Failure in syndromic management due to drug-resistant Mycoplasma genitalium in Florianópolis, South Brazil / Falha no manejo sindrômico devido a Mycoplasma genitalium resistente em Florianópolis, Sul do Brasil

Introduction: Mycoplasma genitalium is a bacterium associated with sexually transmitted infections that can cause urethritis in men and complications in women, including preterm birth. Increasing macrolide resistance in M. genitalium poses challenges to treatment efficacy. Objective: To present a case of treatment failure of urethritis caused by macrolide-resistant M. genitalium. Case report: This case report describes a 20-year-old man with persistent urethral symptoms despite azithromycin treatment, wherein M. genitalium harbored the A2058G mutation in the 23S rRNA. Subsequent treatment with moxifloxacin resolved symptoms and cleared M. genitalium. Conclusion: The study highlights the importance of resistance testing to guide antimicrobial therapy and emphasizes the need for updated treatment guidelines in Brazil. (AU)

Introdução:Mycoplasma genitalium é uma bactéria associada a infecções sexualmente transmissíveis, que pode causar uretrite em homens e complicações em mulheres, incluindo nascimento prematuro. O aumento da resistência aos macrolídeos em M. genitalium coloca desafios à eficácia do tratamento. Objetivo: Apresentar um caso de falha terapêutica de uretrite causada por M. genitalium resistente aos macrolídeos. Relato de caso: Este relato de caso descreve um homem de 20 anos com sintomas uretrais persistentes, apesar do tratamento com azitromicina, em que M. genitalium possuía a mutação A2058G no rRNA 23S. O tratamento subsequente com moxifloxacino resolveu os sintomas e eliminou M. genitalium. Conclusão: O estudo destacou a importância dos testes de resistência para orientar a terapia antimicrobiana e enfatizou a necessidade de atualizar as diretrizes de tratamento no Brasil. (AU)

Development and application syndromic surveillance and early warning system in border area in Yunnan Province / 中华流行病学杂志

Objective: To establish a dynamic syndromic surveillance system in the border areas of Yunnan Province based on information technology, evaluate its effectiveness and timeliness in the response to common communicable disease epidemics and improve the communicable disease prevention and control in border areas. Methods: Three border counties were selected for full coverage as study areas, and dynamic surveillance for 14 symptoms and 6 syndromes were conducted in medical institutions, the daily collection of information about students' school absence in primary schools and febrile illness in inbound people at border ports were conducted in these counties from January 2016 to February 2018 to establish an early warning system based on mobile phone and computer platform for a field experimental study. Results: With syndromes of rash, influenza-like illness and the numbers of primary school absence, the most common communicable disease events, such as hand foot and mouth disease, influenza and chickenpox, can be identified 1-5 days in advance by using EARS-3C and Kulldorff time-space scanning models with high sensitivity and specificity. The system is easy to use with strong security and feasibility. All the information and the warning alerts are released in the form of interactive charts and visual maps, which can facilitate the timely response. Conclusions: This system is highly effective and easy to operate in the detection of possible outbreaks of common communicable diseases in border areas in real time, so the timely and effective intervention can be conducted to reduce the risk of local and cross-border communicable disease outbreaks. It has practical application value.

Surveillance on pediatric bacterial meningitis in Gondar University Hospital, Ethiopia from 2012 to 2021: Retrospective analysis

Introduction: Acute Bacterial meningitis is still a major cause of death in under-five children. Surveillance on Pediatric Bacterial Meningitis has been set up by the World Health Organization to generate data on vaccine preventable causes of Meningitis in under-five children. Ethiopia is one of the countries conducting the surveillance and Gondar University Hospital is one of the sentinel surveillance sites. In this study we described the epidemiological data on Bacterial meningitis in under-five children at Gondar University Hospital from 2012-2021. Methods: Data were extracted directly from Gondar University Hospital surveillance database collected from under-five children admitted to the Hospital with suspected meningitis from January 1st, 2012 to December 31st , 2021. Socio-demographic and clinical characteristics were collected using standard pretested questioners. All under-five children with suspected meningitis over the 10-years period were included and descriptive statistics like frequency, percentage, mean, median and standard deviations were used for the characteristics of under-five Children with Suspected Bacterial Meningitis. Results: In this study, a total of 4311 under-five admitted with suspected bacterial meningitis from 2012 to 2021 were enrolled. The majority, 71% of suspected meningitis were reported in infants. The mortality rate in suspected meningitis during the study period was 1%. The majority (92.4 %) had fever at presentation followed by seizure (62.7 %), altered consciousness (58.9 %) and bulged fontanel in 48.3 %, respectively. The commonest bacteria identified by CSF culture and Polymerase Chain Reaction was Streptococcus pneumonia (SPN). There was a reduction of confirmed meningitis cases from 2012 to 2021 (26 cases in 2012 and 6cases in 2021). Conclusions: Streptococcus pneumoniae was the commonest cause of PBM. Bacterial detection by culture was low which showed that Polymerase Chain Reaction (PCR) test should be encouraged to improve bacterial detection.

HIV infection status and related factors in men who have sex with men in sentinel surveillance in Shanxi province, 2010, 2015 and 2020 / 中华流行病学杂志

Objective: To understand the infection status of HIV and related factors in men who have sex with men (MSM) in Shanxi province in 2010, 2015 and 2020. Methods: According to the sentinel surveillance protocol, continuous cross-sectional survey were conducted to collect the information about basic characteristics, general demographic characteristics, AIDS knowledge awareness, high-risk sexual behavior, sexually transmitted diseases, intervention services and HIV infection rate of the MSM in Shanxi in 2010, 2015 and 2020. Results: In 2010, 2015 and 2020, a total of 2 708 MSM were included in this study. There were significant differences in HIV infection rate among three years (χ2=23.76, P<0.001) with an increasing trend with year (trend χ2 =17.34, P<0.001). The rates of anal sex, commercial sex and heterosexual behavior in the past 6 months were 77.62% (2 102/2 708), 5.91% (160/2 708) and 28.14% (762/2 708) respectively, and the rates of consistent use of condom were 52.52% (1 104/2 102), 63.13% (101/160) and 23.49%(179/762) respectively, and the rate of consistent condom use was low. Results from multivariate logistic regression analysis showed that different cities, having educational level of junior high school or below, being recruited through internet, voluntary counseling and testing, suffering from sexually transmitted diseases, occasional condom use in anal sex in the past 6 months were the correlative factors of HIV infection of MSM. Conclusions: The HIV infection rate of MSM in Shanxi increased year by year from 2010, 2015 to 2020. The HIV/AIDS-related risk behavior persisted, and the proportion of condomuse adherence was low, and the HIV detection rate was low in the MSM, so targeted and effective measures should be taken to promote the condom use adherence and regular HIV testing in MSM.

Prevalence and antimicrobial resistance profiles of Neisseria gonorrhea and Chlamydia trachomatis isolated from individuals attending STD clinics in Kampala, Uganda

Background: Sexually transmitted diseases (STDs) management in sub-Saharan Africa is syndromic but molecular diagnostics provide quicker, sensitive diagnosis and treatment. Effective STD control hinges on identification and treatment of infected persons and sexual partner contact tracing. Objectives: This study assessed feasibility of using the Xpert CT/NG test to identify prevalent Chlamydia trachomatis (CT) and Neisseria gonorrhea (NG) infections among STD clinic attendees and their sexual partners and tested for antimicrobial resistance for N. gonorrhea. Methods: A cross-sectional study was conducted at 4 outpatient STD clinics in Kampala, Uganda from February 2019 to October 2019. Participants received a syndromic diagnosis, were tested for NG and CT, as well as their sexual partners. Urine (men) and high vaginal swabs (women) were collected, examined using Xpert CT/NG assay. A total of 79 participants were enrolled at baseline of whom 25 had CT/NG. 21 partners of infected baseline participants and 7 partners of the 21 primary partners were enrolled. Results: The mean age of the reported sexual partners was 26 (18-43) years. The prevalence of NG was 25% at baseline and 18 % for CT. Nine (11.4%) people were dually infected. Men were more likely to have NG (p<0.001) at multivariable level. Two participants tested HIV-1 positive. On microbiological culture, 8 samples (2.5%) grew NG, and all were resistant to penicillin, ciprofloxacin. For CT, we found a preponderance of the F-serovar in this population. Conclusion: The most prevalent organism was Neisseria gonorrhea. Generally, the prevalence of CT and NG was high. Infection proportions increased among primary partners, particularly women. Etiologic testing without partner tracing and treatment may underestimate burden of CT/NG in this population and contribute to re-infection

Sentinel surveillance for bacterial pneumonia and meningitis in children under the age of 5 in a tertiary pediatric hospital in Colombia - 2016 / Vigilancia centinela de neumonías y meningitis bacterianas en menores de 5 años en un hospital pediátrico de tercer nivel en Colombia - 2016

Abstract | Introduction: Bacterial pneumonia and meningitis are vaccine-preventable diseases. Sentinel surveillance provides relevant information about their behavior. Objective: To present the data from sentinel surveillance carried out at the Fundación HOMI, Fundación Hospital Pediátrico La Misericordia in 2016. Materials and methods: We conducted a descriptive study from January 1 to December 31, 2016, on the daily surveillance of patients under 5 years of age diagnosed with pneumonia or bacterial meningitis according to PAHO's definitions. We identified the microorganisms using the automated VITEKTM 2 system. Bacterial isolates were sent to the Microbiology Group at the Colombian Instituto Nacional de Salud for confirmation, serotyping, phenotypic, and genotypic characterization. Antimicrobial susceptibility profiles were established. Results: From 1,343 suspected cases of bacterial pneumonia, 654 (48.7%) were probable, 84% had complete Hib vaccination schedules, and 87% had complete pneumococcal vaccination schedules for age. Blood culture was taken in 619 (94.6%) and 41 (6.6%) were positive while S. pneumoniae was isolated in 17 (41%) of them. The most frequent serotype was 19A in five cases (29.4%), and four 19A serotypes were associated with the reference isolate ST320. The incidence rate of probable bacterial pneumonia was 7.3 cases/100 hospitalized patients, and lethality was 2.1%. As for bacterial meningitis, 22 suspected cases were reported, 12 (54%) were probable, four (33%) were confirmed: two by Escherichia coli and two by group C N. meningitidis. The incidence of probable bacterial meningitis was 0.14 cases/100 hospitalized patients. Conclusion: Streptococcus pneumoniae serotypes 19A and 3 were the most frequent cause of pneumonia. Spn19A is related to the multi-resistant clone ST320. Strengthening and continuing this strategy will allow understanding the impact of vaccination.

Resumen | Introducción. La neumonía y la meningitis bacterianas son enfermedades inmunoprevenibles; la vigilancia centinela aporta información relevante acerca de su comportamiento. Objetivo. Presentar los resultados de la vigilancia centinela de neumonía y meningitis llevada a cabo en la HOMI, Fundación Hospital Pediátrico La Misericordia. Materiales y métodos. Se hizo un estudio descriptivo entre el 1 de enero y el 31 diciembre del 2016, de la vigilancia diaria de pacientes menores de 5 años con diagnóstico de neumonía o meningitis bacteriana, según las definiciones de la Organización Panamericana de la Salud (OPS). Los microorganismos fueron identificados usando el sistema automatizado VITEK TM2. Los aislamientos se enviaron al grupo de microbiología del Instituto Nacional de Salud para confirmación, serotipificación, y caracterización genotípica y fenotípica. Asimismo, se establecieron los perfiles de sensibilidad antimicrobiana. Resultados. De 1.343 casos sospechosos de neumonía bacteriana, 654 (48,7 %) fueron probables, el 84 % tenía el esquema de vacunación completo para la edad contra Haemophilus influenzae de tipo b, y el 87 %, contra neumococo. En 619 (94,6 %) pacientes se hizo hemocultivo y 41 (6,6 %) fueron positivos. S. pneumoniae se aisló en 17 (41 %) casos. El serotipo más frecuente fue el 19A, en cinco pacientes (29,4 %), en tanto que cuatro aislamientos de spn19A fueron relacionados con el clon ST320. La tasa de incidencia de neumonía bacteriana probable fue de 7,3 casos/100 pacientes hospitalizados. La letalidad fue de 2,1 %. Hubo 22 casos sospechosos de meningitis bacteriana, 12 (54 %) probables, y cuatro (33 %) confirmados: dos por Escherichia coli y dos por Neisseria meningitidis del grupo C. La incidencia de meningitis bacteriana probable fue de 0,14/100 pacientes hospitalizados. Conclusión. Los serotipos 19A y 3 de S. pneumoniae fueron la causa más frecuente de neumonía. El Spn19A se relacionó con el clon ST320 mulitirresistente. El fortalecimiento continuo de la vigilancia centinela permitirá entender el impacto de la vacunación.

Detección molecular de patógenos entéricos en niños con diarrea en un hospital centinela de vigilancia de rotavirus en Chile / Molecular detection of gastrointestinal pathogens among children under 5 years old with diarrhea in a hospital center for rotavirus sentinel surveillance in Chile

INTRODUCCIÓN: Las diarreas de causa infecciosa son un problema de salud pública, especialmente en niños bajo los cinco años. La identificación de los agentes etiológicos puede ser relevante para el manejo del cuadro clínico y, desde el punto de vista epidemiológico, para la implementación de medidas de control. OBJETIVO: Determinar la presencia de patógenos entéricos en niños bajo los cinco años que se hospitalizaron por diarrea aguda en uno de los centros centinelas de la red de vigilancia de rotavirus en Chile. PACIENTES Y MÉTODOS: Estudio observacional en niños menores de cinco años que se internaron por cuadros de diarrea en el Hospital Dr. Luis Calvo Mackenna, durante diciembre del 2015 a diciembre del 2019, el que forma parte de la red de vigilancia de rotavirus del Ministerio de Salud de Chile. Las muestras fecales se analizaron mediante un test molecular, FilmArray GI® panel, que permite la detección de 22 patógenos entéricos virales, bacterianos y parasitarios. RESULTADOS: Se analizaron 493 muestras fecales de niños con episodios de diarrea infecciosa, detectando al menos un patógeno en 427 muestras (87%). De estas muestras positivas, se detectó solo un patógeno en 174 muestras (41%) y dos o más patógenos en 253 muestras (59%). En el grupo de niños bajo un año y el grupo entre uno y cuatro años hubo un predominio de infecciones causadas por virus gastroentéricos, siendo rotavirus y norovirus los virus más detectados en ambos grupos de edad. Las bacterias más frecuentes fueron EPEC (27%), C. difficile (17%), EAEC (14%) y Campylobacter (9%). Respecto a los parásitos, se identificó Giardia lamblia y Cryptosporidium, en el 3 y 1% del total de las muestras, respectivamente. CONCLUSIÓN: La detección molecular utilizada permitió detectar un alto número de enteropatógenos en niños bajo los cinco años. La información generada por este tipo de vigilancia, podría ayudar a caracterizar en la población los episodios de diarrea causados por los principales patógenos entéricos y podría ser una herramienta para asesorar técnicamente a las autoridades en la toma de decisión para la implementación de medidas de control contra estos patógenos.

BACKGROUND: Infectious diarrhea is still a major problem in public health, especially in children under 5 years of age. The identification of the etiologic agent is important for the clinical management of the diarrhea episode and, from the epidemiological point of view, to implement control measures. AIM: To determine the presence of gastrointestinal pathogens in children under five years of age with diarrhea in a Chilean rotavirus surveillance center. METHODS: Observational study in children under five years of age who were hospitalized for diarrhea at the Dr. Luis Calvo Mackenna Hospital from December 2015 to December 2019. Molecular detection was performed using the FilmArray gastrointestinal (FilmArray GI®) panel. RESULTS: We analyzed 493 diarrheal stool samples of children, 427 samples (87%) were positive and 66 samples (13%) were negative. Of positive samples, 174 samples (41%) and 253 samples (59%) were positive for one or more pathogen, respectively. In children under one year and the group between one and four years there was a predominance of infections caused by enteric virus. Rotavirus and norovirus were the most common virus in both age groups. The most frequent bacteria were EPEC (27%), C. difficile (17%), EAEC (14%) and Campylobacter (9%). In parasites, Giardia lamblia and Cryptosporidium were identified, in 3% and 1% of the total samples, respectively. CONCLUSIONS: The molecular detection system used allowed an increase in the detection of enteropathogens in children under five years of age. The information generated by this type of surveillance could help to characterize the episodes of diarrhea in the population and might be a tool to technically advise the authorities in the decision-making process for the implementation of control measures.

Descrição geoespacial da dispersão do vírus amarílico e a estratégia de imunização no Município de Louveira em um contexto de surto no Estado de São Paulo em 2017 / Geospatial description of the spread of the yellow fever virus and the immunization strategy in the City of Louveira in an outbreak context in the State of São Paulo in 2017

Introdução: A febre amarela é uma doença infecciosa febril aguda, imunoprevenível e cujo principal reservatório sentinela é o primata não humano (PNH). Fatores agravantes dizem respeito à clínica da doença e ao alto potencial de transmissão no ciclo urbano em área s com a presença de Aedes aegypti. Objetivos: Descrever a experiência de um município frente à situação epidemiológica da febre amarela no ano de 2017 e elaborar uma norma técnica com base nas ações desencadeadas para o controle e prevenção da doença que seja replicável para outros municípios. Métodos: Trata se de uma pesquisa quantitativa descritiva e documental, do tipo relato de experiência. Foi realizada no município de Louveira SP. As duas variáveis selecionadas foram número de casos de epizootia por febre amarela em PNH e cobertura vacinal. A análise dos dados foi realizada a partir da construção de mapas com distribuição temporal e espacial dos casos de epizootia e indivíduos vacinados através do Programa QGIS, versão 3.10. Resultados: No ano de 2017 foram notificados 67 casos de óbito em PNH, sendo 24 casos confirmados. Foram vacinadas 3.952 pessoas na estratégia de vacinação casa a casa nas áreas selecionadas como prioritárias. Os bugios se mostraram a melhor espécie sentinela para a doença, indicando uma tendência de dispersão sentido norte sul no território, de acordo com a teoria de corredor es ecológicos. Os casos de epizootia ocorreram nas áreas consideradas prioritárias para vacinação casa a casa e nas quais foi atingida uma cobertura de 42%. Não houve registro de casos humanos e óbitos no município. Conclusão: A detecção oportuna de casos de epizootias por febre amarela em determinado território é essencial para otimizar doses da vacina para populações prioritárias, quando não há oferta do insumo suficiente para vacinações em massa, atuando de forma preventiva na redução de casos humanos e óbitos.

Introduction: Yellow fever is an infectious disease with acute fever, it is immunopreventable and which the main sentinel and reservoir are non-human primates (PNH). Aggravating factors concern the clinic of the disease and the high potential for transmission in the urban cycle in areas with the presence of the mosquito Aedes aegypti. Objectives: To describe an experience of a municipality facing a epidemiological situation of yellow fever virus circulation in 2017 and to develop a technical standard based on the actions triggered for the control and prevention of the disease that may be replicable for other municipalities. Methods: This is a descriptive and documentary quantitative research, of the experience report type. It was carried out in the city of Louveira - SP. The two selected variables were number of cases of epizooties due to yellow fever virus in PNH and vaccination coverage for the human population. An analysis of the data was performed based on the construction of maps with temporal and spatial distribution of cases of epizootic and vaccinated data through the QGIS Program, version 3.10. Results: In 2017, 67 cases of death in PNH were reported, 24 of which were confirmed. 3.952 people were vaccinated in the house-to-house vaccination strategy in the areas selected as priority. Howler monkeys proved to be the best sentinel species for the disease, indicating a north-south dispersal trend in the territory, according to the ecological corridor theory. The epizootic cases occurred in areas considered priority for house-to-house vaccination and in which coverage of 42% was achieved. There were no records of human cases and deaths in the city. Conclusion: The timely detection of cases of epizootics due to yellow fever in a determined territory is essential to optimize the doses of the vaccine in the priority populations, when there is not enough supply for mass vaccinations, acting preventively in the reduction of human cases and deaths.

Análise de causa raiz em internações por drogas de abuso como eventos sentinelas / Análisis de causa raíz em internaciones por drogas de abuso como eventos centinelas / Root cause analysis in hospitalizations due to drugs as sentinel surveillance

Objetivo: Analisar os fatores de iniciação e continuidade do uso de drogas, a partir do evento sentinela, internação hospitalar com diagnóstico de trauma associado à intoxicação por drogas de abuso. Métodos: Estudo exploratório e retrospectivo, com referencial de vigilância epidemiológica de 30 eventos sentinelas, a partir de revisão de documentos hospitalares e entrevista com familiar dos usuários de drogas. A matriz para avaliação foi a análise da causa raiz, estabelecida pela investigação e pelar e construção da trajetória do uso de drogas. Resultados: Houve predomínio de sexo masculino, baixa escolaridade e desemprego, com média de 40,1 anos. A droga mais utilizada foi o álcool, isolada ou associada a drogas ilícitas. Identificaram-se pontos críticos de vulnerabilidade social, permitindo uma discussão sobre o desempenho das políticas públicas. Conclusão: A maioria dos fatores subjacentes se relacionava à ausência ou à precariedade de políticas públicas, com pontos críticos na intersetorialidade (AU)

Objective: to analyze the initiation and continuity factors for drug use from the hospitalization sentinel surveillance diagnosed with trauma associated with drug intoxication. Methods: this is an exploratory and retrospective study with the epidemiological surveillance framework of 30 sentinel events based on hospital documents review and interviews with family members of drug users. The matrix for the evaluation was the root cause analysis, established by the investigation and reconstruction of the drug use trajectory. Results: we found predominance of male gender, low education and unemployment, with average 40.1 years. The most consumed drug was alcohol, alone or associated with illicit drugs. Critical points of social vulnerability were identified, admitting the discussion of public policies performance. Conclusions: most of the underlying factors were related to the absence or precariousness of public policies, with critical points in intersectoriality (AU)

Objetivo: analizar los factores de iniciación y continuidad para el consumo de drogas del evento centinela de hospitalización, diagnosticado con trauma asociado con la intoxicación por abuso de drogas. Métodos: estudio exploratorio y retrospectivo con el marco de vigilancia epidemiológica de 30 eventos centinela, basado en la revisión de documentos hospitalarios y entrevistas con familiares de usuarios de drogas. La matriz para la evaluación fue el análisis de la causa raíz, establecido por la investigación y reconstrucción de la trayectoria del consumo de drogas. Resultados: predominó el sexo masculino, baja educación y desempleo, con un promedio de 40,1 años. La droga más utilizada fue el alcohol, solo o asociado con drogas ilícitas. Se identificaron puntos críticos de vulnerabilidad social, lo que permite una discusión sobre el desempeño de las políticas públicas. Conclusión: la mayoría de los factores subyacentes estaban relacionados con la ausencia o precariedad de las políticas públicas, con puntos críticos en la intersectorialidad (AU)

Alfabetización en salud pública ante la emergencia de la pandemia por Covid-19 / Public health literacy in the face of the Covid-19 pandemic emergency

Resumen: La alfabetización en salud es el proceso centrado en la obtención del conocimiento, la motivación y las competencias individuales para entender y acceder a información, expresar opiniones y tomar decisiones relacionadas con la promoción y el mantenimiento de la salud, lo que es aplicable en diferentes contextos, entornos y a lo largo de toda la vida. Esta perspectiva conceptual es muy necesaria ante la emergencia del virus SARS-CoV-2 que produce la enfermedad Covid-19, la cual ha producido una pandemia con efectos devastadores, no sólo desde el punto de vista de la salud, sino también, de manera muy importante, desde el económico, político y social. En este ensayo se tratan de establecer los elementos basados en la evidencia científica que orientan las políticas públicas de prevención y control, entre los que destacan: a) la inteligencia epidemiológica, la cual incluye no sólo la estrategia de vigilancia poblacional sino, ante la imposibilidad real de identificación de todos los casos positivos, la puesta en práctica de estrategias de vigilancia centinela y la vigilancia basada en eventos; b) las medidas de mitigación de la propagación de la epidemia, tales como distanciamiento social e higiene, lavado de manos, cuarentena, restricción de movimiento y utilización de cubrebocas, entre otras; c) medidas de supresión de la transmisión cuando el número de casos es muy elevado, como el endurecimiento de medidas drásticas de encierro en casa; d) fortalecimiento de la capacidad de atención médica en los sistemas de salud e incremento de la capacidad de prevención de la transmisión en los servicios de salud, incluyendo la utilidad de las pruebas diagnósticas; y e) el desarrollo de vacunas profilácticas contra Covid-19, así como la generación de agentes terapéuticos. Todas estas acciones no sólo deben implementarse rápidamente desde la perspectiva multidisciplinaria y multisectorial de la salud pública para contener, prevenir y controlar la epidemia, sino que necesitan obligatoriamente del concurso de la comunidad como responsabilidad compartida. Debido a todo esto, es necesaria la alfabetización en salud pública.

Abstract: Health literacy is the process of obtaining knowledge, motivation and individual competencies to understand and access information, express opinions and make decisions with respect to health promotion and maintenance. This applies in different contexts, environments, and throughout life. This conceptual perspective is very necessary in the face of the SARS-CoV-2 virus emergency. This virus produces the Covid-19 disease, which has become a pandemic of devastating effects not only healthwise, but also, importantly, from an economic, political and social point of view. This essay seeks to establish the scientific evidence-based elements that guide public policies for prevention and control. Some of these elements are: a) epidemiologic intelligence. This includes not only the strategy of public surveillance, but also sentinel and event-based surveillance, as it is impossible to actually identify all positive cases; b) Mitigating measures against the spread of the epidemic, such as social distancing and hygiene, washing hands, quarantine, restricting movement and using masks, among others; c) Measures to suppress transmission when the number of cases is very high, such as strict measures to stay at home; d) strengthening health services 'capacity for medical attention and improving health services' ability to prevent transmission, including the use of diagnostic tests; e) the development of prophylactic vaccines against Covid-19, as well as the development of therapeutic agents. All of these actions must be rapidly implemented, from a multidisciplinary and multisectorial public health perspective, and they absolutely must also be taken with the community's participation as shared responsibility. Therefore, public health literacy is needed.

Influenza Sentinel Surveillance and Severe Acute Respiratory Infection in a Reference Hospital in Southern Brazil

Abstract INTRODUCTION: We report the results of the active surveillance of influenza infections in hospitalized patients and the evaluation of the seasonality and correlation with temperature and rainfall data. METHODS: During the 2-year study period, 775 patients were tested for 15 respiratory viruses (RVs). RESULTS: Most of the 57% of (n=444) virus-positive samples were human rhinovirus and respiratory syncytial virus. However, 10.4% (n=46) were influenza virus (80% FluA; 20% FluB). Age and SARI were significantly associated with influenza. FluB circulation was higher is 2013. CONCLUSIONS: In the post-epidemic period, influenza remains an important cause of hospitalization in SARI patients.

An evaluation of the perinatal mortality surveillance system in Gwanda District, Matabeleland South Province, Zimbabwe

Background. A preliminary review of perinatal mortality surveillance data (January - August 2017) suggested an under-reporting of perinatal deaths in Gwanda District, Matabeleland South.Objective. To evaluate the effectiveness of the perinatal mortality surveillance system in Gwanda District, Matabeleland South, Zimbabwe.Methods. This descriptive cross-sectional study interviewed 50 healthcare workers employed in the district using pretested intervieweradministered questionnaires. The sample was drawn from 16 randomly selected healthcare facilities. Records for perinatal mortality cases were reviewed and data were analysed.Results. Only 32% of healthcare workers knew the case definition of perinatal death. Approximately two-thirds of participants (68%) knew who should complete notification forms and ~half (52%) of the respondents cited fear of blame as the reason for a low perinatal death report rate in the district. Although 50% of participants reporting having participated in perinatal death reviews and 78% reporting using the data for planning community health programmes, there was no recorded evidence in support. Perinatal mortality case notification forms were not in stock at 13 of the 16 sampled healthcare facilities.Conclusion. Poor knowledge of the perinatal mortality surveillance system was found among participants. The low reporting rate suggests that the system does not function effectively in the district. Healthcare workers feared blame, which suggests management intervention is required to create a trusted reporting environment

Vigilância sindrômica: estudo epidemiológico da doença febril aguda em casos suspeitos de arboviroses no estado do Rio de Janeiro / Syndromic surveillance: an epidemiological study of acute febrile illness in suspected cases of arboviruses in the state of Rio de Janeiro

Introdução: As doenças febris agudas (DFA) constituem um grupo de doenças de alta incidência e frequentemente relacionadas a agentes infecciosos em países tropicais. No contexto epidemiológico brasileiro, dentro desse grupo, destacam-se as arboviroses. Estas apresentam manifestações clínicas inespecíficas e semelhantes, cuja diferenciação etiológica é de elevada complexidade diagnóstica. Objetivos: Descrever aspectos epidemiológicos e clínicos dos casos suspeitos de dengue (DENV), chikungunya (CHIKV) ou zika (ZIKV), atendidos em unidades de saúde do estado do Rio de Janeiro, durante o período de 2017 a 2018. Metodologia: Estudo transversal e retrospectivo com dados coletados do sistema GAL (Gerenciador de Ambiente Laboratorial), disponibilizado pelo Laboratório Central Noel Nutels (LACEN-RJ), de todos os pacientes assistidos na rede estadual de saúde e que realizaram exame laboratorial para diagnóstico de CHIKV, DENV or ZIKV durante o período de 2017 a 2018. Resultados: A avaliação inicial do banco de dados mostra elevado percentual de notificações com preenchimento incompleto com 93% em 2017 e 88,9% em 2018. Em relação às requisições, em 2017 foram realizados 11.159 exames: 44,2% para CHIKV, 41,5% para DENV e 14,3% para ZIKV, enquanto que em 2018 foram 24.913 exames: 31,2% para CHIKV, 25,4% para DENV, 9% para ZIKV e 34,4% ZDC, pesquisa simultânea para as três arboviroses. Quanto aos resultados, em 2017 foram confirmados como causados por arbovírus apenas 1.216 casos (21%), enquanto que em 2018 foram 5.526 casos (40%). As três manifestações clínicas mais prevalentes foram as mesmas, tanto para os casos confirmados quanto para os sem confirmação: febre, artralgia e mialgia e as únicas manifestações mais prevalentes nos casos confirmados em relação aos casos sem etiologia definida foi a artralgia e o edema articular.

Conclusão: O estado do Rio de Janeiro é uma região endêmica de arboviroses. Os casos suspeitos de arbovírus sem definição etiológica constituem a maioria dos casos no estado e a ausência de identificação destes diagnósticos diferenciais impede ações de controle e prevenção específicos para esses agravos. Nesse contexto, a implementação da vigilância sindrômica, assessorada por uma vigilância epidemiológica munida de dados, é necessária para reduzir o número elevado de casos sem etiologia e contribuir para adequada vigilância em saúde. (AU)

Evolução da prevalência de infecção por COVID-19 no Rio Grande do Sul, Brasil: inquéritos sorológicos seriados / Trends in the prevalence of COVID-19 infection in Rio Grande do Sul, Brazil: repeated serological surveys

Resumo A COVID-19 é uma doença produzida pelo vírus SARS-CoV-2. Esse vírus se espalhou rapidamente pelo mundo, o que levou a Organização Mundial da Saúde a classificar a COVID-19 como uma emergência de saúde internacional e, posteriormente, a declará-la uma pandemia. O número de casos confirmados, no dia 11 de abril de 2020, já passa de 1.700.000, porém esses dados não refletem a real prevalência de COVID-19 na população, visto que, em muitos países, os testes são quase que exclusivamente realizados em pessoas com sintomas, especialmente os mais graves. Para definir políticas de enfrentamento, é essencial dispor de dados sobre a prevalência real de infecção na população. Este estudo tem por objetivos avaliar a proporção de indivíduos já infectados pelo SARS-CoV-2 no Rio Grande do Sul, Brasil, analisar a velocidade de expansão da infecção e estimar o percentual de infectados com e sem sintomas. Serão realizados quatro inquéritos sorológicos repetidos a cada 15 dias, com amostragem probabilística de nove cidades sentinela, em todas as sub-regiões do Estado. As entrevistas e testes ocorrerão no âmbito domiciliar. Serão utilizados testes rápidos para detecção de anticorpos, validados previamente ao início da coleta de dados.

Abstract COVID-19, the disease produced by the virus SARS-CoV-2, has spread quickly throughout the world, leading the World Health Organization to first classify it as an international health emergency and, subsequently, declaring it pandemic. The number of confirmed cases, as April 11, surpassed 1,700,000, but this figure does not reflect the prevalence of COVID-19 in the population as, in many countries, tests are almost exclusively performed in people with symptoms, particularly severe cases. To properly assess the magnitude of the problem and to contribute to the design of evidence-based policies for fighting COVID-19, one must accurately estimate the population prevalence of infection. Our study is aimed at estimating the prevalence of infected individuals in the state of Rio Grande do Sul, Brazil, to document how fast the infection spreads, and to estimate the proportion of infected persons who present or presented symptoms, as well as the proportion of asymptomatic infections. Four repeated serological surveys will be conducted in probability samples of nine sentinel cities every two weeks. Tests will be performed in 4,500 participants in each survey, totaling18,000 interviews. Interviews and tests will be conducted at the participants' household. A rapid test for the detection of antibodies will be used; the test was validated prior to the beginning of the fieldwork.

Profile of tuberculosis mortality in Brazil, 2001-2011 / Perfil da mortalidade por tuberculose no Brasil, 2001-2011 / Perfil de la mortalidad por tuberculosis en Brasil, 2001-2011

Rationale: In the health-disease process of tuberculosis (TB), mortality is one of the health indicators that most reflects the social link with the biological aspect. Death from TB is a sentinel event because it is preventable and indicates a failure of the social network and the health system. Objectives: To describe the sociodemographic and operational characteristics of patients who died of TB and the temporal distribution of the TB mortality rate in Brazil. Methods: A descriptive, cross-sectional, quantitative study performed from the database of the Mortality Information System (Portuguese acronym: SIM), in which all deaths with TB as the main cause registered from 2001 to 2011 were considered. Data analyzed through descriptive statistics. Results: During the study period, 53,747 deaths were recorded with TB as the basic cause. There was a higher percentage of cases of male sex (n = 39,597; 73.6%), mixed race (n=21,697; 40.3%), single marital status (n=23,518; 43.8%), schooling of up to eight years (n=19,443; 36.2%). A higher number of deaths occurred at the hospital (n=43,028; 80.1%) and 19,712 cases (36.7%) received medical assistance before death. The annual crude mortality rate decreased during the study period, ranging from 3.2 to 2.4 deaths per 100 thousand inhabitants. Conclusion: The results show the need for strategies differentiated by sex, age and education at the local level in TB control programs, as well as for planning health promotion and prevention actions available to populations living in these areas.(AU)

Justificativa: No processo saúde-doença da tuberculose (TB), a mortalidade constitui um dos indicadores de saúde que mais traduz o enlace social com o biológico. O óbito por TB é considerado um evento sentinela por ser evitável, indicativo de falha da rede social e do sistema de saúde. Objetivos: Descrever as características sociodemográficas e operacionais dos pacientes que evoluíram a óbito por TB e a distribuição temporal da taxa de mortalidade por TB no Brasil. Métodos: Estudo descritivo do tipo transversal e abordagem quantitativa, realizado a partir do banco de dados do Sistema de Informação sobre Mortalidade (SIM), na qual foram considerados todos os óbitos que apresentaram a TB como causa básica, registrados de 2001 a 2011, analisados por meio da estatística descritiva. Resultados: No período do estudo, foram registrados 53.747 óbitos com TB como causa básica, sendo maior percentual dos casos do sexo masculino (n= 39.597; 73,6%), raça/cor parda (n= 21.697; 40,3%), estado civil solteiro (n= 23.518; 43,8%), escolaridade até 8 anos de estudo (n=19.443; 36,2%), maior ocorrência dos óbitos no hospital (n= 43.028; 80,1%) e 19.712 casos (36,7%) receberam assistência médica antes do óbito. As taxas brutas anuais de mortalidade apresentaram redução no período de estudo, variando de 3,2 a 2,4 óbitos por 100 mil habitantes. Conclusão: Os resultados evidenciam a necessidade de propor estratégias diferenciadas por sexo, idade e escolaridade em nível local nos programas de controle de TB, assim como planejamento de ações de promoção e prevenção da saúde disponíveis às populações residentes nessas áreas.(AU)

Justificación: En el proceso salud-enfermedad de la tuberculosis (TB), la mortalidad es uno de los indicadores de salud que más refleja el vínculo social con el biológico. La muerte por TB se considera un evento centinela porque es prevenible, lo que indica un fallo de la red social y el sistema de salud. Objetivos: Describir las características sociodemográficas y operativas de los pacientes fallecidos por TB y la distribución temporal de la tasa de mortalidad por TB en Brasil. Métodos: un estudio descriptivo, de corte transversal y cuantitativo, realizado a partir de la base de datos del Sistema de Información de Mortalidad (SIM), en el cual se consideraron todas las muertes que presentaron TB como causa básica, registradas desde 2001 hasta 2011. Los datos fueron analizados mediante estadística descriptiva. Resultados: Durante el período de estudio, se registraron 53,747 muertes con TB como la causa básica. Hubo un mayor porcentaje de casos de sexo masculino (n=39,597; 73.6%), raza mixta (n=21,697; 40.3%), estado civil soltero (n=23,518; 43.8%), escolaridad de hasta ocho años (n=19,443; 36.2%). Un mayor número de muertes ocurrieron en el hospital (n=43,028; 80,1%) y 19,712 casos (36.7%) recibieron asistencia médica antes de la muerte. La tasa de mortalidad bruta anual disminuyó durante el período de estudio, oscilando desde 3.2 a 2.4 muertes por cada 100 mil habitantes. Conclusión: Los resultados muestran la necesidad de estrategias diferenciadas por sexo, edad y educación a nivel local en los programas de control de la TB, así como la planificación de acciones de promoción y prevención de la salud disponibles para las poblaciones que viven en estas áreas.(AU)

Pheochromocytoma and paraganglioma: implications of germline mutation investigation for treatment, screening, and surveillance

ABSTRACT Objective Paraganglioma (PGL) and pheochromocytoma (PCC) are rare neuroendocrine tumors that were considered to be predominantly sporadic. However, with the identification of novel susceptibility genes over the last decade, it is currently estimated that up to 40% of cases can occur in the context of a hereditary syndrome. We aimed to characterize PGL/PCC families to exemplify the different scenarios in which hereditary syndromes can be suspected and to emphasize the importance for patients and their families of making an opportune genetic diagnosis. Materials and methods Retrospective analysis of patients diagnosed with PGL/PCC. Germline mutations were studied using next-generation sequencing panels including SDHA, SDHB, SDHC and SDHD. Clinical data were collected from clinical records, and all patients received genetic counseling. Results We describe 4 families with PGL/PCC and germline mutations in SDH complex genes. 2 families have SDHB mutations and 2 SDHD mutations. The clinical presentation of the patients and their families was heterogeneous, with some being atypical according to the literature. Conclusions PGL/PCC are more commonly associated with a germline mutation than any other cancer type, therefore, all individuals with these types of tumors should undergo genetic risk evaluation. NGS multigene panel testing is a cost-effective approach given the overlapping phenotypes. Individuals with germline mutations associated with PGL/PCC should undergo lifelong clinical, biochemical and imaging surveillance and their families should undergo genetic counseling. For all these reasons, it is critical that all medical staff can suspect and diagnose these inherited cancer predisposition syndromes.

Informe especial: Vigilancia de lesiones ocasionadas por siniestros viales en la CABA. Año 2017. Parte II: Atención hospitalaria / Special report: Surveillance of injuries caused by road accidents in the CABA 2017. Part II: Hospital care

El presente informe corresponde a la segunda edición de una serie de cuatro publicaciones en conjunto entre el Observatorio de Seguridad Vial -OSV- (de la Secretaría de Transporte del GCBA) y la Gerencia Operativa de Epidemiología (del Ministerio de Salud del GCBA) sobre la vigilancia de las lesiones ocasionadas por siniestros viales durante el año 2017.Esta edición tiene como objetivo analizar aquellos aspectos de especial relevancia para la gestión hospitalaria de la Ciudad. En función de ello, analiza la distribución de los lesionados según el Hospital de ingreso, la participación de los lesionados por siniestros viales respecto del total de consultas de urgencias recibidas en las Guardias, la proporción de traumatismos graves a causa de siniestros viales que atiende cada Hospital, la duración de la internación de los pacientes lesionados graves que sobrevivieron así como la de aquellos que fallecieron. Los resultados aquí analizados continúan la serie y proporcionan información de utilidad para la planificación sanitaria y vial de la Ciudad. (AU)

Viral and Bacterial Etiology of Acute Febrile Respiratory Syndrome among Patients in Qinghai, China / 生物医学与环境科学（英文）

OBJECTIVE@#This study was conducted to investigate the viral and bacterial etiology and epidemiology of patients with acute febrile respiratory syndrome (AFRS) in Qinghai using a commercial routine multiplex-ligation-nucleic acid amplification test (NAT)-based assay.@*METHODS@#A total of 445 nasopharyngeal swabs specimens from patients with AFRS were analyzed using the RespiFinderSmart22kit (PathoFinder BV, Netherlands) and the LightCycler 480 real-time PCR system.@*RESULTS@#Among the 225 (225/445, 51%) positive specimens, 329 positive pathogens were detected, including 298 (90.58%) viruses and 31 (9%) bacteria. The most commonly detected pathogens were influenza virus (IFV; 37.39%; 123/329), adenovirus (AdV; 17.02%; 56/329), human coronaviruses (HCoVs; 10.94%; 36/329), rhinovirus/enterovirus (RV/EV; 10.03%; 33/329), parainfluenza viruses (PIVs; 8.51%; 28/329), and Mycoplasma pneumoniae (M. pneu; 8.51%; 28/329), respectively. Among the co-infected cases (17.53%; 78/445), IFV/AdV and IFV/M. pneu were the most common co-infections. Most of the respiratory viruses were detected in summer and fall.@*CONCLUSION@#In our study, IFV-A was the most common respiratory pathogen among 22 detected pathogens, followed by AdV, HCoV, RV/EV, PIV, and M. pneu. Bacteria appeared less frequently than viruses, and co-infection was the most common phenomenon among viral pathogens. Pathogens were distributed among different age groups and respiratory viruses were generally active in July, September, and November. Enhanced surveillance and early detection can be useful in the diagnosis, treatment, and prevention of AFRS, as well as for guiding the development of appropriate public health strategies.

Sentinel surveillance for viral hepatitis C in China, 2016-2017 / 中华流行病学杂志

Objective: To understand the prevalence of hepatitis C virus (HCV) infection in 5 populations in China during 2016-2017 and provide evidence for the estimation of prevalence trend of hepatitis C and evaluation on the prevention and control effect. Methods: A total of 87 national sentinel surveillance sites for hepatitis C were set up in 31 provinces (autonomous regions and municipalities) of China to obtain the information about HCV infection prevalence in 5 populations, including volunteer blood donors, people receiving physical examination, patients receiving invasive diagnosis and treatment, patients receiving hemodialysis, and clients visiting family planning outpatient clinics. From April to June, 2016 and 2017, cross-sectional surveys were repeatedly conducted in the 5 populations and blood samples were collected from them for HCV antibody detection. Results: In 2016, 86 sentinel sites completed the surveillance (one sentinel site was not investigated), and 115 841 persons were surveyed. The overall HCV positive rate was 0.38% (442/115 841, 95%CI: 0.23%-0.53%). In 2017, all the 87 sentinel sites completed the surveillance, and 120 486 persons were surveyed. The overall HCV positive rate was 0.37% (449/120 486, 95%CI: 0.23%-0.52%). In 2016 and 2017, the anti-HCV positive rates were 4.46% (223/5 005, 95%CI: 2.18%-6.73%) and 4.39% (216/4 919, 95%CI: 2.29%-6.50%) respectively in hemodialysis patients, 0.85% (44/5 200, 95%CI: 0.27%-1.42%) and 0.70% (36/5 150, 95%CI: 0.15%-1.24%) respectively in patients receiving invasive diagnosis and treatment and remained to be ≤0.25% in volunteer blood donors, people receiving physical examination and clients visiting family planning outpatient clinics. Results for the comparison of the anti-HCV positive rates in the 5 populations indicated that the differences were significant (F=23.091, P<0.001 in 2016 and F=20.181, P<0.001 in 2017). Conclusions: Data from the sentinel surveillance of HCV infection on prevalence in China showed that the anti-HCV positive rates varied in the 5 populations during 2016-2017. The anti-HCV positive rate appeared the highest in the hemodialysis patients, followed by that in the patients receiving invasive diagnosis and treatment, and the prevalence of HCV infection in other 3 populations were at low levels.

Pathogenic surveillance and related factors on bacillary dysentery in Beijing, 2008-2017 / 中华流行病学杂志

Objective: To analyze the pathogenic surveillance programs and related factors on bacillary dysentery in Beijing, 2008-2017, to provide evidence for the practices of diagnosis, treatment and prevention of the disease. Methods: Analysis was conducted on surveillance data of bacillary dysentery, collected from the surveillance areas of national bacillary dysentery in Beijing. Shigella positive rate of stool samples were used as the gold standard while detection rate of Shigella, diagnostic accordance rate and resistance were computed on data from the surveillance programs. Chi-square test was used to compare the rates and unconditional logistic regression was used to analyze the related factors of Shigella infection. Results: Both the reported incidence rate on bacillary dysentery and detection rate of Shigella in diarrhea patients showed significantly decreasing trend, from 2008 to 2017. The accordance rate of bacillary dysentery was only 7.80% (111/1 423). Shigella sonnei was the most frequently isolated strain (73.95%, 159/215) followed by Shigella flexnery. Results from the multivariate logistic regression of Shigella positive rate revealed that among those patients who were routine test of stool positive vs. routine test of stool positive (OR=1.863, 95%CI: 1.402-2.475), onset from July to October vs. other months'time (OR=7.271, 95%CI: 4.514-11.709) temperature ≥38 ℃vs. temperature <38 ℃(OR=4.516, 95%CI: 3.369-6.053) and age from 6 to 59 years old vs. other ages (OR=1.617, 95%CI: 1.085-2.410), presenting higher positive detection rates of Shigella from the stool tests. The resistant rates on ampicillin and nalidixic acid were 97.57% (201/206) and 94.90% (186/196), both higher than on other antibiotics. The resistant rates on ciprofloxacin (16.33%, 32/196), ofloxacin (9.57%, 11/115) and on amoxilin (15.05%, 31/206) were relatively low. The resistant rate appeared higher on Shigella flexnery than on Shigella sonnei. The proportion of strains with resistance on 3 more drugs, was 30.00%(21/70). Conclusions: The diagnostic accordance rate of bacillary dysentery in Beijing was low, with severe resistance of Shigella. Our findings suggested that clinicians should take multiple factors into account in their practices about epidemiological history, clinical symptom and testing results for diarrhea patients.