A snapshot of a representative Brazilian state of illegal mining in indigenous areas during the era of malaria elimination / Um retrato de um estado brasileiro representativo do garimpo ilegal em áreas indígenas durante a campanha de erradicação da malária / Un retrato de un estado brasileño representativo de la minería ilegal en zonas indígenas durante la campaña de erradicación de la malaria

Abstract: Malaria is a public health problem and the cases diagnosed in the capital of Roraima, Brazil, show potential to characterize the burden of the disease in the state. This study aimed to describe the epidemiological, clinical, and laboratory aspects of malaria cases diagnosed in Boa Vista. For this purpose, a descriptive, cross-sectional study was conducted in two health units in the city, with individuals diagnosed and who agreed to respond the questionnaire. Of the total of 206 participants, characterized as men, mixed-race, and young, 96% (198) reported participating in illegal mining activity. Among the group of miners, 66% (131) came from other states of Brazil or other countries. The mines were mainly located in the Yanomami territory in Roraima. Plasmodium vivax infection occurred in 74% (153) of participants. In the miner's group, hospitalizations for severe malaria, previous malaria attacks, and delays in treatment after the onset of symptoms were reported. Although 73% (145) of miners reported knowing how malaria was transmitted, only 54% (107) used mosquito nets or repellents. The use of Artecom and chloroquine by miners is not for the complete treatment but only to relieve symptoms for returning to gold mines, highlighting the importance of molecular surveillance to antimalarial resistance. Indigenous peoples are considered vulnerable to malaria and miners promotes the increase of malaria in Roraima Indigenous Lands. Therefore, access to diagnosis and treatment in Indigenous areas invaded by miners is imperative to confront this disease that ravages Indigenous communities and threatens public health on a large scale to achieve the goal of eliminating malaria in the state.

Resumo: A malária é um problema de saúde pública e os casos diagnosticados na capital de Roraima, Brasil, têm potencial para caracterizar a carga da doença em todo o estado. O objetivo deste estudo foi descrever os aspectos epidemiológicos, clínicos e laboratoriais dos casos de malária diagnosticados em Boa Vista. Para tanto, foi realizado um estudo descritivo e transversal em duas unidades de saúde do município, com indivíduos diagnosticados com malária e que concordaram em responder ao questionário. De 206 participantes, caracterizados como homens, pardos e jovens, 96% (198) relataram atividade de garimpo ilegal. Entre garimpeiros, 66% (131) vieram de outros estados do Brasil ou de outros países. As minas estavam localizadas principalmente no território Yanomami, em Roraima. A infecção por Plasmodium vivax ocorreu em 74% (153) dos participantes. Entre garimpeiros, houve relatos de internações por malária grave, ataques prévios de malária e atrasos no tratamento após o início dos sintomas. Embora 73% (145) dos garimpeiros tenham relatado saber como a malária era transmitida, apenas 54% (107) usavam mosquiteiros ou repelentes. O uso de Artecom e cloroquina pelos garimpeiros não se destina ao tratamento completo, mas apenas ao alívio dos sintomas, permitindo o retorno às minas de ouro. Isso ressalta a importância da vigilância molecular para detectar a resistência antimalárica. Os indígenas são considerados uma população vulnerável à malária, e os garimpeiros promovem o aumento da malária nas Terras Indígenas de Roraima. Portanto, o acesso ao diagnóstico e tratamento em áreas indígenas invadidas por garimpeiros é imperativo para o enfrentamento dessa doença que assola as comunidades indígenas e ameaça a saúde pública em larga escala na meta de erradicar a malária no estado.

Resumen: La malaria es un problema de salud pública y los casos diagnosticados en la capital de Roraima, Brasil, tienen el potencial de caracterizar la carga de la enfermedad en todo el estado. El objetivo de este estudio fue describir los aspectos epidemiológicos, clínicos y de laboratorio de los casos de malaria diagnosticados en Boa Vista. Para ello, se realizó un estudio descriptivo y transversal en dos unidades de salud del municipio, con personas diagnosticadas con malaria y que aceptaron responder el cuestionario. De 206 participantes, caracterizados como hombres, pardos y jóvenes, el 96% (198) reportó actividad minera ilegal. Entre los mineros, el 66% (131) procedían de otros estados de Brasil o de otros países. Las minas estaban ubicadas principalmente en el territorio Yanomami, en Roraima. La infección por Plasmodium vivax se produjo en el 74% (153) de los participantes. Entre los mineros, hubo relatos de hospitalizaciones por malaria grave, ataques previos de malaria y retrasos en el tratamiento tras de la aparición de los síntomas. Aunque el 73% (145) de los mineros informó saber cómo se transmitía la malaria, solo el 54% (107) usaba mosquiteros o repelentes. El uso de Artecom y cloroquina por parte de los mineros no está destinado a un tratamiento completo, sino al alivio de los síntomas para permitir el regreso a las minas de oro. Esto resalta la importancia de la vigilancia molecular para detectar la resistencia a los antipalúdicos. Los indígenas son considerados una población vulnerable a la malaria, y los mineros promueven el aumento de la malaria en las Tierras Indígenas de Roraima. Por lo tanto, el acceso al diagnóstico y tratamiento en zonas indígenas invadidas por mineros es imperativo para combatir esta enfermedad que asola a las comunidades indígenas y amenaza la salud pública a gran escala en el objetivo de erradicar la malaria en el estado.

Transferência tecnológica durante a pandemia de covid-19: relato do primeiro treinamento prático presencial no Brasil / Technology transfer during the COVID-19 pandemic: report on the first face-to-face practical training course in Brazil / Transferencia de tecnología durante la epidemia de COVID-19 en Brasil: informe de la primera formación práctica presencial

O relato descreveu o primeiro curso presencial visando capacitar profissionais de saúde pública na realização de vigilância genômica em tempo real, durante períodos pandêmicos. Relato de experiência sobre um curso teórico-prático com foco em pesquisa e vigilância genômica, incluindo tecnologias de sequenciamento móvel, bioinformática, filogenética e modelagem epidemiológica. O evento contou com 162 participantes e foi o primeiro grande treinamento presencial realizado durante a epidemia de covid-19 no Brasil. Não foi detectada infecção pelo SARS-CoV-2 ao final do evento em nenhum participante, sugerindo a segurança e efetividade de todas as medidas de segurança adotadas. Os resultados do evento sugerem que é possível executar capacitação profissional com segurança durante pandemias, desde que seguidos todos os protocolos de segurança.

The objective of this report was to describe the first face-to-face course aimed at training public health professionals in performing real-time genomic surveillance during the pandemic period. Experience report on a theoretical-practical course focusing on genomic research and surveillance, including mobile sequencing technologies, bioinformatics, phylogenetics and epidemiological modeling. There were 162 participants in the event and it was the first major face-to-face training course conducted during the COVID-19 epidemic in Brazil. No cases of SARS-CoV-2 infection was detected among the participants at the end of the event, suggesting the safety and effectiveness of all safety measures adopted. The results of this experience suggest that it is possible to conduct professional training safely during pandemics, as long as all safety protocols are followed.

Este estudio tuvo como objetivo describir el primer curso presencial para capacitar a los profesionales de la salud pública para llevar a cabo la vigilancia genómica en tiempo real durante los períodos de pandemia. Este es un informe de experiencia en un curso teórico-práctico centrado en la investigación y vigilancia genómica, que incluye secuenciación móvil, bioinformática, filogenética y tecnologías de modelado epidemiológico. Este evento contó con la asistencia de 162 participantes y fue la primera gran capacitación presencial realizada durante la epidemia de COVID-19 en Brasil. No se detectó infección por SARS-CoV-2 al final del evento en ningún participante, lo que sugiere la seguridad y efectividad de todas las medidas de seguridad adoptadas. Por lo tanto, los resultados del evento sugieren que es posible realizar entrenamientos profesionales de manera segura durante pandemias, siempre y cuando se sigan todos los protocolos de seguridad.

Lack of quadruple and quintuple mutant alleles associated with sulfadoxine-pyrimethamine resistance in Plasmodium vivax isolates from Brazilian endemic areas

BACKGROUND AND OBJECTIVE Brazil is responsible for a large number of Plasmodium vivax cases in America. Given the emergence of P. vivax parasites resistant to chloroquine and the effectiveness of antifolates in vivax malaria treatment together with a correlation between mutations in P. vivax dhfr and dhps genes and SP treatment failure, the point mutations in these genes were investigated. METHODS Blood samples from 54 patients experiencing vivax malaria symptomatic episodes in the Amazonian Region were investigated. Genomic DNA was extracted using a DNA extraction kit (QIAGENTM). Nested polymerase chain reaction (PCR) amplification was carried out followed by Sanger sequencing to detect single nucleotide polymorphisms (SNPs). FINDINGS All tested isolates showed non-synonymous mutations in pvdhfr gene: 117N (54/54, 100%) and 58R (25/54, 46%). Double mutant allele 58R/117N (FRTNI, 28%) was the most frequent followed by triple mutant alleles (58R/117N/173L, FRTNL, 11%; 58R/61M/117N, FRMNI, 5% 117N/173L, FSTNL, 4%) and quadruple mutant allele (58R/61M/117N/173L, FRMNL, 2%). A single mutation was observed at codon C383G in pvdhps gene (SGKAV, 48%). CONCLUSION No evidence of molecular signatures associated with P. vivax resistance to SP was observed in the Brazilian samples.

Current vector control challenges in the fight against malaria in Brazil

Abstract In Brazil, malaria is an important public health problem first reported in 1560. Historically, fluctuations in malaria cases in Brazil are attributed to waves of economic development; construction of railroads, highways, and hydroelectric dams; and population displacement and land occupation policies. Vector control measures have been widely used with an important role in reducing malaria cases. In this review article, we reviewed the vector control measures established in the Brazilian territory and aspects associated with such measures for malaria. Although some vector control measures are routinely used in Brazil, many entomological and effectiveness information still need better evidence in endemic areas where Plasmodium vivax predominates. Herein, we outlined some of the needs and priorities for future research: a) update of the cartography of malaria vectors in Brazil, adding molecular techniques for the correct identification of species and complexes of species; b) evaluation of vector competence of anophelines in Brazil; c) strengthening of local entomology teams to perform vector control measures and interpret results; d) evaluation of vector control measures, especially use of insecticide-treated nets and long-lasting insecticidal nets, estimating their effectiveness, cost-benefit, and population acceptance; e) establishment of colonies of malaria vectors in Brazil, i.e., Anopheles darlingi, to understand parasite-vector interactions better; f) study of new vector control strategies with impacts on non-endophilic vectors; g) estimation of the impact of insecticide resistance in different geographical areas; and h) identification of the relative contribution of natural and artificial breeding sites in different epidemiological contexts for transmission.