The triple epidemics of arboviruses in Feira de Santana, Brazilian Northeast: Epidemiological characteristics and diffusion patterns.

Arboviruses are diseases of worldwide importance in the field of communicable diseases. In Brazil, the reemergence of dengue and the emergence of chikungunya and Zika since 2014 have led to epidemic waves of great magnitude and rapid spread. However, their diffusion patterns vary and change over time. This study analyzes the spatial diffusion of the simultaneous circulation of three arboviruses transmitted by the same vector in a large urban space over two epidemic waves in consecutive years. An ecological study of spatial and temporal aggregates on the occurrence of dengue, chikungunya, and Zika, from 2014 to 2019, in Feira de Santana, Bahia State, was carried out using data of cases reported to the national surveillance system. Four different methods were used to analyze the spatial diffusion: Kernel Estimation with sequential maps, cumulative nearest-neighbor ratios (NNI) over time, spatial correlograms and local autocorrelation changes (LISA) over time. From 2014-2019, there were 21,723 confirmed cases of arboviruses. The highest incidences were among women (496.9, 220.2, and 91.0 cases/100,000 women for dengue, chikungunya and Zika respectively). By age group, the highest incidences were from ages 10-19 years old (609.3 dengue cases/100,000), from 60 and more (306.7 chikungunya cases/100,000), and from 0-9 years old (124.1 Zika cases/100,000 inhabitants). The temporal distribution demonstrated two epidemic waves of simultaneous circulation in 2014 and 2015. Kernel maps indicate that arboviruses spread to neighboring areas near the first hotspots, suggesting an expansion diffusion pattern. The NNI, spatial correlograms and LISA changes results suggest expansion patterns for the three arboviruses in all periods. The spatial diffusion pattern of dengue, Zika, and chikungunya in the 2014-2015 epidemics in Feira de Santana was expansion. These findings are useful to guide prevention measures and reduce occurrence in other areas.

Seroprevalence of Chikungunya virus and living conditions in Feira de Santana, Bahia-Brazil.

BACKGROUND: Chikungunya is an arbovirus, transmitted by Aedes mosquitoes, which emerged in the Americas in 2013 and spread rapidly to almost every country on this continent. In Brazil, where the first cases were detected in 2014, it currently has reached all regions of this country and more than 900,000 cases were reported. The clinical spectrum of chikungunya ranges from an acute self-limiting form to disabling chronic forms. The purpose of this study was to estimate the seroprevalence of chikungunya infection in a large Brazilian city and investigate the association between viral circulation and living condition. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a population-based ecological study in selected Sentinel Areas (SA) through household interviews and a serologic survey in 2016/2017. The sample was of 1,981 individuals randomly selected. The CHIKV seroprevalence was 22.1% (17.1 IgG, 2.3 IgM, and 1.4 IgG and IgM) and varied between SA from 2.0% to 70.5%. The seroprevalence was significantly lower in SA with high living conditions compared to SA with low living condition. There was a positive association between CHIKV seroprevalence and population density (r = 0.2389; p = 0.02033). CONCLUSIONS/SIGNIFICANCE: The seroprevalence in this city was 2.6 times lower than the 57% observed in a study conducted in the epicentre of the CHIKV epidemic of this same urban centre. So, the herd immunity in this general population, after four years of circulation of this agent is relatively low. It indicates that CHIKV transmission may persist in that city, either in endemic form or in the form of a new epidemic, because the vector infestation is persistent. Besides, the significantly lower seroprevalences in SA of higher Living Condition suggest that beyond the surveillance of the disease, vector control and specific actions of basic sanitation, the reduction of the incidence of this infection also depends on the improvement of the general living conditions of the population.

Yellow fever transmission in non-human primates, Bahia, Northeastern Brazil.

Yellow fever virus (YFV) causes a clinical syndrome of acute hemorrhagic hepatitis. YFV transmission involves non-human primates (NHP), mosquitoes and humans. By late 2016, Brazil experienced the largest YFV outbreak of the last 100 years, with 2050 human confirmed cases, with 681 cases ending in death and 764 confirmed epizootic cases in NHP. Among affected areas, Bahia state in Northeastern was the only region with no autochthonous human cases. By using next generation sequence approach, we investigated the molecular epidemiology of YFV in NHP in Bahia and discuss what factors might have prevented human cases. We investigated 47 YFV positive tissue samples from NHP cases to generate 8 novel YFV genomes. ML phylogenetic tree reconstructions and automated subtyping tools placed the newly generated genomes within the South American genotype I (SA I). Our analysis revealed that the YFV genomes from Bahia formed two distinct well-supported phylogenetic clusters that emerged most likely of an introduction from Minas Gerais and Espírito Santo states. Vegetation coverage analysis performed shows predominantly low to medium vegetation coverage in Bahia state. Together, our findings support the hypothesis of two independent YFV SA-I introductions. We also highlighted the effectiveness of the actions taken by epidemiological surveillance team of the state to prevented human cases.

ACIDENTES DE TRABALHO COM EXPOSIÇÃO A MATERIAL BIOLÓGICO: OCORRÊNCIAS EM PROFISSIONAIS DE SAÚDE EM UM HOSPITAL GERAL / ACCIDENTS WITH EXPOSURE TO BIOLOGICAL MATERIAL: EVENTS INVOLVING HEALTH PROFESSIONALS IN A GENERAL HOSPITAL / ACCIDENTES CON EXPOSICIÓN A MATERIAL BIOLÓGICO: OCURRENCIAS ENVOLVIENDO PROFESIONALES DE SALUD EN UN HOSPITAL GENERAL

A exposição a material biológico por acidente é um fato um tanto quanto frequente em acidentes de trabalho envolvendo profissionais de saúde, figurando como um risco para a saúde do profissional e do paciente, posto que o material é potencialmente infectante e por indicar a possibilidade de soroconversão. O objetivo desse estudo foi analisar os acidentes ocupacionais com exposição a material biológico envolvendo profissionais de saúde no Hospital Geral Clériston Andrade no município de Feira de Santana. Teve como método o estudo do tipo corte transversal, de abordagem quantitativa, sendo utilizadas as notificações de acidentes ocupacionais com exposição a material biológico envolvendo profissionais de saúde que foram notificados no hospital em estudo nos anos de 2011 e 2012. Foram analisados 254 acidentes. Os resultados indicaram que a categoria profissional mais acometida foi a dos técnicos e auxiliares de enfermagem (47,6%). A maioria dos acidentes ocorreram durante punções (21,3%); quanto à situação vacinal, 88,1% estavam devidamente vacinados. Com isso, concluiu-se que é importante a implantação de estratégias que visem a capacitar os profissionais na notificação, no uso de medidas profiláticas e nas condutas a serem tomadas frente aos acidentes com exposição a material biológico.

Accidental exposure to biological material is somewhat frequent in occupational accidents involving health professionals, it's a risk to the health of the professional and the patient because the material is potentially infectious and it indicates the possibility of seroconversion. The objective of this study is to analyze occupational accidents involving exposure to biological material involving health professionals at the General Hospital Clériston Andrade in city of Feira de Santana, Bahia, Brazil. The method adopted was a cross sectional study, with quantitative approach using notifications of occupational accidents with exposure to biological material involving health professionals reported in HGCA between 2011 and 2012. We analyzed 254 accidents. Results indicate that the professional categories most affected were the nursing technicians and nursing assistants (47.6%). Most of the accidents occurred during punctures (21.3%), regarding vaccination status, 88.1% were properly vaccinated. Thus, in conclusion, it is important to implement strategies that enable professionals to notify, to use prophylactic measures and to act properly in case of accidents involving exposure to biological material.

El objetivo de este estudio es analizar los accidentes de trabajo con exposición a material biológico envolviendo profesionales de la salud en el Hospital General Clériston Andrade en la ciudad de Feira de Santana, Bahía, Brasil. Tuvo como método el estudio de corte transversal, con enfoque cuantitativo, siendo utilizadas notificaciones de accidentes de trabajo con exposición a material biológico envolviendo profesionales de la salud reportados en HGCA entre 2011 y 2012. Se analizaron 254 accidentes. Los resultados indicaron que las categorías profesionales más afectadas fueron los auxiliares y técnicos de enfermería (47,6%). La mayoría de los accidentes se produjeron durante las punciones (21,3%), con respecto al estado de vacunación, 88,1% fueron vacunados correctamente. Por lo tanto, concluyese que es importante la implementación de estrategias para capacitar a los profesionales en la notificación, en el uso de medidas profilácticas y en las acciones a tomar en los accidentes con exposición a material biológico.