The women were interviewed at late pregnancy to assess current or past symptoms of dengue. All parturients and their neonates were screened using Dengue IgG Indirect ELISA (Panbio) to assess previous dengue exposure. A semi-quantitative measurement of the IgG antibody expressed by the index ratio was calculated using optical density (OD) values according to the manufacturer's instructions. The studied population of parturients and their offspring was also screened for recent dengue infection by the Dengue IgM-capture ELISA (Panbio). Those participants with history of fever and two or more symptoms of dengue at least 10 days before the delivery were also tested for the dengue NS1 antigen using the Dengue Early ELISA (Panbio) and RT-PCR. RESULTS: The mean maternal age was 25.8 (SD = 6.4), and 83.6% of deliveries were between 37 and 41 weeks. Approximately half of the 505 women and neonates were IgG-seropositive, yielding 99.3% co-positive mother-child frequency of antibody transfer (Kappa = 0.96). The incidence of dengue infection was 2.8% (95% CI 1.4-4.4%) among the women considering 14 IgM-positive results and one DENV2 detected by RT-PCR. The dengue NS1 antigen was undetectable in the matched pairs. CONCLUSION: This study provides critical data on the prevalence of transplacental transferred maternal-infant anti-dengue antibodies and incidence of infection. The design of future vaccine trials should consider diverse regional epidemiological scenarios.

[Mortality due to Road Traffic Accidents in Brazil in the last decade: trends and risk clusters]. / Mortalidade por Acidentes de Transporte Terrestre no Brasil na última década: tendência e aglomerados de risco.

OBJECTIVE: To analyze the temporal trends of mortality due to Road Traffic Accidents (RTA) as well as identify the existence and location of high risk death clusters for RTA using spatial analysis. METHODOLOGY: Descriptive study of temporal trends by RTA, pedestrians, motorcyclists, motorists and passengers and spatial analysis for 2000 and 2010. The data was obtained from the Mortality Information System, and standardized rates were calculated by age in Brazilian states and municipalities grouped by population size. RESULTS: The mortality rates due to RTA between 2000 and 2010 varied from 18 to 22.5 deaths/100,000 inhabitants. The risk of death for pedestrians decreased in recent years, though motorists, motorcyclists and passengers saw a rising trend. A higher risk of death by RTA occurred in municipalities with populations up to 20,000 inhabitants and in those from 20,000 to 100,000 inhabitants. Spatial analysis revealed risk clusters for RTA and motorcyclists and pillion riders with an increase between 2000 and 2010 and enlargement of the areas most at risk in the Northeast. CONCLUSION: Increase in the rates of mortality by RTA mostly in the Northeast. Coordinated action between government, civil society and the citizens themselves is required to tackle this problem.

Mortalidade por acidentes de transporte terrestre no Brasil na última década: tendência e aglomerados de risco / Mortality due to road traffic accidents in Brazil in the last decade: trends and risk clusters

OBJETIVO: Analisar a tendência temporal da mortalidade por Acidentes de Transporte Terrestre (ATT) e identificar a existência e a localização de aglomerados de alto risco de mortes por ATT. METODOLOGIA: Estudo descritivo de tendência da mortalidade por ATT, pedestre, ocupante de motocicleta e de veículo, de 2000 a 2010 e análise espacial para 2000 e 2010. Os dados foram obtidos do Sistema de Informações sobre Mortalidade; calcularam-se as taxas padronizadas por idade, para Unidades Federadas (UF) e municípios por porte populacional. RESULTADOS: A taxa de mortalidade por ATT entre 2000 e 2010 variou de 18 para 22,5 óbitos/100 mil habitantes. O risco de morte para pedestre reduziu, os de ocupantes de veículos e de motocicletas apresentaram crescimento. O maior risco de morte por ATT ocorreu nos municípios com até 20 mil habitantes e nos de 20 a 100 mil. A análise espacial mostrou os aglomerados de risco para ATT e para ocupantes de motocicletas com aumento destes entre 2000 e 2010 e ampliação das áreas com maior risco na região Nordeste. CONCLUSÃO: Aumento das taxas de mortalidade por ATT principalmente na região Nordeste. Faz-se necessário uma atuação coordenada do governo, da sociedade civil e dos próprios cidadãos no enfretamento desta realidade.

OBJECTIVE: To analyze the temporal trends of mortality due to Road Traffic Accidents (RTA) as well as identify the existence and location of high risk death clusters for RTA using spatial analysis. METHODOLOGY: Descriptive study of temporal trends by RTA, pedestrians, motorcyclists, motorists and passengers and spatial analysis for 2000 and 2010. The data was obtained from the Mortality Information System, and standardized rates were calculated by age in Brazilian states and municipalities grouped by population size. RESULTS: The mortality rates due to RTA between 2000 and 2010 varied from 18 to 22.5 deaths/100,000 inhabitants. The risk of death for pedestrians decreased in recent years, though motorists, motorcyclists and passengers saw a rising trend. A higher risk of death by RTA occurred in municipalities with populations up to 20,000 inhabitants and in those from 20,000 to 100,000 inhabitants. Spatial analysis revealed risk clusters for RTA and motorcyclists and pillion riders with an increase between 2000 and 2010 and enlargement of the areas most at risk in the Northeast. CONCLUSION: Increase in the rates of mortality by RTA mostly in the Northeast. Coordinated action between government, civil society and the citizens themselves is required to tackle this problem.

Doenças dermatológicas de notificação compulsória no Brasil / Dermatological diseases of compulsory notification in Brazil

A estruturação do Sistema Nacional de Vigilância Epidemiológica do Brasil, em 1975, tornou obrigatória a notificação de algumas doenças transmissíveis com o objetivo de reduzir a carga destes eventos no país. Entretanto, as alterações no perfil epidemiológico destas doenças, associadas a características da sociedade contemporânea, determinam a constante adequação das atividades de vigilância a este cenário. Neste manuscrito, são descritos epidemiologia, tendências e diagnóstico diferencial das seguintes doenças dermatológicas de notificação compulsória no Brasil: aids, dengue, hanseníase, leishmaniose tegumentar americana, sarampo, rubéola e síndrome da rubéola congênita e sífilis. Também são apresentados os principais desafios atuais para o controle e prevenção para cada uma dessas doenças no Brasil.

The development of a Brazilian National Surveillance System in 1975 led to a compulsory reporting of selected infectious diseases aiming to reduce the burden of these events in the country. However, shifts in the epidemiology of these diseases associated with modern life style, demand constant revision of surveillance activities. In this manuscript we present the epidemiology, trends and differential diagnosis of the following compulsory notifiable diseases in Brazil: Aids, dengue fever, hanseniasis, American tegumentary leishmaniasis, measles, rubella and congenital rubella syndrome and syphilis. Additionally, the current challenges for control and prevention of each disease are presented.