Análise da correlação dos índices de estrutura e recursos humanos do serviço veterinário oficial em 2019 e as incidências acumuladas (2017 ­ 2019) de doenças de notificação obrigatória em bovinos e equinos no Brasil / Analysis of the correlation between the structure and human resources indexes of the official veterinary service in 2019 and the accumulated incidences (2017 ­ 2019) of notifiable diseases in cattle and horses in Brazil

As doenças de notificação obrigatória em bovinos podem gerar impactos sociais e econômicos significativos na cadeia pecuária brasileira, além de consequências negativas no mercado internacional devido a embargos sanitários. Para auxiliar no entendimento de como um sistema de vigilância epidemiológica com mais recursos pode gerar mais credibilidade para o país, foram realizadas análises de correlação entre a notificação de doenças e a estrutura veterinária disponível nos Órgãos Executores de Sanidade Agropecuária (OESAs), a partir dos dados contidos no Sistema Nacional de Informação Zoossanitária (SIZ), entre os anos de 2017 e 2019. Com base nos dados do serviço veterinário, foram produzidos o Índice de Estrutura Física Oficial (IEFO) e o Índice de Recursos Humanos do Serviço Oficial (IRHSO). Foi realizada análise de correlação entre a notificação de doenças de bovinos com a capacidade de estrutura física e recursos humanos de vigilância epidemiológica disponíveis no Serviço Veterinário brasileiro. Os estados AP, RR e SC foram os que mais notificaram brucelose e tuberculose no período e estão entre os melhores índices de estrutura e recursos humanos do país. A análise dos índices mostrou que a raiva não possui correlação significativa com estrutura e recursos humanos do serviço, entretanto, brucelose e tuberculose possuem correlação positiva com estrutura veterinária oficial disponível para a vigilância em bovinos. Portanto, melhorias na estrutura podem refletir no incremento dos índices de notificação das doenças de bovinos, assim como na qualidade de suas informações.

Notifiable diseases in cattle can generate significant social and economic impacts on the Brazilian livestock chain, in addition to impacts on the international market due to sanitary embargoes. To help understand how an epidemiological surveillance system with more resources can generate more credibility for the country, correlation analyzes were carried out between the notification of diseases and the veterinary structure available in the Executing Bodies of Agricultural Health (OESAs), based on the data contained in the National System of Zoosanitary Information (SIZ), between the years 2017 to 2019. Based on public data from the veterinary service, the Official Physical Structure Index (IEFO) and the Official Service Human Resources Index (IRHSO) were produced. Correlation analysis was performed between the notification of bovine diseases with the capacity of physical structure and human resources for epidemiological surveillance available in the Brazilian Veterinary Service. AP, RR and SC were the states that most notified brucellosis and tuberculosis in the period and are among the best indices of structure and human resources in the country. The analysis of correlation indices showed that the rabies disease does not have a significant correlation with the structure and the human resources of the service, however, brucellosis and tuberculosis does have a positive correlation with the official veterinary structure available for surveillance in cattle. Therefore, Improvements in the structure can reflect in the increase of the notification rates, as well as in the quality of its information.

Seroprevalence of Rubella among Women of Reproductive Age in Iran: A Prisma-Based Systematic Review and Meta-Analysis.

OBJECTIVE: Rubella is a highly contagious viral disease with a significant teratogenic effect. Various results have been published about the seroprevalence of rubella in Iran. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-systematic review and meta-analysis were conducted to assess the immunity against rubella in Iranian women. METHODS: Eleven English and Persian electronic databases including PubMed, ScienceDirect, Scopus, Web of Science, Google Scholar, Embase, Scientific Information Database, Iran doc, Iran Medex, Magiran, and Medlib were searched using the keywords: Epidemiology, Prevalence, Rubella, Women, Childbearing age, Reproductive age, and Iran. A mathematician (NS) reviewed all steps for accuracy. RESULTS: Out of 1,520 articles, 25 well-conducted studies with a total amount of 10,145 women were reviewed. The pooled prevalence rate of anti-rubella IgG was 84% (95% CI: 83%-86%). The highest prevalence rate of IgG was in Zahedan, Rasht, and Arak (each 100%), while the lowest prevalence was in Jahrom (54%). Subgroup analysis showed that from 1989 through 2012, the IgG prevalence rate increased from 78% (95% CI: 73-83%) to 99% (95% CI: 98 100%). CONCLUSIONS: Although the vaccination program seems working in Iran, some peripheral regions may be a target to improve health care policies.

Using the Newcomb-Benford law to study the association between a country's COVID-19 reporting accuracy and its development.

The COVID-19 pandemic has spurred controversies related to whether countries manipulate reported data for political gains. We study the association between accuracy of reported COVID-19 data and developmental indicators. We use the Newcomb-Benford law (NBL) to gauge data accuracy. We run an OLS regression of an index constructed from developmental indicators (democracy level, gross domestic product per capita, healthcare expenditures, and universal healthcare coverage) on goodness-of-fit measures to the NBL. We find that countries with higher values of the developmental index are less likely to deviate from the Newcomb-Benford law. The relationship holds for the cumulative number of reported deaths and total cases but is more pronounced for the death toll. The findings are robust for second-digit tests and for a sub-sample of countries with regional data. The NBL provides a first screening for potential data manipulation during pandemics. Our study indicates that data from autocratic regimes and less developed countries should be treated with more caution. The paper further highlights the importance of independent surveillance data verification projects.

Can we rely on COVID-19 data? An assessment of data from over 200 countries worldwide.

To fight COVID-19, global access to reliable data is vital. Given the rapid acceleration of new cases and the common sense of global urgency, COVID-19 is subject to thorough measurement on a country-by-country basis. The world is witnessing an increasing demand for reliable data and impactful information on the novel disease. Can we trust the data on the COVID-19 spread worldwide? This study aims to assess the reliability of COVID-19 global data as disclosed by local authorities in 202 countries. It is commonly accepted that the frequency distribution of leading digits of COVID-19 data shall comply with Benford's law. In this context, the author collected and statistically assessed 106,274 records of daily infections, deaths, and tests around the world. The analysis of worldwide data suggests good agreement between theory and reported incidents. Approximately 69% of countries worldwide show some deviations from Benford's law. The author found that records of daily infections, deaths, and tests from 28% of countries adhered well to the anticipated frequency of first digits. By contrast, six countries disclosed pandemic data that do not comply with the first-digit law. With over 82 million citizens, Germany publishes the most reliable records on the COVID-19 spread. In contrast, the Islamic Republic of Iran provides by far the most non-compliant data. The author concludes that inconsistencies with Benford's law might be a strong indicator of artificially fabricated data on the spread of SARS-CoV-2 by local authorities. Partially consistent with prior research, the United States, Germany, France, Australia, Japan, and China reveal data that satisfies Benford's law. Unification of reporting procedures and policies globally could improve the quality of data and thus the fight against the deadly virus.

Distribution of molecular strains of Mycobacterium tuberculosis in an intermediate burden Asia Pacific city.

Hong Kong is an intermediate tuberculosis (TB) burden city in Asia Pacific with slow decline of case notification in the last decade. By 24-loci mycobacterial interspersed repetitive units - variable number of tandem repeats genotyping, we examined 534 Mycobacterium tuberculosis isolates collected from culture-positive hospitalised TB patients in a 1.7 million population geographic region in the city. Overall, 286 (75%) were classified as Beijing genotype, of which 216 (76%) and 59 (21%) belonged to modern and ancient sub-lineage, respectively. Only two cases were genetically clustered while spatial clustering was absent. Male gender, permanent residency in Hong Kong and born in Hong Kong or Mainland China were associated with Beijing genotype. The high prevalence of Beijing modern lineage was similar to that in East Asia, which reflected the pattern resulting from population migration. The paucity of clustering suggested that reactivation accounted for most of the TB disease cases, which was and echoed by observation that half were 60 years old or above, and the presence of co-morbid medical conditions. The predominance of reactivation TB cases in intermediate burden localities implies that the detection and control of latent TB infection would be the major challenge in achieving TB elimination.

Vigilância Epidemiológica estadual no enfrentamento da pandemia pela COVID-19 no Brasil: um relato de experiência / State Epidemiological Surveillance in combating the COVID-19 pandemic in Brazil: an experience report / Vigilancia Epidemiológica estatal en el combate a la pandemia por COVID-19 en Brasil: informe de experiência

Objetivo: sistematizar a experiência do estado do Espírito Santo no enfrentamento da COVID-19, baseando-se na vivência enquanto equipe gestora e operacional da vigilância epidemiológica estadual, no período de março de 2020 a março de 2021. Método: trata-se de um estudo descritivo, do tipo relato de experiência. Os dados foram obtidos por meio de canais oficiais, alimentados por um sistema de notificação em saúde adotado pelo estado do Espírito Santo e por planilhas enviadas diariamente pelos estabelecimentos de saúde. Resultados: observou-se que a aproximação entre a gestão estadual e municipal facilitou a implementação das orientações instituídas e a consolidação das medidas em todo território capixaba, vale salientar que outros órgãos governamentais auxiliaram nesse processo. Conclusão: os desdobramentos exigidos na gestão da pandemia evidenciam a importância da Vigilância em Saúde e o papel estratégico da Vigilância Epidemiológica no controle da pandemia, e na tomada de decisão e direcionamento de recursos humanos e financeiros.

Objective: to systematize the experience of the state of Espírito Santo in facing COVID-19, based on the experience as a manager and operational team of the state epidemiological surveillance, in the period from March 2020 to March 2021. Method: this is a descriptive study, of the experience report type. The data were obtained through official channels, fed by a health notification system adopted by the State of Espírito Santo and by spreadsheets sent daily by health establishments. Results: it was observed that the approximation between state and municipal management facilitated the implementation of the instituted guidelines and the consolidation of the measures in the entire territory of the state of Espírito Santo. Conclusion: it is concluded that the developments required in the management of the pandemic highlight the importance of Health Surveillance and the strategic role of the Epidemiological Surveillance in the control of the pandemic, and in the decision making and direction of human and financial resources

Objetivo: sistematizar la experiencia de estado de Espírito Santo en el enfrentamiento del COVID-19, a partir de la experiencia como equipo gestora y operacional de la vigilancia epidemiológica estatal, de marzo de 2020 a marzo de 2021. Método: se trata de un estudio descriptivo, tipo relato de experiencia. Los datos se obtuvieron a través de canales oficiales, alimentados por un sistema de notificación sanitaria adoptado por el Estado de Espírito Santo y por planillas enviadas diariamente por los establecimientos de salud. Resultados: se observó que la aproximación entre la gestión estatal y municipal facilitó la implementación de orientaciones instituidas y la consolidación de medidas en todo el territorio del estado de Espírito Santo, cabe mencionar que otras agencias gubernamentales asistieron en este proceso. Conclusión: se concluye que los desdoblamientos exigidos en la gestión de la pandemia evidenciaron la importancia de la Vigilancia en Salud y el rol estratégico de la Vigilancia Epidemiológica en el control de la pandemia y en la toma de decisiones y direccionamiento de recursos humanos y financieros

Tuberculosis cases with post-mortem notification in Brazil, 2014: a descriptive study based on surveillance data. / Casos de tuberculose com notificação após o óbito no Brasil, 2014: um estudo descritivo com base nos dados de vigilância.

OBJECTIVE: To characterize tuberculosis cases notified at post-mortem in Brazil in 2014. METHODS: This is a descriptive study of tuberculosis cases notified at post-mortem. Data resulted from linkage of the Notifiable Health Conditions Information System-TB (SINAN-TB) and the Mortality Information System (SIM), and were described according to underlying cause of death: tuberculosis, AIDS and other. RESULTS: In the 2,703 tuberculosis cases notified at post-mortem, a higher proportion was found of people of the male sex (73.5%), aged over 39 (80.8%), <8 years of schooling (66.5%), of Black and brown race/skin color (62.8%), with the pulmonary clinical form of tuberculosis (75.2%); there was also a higher proportion of cases notified by the public health service (57.6%) and in municipalities with HDI-M >0.7 (66.6%). CONCLUSION: The characteristics described of people with post-mortem notification and the magnitude of this outcome suggest weaknesses in tuberculosis care and surveillance services.

Officially Confirmed COVID-19 and Unreported COVID-19-Like Illness Death Counts: An Assessment of Reporting Discrepancy in Bangladesh.

Reporting discrepancies between officially confirmed COVID-19 death counts and unreported COVID-19-like illness (CLI) death counts have been evident across the world, including Bangladesh. Publicly available data were used to explore the differences between confirmed COVID-19 death counts and deaths with possible COVID-19 symptoms between March 2, 2020 and August 22, 2020. Unreported CLI death counts totaled more than half of the confirmed COVID-19 death counts during the study period. However, the reporting authority did not consider CLI deaths, which might produce incomplete and unreliable COVID-19 data and respective mortality rates. All deaths with possible COVID-19 symptoms need to be included in provisional death counts to better estimate the COVID-19 mortality rate and to develop data-driven COVID-19 response strategies. An urgent initiative is needed to prepare a comprehensive guideline for reporting COVID-19 deaths.

Estimating the real burden of disease under a pandemic situation: The SARS-CoV2 case.

The present paper introduces a new model used to study and analyse the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) epidemic-reported-data from Spain. This is a Hidden Markov Model whose hidden layer is a regeneration process with Poisson immigration, Po-INAR(1), together with a mechanism that allows the estimation of the under-reporting in non-stationary count time series. A novelty of the model is that the expectation of the unobserved process's innovations is a time-dependent function defined in such a way that information about the spread of an epidemic, as modelled through a Susceptible-Infectious-Removed dynamical system, is incorporated into the model. In addition, the parameter controlling the intensity of the under-reporting is also made to vary with time to adjust to possible seasonality or trend in the data. Maximum likelihood methods are used to estimate the parameters of the model.

Giardiasis notifications are associated with socioeconomic status in Sydney, Australia: a spatial analysis.

OBJECTIVE: In developed countries prolonged symptoms due to, or following, Giardia intestinalis infection can have a significant impact on the quality of life. In this research, we investigate the presence of a socioeconomic status (SES) gradient in the reporting of giardiasis in South West Sydney Local Health District (SWSLHD), New South Wales (NSW), Australia, across geographic scales. METHODS: We used a large database, spatial-cluster analysis and a linear model. RESULTS: Firstly, we found one spatial cluster of giardiasis in one of the most advantaged neighbourhoods of SWSLHD. Secondly, rates of giardiasis notifications were significantly and consistently lower in SWSLHD compared to an unnamed advantaged Local Health District and NSW over multiple years. Finally, we found an overall significant positive dose-response relationship between counts of giardiasis and area-level SES. CONCLUSIONS: Lower reporting in disadvantaged areas may represent true differences in incidence across SES groups or may result from differential use of health services and reporting. Implications for public health: If the disparities result from differential use of health services, research should be directed toward identifying barriers and facilitators of use. If disparities result from a true difference in incidence, then the behavioural mediators between SES and giardiasis should be identified and addressed.

National tuberculosis prevalence surveys in Africa, 2008-2016: an overview of results and lessons learned.

OBJECTIVE AND METHODS: Worldwide, tuberculosis (TB) is the leading cause of death from a single infectious agent. In many countries, national TB prevalence surveys are the only way to reliably measure the burden of TB disease and can also provide other evidence to inform national efforts to improve TB detection and treatment. Our objective was to synthesise the results and lessons learned from national surveys completed in Africa between 2008 and 2016, to complement a previous review for Asia. RESULTS: Twelve surveys completed in Africa were identified: Ethiopia (2010-2011), Gambia (2011-2013), Ghana (2013), Kenya (2015-2016), Malawi (2013-2014), Nigeria (2012), Rwanda (2012), Sudan (2013-2014), Tanzania (2011-2012), Uganda (2014-2015), Zambia (2013-2014) and Zimbabwe (2014). The eligible population in all surveys was people aged ≥15 years who met residency criteria. In total 588 105 individuals participated, equivalent to 82% (range 57-96%) of those eligible. The prevalence of bacteriologically confirmed pulmonary TB disease in those ≥15 years varied from 119 (95% CI 79-160) per 100 000 population in Rwanda and 638 (95% CI 502-774) per 100 000 population in Zambia. The male:female ratio was 2.0 overall, ranging from 1.2 (Ethiopia) to 4.1 (Uganda). Prevalence per 100 000 population generally increased with age, but the absolute number of cases was usually highest among those aged 35-44 years. Of identified TB cases, 44% (95% CI 40-49) did not report TB symptoms during screening and were only identified as eligible for diagnostic testing due to an abnormal chest X-ray. The overall ratio of prevalence to case notifications was 2.5 (95% CI 1.8-3.2) and was consistently higher for men than women. Many participants who did report TB symptoms had not sought care; those that had were more likely to seek care in a public health facility. HIV prevalence was systematically lower among prevalent cases than officially notified TB patients with an overall ratio of 0.5 (95% CI 0.3-0.7). The two main study limitations were that none of the surveys included people <15 years, and 5 of 12 surveys did not have data on HIV status. CONCLUSIONS: National TB prevalence surveys implemented in Africa between 2010 and 2016 have contributed substantial new evidence about the burden of TB disease, its distribution by age and sex, and gaps in TB detection and treatment. Policies and practices to improve access to health services and reduce under-reporting of detected TB cases are needed, especially among men. All surveys provide a valuable baseline for future assessment of trends in TB disease burden.

OBJECTIF ET MÉTHODES: Dans le monde entier, la tuberculose (TB) est la principale cause de décès par un seul agent infectieux. Dans de nombreux pays, les surveillances nationales de prévalence de la TB sont le seul moyen de mesurer de manière fiable la charge de la TB et peuvent également fournir d'autres données pour éclairer les efforts nationaux visant à améliorer la détection et le traitement de la TB. Notre objectif était de synthétiser les résultats et les leçons tirées des surveillances nationales réalisées en Afrique entre 2008 et 2016, pour complémenter une analyse précédente pour l'Asie. RÉSULTATS: Douze surveillances réalisées en Afrique ont été identifiés: Ethiopie (2010-2011), Gambie (2011-2013), Ghana (2013), Kenya (2015-2016), Malawi (2013-2014), Nigeria (2012), Rwanda (2012), Soudan (2013-2014 ), Tanzanie (2011-2012), Ouganda (2014-2015), Zambie (2013-2014) et Zimbabwe (2014). La population éligible dans toutes les surveillances était des personnes ≥15 ans qui répondaient aux critères de résidence. Au total, 588.105 personnes ont participé, ce qui équivaut à 82% (entre 57% et 96% ) des personnes éligibles. La prévalence de la TB pulmonaire bactériologiquement confirmée chez les ≥15 ans variait de 119 (IC95%: 79-160) pour 100.000 habitants au Rwanda et 638 (IC95%: 502 à 774) pour 100.000 habitants en Zambie. Le ratio hommes/femmes était globalement de 2,0, allant de 1,2 (Ethiopie) à 4,1 (Ouganda). La prévalence pour 100.000 habitants augmentait généralement avec l'âge, mais le nombre absolu de cas était généralement le plus élevé chez les 35 à 44 ans. Parmi les cas de TB identifiés, 44% (IC95%: 40-49) n'ont pas rapporté de symptômes de TB lors du dépistage et n'ont été identifiés comme éligibles aux tests de diagnostic qu'en raison d'une radiographie pulmonaire anormale. Le rapport global entre la prévalence et les notifications de cas était de 2,5 (IC95%: 1,8-3,2) et était systématiquement plus élevé pour les hommes que pour les femmes. De nombreux participants qui avaient rapporté des symptômes de TB n'avaient pas recherché des soins; ceux qui en avaient étaient plus susceptibles de rechercher des soins dans un établissement de santé publique. La prévalence du VIH était systématiquement plus faible parmi les cas prévalents que chez les patients TB officiellement notifiés avec un rapport global de 0,5 (IC95% 0,3 - 0,7). Les deux principales limitations de l'étude étaient les suivantes: aucune des surveillances n'incluait des personnes de moins de 15 ans et 5 des 12 surveillances ne contenaient pas de données sur le statut VIH. CONCLUSIONS: Les surveillances nationales sur la prévalence de la TB en Afrique menées entre 2010 et 2016 ont fourni de nouvelles données sur la charge de morbidité de la TB, la répartition par âge et par sexe, et les lacunes dans la détection et le traitement de la TB. Des politiques et des pratiques pour améliorer l'accès aux services de santé et réduire la sous-déclaration des cas de TB détectés sont nécessaires, en particulier chez les hommes. Toutes les surveillances fournissent une base précieuse pour l'évaluation future des tendances de la charge de morbidité TB.

A systematic assessment on COVID-19 preparedness and transition strategy in Bangladesh.

RATIONALE, AIMS, AND OBJECTIVES: The COVID-19 pandemic of 2020 has overpowered the most advanced health systems worldwide with thousands of daily deaths. The current study conducted a situation analysis on the pandemic preparedness of Bangladesh and provided recommendations on the transition to the new reality and gradual restoration of normalcy. METHOD: A complex adaptive system (CAS) framework was theorized based on four structural dimensions obtained from the crisis and complexity theory to help evaluate the health system of Bangladesh. Data sourced from published reports from the government, non-governmental organizations, and mainstream media up to June 15, 2020 were used to conduct a qualitative analysis and visualize the spatial distribution of countrywide COVID-19 cases. RESULTS: The findings suggested that Bangladesh severely lacked the preparedness to tackle the spread of COVID-19 with both short- and long-term implications for health, the economy, and good governance. Absence of planning and coordination, disproportionate resource allocations, challenged infrastructure, adherence to bureaucratic delay, lack of synchronized risk communication, failing leadership of concerned authorities, and incoherent decision-making have led to a precarious situation that will have dire ramifications causing many uncertainties in the coming days. CONCLUSIONS: Implementation of response protocols addressing the needs of the community and the stakeholders from the central level is urgently needed. The development of mechanisms for dynamic decision-making based on regular feedback and long-term planning for a smooth transition between the new reality and normalcy should also be urgently addressed in Bangladesh.

Finding gaps in TB notifications: spatial analysis of geographical patterns of TB notifications, associations with TB program efforts and social determinants of TB risk in Bangladesh, Nepal and Pakistan.

BACKGROUND: In order to effectively combat Tuberculosis, resources to diagnose and treat TB should be allocated effectively to the areas and population that need them. Although a wealth of subnational data on TB is routinely collected to support local planning, it is often underutilized. Therefore, this study uses spatial analytical techniques and profiling to understand and identify factors underlying spatial variation in TB case notification rates (CNR) in Bangladesh, Nepal and Pakistan for better TB program planning. METHODS: Spatial analytical techniques and profiling was used to identify subnational patterns of TB CNRs at the district level in Bangladesh (N = 64, 2015), Nepal (N = 75, 2014) and Pakistan (N = 142, 2015). A multivariable linear regression analysis was performed to assess the association between subnational CNR and demographic and health indicators associated with TB burden and indicators of TB programme efforts. To correct for spatial dependencies of the observations, the residuals of the multivariable models were tested for unexplained spatial autocorrelation. Spatial autocorrelation among the residuals was adjusted for by fitting a simultaneous autoregressive model (SAR). RESULTS: Spatial clustering of TB CNRs was observed in all three countries. In Bangladesh, TB CNR were found significantly associated with testing rate (0.06%, p < 0.001), test positivity rate (14.44%, p < 0.001), proportion of bacteriologically confirmed cases (- 1.33%, p < 0.001) and population density (4.5*10-3%, p < 0.01). In Nepal, TB CNR were associated with population sex ratio (1.54%, p < 0.01), facility density (- 0.19%, p < 0.05) and treatment success rate (- 3.68%, p < 0.001). Finally, TB CNR in Pakistan were found significantly associated with testing rate (0.08%, p < 0.001), positivity rate (4.29, p < 0.001), proportion of bacteriologically confirmed cases (- 1.45, p < 0.001), vaccination coverage (1.17%, p < 0.001) and facility density (20.41%, p < 0.001). CONCLUSION: Subnational TB CNRs are more likely reflective of TB programme efforts and access to healthcare than TB burden. TB CNRs are better used for monitoring and evaluation of TB control efforts than the TB epidemic. Using spatial analytical techniques and profiling can help identify areas where TB is underreported. Applying these techniques routinely in the surveillance facilitates the use of TB CNRs in program planning.

Violence against adolescents: analysis of health sector notifications, Brazil, 2011-2017. / Violências contra adolescentes: análise das notificações realizadas no setor saúde, Brasil, 2011-2017.

INTRODUCTION: Violence experienced in adolescence results in serious damage and suffering to society. This study aims to characterize the profile of violence victims and likely perpetrators of violence against adolescents, as well as to describe the percentage of notifying municipalities according to the federation unit. METHODS: Cross-sectional study conducted with data on notification of violence against adolescents from the Information System for Notifiable Diseases, from 2011 to 2017. The chi-square test was used to assess the statistical significance of the differences between the proportions in the comparison between genders. Proportion ratios for the most frequent types of violence were estimated according to selected variables. RESULTS: The notifications came from 75.4% of all the Brazilian municipalities. Physical violence predominated among males, aged 15-19 years. Psychological violence was predominant among females, between 10 and 14 years old, when perpetrated repeatedly at home by family aggressors. Sexual violence prevailed among females, aged 10 to 14 years old, in the indigenous, black and yellow races/colors, when perpetrated repeatedly at home. Negligence was more common among males, between 10 and 14 years old, when perpetrated repeatedly by family aggressors. CONCLUSIONS: Sexual violence occurred predominantly against females and generated significant negative impacts on mental, physical, sexual and reproductive health. Community violence, perpetrated with sharp objects and firearms, were prominent among males and are important risk factors for male over-mortality. Because the problems are complex, addressing them requires intersectoral actions.

Spatio-temporal analysis of socio-economic characteristics for pulmonary tuberculosis in Sichuan province of China, 2006-2015.

BACKGROUND: The disease burden caused by pulmonary tuberculosis (TB) in Sichuan province still persisted at a high level, and large spatial variances were presented across regional distribution disparities. The socio-economic factors were suspected to affect the population of TB notification, we aimed to describe TB case notification rate (CNR) and identify which factors influence TB epidemic are necessary for the prevention and control of the disease in Sichuan province. METHODS: A retrospective cross-sectional study and an ecological spatial analysis was conducted to quantify the presence and location of spatial clusters of TB by the Moran's I index and examined these patterns with socio-economic risk factors by hierarchical Bayesian spatio-temporal model. RESULTS: A total of 630,009 pulmonary TB cases were notified from 2006 to 2015 in 181 counties of Sichuan province. The CNR decreased year by year since 2007, from 88.70 to 61.37 per 100,000 persons. The spatial heterogeneities of CNR were observed during the study periods. Global Moran's I index varied from 0.23 to 0.44 with all P-value < 0.001. The Bayesian spatio-temporal model with parametric spatio-temporal interactions was chosen as the best model according to the minimum of Deviance Information Criterion (DIC)(19,379.01), and in which the quadratic form of time was taken. The proportion of age group and education year were all associated with CNR after adjusting the spatial effect, temporal effect and spatio-temporal interactions. TB CNR increased by 10.2% [95% credible interval (CI): 6.7-13.7%] for every 1-standard-deviation increase in proportion of age group and decreased by 23% (95% CI: 13.7-32.7%) for every 1-standard-deviation increase in education year. CONCLUSIONS: There were spatial clusters of TB notification rate in Sichuan province from 2006 to 2015, and heavy TB burden was mainly attributed to aging and low socioeconomic status including poor education. Thus, it is more important to pay more attention to the elderly population and improve socioeconomic status including promoting education level in Sichuan province to reduce the TB burden.

Rapidly increasing cumulative incidence of coronavirus disease (COVID-19) in the European Union/European Economic Area and the United Kingdom, 1 January to 15 March 2020.

The cumulative incidence of coronavirus disease (COVID-19) cases is showing similar trends in European Union/European Economic Area countries and the United Kingdom confirming that, while at a different stage depending on the country, the COVID-19 pandemic is progressing rapidly in all countries. Based on the experience from Italy, countries, hospitals and intensive care units should increase their preparedness for a surge of patients with COVID-19 who will require healthcare, and in particular intensive care.

Effect of Free Healthcare Policy for Children under Five Years Old on the Incidence of Reported Malaria Cases in Burkina Faso by Bayesian Modelling: "Not only the Ears but also the Head of the Hippopotamus".

Burkina Faso has recently implemented an additional strategy, the free healthcare policy, to further improve maternal and child health. This policy targets children under five who bear the brunt of the malaria scourge. The effects of the free-of-charge healthcare were previously assessed in women but not in children. The present study aims at filling this gap by assessing the effect of this policy in children under five with a focus on the induced spatial and temporal changes in malaria morbidity. We used a Bayesian spatiotemporal negative binomial model to investigate the space-time variation in malaria incidence in relation to the implementation of the policy. The analysis relied on malaria routine surveillance data extracted from the national health data repository and spanning the period from January 2013 to December 2018. The model was adjusted for meteorological and contextual confounders. We found that the number of presumed and confirmed malaria cases per 1000 children per month increased between 2013 and 2018. We further found that the implementation of the free healthcare policy was significantly associated with a two-fold increase in the number of tested and confirmed malaria cases compared with the period before the policy rollout. This effect was, however, heterogeneous across the health districts. We attributed the rise in malaria incidence following the policy rollout to an increased use of health services combined with an increased availability of rapid tests and a higher compliance to the "test and treat" policy. The observed heterogeneity in the policy effect was attributed to parallel control interventions, some of which were rolled out at different paces and scales. Our findings call for a sustained and reinforced effort to test all suspected cases so that, alongside an improved case treatment, the true picture of the malaria scourge in children under five emerges clearly (see the hippopotamus almost entirely).

Caracterização dos casos confirmados de dengue por meio da técnica de linkage de bancos de dados, para avaliar a circulação viral em Belo Horizonte, 2009-2014 / Características de los casos confirmados de dengue utilizando la técnica de enlace de bases de datos, para evaluar la circulación viral en la ciudad de Belo Horizonte, Brasil, 2009-2014 / Characterization of dengue cases confirmed using the database linkage technique: assessment of virus circulation in Belo Horizonte, Brazil, 2009-2014

Objetivo: descrever a circulação viral de dengue em Belo Horizonte, Brasil, de 2009 a 2014. Métodos: trata-se de estudo de série de casos de dengue infectados por diferentes sorotipos do vírus, identificados por isolamento viral ou RT-PCR; foi realizado linkage das bases de dados do Sistema de Informação de Agravos de Notificação (Sinan), do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS) e do Gerenciador de Ambiente Laboratorial (GAL). Resultados: foram relacionados 91,1% dos registros (n=775); entre os casos (n=851), 60,4% (n=514) foram confirmados como DENV-1, 22,1% (n=188) como DENV-4, 9,8% (n=83) como DENV-2 e 7,7% (n=66) como DENV-3; DENV-2 apresentou maior percentual de casos graves (4,5%). Conclusão: DENV-1 prevaleceu e circulou em todos os anos avaliados.

Objetivo: describir la circulación viral del dengue en Belo Horizonte, Brasil, de 2009 a 2014. Métodos: se trata de estudio de una serie de casos de dengue infectados por diferentes serotipos del virus, identificados por aislamiento viral o RT-PCR; se realizó una conexión con las bases de datos del Sistema de Información para Enfermedades de Notificación (Sinan), el Sistema del Información Hospitalaria del Sistema Único de Salud (SIH/SUS) y el Gestor de Ambiente de Laboratorio (GAL). Resultados: fueron relacionados 91,1% de los registros (n=775); entre los casos (n=851), el 60,4% (n=514) fue confirmado como DENV-1, 22,1% (n=188) como DENV-4, 9,8% (n=83) como DENV-2 y 7,7% (n=66) como DENV-3; DENV-2 tuvo un mayor porcentaje de casos graves (4,5%). Conclusión: DENV-1 prevaleció y circuló en todos los años evaluados.

Objective: to describe dengue virus circulation in Belo Horizonte, Brazil, from 2009 to 2014. Methods: this is a series study of cases of dengue infected by different virus serotypes, identified by virus isolation or RT-PCR; database linkage was performed between the Notifiable Health Conditions Information System (SINAN), the Brazilian National Health System Hospital Information System (SIH/SUS) and the Laboratory Environment Manager (GAL). Results: 91.1% of the records were linked (n=775); among the cases (n=851), 60.4% (n=514) were confirmed as DENV-1, 22.1% (n=188) DENV-4, 9.8% (n=83) as DENV-2, and 7.7% (n=66) as DENV-3; DENV-2 accounted for a higher percentage of severe cases (4.5%). Conclusion: DENV-1 prevailed and circulated in all evaluated years.

Violências contra adolescentes: análise das notificações realizadas no setor saúde, Brasil, 2011-2017 / Violence against adolescents: analysis of health sector notifications, Brazil, 2011-2017

RESUMO: Introdução: A violência sofrida na adolescência resulta em sérios prejuízos e sofrimento para a sociedade. Este estudo objetivou caracterizar o perfil das violências, das vítimas e dos prováveis autores das violências perpetradas contra adolescentes, bem como descrever o percentual de municípios notificantes por unidade da Federação. Métodos: Estudo transversal, realizado com dados de notificação de violência contra adolescentes do Sistema de Informação de Agravos de Notificação referentes ao período de 2011 a 2017. A significância estatística das diferenças entre as proporções na comparação entre sexos foi testada com o qui-quadrado. Estimaram-se razões de proporção para os tipos de violência mais frequentes segundo variáveis selecionadas. Resultados: As notificações foram procedentes de 75,4% dos municípios brasileiros. A violência física predominou no sexo masculino, na idade de 15 a 19 anos. A violência psicológica predominou no sexo feminino, entre 10 e 14 anos, quando praticada de forma repetitiva, no domicílio, por agressores familiares. A violência sexual prevaleceu no sexo feminino, entre 10 e 14 anos, nas raças/cores indígena, negra e amarela, quando perpetrada de forma repetitiva, no domicílio. A negligência predominou no sexo masculino, entre 10 e 14 anos, quando praticada de forma repetitiva, por agressores familiares. Conclusões: Violências sexuais ocorreram preponderantemente no sexo feminino e geram consideráveis impactos negativos à saúde mental, física, sexual e reprodutiva. Violências comunitárias perpetradas com objetos perfurocortantes e arma de fogo tiveram destaque no sexo masculino e são fatores de risco significativos para a sobremortalidade masculina. Como os problemas são complexos, demandam atuação intersetorial para seu enfrentamento.

ABSTRACT: Introduction: Violence experienced in adolescence results in serious damage and suffering to society. This study aims to characterize the profile of violence victims and likely perpetrators of violence against adolescents, as well as to describe the percentage of notifying municipalities according to the federation unit. Methods: Cross-sectional study conducted with data on notification of violence against adolescents from the Information System for Notifiable Diseases, from 2011 to 2017. The chi-square test was used to assess the statistical significance of the differences between the proportions in the comparison between genders. Proportion ratios for the most frequent types of violence were estimated according to selected variables. Results: The notifications came from 75.4% of all the Brazilian municipalities. Physical violence predominated among males, aged 15-19 years. Psychological violence was predominant among females, between 10 and 14 years old, when perpetrated repeatedly at home by family aggressors. Sexual violence prevailed among females, aged 10 to 14 years old, in the indigenous, black and yellow races/colors, when perpetrated repeatedly at home. Negligence was more common among males, between 10 and 14 years old, when perpetrated repeatedly by family aggressors. Conclusions: Sexual violence occurred predominantly against females and generated significant negative impacts on mental, physical, sexual and reproductive health. Community violence, perpetrated with sharp objects and firearms, were prominent among males and are important risk factors for male over-mortality. Because the problems are complex, addressing them requires intersectoral actions.

Casos de tuberculose com notificação após o óbito no Brasil, 2014: um estudo descritivo com base nos dados de vigilância / Casos de tuberculosis notificados después del óbito en Brasil, 2014: un estudio descriptivo basado en datos de vigilância / Tuberculosis cases with post-mortem notification in Brazil, 2014: a descriptive study based on surveillance data

Objetivo: Caracterizar os casos com notificação pós-óbito da tuberculose no Brasil em 2014. Métodos: Estudo descritivo dos casos de tuberculose com notificação pós-óbito. Os dados são resultantes da vinculação do Sistema de Informação de Agravos de Notificação (Sinan-TB) com o Sistema de Informações sobre Mortalidade (SIM), e foram descritos segundo causa básica de óbito: tuberculose, aids e outras. Resultados: Nos 2.703 casos de tuberculose com notificação pós-óbito, observou-se maior proporção de pessoas do sexo masculino (73,5%), com mais de 39 anos de idade (80,8%), com escolaridade <8 anos de estudo (66,5%), de raça/cor da pele negra e parda (62,8%), que adoeceram de tuberculose na forma clínica pulmonar (75,2%); também prevaleceram notificações pelo serviço público (57,6%) e em municípios com índice de desenvolvimento humano >0,7 (66,6%). Conclusão: As características descritas das pessoas notificadas pós-óbito e a magnitude desse desfecho sugerem fragilidades dos serviços de atenção e vigilância da tuberculose

Objetivo: Caracterizar los casos con notificación de tuberculosis post mortem en Brasil en 2014. Métodos: Estudio descriptivo de casos de tuberculosis con notificación post mortem. Los datos son resultantes de la vinculación del Sistema de Información de Enfermedades de Notificación (Sinan-TB) y Sistema de Información de Mortalidad (SIM); y fueron descritos de acuerdo con la causa básica de muerte: tuberculosis, sida y otros. Resultados: De los 2.703 casos de tuberculosis con notificación post mortem, hubo una mayor proporción de hombres (73,5%), >39 años de edad (80,8%), <8 años de escolaridad (66,5%), raza negra/parda (62,8%), que enfermaron con la forma clínica pulmonar (75,2%), notificados por el servicio público (57,6%) y de municipios con índice de desarrollo humano >0,7 (66,6%). Conclusión: Las características descritas de las personas notificadas post mortem y la magnitud de este resultado sugieren fragilidades en los servicios de atención y vigilancia de la tuberculosis.

Objective: To characterize tuberculosis cases notified at post-mortem in Brazil in 2014. Methods: This is a descriptive study of tuberculosis cases notified at post-mortem. Data resulted from linkage of the Notifiable Health Conditions Information System-TB (SINAN-TB) and the Mortality Information System (SIM), and were described according to underlying cause of death: tuberculosis, AIDS and other. Results: In the 2,703 tuberculosis cases notified at post-mortem, a higher proportion was found of people of the male sex (73.5%), aged over 39 (80.8%), <8 years of schooling (66.5%), of Black and brown race/skin color (62.8%), with the pulmonary clinical form of tuberculosis (75.2%); there was also a higher proportion of cases notified by the public health service (57.6%) and in municipalities with HDI-M >0.7 (66.6%). Conclusion: The characteristics described of people with post-mortem notification and the magnitude of this outcome suggest weaknesses in tuberculosis care and surveillance services.