Syndromic Surveillance Using Structured Telehealth Data: Case Study of the First Wave of COVID-19 in Brazil.

BACKGROUND: Telehealth has been widely used for new case detection and telemonitoring during the COVID-19 pandemic. It safely provides access to health care services and expands assistance to remote, rural areas and underserved communities in situations of shortage of specialized health professionals. Qualified data are systematically collected by health care workers containing information on suspected cases and can be used as a proxy of disease spread for surveillance purposes. However, the use of this approach for syndromic surveillance has yet to be explored. Besides, the mathematical modeling of epidemics is a well-established field that has been successfully used for tracking the spread of SARS-CoV-2 infection, supporting the decision-making process on diverse aspects of public health response to the COVID-19 pandemic. The response of the current models depends on the quality of input data, particularly the transmission rate, initial conditions, and other parameters present in compartmental models. Telehealth systems may feed numerical models developed to model virus spread in a specific region. OBJECTIVE: Herein, we evaluated whether a high-quality data set obtained from a state-based telehealth service could be used to forecast the geographical spread of new cases of COVID-19 and to feed computational models of disease spread. METHODS: We analyzed structured data obtained from a statewide toll-free telehealth service during 4 months following the first notification of COVID-19 in the Bahia state, Brazil. Structured data were collected during teletriage by a health team of medical students supervised by physicians. Data were registered in a responsive web application for planning and surveillance purposes. The data set was designed to quickly identify users, city, residence neighborhood, date, sex, age, and COVID-19-like symptoms. We performed a temporal-spatial comparison of calls reporting COVID-19-like symptoms and notification of COVID-19 cases. The number of calls was used as a proxy of exposed individuals to feed a mathematical model called "susceptible, exposed, infected, recovered, deceased." RESULTS: For 181 (43%) out of 417 municipalities of Bahia, the first call to the telehealth service reporting COVID-19-like symptoms preceded the first notification of the disease. The calls preceded, on average, 30 days of the notification of COVID-19 in the municipalities of the state of Bahia, Brazil. Additionally, data obtained by the telehealth service were used to effectively reproduce the spread of COVID-19 in Salvador, the capital of the state, using the "susceptible, exposed, infected, recovered, deceased" model to simulate the spatiotemporal spread of the disease. CONCLUSIONS: Data from telehealth services confer high effectiveness in anticipating new waves of COVID-19 and may help understand the epidemic dynamics.

Frequency and factors associated with Toxoplasma gondii infection in pregnant women and their pets in Ilhéus, Bahia, Brazil.

INTRODUCTION: Toxoplasmosis is an asymptomatic disease that can lead to systemic disease in the fetus of pregnant women with primary infection. This study aimed to determine the prevalence of toxoplasmosis, associated factors, and correlation between the serology of pregnant women and their pets, in the municipality of Ilhéus, Bahia, Brazil. METHODS: This cross-sectional study was conducted in 196 pregnant women and their cats or dogs (n=89). Semi-structured interviews were conducted and serum samples from the pregnant women were tested to detect IgM and IgG antibodies against Toxoplasma gondii, and avidity tests were performed for IgM-positive samples. The serum collected from pets were tested for IgG antibodies, and IgM antibodies in cats. A non-conditional logistic regression analysis was performed to identify infection-associated factors. RESULTS: IgG and IgM antibodies were detected in 67.9% (133/196) and 1.5% (3/196) samples, respectively, for women with an avidity of over 60%. Age ≥ 25 and the presence of cats in the vicinity were found to be associated with infection, while the level of education and previous orientation toward prevention of toxoplasmosis were protective factors in pregnant women. IgG antibodies were detected in 46.1% (41/89) of the animals, and cats were found to be negative for IgM. For the animals, age ≥ 1 year was a factor associated with infection. There was no correlation between serology of the pregnant women and the animals (p=0.15). CONCLUSIONS: An elevated prevalence of toxoplasmosis was detected in the region. Therefore, the adoption of preventive measures by public healthcare bodies is recommended.

Frequency and factors associated with Toxoplasma gondii infection in pregnant women and their pets in Ilhéus, Bahia, Brazil

Abstract INTRODUCTION: Toxoplasmosis is an asymptomatic disease that can lead to systemic disease in the fetus of pregnant women with primary infection. This study aimed to determine the prevalence of toxoplasmosis, associated factors, and correlation between the serology of pregnant women and their pets, in the municipality of Ilhéus, Bahia, Brazil. METHODS: This cross-sectional study was conducted in 196 pregnant women and their cats or dogs (n=89). Semi-structured interviews were conducted and serum samples from the pregnant women were tested to detect IgM and IgG antibodies against Toxoplasma gondii, and avidity tests were performed for IgM-positive samples. The serum collected from pets were tested for IgG antibodies, and IgM antibodies in cats. A non-conditional logistic regression analysis was performed to identify infection-associated factors. RESULTS: IgG and IgM antibodies were detected in 67.9% (133/196) and 1.5% (3/196) samples, respectively, for women with an avidity of over 60%. Age ≥ 25 and the presence of cats in the vicinity were found to be associated with infection, while the level of education and previous orientation toward prevention of toxoplasmosis were protective factors in pregnant women. IgG antibodies were detected in 46.1% (41/89) of the animals, and cats were found to be negative for IgM. For the animals, age ≥ 1 year was a factor associated with infection. There was no correlation between serology of the pregnant women and the animals (p=0.15). CONCLUSIONS: An elevated prevalence of toxoplasmosis was detected in the region. Therefore, the adoption of preventive measures by public healthcare bodies is recommended.

Conhecimento sobre imunoprevenção e situação vacinal dos profissionais de saúde em hospitais no sul da Bahia / Knowledge about vaccine prevention and vaccine health situation of the professionals in hospitals south of Bahia

Objetivo ­ Verificar o conhecimento dos profissionais de saúde (médicos, enfermeiros e técnicos de enfermagem) sobre imunoprevenção e a sua situação vacinal. Métodos ­ Estudo quantitativo, descrito, transversal, realizado em quatro hospitais de médio porte das cidades de Itabuna e Ilhéus, na região sul da Bahia, com 188 profissionais de saúde. Utilizou-se questionário estruturado com os blocos: identificação, formação em biossegurança, situação vacinal e conhecimento sobre imunoprevenção da hepatite B e influenza. Para o armazenamento e análise dos dados utilizou-se o programa Microsoft Excel 2007. Resultados ­ O conhecimento sobre imunoprevenção da hepatite B e influenza apresenta-se relativamente bem disseminado entre os profissionais (87%); sobre a situação vacinal, 98,40% dos profissionais referem estar imunizados para a hepatite B, 12% dos enfermeiros, 17,8% dos médicos e 8,16% dos técnicos em enfermagem não têm controle do número de doses, e apenas 52,13% realizaram o anti-HBs. Sobre a vacinação contra a influenza, 89,98% dos entrevistados afirmam se vacinar, mas não o fazem anualmente. O esquema anual para a influenza foi verificado em 19,58% dos técnicos de enfermagem, 18,42% dos enfermeiros e 11,42% dos médicos. Conclusões ­ Embora o conhecimento e as informações sobre a importância da vacinação para autoproteção dos profissionais de saúde estejam disseminados, observa-se que a prática vacinal e de controle de imunidade deles não são congruentes com o controle destas doenças imunopreviníveis.

Objective ­ To evaluate the knowledge of health professionals (doctors, nurses and nursing technicians) on vaccine prevention and their vaccination status. Methods ­ Quantitative, descriptive, cross-sectional study conducted in four medium-sized hospitals in the cities of Itabuna and Ilheus, in southern Bahia, with 188 health professionals (doctors, nurses and nursing technicians). A structured questionnaire was used with sections: identification, training in biosecurity, vaccination status and knowledge of vaccine prevention of hepatits B and influenza Microsoft Excel 2007 software was used for storage anddata B and influenza. Microsoft Excel 2007software was used for storage anddata analysis. Results ­ Knowledge about vaccine prevention hepatitis B and influenza appears to berelatively well disseminated among professionals (87%); on the vaccination status, 98.40% of the professionals report being immunized for hepatitis B, 12% of nurses, 17,8% for physicians and 8.16% for nursing technicians have no control of the number of doses and only 52 13% had antiHBs. About vaccination against influenza, 89.98% of respondents said be vaccinated, on the other hand, do not do it annually. The annual scheme for influenza was found in 19.58% of nursing technicians, nurses and 18.42% in 11.42% of physicians. Conclusions ­ Although the knowledge and information about the importance of vaccination for health professionals self-protection are disseminated, it is observed that the vaccine praxis and immunity track of them do not match control of these immunopreventable diseases, since the risks and their daily possibilities to establish contact with biological materials in on work activities.

Avaliação dos Sistemas de Informação de Nascidos Vivos e de Mortalidade para a obtenção da mortalidade neonatal em Ilhéus, Bahia / Information Systems Evaluation of alive births and deaths in order to obtain the probability of newborn death in Ilhéus, Bahia

Informações sobre nascimentos vivos e óbitos, com boa cobertura e qualidade, asseguram indicadores de saúde capazes de atender às demandas de gestores do Sistema de Saúde e população. A descentralização dos sistemas de informação impõe a realização de estudos de avaliação no nível local. O objetivo desse trabalho é avaliar o SINASC e o SIM como fontes de dados de dados para obtenção da probabilidade de morte neonatal em Ilhéus, Bahia. Utilizou-se como população de referência os nascidos vivos hospitalares com ocorrência e residência em Ilhéus, em 2001. Os instrumentos de coleta de dados foram elaborados à semelhança da DN e DO. Os dados foram coletados em hospitais e cartórios do município e dos bancos de dados do SIM e SINASC cedidos pela Secretaria de Saúde de Ilhéus. Foram composto seis bancos de dados, utilizando-se a técnica de linkage para identificar os mesmos indivíduos nos diferentes bancos de dados. A coorte é formada por 3426 nascidos vivos, dos quais 3308 foram captados pelo SINASC, representando-se cobertura de 96,6 por cento. O subregistro civil na coorte foi de 14,4 por cento. Observou-se diferenças estatisticamente significante entre os nascidos vivos captados e não captados pelo SINASC e mês de nascimento, hospital de nascimento, peso ao nascer e registro civil. Dos 68 óbitos neonatais da coorte, 34 foram captados pelo SIM como óbito neonatal, 29captados como óbitos fetais e 5 não captados. Constatou-se diferenças estatisticamente significantes entre os óbitos neonatais captados e não captados pelo SIM e hospital de ocorrência do óbito, idade ao morrer e registro civil do óbito. A probabilidade de morte neonatal na coorte foi de 19,84 por cento nascidos vivos e no SIM/SINASC de 9,97 por cento nacidos vivos, indicando que os dados oficiais subestimam em cerca 100 por cento a probabilidade de morte neste grupo. Conclui-se pela necessidade de implementar estratégias para a melhoria da cobertura e qualidade dos sistemas de informação em Ilhéus