[An outbreak of mumps in a high school: Estimation of vaccine effectiveness. Zaragoza 2011]. / Brote escolar de parotiditis: estimación de la efectividad vacunal. Zaragoza 2011.

INTRODUCTION: Mumps outbreaks continue to occur, even after the consolidation of vaccination programs. An outbreak of mumps occurred in a high school in Zaragoza during December 2011. OBJECTIVE: To describe the outbreak and estimate vaccine effectiveness. CASE DEFINITION: unilateral or bilateral swelling of the parotid or other salivary glands for three or more days without any other apparent cause. REFERENCE POPULATION: People attending the 'Parque Goya' High School or with transmission chain origin in the High School. OUTBREAK PERIOD: From two days before the onset of symptoms of the first case to five days after the last case. Samples were collected for virus confirmation (IgM, urine culture and oropharyngeal exudate), and isolates were processed for genotyping. A retrospective cohort study was performed in two high school classrooms to estimate vaccine efficacy. Public health authorities conducted active surveillance, isolation of cases, and vaccination of susceptible contacts. RESULTS: There were 27 cases. Twenty-one (77.8%) were vaccinated with two doses of Measles-Mumps-Rubella vaccine. Twelve (44%) were confirmed microbiologically. G1 genotype was determined in six cases. According to the cohort study, vaccine efficacy for one dose was 34% (95%CI: -44 to 70), and was 67% (95%CI: 28 to 83) for two doses. CONCLUSIONS: Vaccine effectiveness was lower than expected. Early detection and isolation of cases have been instrumental in preventing new cases in schools.

[An outbreak of Burkholderia cepacia bacteremia in a hemodialysis unit, Cadiz, 2014]. / Brote de bacteriemia por Burkholderia cepacia en una unidad de hemodiálisis de Cádiz, 2014.

INTRODUCTION: In January 2014 a possible outbreak of Burkholderia cepacia bacteremia occurred in a hemodialysis center situated in La Linea de la Concepción (Cadiz). An investigation was begun to confirm the outbreak, identify the source, and implement control measures. METHODS: A descriptive analysis was performed to describe the characteristics of the patients affected with Burkholderia cepacia bacteremia from November 2013 to February 2014. Environmental samples were taken. A molecular typing study was performed using pulsed field gel electrophoresis (SpeI PFGE) and MLST analysis in order to determine the genetic similarity between the isolates. RESULTS: The bacterium was isolated from blood cultures of 7 patients during the study period. Three of the samples (2 of which were also cases) were endoluminal fluid from catheter locks, and 4 chlorhexidine bottle samples. The patients were coincident in 2 of the 6 work shifts. The mean age of the cases was 67 years of whom 57% were women. Human samples and an environmental sample was analyzed and found to be genetically identical (ST653 clone). CONCLUSIONS: The analysis confirmed the outbreak of Burkholderia cepacia, with 7 cases among the patients of the hemodialysis center. The outbreak was due to the same strain, probably a common source and secondary transmission from person to person.

[Retrospective estimation of initial COVID-19 infections in the Santiago Metropolitan Region in Chile]. / Estimación retrospectiva de los casos iniciales de COVID-19 en Santiago Región Metropolitana en Chile.

OBJECTIVE: Estimate daily infections of COVID-19 during the first year of the pandemic in the Santiago Metropolitan Region (SRM) in Chile and Chile that are more realistic than those officially registered. METHOD: Retrospective estimate of daily infections from daily data on COVID-19 deaths, a seroprevalence study, and the REMEDID (Retrospective Methodology to Estimate Daily Infections from Deaths) algorithm. RESULTS: In SRM, it is observed that: 1) the maximum peak of infections was more than double that registered in the official statistics; 2) such peak was reached on May 22 (95% CI: 20-24 May), 2022, that is, 24 days before the official date of the peak of infections; and 3) the first estimated contagion took place on January 28, 2020 (95% CI: January 21 to February 16), that is, 36 days before the official date. In Chile, the situation is similar. During the first wave SRM accounted for 70%-76% of those infected in Chile, while from August 2020 onwards it accounted for 36%-39%. CONCLUSIONS: The official records of COVID-19 infections in SRM and Chile underestimated the real number of positives and showed a delay of about a month in the dynamics of infections. This is not an isolated situation, as it is known to have been the case in other countries as well. However, it is important to have reliable estimates for a correct modeling of the spread of the virus.

[Germina: tool for automatic detection of clusters of COVID-19 cases]. / Germina: herramienta para la detección automática de agrupaciones de casos de COVID-19.

The COVID-19 pandemic showed that epidemiological surveillance was under-resourced to respond to increases in cases and outbreaks. The high community transmissibility among the school population in the city of Barcelona at the beginning of the sixth wave strained the local COVID-19 surveillance unit. Using SCRUM methodology, Germina was developed and implemented as a software tool capable of capturing, harmonizing, integrating, storing, analysing and visualizing data from multiple information sources on a daily basis. Germina identifies clusters of three or more school cases and calculates epidemiological indicators. The implementation of Germina facilitated the epidemiological response to the sixth wave of COVID-19 in the school setting in the city of Barcelona. This tool is transferable to other exposure settings and communicable diseases. The use of automated informatics tools such, as Germina, improves epidemiological surveillance systems and supports evidence-based decision making.

Gender perspective in COVID-19. SESPAS Report 2022.

We failed to adequately launch a gender transformative response to COVID-19 pandemic, data by sex on a variety of indicators for most countries are hard to find. Some symptoms reported as common of COVID-19 infection, are more prominent in men, while others are more prominent in women, one cannot with certainty exclude that some of the differences observed could be due to gender bias in the management of cases in health services. The gender implications of the pandemic reach wide and far. Inequalities can be further aggravated as sex and gender intersect with other axes of inequality. The SAGER guidelines exemplify an effort to improve reporting of sex and gender dimensions and encouraging researchers to integrate these aspects in the research design. these observations and emerging evidence about the persistent gender-blind approach to COVID-19 is a wake-up call to change course. National Gender Equality Institutions can be central in ensuring gender matters are considered in government responses. COVID-19 pandemic is an opportunity to reverse the trend and take action to apply an intersectional feminist approach to global health that enables a just and equal world where everyone's health and wellbeing matter.

Impact of the first superspreading outbreak of COVID-19 related to a nightlife establishment in Andalusia, Spain.

INTRODUCTION AND AIM OF THE STUDY: A notable proportion of COVID outbreaks are generated by "super-spreading events", where a few subjects transmit the pathogen to many secondary cases, increasing contact networks and the spread of the pathogen. We conducted a description of a COVID-19 superspreading event in Córdoba during July 2020, linked to a nightlife establishment. MATERIAL AND METHODS: Retrospective observational study describing characteristics of person, time, PCR result and contact network of confirmed cases. PCR results in Córdoba during July and August and information collected in surveillance systems were analyzed. RESULTS: 935 individuals associated with the outbreak were included; 120 (12.83%) became confirmed cases. July 17 was the day with the highest incidence, with 27 new cases (22.5% of the total). People under 25 years old represented 69.2% of the cases. The average number of close contacts per person was 10.7, with a decrease as age raised. During the outbreak, incidence increased at the provincial level compared to previous weeks; at the end, incidence did not return to initial values but remained high with a relevant percentage of cases having unknown epidemiological association. CONCLUSIONS: A greater transmission capacity of SARS-CoV-2 was observed in a closed, crowded space, and among young people that tended to report a greater number of social contacts and may present little or no symptoms. Developing preventive measures in scenarios that combine these factors and early detection of cases are essential to avoid an increase in the spread of the virus.

[Field epidemiology in times of COVID-19: challenges for public health services. SESPAS Report 2022]. / Epidemiología de campo en tiempos de COVID-19: retos para los servicios de salud pública. Informe SESPAS 2022.

During the COVID-19 crisis, local epidemiology units have been forced to manage an increasing number of cases, contacts and outbreaks for which they were not previously prepared or staffed. Under normal circumstances, the efficient study and control of outbreaks and public health alerts requires human and material resources, situation analysis to identify possible causes and present recommendations, coordination with other health system structures, as well as the providing a written report including control and prevention measures implemented and their results or other recommendations. The field study of outbreaks has been systematized in a way that has made it possible to implement quick and effective measures, for the interruption of transmission chains and management of risk situations. To achieve this, a rapid and extraordinary exercise of digital integration, staff mobilization and creation of ad hoc structures needed to be carried out. Solidarity and cooperation between professionals from different administrations has been the pillar that has sustained the surveillance systems. Despite this, obstacles have been found as a result of the lack of coordination, social inequalities, and later, pandemic fatigue, which have reduced adherence and effectiveness of the implemented measures. It has also come to light the need to properly staff these units with trained professionals, and match working conditions and salaries with other health services.

Hepatitis A outbreak associated with a food handler in Bizkaia, 2017. / Brote de hepatitis A asociado a un manipulador de alimentos en Bizkaia, 2017.

INTRODUCTION: The reporting of one case of hepatitis A in a food handler at a bakery and five cases in employees of a company after consuming products from the same bakery prompted an outbreak investigation. METHODS: Outbreak cases were defined as individuals with laboratory-confirmed hepatitis A (HAV) infection, with symptoms which started in June and who, during the incubation period, worked with the food handler and/or had close contact with him and/or consumed products from the bakery. Epidemiologic questionnaires were performed and blood samples were obtained to be tested for the presence of anti-hepatitis A antibodies. Molecular characterisation was carried out by PCR, sequencing of the VP1/2A region and phylogenetic analysis with the maximum likelihood estimation method, bootstrap 1000 (MEGA 7.0 software). RESULTS: A total of 14 primary hepatitis A cases were identified: eleven cases related to the consumption of products from the bakery, two cases among co-workers of the food handler, and one case was a household contact. All 12 sequenced viruses were genotype IA, matching one of the strains (RIVM-HAV16-090) responsible for the outbreaks occurring at that time in Europe, mostly affecting men who have sex with men. CONCLUSIONS: HAV vaccination of at-risk groups should be reinforced in order to prevent future outbreaks. Increasing the use of molecular typing in hepatitis A cases could improve the investigation of outbreaks, which can be expected to increase in the future because of decreasing immunity in the population.

Efficacy of current vaccines against recently isolated foot and mouth disease virus type A South America (Venezuela) in Egypt 2022

Foot and mouth disease is a highly contagious viral disease that poses a significant economic threat to cloven-hoofed animals, including cattle and sheep. The emergence of a novel foot and mouth disease virus-A isolate, FMDV-A-Egy-AHRI-RL385-Ven-2022, in Egypt in 2022 has raised concerns about its potential impact on existing vaccination programs. Given that vaccination is a key strategy for foot and mouth disease virus control, the present study was aimed to assess the cross-protective efficacy of both local and imported inactivated vaccines against this new threat. Through challenge experiments and serum neutralization tests, we observed limited effectiveness of both vaccine types. The calculated r1-values at 28 days post-vaccination indicated a minimal immune response to FMDV-A-Egy-AHRI-RL385-Ven-2022 (0.176 and 0.175 for local and imported vaccines, respectively). Challenge experiments further confirmed these findings, revealing 0percent protection from the local vaccine and only 20percent rotection from imported vaccines by day 7 post-challenge. These results underscore the urgent need to update existing foot and mouth disease virus vaccines in Egypt by incorporating the newly circulating FMDV-A-Egy-AHRI-RL385-Ven-2022 strain. This proactive measure is crucial to prevent future outbreaks and ensure effective disease control(AU)

La fiebre aftosa es una enfermedad vírica muy contagiosa que supone una importante amenaza económica para los animales biungulados, entre ellos el ganado vacuno y ovino. La aparición de un nuevo aislado del virus A de la fiebre aftosa, el FMDV-A-Egy-AHRI-RL385-Ven-2022, en Egipto en 2022 ha suscitado preocupación por su posible impacto en los programas de vacunación existentes. Dado que la vacunación es una estrategia clave para el control del virus de la fiebre aftosa, el objetivo del presente estudio fue evaluar la eficacia protectora cruzada de las vacunas inactivadas locales e importadas frente a esta nueva amenaza. Mediante experimentos de desafío y pruebas de seroneutralización, observamos una eficacia limitada de ambos tipos de vacuna. Los valores r1 calculados a los 28 días posvacunación indicaron una respuesta inmunitaria mínima frente a FMDV-A-Egy-AHRI-RL385-Ven-2022 (0,176 y 0,175 para las vacunas local e importada, respectivamente). Los experimentos de provocación confirmaron aún más estos resultados, revelando un 0 por ciento de protección de la vacuna local y sólo un 20 por ciento de protección de las vacunas importadas al séptimo día después de la provocación. Estos resultados subrayan la urgente necesidad de actualizar las vacunas existentes contra el virus de la fiebre aftosa en Egipto incorporando la nueva cepa circulante FMDV-A-Egy-AHRI-RL385-Ven-2022. Esta medida proactiva es crucial para prevenir futuros brotes y garantizar un control eficaz de la enfermedad(AU)

Comportamiento de enfermedades vectoriales en una población manabita, Ecuador / Behavior of vector diseases in a Manabí population, Ecuador

Objetivo: Analizar el comportamiento de enfermedades vectoriales en una población manabita. Materiales y métodos: Se desarrolló bajo un tipo de investigación descriptiva de corte transversal y enfoque cuantitativo, con la utilización de un cuestionario como instrumento de recolección de datos. La muestra fueron 200 adultos del barrio San José de la parroquia Tarqui ­ Manta, de la provincia de Manabí ­ Ecuador. Resultados y conclusión: A través de esta investigación se pudo determinar que, de las 200 personas encuestadas, el 24% ha presentado alguna enfermedad vectorial, prevaleciendo el dengue con un 66.66%. Del 26% de familiares y conocidos de los encuestados que ha padecido enfermedades vectoriales, el 77.35% fue dengue. Generalmente, se presentan con síntomas que duran entre 1 a 3 días y sin mayores secuelas. La mayoría cuenta con servicios sanitarios óptimos y el 100% coincide que existen aguas estancadas en espacios públicos. Descriptores: Monitoreo epidemiológico; brotes de enfermedades; enfermedades endémicas. (Fuente: DeCS).

Objective: To analyze the behavior of vectorial diseases in a Manabi population. Materials and methods: It was developed under a type of descriptive cross-sectional research and quantitative approach with the use of a questionnaire as a data collection instrument. The sample consisted of 200 adults from the San José neighborhood of the Tarqui - Manta parish in the province of Manabí - Ecuador. Results and conclusion: Through this investigation it was possible to determine that of the 200 people surveyed, 24% have presented some vector disease, with dengue prevailing with 66.66%. Of the 26% of relatives and acquaintances of the respondents who have suffered vector-borne diseases, 77.35% were dengue. They usually present with symptoms that last between 1 to 3 days and without major sequelae. Most have optimal sanitary services and 100% agree that there is stagnant water in public spaces.

Outbreak report of SARS-CoV-2 infection by airborne transmission: Epidemiologic and molecular evidence / Reporte de un brote de infección por SARS-CoV-2 por transmisión aérea: evidencia epidemiológica y molecular

Introduction: It has been shown that the transmission of SARS-CoV-2 occurs mainly by air, and the risk of infection is greater in closed spaces. Objective: To describe the epidemiology, virology and molecular characterization of a COVID-19 outbreak at a closed vaccination point during the third wave of SARS-CoV-2 in Colombia. Materials and methods: Diagnostic tests, interviews, sampling, cell cultures and viral sequencing were carried out, the latter being molecular characterization and lineage identification. Results: Seven workers were positive for SARS-CoV-2; among these, 3 samples were analyzed, plus an additional sample belonging to the mother of the presumed index case; all samples were identified with lineage B.1.625, with a maximum of 2 nucleotides difference between them. Conclusions: Variant B.1.625 was identified as the cause of the COVID-19 outbreak, and a co-worker was also identified as the index case. Unexpectedly, attending a vaccination day became a risk factor for acquiring the infection.

Introducción. Se ha demostrado que la transmisión de SARS-CoV-2 se produce principalmente por vía aérea y el riesgo de infección es mayor en espacios cerrados con alta concentración de personas; este último factor se presentó en algunos de los puestos de vacunación de la ciudad de Medellín. Objetivo. Describir la epidemiología, virología y caracterización molecular de un brote de COVID-19 en un punto de vacunación cerrado durante la tercera ola de SARS-CoV-2 en Colombia. Materiales y métodos. Se realizaron test diagnósticos, entrevistas, toma de muestras, aislamiento viral y secuenciación genómica. Con esta última, se hizo la caracterización molecular y se identificó el linaje. Resultados. Siete trabajadores fueron positivos para SARS-CoV-2, y de estos, tres muestras fueron secuenciadas, más una muestra adicional perteneciente a la madre del presunto caso índice. Todas las muestras fueron identificadas con el linaje B.1.625, con un máximo de dos nucleótidos de diferencia entre ellas. Conclusiones. Se identificó la variante B.1.625 como la causante del brote de COVID-19, y también un compañero de trabajo fue identificado como el caso índice. De forma imprevista, asistir a una jornada de vacunación se convirtió en un factor de riesgo para adquirir la infección.

Asociación entre las tendencias de búsqueda en internet con el número de casos confirmados por la viruela símica: estudio multinacional en diez países / Association between internet search trends and the number of confirmed monkeypox cases: a multinational study in ten countries

INTRODUCCIÓN: La viruela símica es una infección zoonótica que se ha distribuido por todo el mundo. La búsqueda de información en internet refleja el interés y concientización de la población acerca de salud. OBJETIVO: Determinar la asociación entre el volumen relativo de búsquedas en internet con el número de casos confirmados por la viruela símica en diez países. MÉTODOS: Se realizó un estudio obser- vacional, analítico, retrospectivo, utilizando la herramienta Google Trends (GT™) para encontrar el volumen relativo búsqueda (VRB) sobre viruela símica desde 01 de enero al 31 de agosto del 2022 usando términos de búsqueda en el idioma oficial de los 10 países con mayor número de casos en dichas fechas, registrado por Our World in Data. Para establecer la relación lineal entre el VRB con los nuevos de casos por día se usó el coeficiente de correlación de Pearson con un nivel de significancia (p ≤ 0,05). RESULTADOS: Se encontró un coeficiente de correlación de Pearson fuerte en Brasil (Rp = 0,562,p = 0,001), y débil en países como Alemania (Rp = 0,281, p = 0,004), Estados Unidos de Norteamérica (Rp = 0,255, p = 0,008), España (Rp = 0,122, p = 0,213), Perú (Rp = 0,120, p = 0,333), Canadá (Rp = 0,116, p = 0,238), Francia (Rp = 0,095, p = 0,335), Reino Unido (Rp = 0,085, p = 0,362), Portugal (Rp = 0,024, p = 0,805) y Países Bajos (Rp = 0,067, p = 0,497). CONCLUSIÓN: Nuestro estudio evidencio que el VRB presento una relación positiva con el número de nuevos casos de viruela símica. Asimismo, se observo un coeficiente de correlación fuerte en Brasil, y en el resto de países fue débil.

BACKGROUND: Smallpox is a zoonotic infection that has been distributed worldwide. The search for information on the Internet reflects the interest and awareness of the population about health. AIM: To determine the correlation between the relative volume of internet searches and the number of confirmed cases of smallpox in ten countries. METHODS: An observational, analytical, retrospective study was conducted using the Google Trends (GT™) tool to find the relative search volume (RSV) on monkeypox from January 1 to August 31, 2022 using search terms in the official language of the 10 countries with the highest number of cases on those dates, as recorded by Our World in Data. To establish the relationship between RSV and new cases per day, Spearman's correlation was used with a significance level (p ≤ 0.05). RESULTS: A. strong Pearson correlation coefficient was found in Brazil (Rp = 0.562, p = 0.001), and weak in countries like Germany (Rp = 0.281, p = 0.004), United States (Rp = 0.255, p = 0.008), Spain (Rp = 0. 122, p = 0.213), Peru (Rp = 0.120, p = 0.333), Canada (Rp = 0.116, p = 0.238), France (Rp = 0.095, p = 0.335), United Kingdom (Rp = 0.085, p = 0.362), Portugal (Rp = 0.024, p = 0.805) and Netherlands (Rp = 0.067, p = 0.497). CONCLUSION: Our study showed that RSV had a positive relationship with the number of new cases of smallpox. Also, a strong correlation coefficient was observed in Brazil, while the rest of the countries showed a weak correlation coefficient.

Brote de tinea capitis y otras micosis superficiales en una comunidad urbana de Medellín / Tinea capitis outbreak and other superficial mycosis in an urban community of Medellín

Introducción. Las dermatofitosis son infecciones fúngicas superficiales de epitelios queratinizados. La tinea capitis es una de ellas y afecta a poblaciones escolares vulnerables. Carpinelo es un barrio del área periférica de Medellín con precarias condiciones socioeconómicas. Ante la sospecha de un brote de dermatofitosis, los afectados fueron evaluados. Objetivo. Evaluar clínica y microbiológicamente pacientes del barrio Carpinelo con sospecha de micosis cutáneas para determinar la presencia de un brote por dermatofitos. Materiales y métodos. Se llevó a cabo un estudio descriptivo, de corte longitudinal, con muestreo a conveniencia. Se hizo una búsqueda activa de casos en el Jardín Educativo Buen Comienzo de Carpinelo en niños de la institución y sus familiares. Se evaluaron clínicamente y se tomaron muestras de escamas y cabellos para exámenes directos y cultivos microbiológicos. Se analizó el perfil demográfico, clínico y micológico, con el programa estadístico SPSS™, versión 25. Resultados. Se estudiaron 57 pacientes, 47 eran menores de edad con una media de edad de seis años; se observó una proporción de hombres y mujeres de 2:1. Los pacientes con resultados positivos se diagnosticaron con tinea capitis (78,95 %), tinea faciei (15,79 %) y tinea corporis (10,52 %). El 75,43 % de los pacientes recibió tratamiento previo y de estos el 69,73 % fue con esteroides. El examen directo fue positivo en el 53,84 % y los cultivos en el 46,5 % de los casos. Los agentes aislados fueron: Microsporum canis (77,77 %), Trichophyton spp. (11,11 %), Trichophyton rubrum (5,55 %) y Malassezia spp. (5,55 %). Conclusión. Tinea capitis fue la presentación clínica más común y M. canis el dermatofito más frecuentemente aislado. Llamó la atención el uso de esteroides como primera y única opción del tratamiento empírico' lo cual resalta la importancia del diagnóstico microbiológico para proporcionar la terapia apropiada.

Introduction. Dermatophytoses are superficial fungal infections of the keratinized epithelium like tinea capitis. The latte mainly affects school-vulnerable populations. Carpinelo is a peripheral neighborhood in Medellín with poor socioeconomic conditions and where a suspected tinea capitis outbreak took place. Objective. To study and characterize, clinically and microbiologically, patients with suspected dermatophytosis in Carpinelo. Materials and methods. We carried out a descriptive and longitudinal study with an active case search of tinea capitis in children and their relatives from the Jardín Educativo Buen Comienzo community in Carpinelo. Patients were clinically evaluated, and samples of scales and hair were taken to perform mycological studies with a 10 % potassium hydroxide and culture in Sabouraud and Mycosel agar. We analyzed the data with the statistical program SPSS™. 25 version. Results. Fifty-seven individuals were studied: 47 were children with a mean age of six years and a ratio of 2:1 male to female. Patients with confirmed diagnosis presented the following clinical forms: tinea capitis (78.95%), tinea faciei (15.79%) or tinea corporis (10.52%). Out of the total, 69.76% of the patients had previous treatment with steroids. The direct test was positive in 53.84% of the samples, and 46.15% had positive cultures. The isolated species were: Microsporum canis (77.77%), Trichophyton spp. (11.11%), Trichophyton rubrum (5.55%), and Malassezia spp. (5.55 %). Conclusion.Tinea capitis was the most common clinical form, and M. canis was the most frequently isolated species. The use of steroids as the first and only option for empiric treatment was worth of notice. The findings of this study point out the importance of microbiological diagnosis in choosing the best treatment for the patients.

Presence of SARS-CoV-2 in urban effluents in south-east Buenos Aires, Argentina, May 2020 to March 2022 / Presencia del SARS-CoV-2 en aguas residuales urbanas del sudeste de Buenos Aires, Argentina, de mayo del 2020 a marzo del 2022 / Presença de SARS-CoV-2 em águas residuais urbanas no sudeste de Buenos Aires, Argentina, de maio de 2020 a março de 2022

ABSTRACT Objectives. To implement and evaluate the use of wastewater sampling for detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in two coastal districts of Buenos Aires Province, Argentina. Methods. In General Pueyrredon district, 400 mL of wastewater samples were taken with an automatic sampler for 24 hours, while in Pinamar district, 20 L in total (2.2 L at 20-minute intervals) were taken. Samples were collected once a week. The samples were concentrated based on flocculation using polyaluminum chloride. RNA purification and target gene amplification and detection were performed using reverse transcription polymerase chain reaction for clinical diagnosis of human nasopharyngeal swabs. Results. In both districts, the presence of SARS-CoV-2 was detected in wastewater. In General Pueyrredon, SARS-CoV-2 was detected in epidemiological week 28, 2020, which was 20 days before the start of an increase in coronavirus virus disease 2019 (COVID-19) cases in the first wave (epidemiological week 31) and 9 weeks before the maximum number of laboratory-confirmed COVID-19 cases was recorded. In Pinamar district, the virus genome was detected in epidemiological week 51, 2020 but it was not possible to carry out the sampling again until epidemiological week 4, 2022, when viral circulation was again detected. Conclusions. It was possible to detect SARS-CoV-2 virus genome in wastewater, demonstrating the usefulness of the application of wastewater epidemiology for long-term SARS-CoV-2 detection and monitoring.

RESUMEN Objetivos. Aplicar y evaluar la utilización de muestreos de aguas residuales como método para la detección del coronavirus del síndrome respiratorio agudo severo de tipo 2 (SARS-CoV-2) en dos distritos costeros de la Provincia de Buenos Aires, Argentina. Métodos. Se utilizó un dispositivo de muestreo automático para tomar muestras de 400 mL de las aguas residuales de 24 horas en el distrito de General Pueyrredon, mientras que en el distrito de Pinamar se tomaron muestras de 2,2 L a intervalos de 20 minutos hasta un volumen total de 20 L. Los muestreos se realizaron una vez por semana. Las muestras se concentraron mediante floculación con policloruro de aluminio. La purificación del ARN y la amplificación y detección del gen diana se llevaron a cabo mediante la prueba de reacción en cadena de la polimerasa con retrotranscripción para el diagnóstico clínico a partir de hisopados nasofaríngeos. Resultados. Se observó la presencia de SARS-CoV-2 en las aguas residuales de ambos distritos. En General Pueyrredon, el SARS-CoV-2 se halló en la semana epidemiológica 28 del 2020, es decir, 20 días antes del inicio del aumento de casos de enfermedad por coronavirus 2019 (COVID-19) registrado en la primera ola (semana epidemiológica 31) y nueve semanas antes de que se alcanzara el número máximo de casos de COVID-19 con confirmación de laboratorio. En el distrito de Pinamar se detectó el genoma viral en la semana epidemiológica 51 del 2020, pero solo se pudo volver a realizar el muestreo en la semana epidemiológica 4 del 2022, en la que se volvió a detectar la circulación del virus. Conclusiones. Se pudo detectar el genoma del virus SARS-CoV-2 en aguas residuales, lo que muestra la utilidad de la aplicación de la epidemiología de aguas residuales como método para la detección y el seguimiento del SARS-CoV-2 a largo plazo.

RESUMO Objetivos. Implementar e avaliar o uso de amostragem de águas residuais na detecção do coronavírus da síndrome respiratória aguda grave 2 (SARS-CoV-2) em dois distritos costeiros da Província de Buenos Aires, Argentina. Métodos. No distrito de General Pueyrredon, amostras de 400 mL de águas residuais foram coletadas ao longo de 24 horas com um amostrador automático; já no distrito de Pinamar, foram coletados 20 L no total (2,2 L a intervalos de 20 minutos). As amostras foram coletadas uma vez por semana e concentradas por floculação com cloreto de polialumínio. A purificação do RNA e a amplificação e detecção de genes-alvo foram realizadas por meio de reação em cadeia da polimerase com transcrição reversa para diagnóstico clínico de esfregaços nasofaríngeos humanos. Resultados. Detectou-se presença de SARS-CoV-2 em águas residuais dos dois distritos. Em General Pueyrredon, o SARS-CoV-2 foi detectado na semana epidemiológica 28 de 2020, ou seja, 20 dias antes do início de um aumento no número de casos da doença provocada pelo coronavírus de 2019 (COVID-19) na primeira onda (semana epidemiológica 31) e 9 semanas antes de se registrar o número máximo de casos de COVID-19 confirmados em laboratório. No distrito de Pinamar, o genoma viral foi detectado na semana epidemiológica 51 de 2020, mas não foi possível realizar a amostragem novamente até a semana epidemiológica 4 de 2022, quando a circulação do vírus foi novamente constatada. Conclusões. Foi possível detectar o genoma do vírus SARS-CoV-2 em águas residuais, demonstrando a utilidade da aplicação da epidemiologia baseada em águas residuais para detectar e monitorar o SARS-CoV-2 em longo prazo.

Effects of public health emergencies of international concern on disease control: a systematic review / Efectos de las emergencias de salud pública de importancia internacional en el control de enfermedades: revisión sistemática / Efeitos das emergências de saúde pública de importância internacional no controle de doenças: revisão sistemática

ABSTRACT Objectives. To assess the accumulated knowledge of the effects of public health emergencies of international concern on disease control and local health systems, and contribute to a better understanding of their effects on health programs and systems. Methods. This was a systematic review of published and gray literature (in English, Portuguese, or Spanish). Electronic databases (BVS/LILACS, PubMed, and SciELO) and Google Scholar were searched. Search terms were: COVID-19 OR H1N1 OR Ebola OR Zika OR poliomyelitis AND (outbreaks OR epidemics) AND (public health systems OR public health surveillance). Results. A total of 3 508 studies were retrieved, of which 31 met the inclusion criteria. The studies addressed the effects of the emergencies on: communicable diseases notification systems; malaria, HIV/AIDS, tuberculosis, poliomyelitis, and malaria surveillance, control, and treatment; microcephaly; dengue; and vaccinations. The populations affected by the emergencies experienced reduced health services, which included fewer health visits, failures in the diagnostic chain, decrease in vaccination, and increased incidence or underreporting of notifiable diseases. Conclusions. Socioeconomic inequity is a determinant of the effects of public health emergencies of international concern within affected populations. The diversion of resources and attention from health authorities disproportionately affects vulnerable populations and can lead, over time, to a weakening of health systems. The analysis of the effects of public health emergencies is important for the development of new protocols that can better respond to future crises.

RESUMEN Objetivos. Evaluar el conocimiento acumulado acerca de los efectos de las emergencias de salud pública de importancia internacional en el control de enfermedades y en los sistemas de salud locales, y contribuir a una mejor comprensión de estos efectos en los programas y sistemas de salud. Métodos. Se hizo una revisión sistemática de bibliografía gris y publicada (en español, inglés o portugués) para la que se realizaron búsquedas en bases de datos electrónicas (BVS/LILACS, PubMed y SciELO) y en Google Scholar. Los términos de búsqueda fueron: COVID-19 OR H1N1 OR Ebola OR Zika OR poliomyelitis AND (Outbreaks OR epidemics) AND (public health systems OR public health surveillance). Resultados. Se encontraron 3 508 estudios, de los cuales 31 cumplieron los criterios de inclusión. En los estudios se abordaban los efectos de las emergencias en: los sistemas de notificación de enfermedades transmisibles; la vigilancia, el control y el tratamiento de la malaria, el VIH/sida, la tuberculosis y la poliomielitis; la microcefalia; el dengue; y las vacunas. Las poblaciones afectadas por las emergencias experimentaron una reducción de los servicios de salud, incluida una reducción de las consultas de salud, errores en la cadena de diagnóstico, una disminución de la vacunación y el aumento de la incidencia o subnotificación de enfermedades de notificación obligatoria. Conclusiones. La inequidad socioeconómica es un determinante de los efectos de las emergencias de salud pública de importancia internacional en los grupos poblacionales afectados. El desvío de recursos y atención de las autoridades de salud afecta desproporcionadamente a los grupos vulnerables y puede suponer, con el tiempo, un debilitamiento de los sistemas de salud. El análisis de los efectos de las emergencias de salud pública es crucial para la elaboración de nuevos protocolos que puedan mejorar la respuesta ante futuras crisis.

RESUMO Objetivos. Avaliar o conhecimento acumulado sobre os efeitos das emergências de saúde pública de importância internacional no controle de doenças e nos sistemas de saúde locais e contribuir para uma melhor compreensão desses efeitos sobre os programas e sistemas de saúde. Métodos. Trata-se de uma revisão sistemática da literatura branca e cinzenta (em inglês, português ou espanhol) realizada por meio de pesquisas nos bancos de dados eletrônicos BVS/LILACS, PubMed e SciELO e no Google Scholar. Foram utilizados os seguintes termos de busca: COVID-19 OR H1N1 OR Ebola OR Zika OR poliomyelitis AND (outbreaks OR epidemics) AND (public health systems OR public health surveillance). Resultados. Foi identificado um total de 3 508 estudos, dos quais 31 preencheram os critérios de inclusão. Os estudos abordavam os efeitos das emergências sobre: sistemas de notificação de doenças transmissíveis; vigilância, controle e tratamento de HIV/AIDS, tuberculose, poliomielite e malária; microcefalia; dengue; e vacinações. As populações afetadas pelas emergências enfrentaram uma redução nos serviços de saúde, como menos consultas médicas, problemas na cadeia de diagnóstico, diminuição da vacinação e maior incidência ou subnotificação de doenças de notificação compulsória. Conclusões. A desigualdade socioeconômica é um fator determinante dos efeitos das emergências de saúde pública de importância internacional nas populações afetadas. O desvio dos recursos e da atenção das autoridades sanitárias afeta desproporcionalmente as populações vulneráveis e pode levar, com o passar do tempo, a um enfraquecimento dos sistemas de saúde. A análise dos efeitos das emergências de saúde pública é importante para a elaboração de novos protocolos que possam enfrentar melhor futuras crises.

The role of a genetically stable, novel oral type 2 poliovirus vaccine in the poliomyelitis endgame / Utilidad de una nueva vacuna antipoliomielítica oral del serotipo 2 genéticamente estable contra el poliovirus de tipo 2 en la erradicación de la poliomielitis / O papel de uma nova vacina oral contra o poliovírus tipo 2, geneticamente estável, no estágio final da eliminação da poliomielite

ABSTRACT Poliovirus infection causes paralysis in up to 1 in 200 infected persons. The use of safe and effective inactivated poliovirus vaccines and live attenuated oral poliovirus vaccines (OPVs) means that only two pockets of wild-type poliovirus type 1 remain, in Afghanistan and Pakistan. However, OPVs can revert to virulence, causing outbreaks of circulating vaccine-derived poliovirus (cVDPV). During 2020-2022, cVDPV type 2 (cVDPV2) was responsible for 97-99% of poliomyelitis cases, mainly in Africa. Between January and August 2022, cVDPV2 was detected in sewage samples in Israel, the United Kingdom and the United States of America, where a case of acute flaccid paralysis caused by cVDPV2 also occurred. The Pan American Health Organization has warned that Brazil, the Dominican Republic, Haiti and Peru are at very high risk for the reintroduction of poliovirus and an additional eight countries in Latin America are at high risk, following dropping vaccination rates (average 80% coverage in 2022). Sabin type 2 monovalent OPV has been used to control VDPV2 outbreaks, but its use could also lead to outbreaks. To address this issue, a more genetically stable, novel OPV2 (nOPV2) was developed against cVDPV2 and in 2020 was granted World Health Organization Emergency Use Listing. Rolling out a novel vaccine under the Emergency Use Listing in mass settings to contain outbreaks requires unique local regulatory and operational preparedness.

RESUMEN La infección por poliovirus ocasiona parálisis en hasta 1 de cada 200 personas infectadas. La utilización de vacunas con poliovirus inactivados y de vacunas antipoliomielíticas orales con poliovirus vivos atenuados (OPV) seguras y eficaces ha logrado que solo queden dos focos de poliovirus salvaje de tipo 1, en Afganistán y Pakistán. Sin embargo, las vacunas con OPV pueden revertir a la virulencia y producir brotes de poliovirus circulantes de origen vacunal (cVDPV). Durante el período 2020-2022, el cVDPV de tipo 2 (cVDPV2) fue la causa del 97-99% de los casos de poliomielitis, sobre todo en África. Entre enero y agosto del 2022, se encontró el cVDPV2 en muestras de aguas residuales en Estados Unidos de América, donde se produjo un caso de parálisis flácida aguda por el cVDPV2, Israel y Reino Unido y. La Organización Panamericana de la Salud ha advertido que, tras la caída de las tasas de vacunación (con una cobertura promedio del 80% en el 2022), Brasil, Haití, Perú y República Dominicana corren un riesgo muy alto de reintroducción del poliovirus, en tanto que otros ocho países de América Latina se encuentran en una situación de alto riesgo. La OPV monovalente de tipo 2 de Sabin se ha utilizado para controlar los brotes de VDPV2, pero su empleo también podría ocasionar brotes. Para hacer frente a este problema, se creó una nueva OPV2 (nOPV2) contra el cVDPV2, genéticamente más estable, que en el 2020 se incluyó en la lista de uso en emergencias de la Organización Mundial de la Salud. El despliegue a gran escala de una nueva vacuna incluida en la lista de uso en emergencias con el fin de contener los brotes exige una extraordinaria preparación regulatoria y operativa local.

RESUMO A infecção pelo poliovírus causa paralisia em 1 de cada 200 pessoas infectadas. O uso de vacinas seguras e eficazes, tanto vacinas inativadas contra o poliovírus quanto vacinas orais contendo poliovírus atenuado (VOP), significa que restam apenas dois bolsões de poliovírus selvagem tipo 1, um no Afeganistão e outro no Paquistão. No entanto, a VOP pode reverter à virulência, causando surtos de poliovírus circulante derivado de vacina (cPVDV). No período 2020-2022, o cPVDV tipo 2 (cPVDV2) foi responsável por 97% a 99% dos casos de poliomielite, principalmente na África. Entre janeiro e agosto de 2022, o cPVDV2 foi detectado em amostras de esgoto em Israel, no Reino Unido e nos Estados Unidos da América, onde também houve um caso de paralisia flácida aguda causada pelo cPVDV2. A Organização Pan-Americana da Saúde alertou que, devido à queda nas taxas de vacinação (cobertura média de 80% em 2022), o Brasil, o Haiti, o Peru e a República Dominicana correm um risco muito alto de reintrodução do poliovírus e outros oito países da América Latina correm um risco alto. A VOP monovalente Sabin tipo 2 tem sido usada para controlar surtos de PVDV2, mas seu uso também pode levar a surtos. Para resolver esse problema, foi desenvolvida uma nova VOP2 (nVOP2), mais estável geneticamente, para combater o cPVDV2. Em 2020, a nVOP2 entrou na Lista de Uso Emergencial da Organização Mundial da Saúde. A distribuição de uma nova vacina incluída na Lista de Uso Emergencial em contextos de massa para conter surtos requer medidas originais de preparação operacional e regulatória em âmbito local.

Investigação de surto de doença compatível com escorbuto em uma penitenciária masculina do Ceará, 2019-2020: um estudo de caso-controle / Investigation of an outbreak of disease compatible with scurvy in a male penitentiary in the state of Ceará, Brazil, 2019-2020: a case-control study / Investigación de un brote de enfermedad compatible con escorbuto en una penitenciaría masculina en el estado de Ceará, Brasil, 2019-2020: un estudio de casos y controlesInvestigação de surto

Objetivo: identificar ocorrência de surto compatível com escorbuto e fatores de exposição associados aos sinais/sintomas típicos de hipovitaminose, em penitenciária masculina, Ceará, Brasil, 2019-2020. Métodos: estudo de caso-controle populacional; foram utilizados registros clínicos e entrevistas com casos compatíveis - sinais/sintomas iniciados no período - e com controles; realizou-se análise multivariável. Resultados: 62 casos; idade média de 40,6 anos (DP = 10,8); principais sinais/sintomas foram edema e dor em membros inferiores (100,0%), dificuldade para deambular (91,9%), hematoma/equimose em membros inferiores (90,3%), febre (88,7%); identificou-se, como fator de exposição, média de idade > 40 anos (ORa = 1,10; IC95% 1,05;1,17; p-valor = 0,001); e como fatores protetores, trabalho (ORa = 0,11; IC95% 0,03;0,36; p-valor < 0,001) e participação em aulas (ORa = 0,21; IC95% 0,08;0,59; p-valor = 0,003) dentro da penitenciária. Conclusão: surto da penitenciária compatível com escorbuto pelos sinais/sintomas característicos, associados aos fatores identificados; recomendou-se oferta regular de dieta rica em vitamina C para todos os internos e acompanhamento clínico dos casos.

Objective: to identify the occurrence of an outbreak compatible with scurvy and exposure factors associated with typical signs/symptoms of hypovitaminosis that occurred in a male penitentiary in Ceará, Brazil between 2019-2020. Methods: this was a population-based case-control study; we used clinical records and interviews with compatible cases - based on sign/symptom onset during the study period - and with controls; we carried out multivariate analysis. Results: out of 62 cases, mean age was 40.6 years (SD = 10.8); main signs/symptoms were edema and pain in the lower limbs (100.0%), difficulty in walking (91.9%), hematoma/ecchymosis in the lower limbs (90.3%) and fever (88.7%); we identified being over 40 years old as an associated factor (aOR = 1.10; 95%CI 1.05;1.17; p-value = 0.001); and as protective factors: working (aOR = 0.11; 95%CI 0.03;0.36; p-value < 0.001) and taking part in classes (aOR = 0.21; 95%CI 0.08;0.59; p-value = 0.003) in the prison. Conclusion: we considered the penitentiary outbreak to be compatible with scurvy due to characteristic signs/symptoms, associated with the identified factors; we recommended regular provision of a diet rich in vitamin C to all male inmates and clinical follow-up of cases.

Objetivo: identificar la ocurrencia del brote compatible con escorbuto y los factores de exposición asociados con signos/síntomas típicos de hipovitaminosis que ocurrieron en una penitenciaría masculina en Ceará, Brasil entre 2019-2020. Métodos: estudio poblacional de casos y controles; se utilizaron historias clínicas y entrevistas con casos compatibles, con inicio de signos/síntomas durante el período de estudio, y controles; se realizó análisis multivariable. Resultados: de los 62 casos, edad media fue 40,6 años (DE = 10,8); principales signos/síntomas fueron edema y dolor en miembros inferiores (100,0%), dificultad para caminar (91,9%), hematoma/equimosis en miembros inferiores (90,3%) y fiebre (88,7%); la edad mayor de 40 años se identificó como factor asociado (ORa = 1,10; IC95% 1,05;1,17; p-valor = 0,001); y como factores protectores: trabajo (ORa = 0,11; IC95% 0,03;0,36; p-valor< 0,001) y participación en clases (ORa = 0,21; IC95% 0,08;0,59; p-valor = 0,003) dentro del centro penitenciario. Conclusión: el brote en centro penitenciario fue considerado compatible con escorbuto debido a los signos/síntomas característicos, asociados a los factores identificados; se recomendó oferta regular de dieta rica en vitamina C a todos los internos y seguimiento clínico de los casos.

Mantenimiento del estatus de eliminación del sarampión en Colombia durante el control de brotes, 2019 / Maintaining measles elimination status in Colombia during outbreak control, 2019 / Manutenção do status de eliminação do sarampo na Colômbia durante o controle de surtos, 2019

RESUMEN Objetivo. Describir los brotes de sarampión generados por la múltiple importación de casos y las intervenciones de control. Métodos. Estudio descriptivo de brotes por múltiple importación de casos a Colombia entre 2018-2019. Se utilizaron las definiciones de caso, clasificación de fuente de infección, recolección de muestras biológicas, rastreo de casos sospechosos, identificación y seguimiento de contactos. El antecedente vacunal se obtuvo del carné o del sistema de información de Colombia. La nacionalidad se definió de acuerdo con el registro en el sistema de vigilancia en salud pública. Se empleó el sistema de comando de incidente con equipos de respuesta y planes de acción para controlar los brotes. Resultados. En marzo de 2018 se confirmó el primer caso de sarampión importado de Venezuela. La incidencia en 2018 fue 0,2 casos por 100 000 habitantes y en 2019 fue 0,3. La letalidad en 2019 fue de 0,4%. Se confirmaron 214 casos en población venezolana (91% sin antecedente vacunal). Se estudiaron 69 brotes sin vínculo epidemiológico. Se identificó el genotipo D8 linaje MVi/Hulu Langat.MYS/26.11. Se evitó la circulación endémica a través de intervenciones innovadoras tales como, la vigilancia y control de infecciones, notificación super inmediata, priorización de visitas de campo y criterios de niveles de riesgo de transmisión. Conclusiones. Colombia controló los brotes de sarampión que se presentaron por la importación de casos e impido la circulación endémica para conservar la certificación de la eliminación del virus de sarampión en el país.

ABSTRACT Objective. Describe measles outbreaks caused by importation of multiple cases, and the corresponding control interventions. Methods. Descriptive study of measles outbreaks caused by the importation of multiple cases to Colombia in 2018-2019. Case definitions, classification of source of infection, collection of biological specimens, searches for suspected cases, case identification, and contact tracing were employed. Vaccination records were obtained from vaccination cards or from the Colombian information system. Nationality was determined from records found in the public health surveillance system. The incident command system was used, and response teams and action plans were activated to control outbreaks. Results. In March 2018, the first case of measles imported from Venezuela was confirmed. Measles incidence in 2018 was 0.2 cases per 100 000 population, and it was 0.3 per 100 000 in 2019. The case fatality rate in 2019 was 0.4%. A total of 214 cases were confirmed in the Venezuelan population (91% with no vaccination history); and 69 outbreaks with no epidemiological link were studied. The MVi/Hulu Langat.MYS/26.11[D8] lineage was identified. Endemic circulation was prevented through innovative interventions such as infection surveillance and control, immediate notification, prioritization of field visits, and transmission risk level criteria. Conclusions. Colombia controlled measles outbreaks that resulted from imported cases, and it prevented endemic circulation, thereby maintaining certification of measles elimination in the country.

RESUMO Objetivo. Descrever os surtos de sarampo gerados por múltiplas importações de casos e as intervenções de controle. Métodos. Estudo descritivo de surtos devido a múltiplas importações de casos para a Colômbia entre 2018 e 2019. Foram utilizadas definições de caso, classificação da fonte de infecção, coleta de amostras biológicas, rastreamento de casos suspeitos, identificação e seguimento de contatos. O histórico de vacinação foi obtido do cartão de vacinação ou do sistema de informações da Colômbia. A nacionalidade foi definida de acordo com o registro no sistema de vigilância em saúde pública. O sistema de comando de incidentes foi usado, com equipes de resposta e planos de ação para controlar os surtos. Resultados. O primeiro caso de sarampo importado da Venezuela foi confirmado em março de 2018. Nesse ano, a incidência foi de 0,2 casos por 100 mil habitantes e, em 2019, de 0,3 casos por 100 mil habitantes. A taxa de letalidade em 2019 foi de 0,4%. Um total de 214 casos foi confirmado na população venezuelana (91% sem histórico de vacinação). Foram estudados 69 surtos sem vínculo epidemiológico. Foi identificado o genótipo D8, cepa MVi/Hulu Langat.MYS/26.11. A circulação endêmica foi evitada por meio de intervenções inovadoras, como vigilância e controle de infecções, notificação "superimediata", priorização de visitas de campo e critérios para níveis de risco de transmissão. Conclusões. A Colômbia controlou os surtos de sarampo decorrentes de casos importados e impediu a circulação endêmica a fim de manter a certificação da eliminação do vírus do sarampo no país.

Effects of migration rates and vaccination on the spread of yellow fever in Latin American communities / Efectos de las tasas de migración y de la vacunación en la propagación de la fiebre amarilla en comunidades de América Latina / Efeitos das taxas de migração e vacinação na propagação da febre amarela em comunidades latino-americanas

ABSTRACT Objective. To assess how relevant the flow of people between communities is, compared to vaccination and type of vector, on the spread and potential outbreaks of yellow fever in a disease-free host community. Methods. Using a SEIRV-SEI model for humans and vectors, we applied numerical simulations to the scenarios: (1) migration from an endemic community to a disease-free host community, comparing the performance of Haemagogus janthinomys and Aedes aegypti as vectors; (2) migration through a transit community located on a migratory route, where the disease is endemic, to a disease-free one; and (3) effects of different vaccination rates in the host community, considering the vaccination of migrants upon arrival. Results. Results show no remarkable differences between scenarios 1 and 2. The type of vector and vaccination coverage in the host community are more relevant for the occurrence of outbreaks than migration rates, with H. janthinomys being more effective than A. aegypti. Conclusions. With vaccination being more determinant for a potential outbreak than migration rates, vaccinating migrants on arrival may be one of the most effective measures against yellow fever. Furthermore, H. janthinomys is a more competent vector than A. aegypti at similar densities, but the presence of A. aegypti is a warning to maintain vaccination above recommended levels.

RESUMEN Objetivo. Evaluar la importancia del flujo de personas entre comunidades, en comparación con la vacunación y el tipo de vector, para la propagación y los posibles brotes de fiebre amarilla en una comunidad de acogida libre de la enfermedad. Métodos. Con el empleo de un modelo SEIRV—SEI para personas y vectores, aplicamos simulaciones numéricas a las siguientes situaciones hipotéticas: 1) migración desde una comunidad con endemicidad a una comunidad de acogida libre de la enfermedad, en la que se compararon los resultados producidos por Haemagogus janthinomys y Aedes aegypti como vectores; 2) migración a través de una comunidad de tránsito situada en una ruta migratoria, donde la enfermedad es endémica, hacia otra comunidad libre de la enfermedad; y 3) efectos de tasas de vacunación diferentes en la comunidad de acogida, tomando en consideración la vacunación de las personas migrantes a su llegada. Resultados. Los resultados no muestran diferencias notables entre las situaciones 1 y 2. En cuanto a la aparición de brotes, tanto la cobertura vacunal en la comunidad de acogida como el tipo de vector tienen más importancia que las tasas de migración; y H. janthinomys muestra mayor eficacia que A. aegypti. Conclusiones. Dado que, para determinar la aparición de un posible brote, la vacunación tiene mayor importancia que las tasas de migración, la vacunación de las personas migrantes a su llegada puede ser una de las medidas más eficaces contra la fiebre amarilla. Además, a densidades similares, H. janthinomys es un vector más competente que A. aegypti, por lo que la presencia de A. aegypti constituye una señal de alerta para mantener la vacunación por encima de los niveles recomendados.

RESUMO Objetivo. Avaliar a relevância do fluxo de pessoas entre comunidades em comparação com a vacinação e tipo de vetor para a propagação e potenciais surtos de febre amarela em uma comunidade de destino livre da doença. Métodos. Usando um modelo SEIRV-SEI para humanos e vetores, foram aplicadas simulações numéricas aos seguintes cenários: (1) migração de uma comunidade endêmica para uma comunidade de destino livre da doença, comparando o desempenho de Haemagogus janthinomys e de Aedes aegypti como vetores; (2) migração através de uma comunidade de trânsito localizada em uma rota migratória, onde a doença é endêmica, para uma comunidade de destino livre da doença; e (3) efeitos de diferentes taxas de vacinação na comunidade de destino, considerando-se a vacinação dos migrantes ao chegarem. Resultados. Os resultados não revelaram diferenças marcantes entre os cenários 1 e 2. O tipo de vetor e a cobertura vacinal na comunidade de destino são mais relevantes para a ocorrência de surtos do que as taxas de migração; o vetor H. janthinomys é mais efetivo do que A. aegypti. Conclusões. Na medida em que a vacinação é mais determinante para um potencial surto que as taxas de migração, a vacinação de migrantes na chegada pode ser uma das medidas mais efetivas contra a febre amarela. Além disso, o H. janthinomys é um vetor mais competente do que o A. aegypti em densidades similares, mas a presença de A. aegypti é um alerta para manter a vacinação acima dos níveis recomendados.

Viruela del simio: Preocupación por una zoonosis emergente / Monkeypox: Concern about an emerging zoonosis

Introducción: La viruela del simio es una enfermedad zoonótica viral, causada por el poxvirus del mismo nombre; endémica de África central y occidental. Sin embargo, su presencia se ha incrementado en otras regiones del mundo durante la última década en comparación con los 40 años anteriores. Objetivo. Describir y actualizar las características etiológicas, epidemiológicas y clínicas de la viruela del simio, así como discutir el potencial riesgo de diseminación internacional. Material y Métodos. Se realizó una revisión de literatura publicada en los últimos cinco años, utilizando los descriptores Medical Subject Headings. La búsqueda se hizo en las bases de datos MEDLINE / PubMed y LILACS, sin restricciones de idioma. Se excluyeron los estudios duplicados y aquellos que no se ajustaban al objetivo de la investigación, seleccionando 47 artículos. Resultados. El virus de la viruela del simio está emparentado con el de la viruela humana (erradicada en 1979). Se transmite desde un individuo enfermo mediante gotitas de fluido respiratorio, contacto con material de lesión cutánea y fluidos corporales; o mediante fómites contaminados. Después de 6 a 13 días de incubación aparecen los síntomas, semejantes al de la viruela humana: comenzando con un proceso febril agudo y seguido de erupción cutánea en rostro y cuerpo, que cura dejando cicatrices visibles. Conclusiones. Este virus puede ocupar el nicho ecológico dejado por el virus de la viruela humana. Actualmente se ha expandido a Europa y América, por lo que ya no debe considerarse una enfermedad limitada al África, sino una amenaza sanitaria para la salud pública global.

background:Monkeypox is a viral zoonotic disease caused by the poxvirus of the same name, endemic to central and western Africa. However, its presence has increased in other regions of the world during the last decade compared to the previous 40 years.To describe and update the etiologic, Objective.epidemiologic, and clinical features of simian pox, as well as to discuss the potential risk of international spread. . Areview of Material and Methods literature published in the last five years was performed using the descriptors Medical Subject Headings. The search was performed in the MEDLINE/PubMed and LILACS data bases, without language restrictions. Duplicate studies and those that did not fit the research objective were excluded, selecting 47 articles. Results.Simian smallpox virus is related to human smallpox virus (eradicated in 1979). It is transmitted from a sick individual by respiratory fluid droplets, contact with skin lesion material and body fluids; or by contaminated fomites. After 6 to 13 days of incubation, symptoms appear, similar to those of human smallpox: beginning with an acute febrile process and followed by a cutaneous eruption on the face and body, which heals leaving visible scars. This virus may occupy the Conclusions.ecological niche left by the smallpox virus. It has now spread to Europe and America, so it should no longer be considered a disease limited to Africa, but a health threat to global public health