Occurrence of Tungiasis in Ceará State, Northeast Brazil: Results of a Rapid Assessment Method

ABSTRACT Background: Systematic data on the occurrence of tungiasis are scarce. Methods: We analyzed data on tungiasis in humans and animals from all municipalities of Ceará State, Northeast Brazil, using a rapid assessment questionnaire. Results: Among the 184 municipalities, 181 (98.3%) reported tungiasis in the past (before 2021) or currently, 120 (65.2%) reported current occurrence, 155 (84.2%) reported severe cases in the past or currently, 47 (25.5 %) reported severe cases currently, and 132 (71.7%) reported tungiasis in animals. Conclusions: Tungiasis is a significant public health concern in Ceará. A One Health approach is required to reduce the disease burden in humans and animals.

Leishmaniose visceral: aspectos epidemiológicos, espaciais e temporais no município de Sobral, nordeste do Brasil, 2007-2019 / Visceral leishmaniasis: epidemiological, spatial and temporality aspects in the municipality of Sobral, northeast Brazil, 2007-2019

Objetivos: descrever os aspectos epidemiológicos, espaciais e temporais da leishmaniose visceral humana, no município de Sobral, no período de 2007 a 2019. Métodos: foi realizado um estudo epidemiológico descritivo e ecológico de análise espacial e temporal, com uso dos programas Quantum-Gis e Joinpoint. Resultados: foram confirmados 316 casos novos, predominantemente, no sexo masculino, nas faixas etárias de 1 a 4 anos (26,3%) e de 20 a 39 anos (24,0%), na zona urbana. Febre (95,9%), fraqueza (85,1%), emagrecimento (80,1%), palidez (73,7%), esplenomegalia (75,6%) e hepatomegalia (69,3%) foram os sinais clínicos mais frequentes. A doença se concentrou em quatro bairros: Terrenos Novos, Centro, Expectativa e Sinhá Saboia, expressando áreas mais densas (quentes). A incidência e a letalidade foram crescentes no início do período e decrescentes no final, com uma inversão destes indicadores no ano de 2014. Conclusão: em Sobral, a leishmaniose visceral humana é um agravo considerado relevante para o serviço de vigilância em saúde com necessidade de intensificação das ações de controle entomológico, zoonótico e de manejo ambiental, principalmente nas áreas mais densas.

Objectives: the objective was to describe the epidemiological, spatial, and temporal aspects of human visceral leishmaniasis, in the municipality of Sobral, from 2007 to 2019. Methods: A descriptive, spatial and temporal ecological study was carried out using Quantum-Gis and Joinpoint programs. Results: 316 new cases were confirmed, predominantly in males, in the age groups of 1 to 4 years (26.3%) and 20 to 39 years (24.0%), mainly in the urban area. Fever (95.9%), weakness (85.1%), weight loss (80.1%), pallor (73.7%), splenomegaly (75.6%), and hepatomegaly (69.3%) were the most frequent clinical signs. The disease was concentrated in four neighborhoods (Terrenos Novos, Centro, Expectativa, and Sinhá Saboia), hot spots. The incidence and case-fatality increased at the beginning of the period but decreased at the end, with an inversion in these in the year 2014. Conclusion: In Sobral, human visceral leishmaniasis is a disease considered relevant to the health surveillance service, with the need to intensify entomological, zoonotic, and environmental management actions, especially in denser areas.

Complications of herpes zoster hospitalizations in a reference hospital in Fortaleza-Ceará, 2009-2018 / Complicações de internações por herpes zoster em um hospital de referência em Fortaleza-Ceará, 2009-2018

Objective: the aim of this study was to relate sociodemographic, epidemiological and clinical conditions to the occurrence of severe cases of HZ in reference hospital of Fortaleza. Methods: this is a cross-sectional analytical study, based on medical records of patients admitted from 2009 to 2018. Pearson's x2 test or Fisher's exact test were used when appropriate. Results: we analyzed 196 medical records. The presence of complications occurred in 69.9%, the most affected region was the cranial (68.9%), and 1.5% died. The presence of vesicles (PR=1.37; 95%CI: 1.03-1.82; p=0.01) and the choice of antibiotic associated antiviral therapy (PR=0.58; 95%CI: 0.46-0.73; p=0.00) were significantly associated with the severity. Conclusions: the disease may be more severe at ages over 50. The presence of lesions in vesicles was associated with a higher prevalence of complications and the use of antibiotics and antivirals as a protective factor.

Objetivo: relacionar condições sociodemográficas, epidemiológicas e clínicas à ocorrência de casos graves de HZ em hospital de referência de Fortaleza. Métodos: trata-se de um estudo analítico transversal, baseado em prontuários de pacientes internados de 2009 a 2018. Foram utilizados o teste x2 de Pearson ou o teste exato de Fisher, quando apropriado. Resultados: foram analisados 196 prontuários. A presença de complicações ocorreu em 69,9%, a região mais acometida foi a craniana (68,9%), e 1,5% foi a óbito. A presença de vesículas (RP=1,37; IC95%: 1,03-1,82; p=0,01) e a escolha da terapia antiviral associada a antibióticos (RP=0,58; IC95%: 0,46-0,73; p=0,00) foram significativamente associadas com a gravidade. Conclusões: a doença pode ser mais grave a partir dos 50 anos. A presença de lesões em vesículas foi associada à maior prevalência de complicações e o uso de antibióticos e antivirais como fator de proteção.

Epidemiological Aspects and High Magnitude of Human Visceral Leishmaniasis in Ceará, Northeast of Brazil, 2007-2021

ABSTRACT Background: Human visceral leishmaniasis HVL is endemic to 75 countries. The state of Ceará, the Northeast region of Brazil, is of great sanitary importance for the transmission of HVL, and it stands out as an area of interest for epidemiological aspects and control strategies. This study aimed to characterize HVL in relation to epidemiological aspects, composite incidence, and mortality rates in the state of Ceará, Brazil, from 2007 to 2021. Methods: This ecological study used temporal and spatial cuts of HVL data from the notifiable diseases information system. Epidemiological indicators such as incidence, mortality, and composite indices of incidence and mortality were calculated according to the Ministry of Health standardization. Results: There were 6,775 confirmed cases, with high incidence coefficients in 2009 6.96 cases/100,000 inhabitants and 2011 9.83 cases/100,000 inhabitants, and the highest mortality rate in 2011 6.96 deaths/100,000 inhabitants. The composite index of incidence and mortality identified municipalities in the Northern, Northwestern, and Southern regions of Ceará as having the highest risk of HVL. Conclusions: HVL remained endemic throughout the study period, with epidemiological indicators and risk of transmission expressing high magnitude, mainly in the Northeast, Northwest, and South regions of Ceará.

Seroprevalence and factors associated with SARS-CoV-2 infection among education workers after the first wave: the first cross-sectional study in Brazil

ABSTRACT Background: The school community was heavily impacted by the Covid-19 pandemic, especially with the long time of school closures. This study aimed to analyze the seroprevalence of SARS-CoV-2 antibodies and possible factors associated with seropositivity for COVID-19 in teachers and other school staff, and to estimate the fraction of asymptomatic individuals by sex and age group. Methods: We conducted a serological survey of SARS-CoV-2 infections. An analytical cross-sectional study was conducted in Fortaleza, Brazil. Teachers and other staff members from pre-schools to universities of higher education to were investigated. Results: A total of 1,901 professionals participated in the study, of which 1,021 were staff and 880 were teachers. The seroprevalence of SARS-CoV-2 was 8.0% (152/1901). In the seropositive group, 48.3% were asymptomatic. There was a predominance of women (68.4%); and, 47.1% of the participants were between 31 and 45 years old. There was an increase in prevalence with increasing age. An inverse relationship was found for education level: more professionals with less education tested positive for COVID-19. The presence of an infected person living in the same household was significantly associated with positive results for COVID-19 among the professionals. Conclusions: This is the first study to report the seroprevalence of IgG against SARS-CoV-2 in Brazilian educational staff after the first wave of the disease. In this study, the seroprevalence was much lower than that in the general population. During school reopening, a small fraction of school workers showed serologically detectable signs of SARS-CoV-2 exposure.

Epidemiological and clinical factors associated with lethality from Human Visceral Leishmaniasis in Northeastern Brazil, 2007 to 2018

ABSTRACT Human Visceral Leishmaniasis (HVL) presents a subacute clinical evolution with systemic involvement, which can result in high case fatality, especially among untreated individuals or those with low socioeconomic status. This study aimed to identify epidemiological and clinical factors associated with HVL case fatality in the Ceara State, from 2007 to 2018. This is an analytical cross-sectional study. The bivariate analysis was performed by Stata 15.1 using Pearson's Chi-square or Fisher's exact test; and Poisson regression for age-controlled multivariate analysis. From 2007 to 2018, there were 4,863 new confirmed cases and 343 deaths from HVL (case fatality rate=7.05%). The risk factors associated with case fatalities were: age group (RR=8.69; 95%CI:3.56-21.20); black population (RR=2.21; 95%CI:1.45-3.35); jaundice symptoms (RR=1.72; 95%CI:1.38-2.14); edema (RR=2.62; 95%CI:2.10-3.26) and hemorrhagic phenomena (RR=1.63; 95%CI:1.26-2.10); and no prescription drug intake (RR=4.03; 95%CI:2.98-5.46). Treatment with pentavalent antimonial was a protective factor (RR=0.35; 95%CI:0.27-0.45). The number of deaths increased among the elderly, illiterate, urban residents, and black skin color individuals. The drugs pentavalent antimonial and amphotericin B showed an association with death, but were not considered causal factors. Treatment failure led to a high risk of death. In multivariate analysis, the risk factors for fatal cases were age group, black skin, symptoms of jaundice, edema and hemorrhagic phenomena; and failure to take the prescription drugs. Treatment with pentavalent antimonial was shown to be a protective factor. Knowing the factors associated with the fatality of VL-HIV cases may help to improve public policies, in order to refine the epidemiological surveillance program and, consequently, prevent deaths related to the disease in Ceara.

Surveillance of Chagas disease vectors in Ceará State, Northeastern Brazil / Vigilância dos vetores da Doença de Chagas no Estado do Ceará, Nordeste do Brasil

Objective: Describe the spatial distribution, temporal trend and the natural infection rates by Trypanosoma cruzi in triatomines captured in Ceará State, between 2003 and 2014. Methods: Chagas Disease Control Program data were used to describe triatomine species circulating, their distribution in the state, the capture places (intradomicile and peridomicile), and the rates of natural infection by T. cruzi, between 2003 and 2014. Results: During this period, 401,721 triatomines were captured in 89.1% of the municipalities of the State, belonging to the species Triatoma pseudomaculata (53.9%), Triatoma brasiliensis (40.5%), Rhodnius nasutus (1.9%), Panstrongylus megistus (1.5%), Panstrogylus lutzi (1.3%), Triatoma rubrofasciata (0.8%), Panstrongylus geniculatus (< 0.1%), and Triatoma petrochiae (< 0.1%). Most of the specimens were caught in peridomicile areas (83.0%), with emphasis on T. pseudomaculata and T. brasiliensis, while P. lutzi was predominant in the intradomicile. P. lutzi had the highest infection rate by T. cruzi (7.8%), while T. pseudomaculata (0.9%), T. brasiliensis (1.0%), and P. megistus (1.3%) had the lowest rates. Conclusions: The occurrence of an enzootic cycle of T. cruzi and the presence of synanthropic animals that provide a source of blood meals to triatomines increases the risk of its transmission to humans, requiring constant vigilance by the sanitary authorities.

Objetivo: Descrever a distribuição especial, tendência temporal e a as taxas de infecção natural por T. cruzi em triatomíneos capturados no Estado do Ceará, entre 2003 e 2014. Métodos: Dados do Programa de Controle da Doença de Chagas foram utilizados para descrever as espécies de triatomíneos circulantes, sua distribuição no Estado, os locais de captura (intradomicílio e peridomicílio) e as taxas de infecção natural por T. cruzi entre os anos de 2003 e 2014. Resultados: Durante este período, 401.721 triatomíneos foram capturados em 89,1% dos municípios do Estado, pertencendo às espécies Triatoma pseudomaculata (53,9%), T. brasiliensis (40,5%), Rhodnius nasutus (1,9%), Panstrongylus megistus (1,5%), P. lutzi (1,3%), T. rubrofasciata (0,8%), P. geniculatus (< 0,1%) e T. petrochiae (< 0,1%). A maioria dos espécimes foi capturada no peridomicílio (83,0%), com destaque para T. pseudomaculata e T. brasiliensis, enquanto P. lutzi foi predominante no intradomicílio. P. lutzi teve a maior taxa de infecção por T. cruzi (7,8%), enquanto T. pseudomaculata (0,9%), T. brasiliensis (1,0%) e P. megistus (1,3%) tiveram as menores taxas. Conclusões: A ocorrência de um ciclo enzoótico de T. cruzi e a presença de animais sinantrópicos que proporcionam uma fonte de alimentação sanguínea aos triatomíneos aumentam o risco de sua transmissão aos humanos, exigindo das autoridades sanitárias uma vigilância constante desses vetores

Complicações das internações por varicela em um hospital de referência em Fortaleza- Ceará, 2012-2018 / Complications of varicella hospitalizations in a reference hospital in Fortaleza-Ceará, 2012-2018

Objetivo: Relacionar as condições sociodemográficas, epidemiológicas e clínicas à ocorrência de casos graves de varicela. Métodos: Trata-se de um estudo transversal e analítico, tendo como fonte de dados prontuários de pacientes internados entre os anos de 2009 a 2018 no Hospital São José de doenças infecciosas (HSJ). Todas as variáveis selecionadas foram analisadas pelo programa Stata versão 15.1 e relacionadas com a presença de complicação, de forma a descobrir os fatores associados. Resultado: De um total de 302 prontuários, 54,3% eram do sexo masculino com idade mediana de 8 anos. A presença de complicação ocorreu em 82,4%, sendo complicações cutâneas as mais relatadas (65,4%). Das internações, 2,3% foram a óbito. A escolha da terapêutica com uso de antivirais associados a antibióticos (RP: 0,44; IC95%: 0,33 ­ 0,59 p=0,00) e alterações no exame de raios x de tórax (RP: 1,37; IC95%: 1,13 ­ 1,66; p=0,01) foram significativamente associados à gravidade do quadro de infecção por varicela. Conclusão: A varicela não deve ser considera uma doença inofensiva devido aos inúmeros tipos de complicações que podem associar-se à doença, causando internamento hospitalar e, em alguns casos, necessidade de tratamento intensivo. Os fatores associados foram a terapêutica utilizada, reduzindo a gravidade, e alteracoes no raio-x, aumentando a gravidade do caso.

Objective: The aim of this study is to relate sociodemographic, epidemiological and clinical conditions to the occurrence of severe cases of varicella. Methods: This is a cross-sectional and analytical study, using as a source of data medical records of patients hospitalized between the years 2009 to 2018 at the São José Hospital for infectious diseases (HSJ). All selected variables were analyzed by Stata program version 15.1 and related to the presence of complication in order to discover the associated factors. Result: From a total of 302 records, 54.3% were male, with a median age of 8 years. The presence of complications occurred in 82.4%, with cutaneous complications being the most reported (65.4%). Of the hospitalizations, 2.3% died. Choice of therapy with use of antivirals associated with antibiotics (PR: 0.44; 95% CI: 0.33 - 0.59; p = 0.00) and changes in chest x-ray exams (PR: 1.37; 95% CI: 1.13 - 1.66; p = 0.01) were significantly associated with the severity of varicella infection. Conclusion: Varicella should not be considered a harmless disease due to the numerous types of complications that can be associated with the disease, causing hospitalization and, in some cases, the need for intensive treatment. The associated factors were the therapy used, reducing the severity, and changes on x-ray that increased the severity of the case.

Magnitude and temporal trends of leprosy relapse in the state of Ceará, Brazil in the period 2001-2018

Abstract INTRODUCTION: This study analyzed the magnitude and temporal trends of leprosy relapse in Ceará in 2001-2018. METHODS: Descriptive cross-sectional and ecological-time trend studies were performed. RESULTS: We diagnosed 1,777 leprosy relapse cases. Higher prevalence of relapse was observed in men, illiterates, mixed race, multibacillary leprosy, lepromatous leprosy, and persons with visible disabilities. The proportion of relapse increased throughout the study period. CONCLUSIONS: Leprosy relapse is prevalent in certain groups.

Epidemiologia da raiva humana no estado do Ceará, 1970 a 2019 / Epidemiología de la rabia humana en el estado de Ceará, Brasil, 1970 a 2019 / Epidemiology of human rabies in the state of Ceará, Brazil, 1970 to 2019

Objetivo: Descrever os casos de raiva humana no estado do Ceará, Brasil, no período 1970-2019. Métodos: Estudo descritivo, sobre dados secundários da Secretaria da Saúde e do hospital de referência do Ceará. Resultados: Dos 171 casos, 75,7% ocorreram em homens, 60,0% nas idades até 19 anos e 56,0% em áreas urbanas. O cão foi agente transmissor em 74,0% dos casos; sagui em, 16,7%; e morcego, em 7,3%. Entre 1970 e 1978, houve crescimento do número de casos (pelo Joinpoint Regression Program, percentual da mudança anual [APC] = 13,7 - IC95% 4,6;41,5); e entre 1978 e 2019, redução (APC = -6,7 - IC95% -8,8;-5,9). Houve redução da transmissão por cães (71 casos; último caso em 2010) e aumento relativo por mamíferos silvestres (5 casos a partir de 2005). Conclusão: O estudo evidencia mudança na dinâmica da transmissão da raiva no período observado, com redução da transmissão por cão e incremento de casos por animais silvestres.

Objetivo: Describir los casos de la rabia humana en Ceará, Brasil, 1970-2019. Métodos: Estudio descriptivo con datos secundarios de la Secretaría de Salud y del hospital de referencia de Ceará. Resultados: De los 171 casos, 75,7% ocurrió en hombres, el 60,0% en los 19 años y el 56,0% en áreas urbanas. El perro fue transmisor en 74,0%, el mono tití en 16,7% y el murciélago el 7,3%. Entre 1970 y 1978, hubo un aumento de casos (por el Joinpoint Regression Program, cambio porcentual anual [APC] = 13,7 - IC95% 4,6; 41,5), entre 1978 y 2019 una disminución (APC= -6,7 - IC95% -8,8; -5,9). Hubo una reducción de la transmisión por perros (71 casos, el último en 2010) y un aumento por mamíferos salvajes (5 casos, desde 2005). Conclusión: El estudio muestra un cambio en la dinámica de la transmisión de la rabia en los últimos años, con reducción de la transmisión por perros y aumento de casos por animales salvajes.

Objective: To describe cases of human rabies in Ceará State, Brazil between 1970 and 2019. Methods: This was a descriptive study using secondary data from the Ceará State Department of Health and the state reference hospital. Results: Of 171 cases, 75.7% occurred in males, 60.0% in <19-year-olds, and 56.0% in urban areas. Rabies was transmitted by dogs in 74.0% of cases, marmosets in 16.7% and bats in 7.3%. Between 1970 and 1978, there was an increase of cases (using the Joinpoint Regression Program, annual percentage change [APC] = 13.7 - 95%CI 4.6;41.5), while between 1978 and 2019 there was a decrease (APC = -6.7 - 95%CI -8.8;-5.9). There was a reduction in transmission by dogs (71 cases, last case in 2010) and an increase by sylvatic animals (5 cases since 2005). Conclusion: This study demonstrates changes in rabies transmission dynamics during the period studied, with a reduction in transmission by dogs and an increase of transmission by sylvatic animals.

Influence of the social determinants on the incidence of aids in Piauí: an ecological study / Influencia de los determinantes sociales sobre la incidencia del sida en Piauí: un estudio ecológico / Influência dos determinantes sociais sobre a incidência de aids no Piauí: um estudo ecológico

ABSTRACT Objective: to identify the social factors that determine the incidence of aids in the Piauí territory. Method: an ecological study that uses geoprocessing techniques in which 2,908 aids cases of individuals residing in Piauí were considered, notified to the Notifiable Disease Information System (Sistema de Informações de Agravos de Notificação, SINAN), from 2007 to 2015. Gross and Bayesian incidence rates were calculated using the population of the central year (2011), multiplied by 100,000 inhabitants, with Bayesian statistics used to identify spatial clusters. The non-spatial Ordinary Least Squares Estimation (OLS) and spatial Geographically Weighted Regression (GWR) regression models were used to identify the social determinants of the incidence of aids in the state, with 5% of significance. Results: the highest rates of the disease are concentrated in cities near the capital Teresina, with a Bayesian incidence of over 11.27 cases/100,000 inhabitants. The predictor variables of the incidence of ADIS in Piauí cities were the following: the percentage of individuals in houses with inadequate walls (p=0.0139), the mean number of residents per household (p=0.0309), and the percentage of individuals in households vulnerable to poverty and in which no one has completed elementary school (p=0.0051). Conclusion: according to GWR, the social factors that influence the incidence of aids in the cities of Piauí are the percentage of individuals in houses with inadequate walls, the mean number of residents per household, and the percentage of individuals in houses vulnerable to poverty and in which no one has completed elementary school. Given the above, interventions on the health social determinants of a structural nature should be established as effective methods for the prevention of HIV/ aids.

RESUMEN Objetivo: identificar los factores sociales que determinan la incidencia del SIDA en el territorio de Piauí. Método: estudio ecológico en el que se emplearon técnicas de geoprocesamiento donde se consideraron 2.908 casos de SIDA de residentes de Piauí notificados al Sistema de Información de Enfermedades Notificables (Sistema de Informações de Agravos de Notificação, SINAN) en el período 2007-2015. Los índices brutos y Bayesianos de incidencia se calcularon utilizando la población del año central (2011), multiplicada por 100.000 habitantes, empleándose la estadística Bayesiana para identificar agrupamientos espaciales. Se utilizaron los modelos de regresión no espacial Ordinary Least Squares Estimation (OLS) y espacial Geographically Weighted Regression (GWR) para identificar los determinantes sociales de la incidencia del SIDA en el estado, con una significancia del 5%. Resultados: los índices más elevados de la enfermedad se concentran especialmente en municipios próximos a la capital Teresina, con incidencia Bayesiana superior a 11,27 casos/100.000 habitantes. Las variables predictoras de la incidencia del SIDA en los municipios de Piauí fueron las siguientes: porcentaje de personas que viven en domicilios con paredes no adecuadas (p=0,0139), media de moradores por domicilio (p=0,0309) y porcentaje de personas que viven en domicilios vulnerables a la pobreza y en los que ninguno de los moradores ha completado la educación primaria (p=0,0051). Conclusión: De acuerdo con el modelo GWR, los factores sociales que influencian la incidencia del SIDA en los municipios de Piauí son los siguientes: porcentaje de personas que viven en domicilios con paredes no adecuadas, media de moradores por domicilio y porcentaje de personas que viven en domicilios vulnerables a la pobreza y en los que ninguno de los moradores ha completado la educación primaria. Frente a esta situación, se deben instaurar intervenciones sobre los determinantes sociales de la salud de carácter estructural como métodos efectivos de prevención del VIH/SIDA.

RESUMO Objetivo: identificar os fatores sociais que determinam a incidência de aids no território piauiense. Método: estudo ecológico com uso de técnicas de geoprocessamento em que se considerou 2.908 casos de aids de residentes no Piauí notificados no Sistema de Informações de Agravos de Notificação (SINAN) no período 2007-2015. As taxas de incidência brutas e bayesianas foram calculadas utilizando-se a população do ano central (2011), multiplicado por 100.000 habitantes, sendo a estatística bayesiana empregada para identificação de clusters espaciais. Os modelos de regressão não espacial Ordinary Least Squares Estimation (OLS) e espacial Geographically Weighted Regression (GWR) foram usados para identificar os determinantes sociais da incidência de aids no estado, com significância de 5%. Resultados: as maiores taxas da doença se concentram especialmente em municípios próximos à capital Teresina, com incidência bayesiana acima de 11,27 casos/100.000 habitantes. As variáveis preditoras da incidência de aids nos municípios piauienses foram: percentual de pessoas em domicílios com paredes inadequadas (p=0,0139), média de moradores por domicílio (p=0,0309) e percentual de pessoas em domicílios vulneráveis à pobreza e em que ninguém tem ensino fundamental completo (p=0,0051). Conclusão: de acordo com o GWR, os fatores sociais que influenciam a incidência de aids nos municípios piauienses são percentual de pessoas em domicílios com paredes inadequadas, média de moradores por domicílio e percentual de pessoas em domicílios vulneráveis à pobreza e em que ninguém tem ensino fundamental completo. Diante disso, Intervenções sobre os determinantes sociais da saúde de caráter estrutural devem se fixar como métodos efetivos de prevenção do HIV/aids.

Leishmaniose visceral: distribuição temporal e espacial em Fortaleza, Ceará, 2007-2017 / Leishmaniasis visceral: distribución temporal y espacial en Fortaleza, Ceará, Brasil, 2007-2017 / Visceral Leishmaniasis: temporal and spatial distribution in Fortaleza, Ceará State, Brazil, 2007-2017

Objetivo: Analisar a tendência temporal e descrever a distribuição espacial da leishmaniose visceral (LV) em Fortaleza, 2007-2017. Métodos: Estudo ecológico, mediante regressão temporal segmentada e mapeamento temático. Resultados: No período 2007-2017, foram confirmados 1.660 casos novos e 97 óbitos. No período 2007-2010, a incidência foi ascendente (variação percentual anual [Annual Percent Change], APC=8,7% - IC95% -3,3;34,1), enquanto a mortalidade (APC=-25,9 - IC95% -48,5; -10,6) e a letalidade (APC=-33,0 - IC95% -53,7;-17,6), descendentes. No período 2010-2015, a incidência reduziu (APC=-15,8 - IC95% -25,1;-4,0), mas a mortalidade (APC=18,7 - IC95% 9,4;50,6) e a letalidade (APC=40,1 - IC95% 22,5;72,0) apresentaram tendência de crescimento. Em 2015-2017, decresceram a incidência (APC=-24,6 - IC95% -36,2;-10,3) e a mortalidade (APC= -44,6 - IC95% -58,8;-17,6); a letalidade se manteve estável (APC=-13,5 - IC95% -38,7;3,8). Houve concentração de bairros com incidência elevada na região oeste da cidade; porém, a mortalidade e a letalidade não apresentaram padrões espaciais definidos. Conclusão: A LV é endêmica em Fortaleza, embora tenha havido declínio no último triênio estudado.

Objetivo: Analizar la tendencia temporal y describir la distribución espacial de la leishmaniasis visceral (LV) en Fortaleza de 2007 a 2017. Métodos: Estudio ecológico utilizando regresión temporal segmentada y mapas temáticos. Resultados: Entre 2007-2017, se confirmaron 1,660 casos nuevos y 97 muertes. La incidencia fue ascendente (cambio porcentual anual [Annual Percent Change], APC=8,7% - IC95% -3,3;34,1), y mortalidad y letalidad descendentes: APC=-25,9 (IC95% -48,5;-10,6) y APC=-33,0 (IC95% -53,7;-17,6), respectivamente. Desde 2010-2015, la incidencia disminuyó (APC=-15,8 - IC95% -25,1;-4,0), pero la mortalidad (APC=18,7 - IC95% 9,4; 50,6) y la letalidad (APC=40,1 - IC95% 22,5; 72,0) tuvieron una tendencia al alza. En 2015-2017, disminuyeron incidencia (APC=-24,6 - IC95% -36,2;-10,3), y mortalidad (APC=-44,6 - IC95% -58,8;-17,6) la letalidad se mantuvo estable (APC=-13,5 - IC95% -38,7; 3,8). Los barrios con alta incidencia se agruparon en la región oeste de la ciudad, pero, la mortalidad y la letalidad no fueron definidos espacialmente. Conclusión: La LV es endémica en Fortaleza, aunque ha habido una disminución en el último trienio estudiado.

Objective: To analyze the temporal trend and describe the spatial distribution of Visceral Leishmaniasis (VL) in Fortaleza from 2007 to 2017. Methods: This was an ecological study using segmented temporal regression and thematic mapping. Results: Between 2007-2017, 1,660 new cases and 97 deaths were confirmed. The overall incidence rate showed a rising trend (Annual Percent Change - APC=8.7% - 95%CI -3.3;34.1), while the mortality rate (APC=-25.9 - 95%CI -48.5;-10.6) and lethality (APC=-33.0 - 95%CI -53.7;-17.6) showed a falling trend. From 2010-2015 the incidence rate fell (APC=-15.8 - 95%CI -25.1;-4.0), but mortality (APC=18.7 - 95%CI 9.4;50.6) and lethality (APC=40.1 - 95%CI 22.5;72.0) had an upward trend. In 2015-2017, incidence (APC=-24.6 - 95%CI -36.2;-10.3), and mortality (APC=-44.6 - 95%CI -58.8;-17,6) fell, while lethality remained stable (APC=-13.5 - 95%CI -38.7;3.8). High incidence neighborhoods were clustered in the western region of the city, however, mortality and lethality did not present defined spatial patterns. Conclusion: VL is endemic in Fortaleza, although there was a reduction in the last three years studied.

Dengue in northeastern Brazil: a spatial and temporal perspective

Abstract INTRODUCTION: The state of Ceará (Brazilian Northeast) has a high incidence of dengue. Therefore, we aimed to characterize the temporal patterns and spatial distribution of dengue cases in Ceará during 2001-2019. METHODS: A spatiotemporal ecological study was performed with secondary data. Time-trend analysis was performed using a segmented log-linear regression model to estimate the average annual percentage change (AAPC) and the annual percentage change (APC) in incidence of dengue. We also performed spatiotemporal analysis to identify the place, time, and relative risk (RR) of dengue clusters. RESULTS: There were 539,653 dengue cases. The AAPC reduced over time (-9.5%; 95% confidance interval [CI]: -18.3; -0.3). Three trends were identified-2001-2004: APC=-20.9% (95% CI: -65.1 to 44.8), 2005-2015: APC=7.9% (95% CI: -6.0 to 98.9), and 2016-2019: APC=-48.8% (95% CI: -83.0 to -6.1). During 2001-2007, 10 significant clusters were identified (RR=3.57-14.38: n=4 and RR=0.05-0.39: n=6). During 2008-2013, there was 1 cluster in the western region (RR= 3.40) and four other clusters (RR=0.02-0.15). The last period presented 5 high-RR clusters (RR=2.95-9.24). The low-RR clusters were located in the central-north, central-south, south, and northwest regions. However, the central-west region remained a high-RR cluster region throughout the study period. CONCLUSIONS: Dengue showed a decreasing incidence. During the epidemic years, the southern, eastern, and western regions presented high-risk clusters. Introduction of a new dengue serotype in a low-RR area can cause explosive outbreaks due to population susceptibility.

Post-exposure human rabies prophylaxis: spatial patterns of inadequate procedures in Ceará - Brazil, 2007 to 2015

Abstract INTRODUCTION: This study investigated the spatial distribution of inappropriate post-exposure human rabies procedures in Ceará, Brazil, between 2007 and 2015. METHODS: The ecological study population was based on the records of post-exposure human rabies procedures from the Notification Disease Information System. We analyzed the data using the Moran Index (I) and the Moran Local Index. RESULTS: There were 222,036 (95.8%) records with inappropriate post-exposure human rabies procedures. There was heterogeneity in their spatial distribution, with two significant clusters in the northeast and northwest regions. CONCLUSIONS: These findings help elaborate differentiated strategies to reduce unnecessary post-exposure human rabies procedures.

Mortality due to acquired immunodeficiency syndrome and associated social factors: a spatial analysis / Mortalidad por el síndrome de la inmunodeficiencia adquirida y factores sociales relacionados: un análisis espacial / Mortalidade pela síndrome da imunodeficiência adquirida e fatores sociais associados: uma análise espacial

ABSTRACT Objective: To analyze the spatial pattern of AIDS mortality and social factors associated with its occurrence. Methods: An ecological study that considered 955 AIDS deaths of residents in Piauí, reported in the Mortality Information System (MIS) from 2007 to 2015. Non-spatial and spatial regression models were used to identify social determinants of AIDS mortality, with a significance of 5%. Results: The predictors of AIDS mortality were illiteracy rate in males (p = 0.020), proportion of households with water supply (p = 0.015), percentage of people in households with inadequate walls (p = 0.022), percentage of people in households vulnerable to poverty and in whom no one has completed primary education (p = 0.000) and percentage of people in households vulnerable to poverty and dependent on the elderly (p = 0.009). Conclusion: Social indicators related to education, job and income generation and housing were associated with AIDS mortality.

RESUMEN Objetivo: Analizar el estándar espacial de la mortalidad por sida y factores sociales relacionados a su ocurrencia. Métodos: Estudio ecológico que consideró 955 óbitos por sida de residentes en Piauí, notificados en el Sistema de Informaciones sobre Mortalidad (SIM) de 2007 a 2015. Modelos de regresión no espacial y espacial han sido usados para identificar determinantes sociales de la mortalidad por sida, con significación de 5%. Resultados: Las variables indicadoras de la mortalidad por sida han sido tasa de analfabetismo en el sexo masculino (p = 0,020), proporción de domicilios con abastecimiento de agua (p = 0,015), porcentual de personas en domicilios con paredes inadecuadas (p = 0,022), porcentual de personas en domicilios vulnerables a la pobreza y en que ninguno tiene enseñanza fundamental completa (p = 0,000) y porcentual de personas en domicilios vulnerables a la pobreza y dependientes de ancianos (p = 0,009). Conclusión: Han sido relacionados a la mortalidad por sida indicadores sociales relacionados a la educación, generación de empleo y renta y habitación.

RESUMO Objetivo: Analisar o padrão espacial da mortalidade por aids e fatores sociais associados à sua ocorrência. Métodos: Estudo ecológico que considerou 955 óbitos por aids de residentes no Piauí, notificados no Sistema de Informações sobre Mortalidade (SIM) de 2007 a 2015. Modelos de regressão não espacial e espacial foram usados para identificar determinantes sociais da mortalidade por aids, com significância de 5%. Resultados: As variáveis preditoras da mortalidade por aids foram taxa de analfabetismo no sexo masculino (p = 0,020), proporção de domicílios com abastecimento de água (p = 0,015), percentual de pessoas em domicílios com paredes inadequadas (p = 0,022), percentual de pessoas em domicílios vulneráveis à pobreza e em que ninguém tem ensino fundamental completo (p = 0,000) e percentual de pessoas em domicílios vulneráveis à pobreza e dependentes de idosos (p = 0,009). Conclusão: Foram associados à mortalidade por aids indicadores sociais relacionados à educação, geração de emprego e renda e habitação.

Aspectos nutricionais de pessoas acometidas por hanseníase, entre 2001 e 2014, em municípios do semiárido brasileiro / Nutritional aspects of people affected by leprosy, between 2001 and 2014, in semi-arid Brazilian municipalities

Resumo O estudo buscou caracterizar a insegurança alimentar, o estado nutricional e os hábitos alimentares de pessoas acometidas por hanseníase. Trata-se de um estudo transversal descritivo, de população censitária, em que foram avaliados 276 casos, notificados no Sistema de Informação de Agravos de Notificação, entre 2001 e 2014, nos municípios de Vitória da Conquista e Tremedal, Bahia. Na análise foi empregada a Escala Brasileira de Insegurança Alimentar. Foram coletadas medidas de peso e altura, frequência alimentar, variáveis domiciliares, socioeconômicas, psicossociais e clínicas. A prevalência de insegurança alimentar foi de 41,0% na população; sendo 28,3% leve, 8,0% moderada e 4,7% grave. O sobrepeso/obesidade foi estimado em 60,1% das pessoas avaliadas e o consumo excessivo de sal foi relatado por 8,6%. O feijão e a carne vermelha foram os alimentos mais regularmente consumidos e houve baixo consumo de leite, hortaliças cruas e cozidas e frutas. A insegurança alimentar apresentou elevada prevalência, associada à inadequação do hábito alimentar e estado nutricional, refletindo a vulnerabilidade nutricional desta população. Recomenda-se a inserção da assistência nutricional às políticas públicas da hanseníase, como forma de qualificar a atenção à saúde.

Abstract The study aimed to characterize food insecurity, nutritional status, and eating habits of people affected by leprosy. This is a descriptive cross-sectional study based on a census population. We evaluated 276 cases, reported in the Notifiable Diseases Information System, between 2001 and 2014, in the municipalities of Vitória da Conquista and Tremedal, in the state of Bahia. Food insecurity was estimated according to the Brazilian Food Insecurity Scale. We collected weight and height measurements, meal frequency, and household, socioeconomic, psychosocial and clinical variables. The prevalence of food insecurity was 41.0% among the study population - 28.3% mild, 8.0% moderate and 4.7% severe. Overweight/obesity was estimated in 60.1% of the study participants, and excessive salt intake was reported by 8.6%. Beans and red meat were the most regularly consumed foods; there was low consumption of milk, raw and cooked vegetables, and fruits. This population presented high food insecurity prevalence, inadequate eating habits and nutritional status, reflecting nutritional vulnerability. The insertion of nutritional assistance in the leprosy control programmes is recommended, to improve health care.

Atendimentos antirrábicos humanos pós-exposição: tendência temporal de sua prevalência no Ceará, de 2007 a 2015 / Post-exposure human anti-rabies care: temporal trend of its prevalence in Ceará, from 2007 to 2015

Resumo Introdução A principal recomendação para o controle da raiva em humanos é a vacinação profilática. Objetivo Considerando-se a endemicidade da raiva no Brasil e o direcionamento das ações de controle, buscou-se caracterizar a tendência temporal dos atendimentos antirrábicos humanos pós-exposição no Ceará, de 2007 a 2015. Método O estudo é ecológico de tendência temporal e analítico. Os dados das fichas de atendimento antirrábico foram organizados em planilhas e calculados os coeficientes anuais de prevalência. Resultados Houve 231.694 atendimentos antirrábicos, com coeficientes de prevalência crescentes de 2007 a 2011 (35,09 por 10.000 habitantes; APC=13,5; p<0,001) e ápice em 2015 (40,35 por 10.000 habitantes; APC=5,5; p=0,005). Houve um aumento na faixa etária de 20 a 59 anos (APC=14,0; p<0,001), e residentes da zona urbana (APC=7,0; p<0,001). A espécie canina teve tendência crescente de 2007 a 2011 (APC=14,3; p<0,001). Das notificações, 95,8% apresentaram condutas inadequadas, com crescimento nos coeficientes de prevalência de 2007 a 2011 (APC=13,6; p<0,001). Conclusão As condutas profiláticas inadequadas aconteceram mais de 2007 a 2011. A análise temporal, com tendência crescente no período analisado, deve ser utilizada como componente contínuo das ações de vigilância da raiva no Ceará, para assistência adequada e segura aos pacientes vítimas de agressão animal.

Abstract Background The main recommendation for the control of rabies in humans is the prophylactic vaccination. Objective Considering the endemicity of rabies in Brazil and the direction of control actions, it was aimed to characterize the temporal trend of post-exposure human anti-rabies in Ceará from 2007 to 2015. Method The study is ecological with a temporal trend and analytical. The data of the anti-rabies data sheets were organized into spreadsheets and the annual prevalence coefficients were calculated. Results There were 231,694 rabies treatments, with prevalence coefficients increasing from 2007 to 2011 (35.09 per 10,000 inhabitants, APC = 13.5, p <0.001) and apex in 2015 (40.35 per 10,000 inhabitants, APC = 5, 5, p = 0.005). There was an increase in the age group of 20 to 59 years old (APC = 14.0, p <0.001), and urban residents (APC = 7.0, p <0.001). The canine species showed an increasing trend from 2007 to 2011 (APC = 14.3, p <0.001). Of the notifications, 95.8% presented inadequate behaviors, with an increase in the prevalence coefficients from 2007 to 2011 (APC = 13.6, p <0.001). Conclusion Inadequate prophylactic behaviors occurred more than 2007 to 2011. The temporal analysis, with an increasing trend in the analyzed period, should be used as a continuous component of the rabies surveillance actions in Ceará, for adequate and safe assistance to the patients who are victims of animal aggression.

Fatores Associados à Manutenção do Vício de Fumar e do Consumo de Álcool entre Acadêmicos de Medicina em uma Capital do Nordeste do Brasil / Factors Associated with Continued Smoking Addiction and Alcohol Consumption among Medical Students in Capital City in the Northeast of Brazil

RESUMO Introdução Há um aumento no consumo de drogas entre os jovens no Brasil. Esse consumo se destaca entre os estudantes universitários, acarretando uma preocupação adicional quando associado aos estudantes da área da saúde. Objetivo Identificar os fatores associados à manutenção do vício de fumar e do consumo de álcool entre acadêmicos de Medicina. Métodos Trata-se de um estudo analítico, de prevalência, envolvendo estudantes de Medicina das quatro escolas médicas da cidade de Fortaleza, Nordeste do Brasil. Foi aplicado um questionário semiestruturado, contendo 46 perguntas objetivas, aos estudantes que cursavam o primeiro ano (S1/S2) durante o ano de 2012 e novamente em 2016, quando esses mesmos estudantes se encontravam no internato (I3/I4). A amostra foi calculada considerando como população do estudo o número máximo de alunos nos dois períodos avaliados.O projeto foi aprovado pelo CEP, por meio do Parecer nº020/2012. Resultados Foram entrevistados 360 estudantes no primeiro momento da pesquisa e 354 estudantes no segundo momento. O consumo de tabaco passou de 17,4% durante o primeiro ano do curso para 28,2% durante o internato (p<0,001). O mesmo ocorreu com o consumo de álcool, que já era elevado no início do curso (84,6%) e aumentou para 92,6% (p<0,001). No primeiro ano do curso, 40,5% dos estudantes referiram já ter se embriagado pelo menos uma vez. Durante a faculdade, esse percentual subiu para 59,5% (RP=1,66; p<0,001). Conclusão O consumo de álcool e tabaco aumentou de forma importante durante o curso de Medicina. Há necessidade de intervenções nos hábitos dos acadêmicos de Medicina com o objetivo de reduzir o consumo exagerado de álcool e a manutenção do tabagismo nesta população.

ABSTRACT Introduction Drug use among young people in Brazil is increasing, particularly among the university students, leading to additional health-related concerns for students. Objective To identify factors associated with continued smoking addiction and alcohol consumption among medical students. Methods An analytical, prevalence study was carried out involving medical students at the four medical schools of Fortaleza, northeastern Brazil. A semi-structured questionnaire with 46 objective questions was applied to students in their first year of the course (S1/S2) in 2012 and again in 2016, when these same students were taking their internship (I3/I4). The sample was calculated based on a study population consisting of all the students in the two periods evaluated. The project was approved by the REC, through opinion no. 020/2012. Results 360 students were interviewed in the first phase of the research, and 354 students in the second phase. Tobacco consumption increased from 17.4% during the first year of the course to 28.2% during the internship (p <0.001). The same occurred with alcohol consumption, which was already high at the beginning of the course (84.6%) and increased to 92.6% (p <0.001). In the first year of the course, 40.5% of the students reported having got drunk at least once. During their time at medical school, this percentage rose to 59.5% (PR = 1.66, p <0.001). Conclusion Alcohol and tobacco consumption increased significantly during medical school. There is a need for interventions in the habits of medical student, in order to reduce excessive alcohol consumption and smoking in this population.

A major chikungunya epidemic with high mortality in northeastern Brazil

Abstract INTRODUCTION Chikungunya causes fever and severe and persistent joint pain. METHODS We reported a chikungunya outbreak that occurred in Ceará State, Brazil between 2016 and 2017 with emphasis on epidemiological characterization of cases, high number of deaths, mortality-associated factors, and spatial and temporal spread of the epidemic among municipalities. RESULTS: In November 2015, the first autochthonous cases of chikungunya were confirmed in Ceará, Brazil. In 2016-2017, 195,993 cases were reported, with an incidence of 2,186.5/100,000 inhabitants and 244 confirmed deaths. CONCLUSIONS: Rapid transmission and high mortality rate are serious problems, especially in regions with co-circulating arboviruses.

Predictive factors for disseminated histoplasmosis in AIDS patients with fever admitted to a reference hospital in Brazil

Abstract INTRODUCTION: In many settings, the lack of sensitive biomarkers of disseminated histoplasmosis (DH) leads to a clinical reliance on older diagnostic methods and delayed treatment initiation. The early recognition of DH is critical for survival, especially in patients with human immunodeficiency virus (HIV). This study aimed to identify clinical and laboratory findings associated with the definitive diagnosis of DH in low-income HIV patients in endemic areas. METHODS: Febrile AIDS patients with suspected DH who were admitted to a reference hospital in northeastern Brazil from January 2006 to January 2007 were evaluated for clinical and laboratory findings associated with DH diagnosis. RESULTS: One hundred seventeen patients with fever were included, and 48 (41%) cases of DH were determined by Histoplasma capsulatum identification. A higher fever (≥38.5ºC), maculopapular/papular rash, splenomegaly, hepatomegaly, wheezing, hemoglobin ≤9.5g/dL, platelets ≤80,000/µL, CD4 count ≤75/µL, aspartate aminotransferase (AST) level ≥2.5 times the upper limit of normal (ULN), lactate dehydrogenase (LDH) ≥5times the ULN; and international normalized ratio (INR) >2 times the ULN were significantly associated with DH. A multivariable analysis identified hepatomegaly [adjusted (a) prevalence ratio (PR)= 1.96; 95% confidence interval (CI): 1.21-3.16), CD4 count ≤75/µL (aPR = 2.02; 95% CI: 1.06-3.83), LDH ≥5 times the ULN (aPR = 2.23; 95% CI: 1.44-3.48), and maculopapular/papular rash (aPR = 1.70; 95% CI: 1.02-2.83) were independent risk factors for DH. CONCLUSIONS: These easily assessed parameters can facilitate clinical decision-making for febrile AIDS patients with suspected DH in low socioeconomic and Histoplasma-endemic regions.