RESUMO
Widespread transmission of Zika virus by Aedes mosquitoes has been recognized in Brazil since late 2014, and in October 2015, an increase in the number of reported cases of microcephaly was reported to the Brazil Ministry of Health.* By January 2016, a total of 3,530 suspected microcephaly cases had been reported, many of which occurred in infants born to women who lived in or had visited areas where Zika virus transmission was occurring. Microcephaly surveillance was enhanced in late 2015 by implementing a more sensitive case definition. Based on the peak number of reported cases of microcephaly, and assuming an average estimated pregnancy duration of 38 weeks in Brazil (1), the first trimester of pregnancy coincided with reports of cases of febrile rash illness compatible with Zika virus disease in pregnant women in Bahia, Paraíba, and Pernambuco states, supporting an association between Zika virus infection during early pregnancy and the occurrence of microcephaly. Pregnant women in areas where Zika virus transmission is occurring should take steps to avoid mosquito bites. Additional studies are needed to further elucidate the relationship between Zika virus infection in pregnancy and microcephaly.
Assuntos
Microcefalia/epidemiologia , Complicações Infecciosas na Gravidez/virologia , Primeiro Trimestre da Gravidez , Características de Residência/estatística & dados numéricos , Infecção por Zika virus/transmissão , Brasil/epidemiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Prevalência , Infecção por Zika virus/epidemiologiaRESUMO
BACKGROUND: In December 2013, an outbreak of Chikungunya virus (CHIKV) caused by the Asian genotype was notified in the Caribbean. The outbreak has since spread to 38 regions in the Americas. By September 2014, the first autochthonous CHIKV infections were confirmed in Oiapoque, North Brazil, and in Feira de Santana, Northeast Brazil. METHODS: We compiled epidemiological and clinical data on suspected CHIKV cases in Brazil and polymerase-chain-reaction-based diagnostic was conducted on 68 serum samples from patients with symptom onset between April and September 2014. Two imported and four autochthonous cases were selected for virus propagation, RNA isolation, full-length genome sequencing, and phylogenetic analysis. We then followed CDC/PAHO guidelines to estimate the risk of establishment of CHIKV in Brazilian municipalities. RESULTS: We detected 41 CHIKV importations and 27 autochthonous cases in Brazil. Epidemiological and phylogenetic analyses indicated local transmission of the Asian CHIKV genotype in Oiapoque. Unexpectedly, we also discovered that the ECSA genotype is circulating in Feira de Santana. The presumed index case of the ECSA genotype was an individual who had recently returned from Angola and developed symptoms in Feira de Santana. We estimate that, if CHIKV becomes established in Brazil, transmission could occur in 94% of municipalities in the country and provide maps of the risk of importation of each strain of CHIKV in Brazil. CONCLUSIONS: The etiological strains associated with the early-phase CHIKV outbreaks in Brazil belong to the Asian and ECSA genotypes. Continued surveillance and vector mitigation strategies are needed to reduce the future public health impact of CHIKV in the Americas.
Assuntos
Febre de Chikungunya/epidemiologia , Febre de Chikungunya/transmissão , Febre de Chikungunya/virologia , Vírus Chikungunya/genética , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Criança , Pré-Escolar , Surtos de Doenças , Feminino , Genótipo , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Filogenia , Saúde Pública , Risco , Adulto JovemRESUMO
Currently, sticky traps are regularly employed to assist in the surveillance of Aedes aegypti infestation. We tested two alternative procedures for specimen identification performed by local health agents: directly in the field, as recommended by certain manufacturers, or after transportation to the laboratory. A total of 384 sticky traps (MosquiTRAP) were monitored monthly during one year in four geographically representative Brazilian municipalities. When the same samples were inspected in the field and in the laboratory, large differences were noted in the total number of mosquitoes recorded and in the number of specimens identified as Ae. aegypti by both procedures. Although field identification has the potential to speed vector surveillance, these results point to uncertainties in the evaluated protocol.
Assuntos
Aedes/classificação , Insetos Vetores/classificação , Animais , Brasil , Cidades , Monitoramento Ambiental , Laboratórios , Controle de Mosquitos/métodosRESUMO
Brazil will host the FIFA World Cup™, the biggest single-event competition in the world, from June 12-July 13 2014 in 12 cities. This event will draw an estimated 600,000 international visitors. Brazil is endemic for dengue. Hence, attendees of the 2014 event are theoretically at risk for dengue. We calculated the risk of dengue acquisition to non-immune international travellers to Brazil, depending on the football match schedules, considering locations and dates of such matches for June and July 2014. We estimated the average per-capita risk and expected number of dengue cases for each host-city and each game schedule chosen based on reported dengue cases to the Brazilian Ministry of Health for the period between 2010-2013. On the average, the expected number of cases among the 600,000 foreigner tourists during the World Cup is 33, varying from 3-59. Such risk estimates will not only benefit individual travellers for adequate pre-travel preparations, but also provide valuable information for public health professionals and policy makers worldwide. Furthermore, estimates of dengue cases in international travellers during the World Cup can help to anticipate the theoretical risk for exportation of dengue into currently non-infected areas.
Assuntos
Dengue/transmissão , Futebol , Aniversários e Eventos Especiais , Brasil/epidemiologia , Dengue/epidemiologia , Humanos , Incidência , Modelos Estatísticos , Medição de Risco , ViagemRESUMO
OBJECTIVE: to describe the challenges in implementing the chikungunya surveillance and prevention system in Brazil. METHODS: this was a descriptive study of suspected cases of the disease based on records held on the Notifiable Diseases Information System (Sinan) for the period 2014-2016. RESULTS: more than 100,000 probable chikungunya cases were notified in Brazil in this period, with the largest concentration in the Northeast states (83.3% between 2014 and 2015; 91.0% in 2016); Sinan provided an excellent opportunity for closing records of cases occurring between 2014 and 2015 (85%) and high completeness of obligatory variables. CONCLUSION: given the imminence of the introduction of chikungunya in Brazil in 2014, advance public health preparation took place in order to minimize its effects on society; implementation of the surveillance system improved collection of information regarding the disease, however many challenges can be seen in practice, in view of increasing case incidence. This requires greater handling capacity in this sector.
Assuntos
Febre de Chikungunya/epidemiologia , Coleta de Dados/métodos , Vigilância da População/métodos , Saúde Pública , Adolescente , Adulto , Brasil/epidemiologia , Notificação de Doenças/estatística & dados numéricos , Feminino , Humanos , Incidência , Sistemas de Informação , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
BACKGROUND: In 2015, the number of infants born with microcephaly increased in Paraíba, Brazil, after a suspected Zika virus outbreak. We did a retrospective case-control investigation to assess the association of microcephaly and Zika virus. METHODS: We enrolled cases reported to the national database for microcephaly and born between Aug 1, 2015, and Feb 1, 2016, on the basis of their birth head circumference and total body length. We identified controls from the national birth registry and matched them to cases by location, aiming to enrol a minimum of two controls per case. Mothers of both cases and controls were asked about demographics, exposures, and illnesses and infants were measured at a follow-up visit 1-7 months after birth. We took blood samples from mothers and infants and classified those containing Zika virus IgM and neutralising antibodies as evidence of recent infection. We calculated prevalence of microcephaly and odds ratios (ORs) using a conditional logistic regression model with maximum penalised conditional likelihood, and combined these ORs with exposure probability estimates to determine the attributable risk. FINDINGS: We enrolled 164 of 706 infants with complete information reported with microcephaly at birth, of whom we classified 91 (55%) as having microcephaly on the basis of their birth measurements, 36 (22%) as small, 21 (13%) as disproportionate, and 16 (10%) as not having microcephaly. 43 (26%) of the 164 infants had microcephaly at follow-up for an estimated prevalence of 5·9 per 1000 livebirths. We enrolled 114 control infants matched to the 43 infants classified as having microcephaly at follow-up. Infants with microcephaly at follow-up were more likely than control infants to be younger (OR 0·5, 95% CI 0·4-0·7), have recent Zika virus infection (21·9, 7·0-109·3), or a mother with Zika-like symptoms in the first trimester (6·2, 2·8-15·4). Once Zika virus infection and infant age were controlled for, we found no significant association between microcephaly and maternal demographics, medications, toxins, or other infections. Based on the presence of Zika virus antibodies in infants, we concluded that 35-87% of microcephaly occurring during the time of our investigation in northeast Brazil was attributable to Zika virus. We estimate 2-5 infants per 1000 livebirths in Paraíba had microcephaly attributable to Zika virus. INTERPRETATION: Time of exposure to Zika virus and evidence of infection in the infants were the only risk factors associated with microcephaly. This investigation has improved understanding of the outbreak of microcephaly in northeast Brazil and highlights the need to obtain multiple measurements after birth to establish if an infant has microcephaly and the need for further research to optimise testing criteria for congenital Zika virus infection. FUNDING: Centers for Disease Control and Prevention.
Assuntos
Microcefalia/epidemiologia , Microcefalia/virologia , Infecção por Zika virus/epidemiologia , Brasil/epidemiologia , Estudos de Casos e Controles , Feminino , Humanos , Recém-Nascido , Masculino , Prevalência , Estudos Retrospectivos , Fatores de TempoRESUMO
OBJECTIVE: to characterize the probable cases of dengue in pregnant women reported in Brazil, from 2007 to 2015. METHODS: descriptive study of sociodemographic, epidemiological, clinical and laboratory characteristics, with data from the Information System for Notifiable Diseases (Sinan). RESULTS: the annual incidence of dengue in pregnant women ranged from 3.3 (2009) to 816.6 (2010) cases per 100 thousand live births; of the 43,772 probable cases of dengue in pregnant women, 81.6% were investigated, 34.1% were confirmed by laboratory tests, and 1.7% were severe cases; hospitalization and fatality rates were of 5.4% and 1.6, respectively; the risk of death due to dengue was higher in pregnant women than in the population of non-pregnant women at reproductive age (ratio=3.95; 95%CI=3.07;5.08), and higher in the third trimester of pregnancy (ratio=8.55; 95%CI=6.08;12.02). CONCLUSION: the results show the burden of dengue in pregnant women and their vulnerability to worsening of the disease and death.
Assuntos
Dengue/epidemiologia , Hospitalização/estatística & dados numéricos , Complicações Infecciosas na Gravidez/epidemiologia , Dengue Grave/epidemiologia , Adolescente , Adulto , Brasil/epidemiologia , Criança , Dengue/mortalidade , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Gravidez , Complicações Infecciosas na Gravidez/mortalidade , Complicações Infecciosas na Gravidez/virologia , Terceiro Trimestre da Gravidez , Dengue Grave/mortalidade , Índice de Gravidade de Doença , Adulto JovemRESUMO
Objective: to describe the reported cases of Guillain-Barré Syndrome (GBS) and other neurological manifestations with a history of dengue, chikungunya or Zika virus infections, in the Metropolitan Region of Salvador and in the municipality of Feira de Santana, Brazil. Methods: this is a descriptive study with data of an investigation conducted by the epidemiological surveillance from March to August 2015; to confirm the neurological manifestations, medical diagnosis records were considered, and to prior infection, clinical and laboratory criteria were used. Results: 138 individuals were investigated, 57 reported infectious process up to 31 days before neurological symptoms - 30 possibly due to Zika, 13 to dengue, 8 to chikungunya and 6 were inconclusive -; GBS was the most frequent neurological condition (n=46), with predominance of male sex (n=32) and the median age was 44. Conclusion: most cases reported a clinical picture consistent with acute Zika virus disease, which preceded the occurrence of neurological symptoms.
Assuntos
Febre de Chikungunya/epidemiologia , Dengue/epidemiologia , Síndrome de Guillain-Barré/epidemiologia , Infecção por Zika virus/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Criança , Pré-Escolar , Cidades , Surtos de Doenças , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Adulto JovemAssuntos
Vírus da Dengue/fisiologia , Dengue/epidemiologia , Dengue/virologia , Surtos de Doenças , Adolescente , Adulto , Brasil/epidemiologia , Criança , Dengue/diagnóstico , Vírus da Dengue/classificação , Vírus da Dengue/genética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Filogenia , RNA Viral/genética , Sorotipagem , Proteínas do Envelope Viral/genética , Adulto JovemRESUMO
We evaluated the sensitivity of the dengue surveillance system in detecting hospitalized cases in ten capital cities in Brazil from 2008 to 2013 using a probabilistic record linkage of two independent information systems hospitalization (SIH-SUS) adopted as the gold standard and surveillance (SINAN). Sensitivity was defined as the proportion of cases reported to the surveillance system amid the suspected hospitalized cases registered in SIH-SUS. Of the 48,174 hospitalizations registered in SIH-SUS, 24,469 (50.7%) were reported and registered in SINAN, indicating an overall sensitivity of 50.8% (95%CI 50.3-51.2). The observed sensitivity for each of the municipalities included in the study ranged from 22.0% to 99.1%. The combination of the two data sources identified 71,161 hospitalizations, an increase of 97.0% over SINAN itself. Our results allowed establishing the proportion of underreported dengue hospitalizations in the public health system in Brazil, highlighting the use of probabilistic record linkage as a valuable tool for evaluating surveillance systems.
Assuntos
Dengue/epidemiologia , Monitoramento Epidemiológico , Registros Hospitalares , Hospitalização/estatística & dados numéricos , Adolescente , Adulto , Brasil/epidemiologia , Criança , Estudos Transversais , Dengue/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Metanálise em Rede , Saúde Pública , Adulto JovemRESUMO
OBJECTIVE: to describe the main strategies to control Aedes aegypti, with emphasis on promising technological innovations for use in Brazil. METHODS: this study is a non-systematic review of the literature. Results: several technologies have been developed as alternatives in the control of Ae. aegypti, using different mechanisms of action, such as selective monitoring of the infestation, social interventions, dispersing insecticides, new biological control agents and molecular techniques for population control of mosquitoes, also considering the combination between them. Evolving technologies require evaluation of the effectiveness, feasibility and costs of implementation strategies as complementary to the actions already recommended by the National Program for Dengue Control. CONCLUSION: the integration of different compatible and effective vector control strategies, considering the available technologies and regional characteristics, appears to be a viable method to try to reduce the infestation of mosquitoes and the incidence of arbovirus transmitted by them.
Assuntos
Aedes , Controle de Mosquitos/métodos , Animais , Animais Geneticamente Modificados , Brasil , Dengue/prevenção & controle , Controle Biológico de Vetores/métodos , Esterilização Reprodutiva/métodosRESUMO
BACKGROUND: With more than a million spectators expected to travel among 12 different cities in Brazil during the football World Cup, June 12-July 13, 2014, the risk of the mosquito-transmitted disease dengue fever is a concern. We addressed the potential for a dengue epidemic during the tournament, using a probabilistic forecast of dengue risk for the 553 microregions of Brazil, with risk level warnings for the 12 cities where matches will be played. METHODS: We obtained real-time seasonal climate forecasts from several international sources (European Centre for Medium-Range Weather Forecasts [ECMWF], Met Office, Meteo-France and Centro de Previsão de Tempo e Estudos Climáticos [CPTEC]) and the observed dengue epidemiological situation in Brazil at the forecast issue date as provided by the Ministry of Health. Using this information we devised a spatiotemporal hierarchical Bayesian modelling framework that enabled dengue warnings to be made 3 months ahead. By assessing the past performance of the forecasting system using observed dengue incidence rates for June, 2000-2013, we identified optimum trigger alert thresholds for scenarios of medium-risk and high-risk of dengue. FINDINGS: Our forecasts for June, 2014, showed that dengue risk was likely to be low in the host cities Brasília, Cuiabá, Curitiba, Porto Alegre, and São Paulo. The risk was medium in Rio de Janeiro, Belo Horizonte, Salvador, and Manaus. High-risk alerts were triggered for the northeastern cities of Recife (p(high)=19%), Fortaleza (p(high)=46%), and Natal (p(high)=48%). For these high-risk areas, particularly Natal, the forecasting system did well for previous years (in June, 2000-13). INTERPRETATION: This timely dengue early warning permits the Ministry of Health and local authorities to implement appropriate, city-specific mitigation and control actions ahead of the World Cup. FUNDING: European Commission's Seventh Framework Research Programme projects DENFREE, EUPORIAS, and SPECS; Conselho Nacional de Desenvolvimento Científico e Tecnológico and Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro.
Assuntos
Dengue/epidemiologia , Futebol , Teorema de Bayes , Brasil/epidemiologia , Clima , Previsões/métodos , Humanos , Risco , Estações do AnoRESUMO
BACKGROUND: During a dengue outbreak with co-circulation of DENV-1 and -2 in the city of Boa Vista, one patient was diagnosed with DENV-4, a serotype supposed absent from Brazil for almost 30 years. The re-emergence of DENV-4 triggered the intensification of mechanical and chemical Aedes aegypti control activities in order to reduce vector density and avoid DENV-4 dissemination throughout the country. METHODS/PRINCIPAL FINDINGS: Vector control activities consisted of (a) source reduction, (b) application of diflubenzuron against larvae and (c) vehicle-mounted space spraying of 2% deltamethrin to eliminate adults. Control activity efficacy was monitored by comparing the infestation levels and the number of eggs collected in ovitraps before and after interventions, performed in 22 Boa Vista districts, covering an area of â¼ 80% of the city and encompassing 56,837 dwellings. A total of 94,325 containers were eliminated or treated with diflubenzuron. The most frequently positive containers were small miscellaneous receptacles, which corresponded to 59% of all positive breeding sites. Insecticide resistance to deltamethrin was assessed before, during and after interventions by dose-response bioassays adopting WHO-based protocols. The intense use of the pyrethroid increased fourfold the resistance ratio of the local Ae. aegypti population only six months after the beginning of vector control. Curiously, this trend was also observed in the districts in which no deltamethrin was applied by the public health services. On the other hand, changes in the resistance ratio to the organophosphate temephos seemed less influenced by insecticide in Boa Vista. CONCLUSIONS: Despite the intense effort, mosquito infestation levels were only slightly reduced. Besides, the median number of eggs in ovitraps remained unaltered after control activity intensification. The great and rapid increase in pyrethroid resistance levels of natural Ae. aegypti populations is discussed in the context of both public and domestic intensification of chemical control due to a dengue outbreak.
Assuntos
Aedes/efeitos dos fármacos , Vírus da Dengue , Dengue/epidemiologia , Surtos de Doenças , Resistência a Inseticidas , Inseticidas/farmacologia , Controle de Mosquitos , Animais , Brasil/epidemiologia , Dengue/transmissão , Vírus da Dengue/classificação , Geografia , Cavalos , Humanos , Controle de Mosquitos/métodos , Vigilância da PopulaçãoRESUMO
Introdução: No cenário internacional, o vírus Chikungunya é importante causa de morbidade. Por dispersar-se rapidamente para locais em que são encontrados os mosquitos Aedes aegypti e Aedes albopictus, tornou-se um desafio para a vigilância em saúde mundial. Objetivos: Revisar a literatura científica sobre a ocorrência da Febre do Chikungunya e a resposta da vigilância em saúde frente a surtos e epidemias. Métodos: Revisão sistemática de estudos primários publicados no período de 2005 a 2015, pesquisados nas bases de dados MEDLINE, SCOPUS, Web of Science, TripDatabase e BVS, com estratégia de busca que utilizou descritores em saúde referentes ao vírus Chikungunya e à vigilância em saúde. Resultados: Foram selecionados 13 artigos sobre o tema proposto. Conclusão: Evidenciou-se a necessidade de potencializar a integração das redes de vigilância, instituições de saúde, laboratórios de diagnóstico e ações de combate ao vetor, para acelerar a detecção de casos importados e de transmissão autóctone, bem como eliminação do vetor competente
Introduction: The Chikungunya virus is an important cause of morbidity in the international scene. It rapidly disperses to the sites where the Aedes aegypti and Aedes albopictus mosquitoes are found. Because this, it is a challenge for global health surveillance. Objectives: To review the scientific literature about Chikungunya fever's incidence and the health surveillance response to outbreaks and epidemics. Methods: Systematic review of primary studies published between 2005 and 2015, searched in databases (MEDLINE, SCOPUS, Web of Science, TripDatabase and BVS) using a strategy with Medical Subject Headings about Chikungunya virus and health Surveillance. Results: Were found 13 articles about the proposed theme of study. Conclusion: It is necessary to strengthen the integration of surveillance networks, health institutions, diagnostic laboratories and anti-vector actions in order to facilitate the early detection of imported cases and autochthonous transmission, and the elimination of the vector
Assuntos
Humanos , Animais , Surtos de Doenças , Sistema de Vigilância em Saúde , Febre de Chikungunya/epidemiologia , Mosquitos Vetores , Controle de Mosquitos , Saúde Global , Epidemias , Febre de Chikungunya/prevenção & controleRESUMO
Objetivo: descrever os desafios da implantação do sistema de vigilância e prevenção de chikungunya no Brasil. Métodos: estudo descritivo dos casos suspeitos da doença notificados no Sistema de Informação de Agravos de Notificação (Sinan) entre 2014 e 2016. Resultados: no período estudado, foram notificados mais de 100 mil casos prováveis de chikungunya no país, com maior concentração nos estados do Nordeste (83,3% entre 2014 e 2015; 91,0% em 2016); o Sinan apresentou excelente oportunidade de encerramento dos casos entre 2014 e 2015 (85%) e alta completitude das variáveis obrigatórias. Conclusão: com a introdução de chikungunya no Brasil em 2014, houve um preparo prévio em termos de Saúde Pública para minimizar seus efeitos na sociedade; a implantação do sistema de vigilância ampliou a coleta de informações da doença, embora muitos desafios mostrem-se evidentes na prática, haja vista a incidência crescente de casos, demandando maior capacidade operante desse setor.
Objetivo: describir los desafíos de la implantación del sistema de vigilancia y prevención de chikungunya en Brasil. Métodos: estudio descriptivo de los casos sospechosos notificados en el Sistema de Notificación de Enfermedades Obligatorias (Sinan) entre 2014 y 2016. Resultados: en el período estudiado se notificaron más de 100 mil casos probables de chikungunya con mayor concentración en los estados del Nordeste (83,3% entre 2014 y 2015 y el 91,0% en 2016); el Sinan presentó una excelente oportunidad de cierre de los casos entre 2014 y 2015 (85%) y alta completitud de las variables obligatorias. Conclusión: con la introducción de chikungunya en Brasil hubo una preparación previa para minimizar sus efectos en la sociedad; la implantación del sistema de vigilancia ha ampliado la recolección de información sobre la enfermedad, sin embargo, muchos desafíos son evidenciados en la práctica, pues la incidencia de casos es creciente, necesitando de mayor capacidad operante de ese sector.
Objective: to describe the challenges in implementing the chikungunya surveillance and prevention system in Brazil. Methods: this was a descriptive study of suspected cases of the disease based on records held on the Notifiable Diseases Information System (Sinan) for the period 2014-2016. Results: more than 100,000 probable chikungunya cases were notified in Brazil in this period, with the largest concentration in the Northeast states (83.3% between 2014 and 2015; 91.0% in 2016); Sinan provided an excellent opportunity for closing records of cases occurring between 2014 and 2015 (85%) and high completeness of obligatory variables. Conclusion: given the imminence of the introduction of chikungunya in Brazil in 2014, advance public health preparation took place in order to minimize its effects on society; implementation of the surveillance system improved collection of information regarding the disease, however many challenges can be seen in practice, in view of increasing case incidence. This requires greater handling capacity in this sector.
Assuntos
Humanos , Masculino , Feminino , Epidemiologia , Vigilância em Saúde Pública , Febre de Chikungunya/prevenção & controle , Estudo de AvaliaçãoRESUMO
OBJETIVO: caracterizar os casos prováveis de dengue em gestantes notificados no Brasil, de 2007 a 2015. MÉTODOS: estudo descritivo das características sociodemográficas, epidemiológicas, clínicas e laboratoriais, com dados do Sistema de Informação de Agravos de Notificação (Sinan). RESULTADOS: a incidência anual de dengue em gestantes variou de 3,3 (2009) a 816,6 (2010) casos por 100 mil nascidos vivos; dos 43.772 casos prováveis de dengue em gestantes, 81,6% foram investigados, 34,1% confirmados laboratorialmente e 1,7% graves; as taxas de hospitalização e letalidade foram de 5,4% e 1,6‰, respectivamente; o risco de óbito por dengue foi maior na população de gestantes do que na população de mulheres em idade fértil não gestantes (razão=3,95; intervalo de confiança de 95% ou IC95%=3,07;5,08), superior no terceiro trimestre da gestação (razão=8,55; IC95%=6,08;12,02). CONCLUSÃO: os resultados evidenciam a carga da dengue entre gestantes, sua vulnerabilidade ao agravamento e óbito pela doença.
OBJETIVO: caracterizar los casos probables de dengue en las mujeres embarazadas reportados en Brasil entre 2007 y 2015. MÉTODOS: estudio descriptivo de los datos de las enfermedades de declaración obligatoria del Sistema de Información (Sinan). RESULTADOS: la incidencia anual de dengue osciló entre 3,3 (2009) a 816,6 (2010) casos por cada 100 mil nacidos vivos; de los 43.772 casos probables de dengue, el 81,6% fueron investigados, 34,1% confirmados en laboratorio y 1,7% grave; las tasas de hospitalización y letalidad fueron 5,4% y 1,6%, respectivamente; el riesgo de muerte por dengue fue mayor en embarazadas que en mujeres en edad fértil no embarazadas (ratio=3,95 [IC95%=3,07;5,08]), y mayor en el tercer trimestre (ratio=8,55; [IC95%=6.08;12.02]). CONCLUSIÓN: los resultados muestran la carga de dengue en embarazadas y la vulnerabilidad de éstas al agravamiento y muerte por esta enfermedad.
OBJECTIVE: to characterize the probable cases of dengue in pregnant women reported in Brazil, from 2007 to 2015. METHODS: descriptive study of sociodemographic, epidemiological, clinical and laboratory characteristics, with data from the Information System for Notifiable Diseases (Sinan). RESULTS: the annual incidence of dengue in pregnant women ranged from 3.3 (2009) to 816.6 (2010) cases per 100 thousand live births; of the 43,772 probable cases of dengue in pregnant women, 81.6% were investigated, 34.1% were confirmed by laboratory tests, and 1.7% were severe cases; hospitalization and fatality rates were of 5.4% and 1.6‰, respectively; the risk of death due to dengue was higher in pregnant women than in the population of non-pregnant women at reproductive age (ratio=3.95; 95%CI=3.07;5.08), and higher in the third trimester of pregnancy (ratio=8.55; 95%CI=6.08;12.02). CONCLUSION: the results show the burden of dengue in pregnant women and their vulnerability to worsening of the disease and death.
Assuntos
Humanos , Feminino , Gravidez , Dengue , Gestantes , Epidemiologia DescritivaRESUMO
Objetivo: descrever os casos notificados de síndrome de Guillain-Barré (SGB) e outras manifestações neurológicas com histórico de infecção por dengue, chikungunya ou Zika, na Região Metropolitana de Salvador e no município de Feira de Santana, Brasil. Métodos: estudo descritivo com dados de investigação conduzida pela vigilância epidemiológica, de março a agosto de 2015; para confirmar as manifestações neurológicas, considerou-se o registro de diagnóstico médico, e para infecção prévia, utilizaram-se critérios clínicos e laboratoriais. Resultados: dos 138 casos suspeitos investigados, 57 relataram quadro infeccioso até 31 dias antes dos sintomas neurológicos - 30 prováveis de infecção por Zika, 13 por dengue, 8 por chikungunya e 6 inconclusivos -; SGB foi a condição neurológica mais frequente (n=46); houve predomínio do sexo masculino (n=32), e a mediana de idade foi de 44 anos. Conclusão: a maioria dos casos relatou quadro clínico compatível com doença aguda pelo vírus Zika, que precedeu a ocorrência dos sintomas neurológicos.
Objetivo: investigar los casos notificados de síndrome de Guillain-Barré (SGB) y otras manifestaciones neurológicas con antecedentes de infección por dengue, chikungunya o Zika en la Región Metropolitana de Salvador y Feira de Santana, Brasil. Métodos: estudio descriptivo con datos de la investigación realizada por la vigilancia epidemiológica, de marzo a agosto de 2015. ; para confirmar una manifestación neurológica se consideró el registro de diagnóstico médico y para infección previa, criterios clínicos y de laboratorio. Resultados: de los 138 casos sospechosos investigados, 57 presentaron un cuadro infeccioso, hasta 31 días antes de presentar síntomas neurológicos. - 30 probablemente con infección por zika, 13 dengue, 8 chikungunya y 6 no concluyentes -; de éstos, SGB fue la condición neurológica más frecuente (n=46), hubo un predominio del sexo masculino (n=32) y la mediana de edad fue 44 (rango: 2-83) años. Conclusión: la mayoría de los casos relató un cuadro clínico compatible con enfermedad aguda por virus Zika, que precedió la aparición de síntomas neurológicos.
Objective: to describe the reported cases of Guillain-Barré Syndrome (GBS) and other neurological manifestations with a history of dengue, chikungunya or Zika virus infections, in the Metropolitan Region of Salvador and in the municipality of Feira de Santana, Brazil. Methods: this is a descriptive study with data of an investigation conducted by the epidemiological surveillance from March to August 2015; to confirm the neurological manifestations, medical diagnosis records were considered, and to prior infection, clinical and laboratory criteria were used. Results: 138 individuals were investigated, 57 reported infectious process up to 31 days before neurological symptoms - 30 possibly due to Zika, 13 to dengue, 8 to chikungunya and 6 were inconclusive -; GBS was the most frequent neurological condition (n=46), with predominance of male sex (n=32) and the median age was 44. Conclusion: most cases reported a clinical picture consistent with acute Zika virus disease, which preceded the occurrence of neurological symptoms.
Assuntos
Humanos , Masculino , Feminino , Síndrome de Guillain-Barré/epidemiologia , Infecção por Zika virus/complicações , Manifestações Neurológicas , Epidemiologia Descritiva , Monitoramento EpidemiológicoRESUMO
OBJETIVO: descrever as principais estratégias de controle do Aedes aegypti, com ênfase nas inovações tecnológicas promissoras para utilização no Brasil. MÉTODOS: trata-se de estudo de revisão não sistemática da literatura. RESULTADOS: diversas tecnologias têm sido desenvolvidas como alternativas no controle do Ae. aegypti, utilizando-se diferentes mecanismos de ação - como monitoramento seletivo da infestação, medidas sociais, dispersão de inseticidas, novos agentes de controle biológico e técnicas moleculares para controle populacional dos mosquitos -, considerando-se também a combinação entre elas. As tecnologias em desenvolvimento demandam avaliação da eficácia, viabilidade e custos para implementação como estratégias complementares às ações já preconizadas pelo Programa Nacional de Controle da Dengue. CONCLUSÃO: a integração de diferentes estratégias de controle vetorial compatíveis e eficazes, considerando as tecnologias disponíveis e as características regionais, parece ser um método viável para tentar reduzir a infestação dos mosquitos e a incidência das arboviroses transmitidas por eles.
OBJECTIVE: to describe the main strategies to control Aedes aegypti, with emphasis on promising technological innovations for use in Brazil. METHODS: this study is a non-systematic review of the literature. Results: several technologies have been developed as alternatives in the control of Ae. aegypti, using different mechanisms of action, such as selective monitoring of the infestation, social interventions, dispersing insecticides, new biological control agents and molecular techniques for population control of mosquitoes, also considering the combination between them. Evolving technologies require evaluation of the effectiveness, feasibility and costs of implementation strategies as complementary to the actions already recommended by the National Program for Dengue Control. CONCLUSION: the integration of different compatible and effective vector control strategies, considering the available technologies and regional characteristics, appears to be a viable method to try to reduce the infestation of mosquitoes and the incidence of arbovirus transmitted by them.
Assuntos
Animais , Aedes , Insetos Vetores , Controle de Vetores de Doenças , Controle de Mosquitos/história , Literatura de Revisão como Assunto , TecnologiaRESUMO
OBJETIVO: estimar os custos do Programa Municipal de Controle da Dengue de Goiânia-GO, Brasil. MÉTODOS: estudo de custo de programa considerando períodos epidêmico (outubro/2009-abril/2010) e endêmico (maio-setembro/2010) de transmissão da doença, na perspectiva do Sistema Único de Saúde (SUS); os componentes de custo analisados foram recursos humanos, capacitação, infraestrutura, equipamentos de escritório, transporte, equipamentos de proteção individual, material de campo, material laboratorial, inseticidas e mobilização social; custos de capital (investimento) e recorrentes foram considerados. RESULTADOS: a média mensal de custos recorrentes foi de R$1.355.760 (US$814,075) e R$981.100 (US$589,108) nos períodos epidêmico e endêmico respectivamente; o custo de capital anual foi estimado em R$683.315 (US$410,301); cerca de 82%, 15% e 3% do custo total referem-se, respectivamente, às fontes de recurso municipal, federal e estadual. CONCLUSÃO: o custo adicional resultante das epidemias de dengue fornece subsídios para um melhor planejamento das atividades de prevenção e controle da infecção.
OBJECTIVE: to estimate the cost of the Municipal Program for Dengue Control in Goiânia, GO, Brazil. METHODS: Costs of program considering epidemic (October/2009-April/2010) and endemic (May-September/2010) periods of dengue transmission, from the perspective of the National Unified Health System (SUS); cost components considered were human resources, training, infrastructure, office equipment, transportation, personal protective equipment, field equipment, laboratory equipment, insecticides and social mobilization; capital (investment) and recurring costs were considered. RESULTS: average monthly recurring costs were R$1,355,760 (US$814,075) and R$981,100 (US$589,108), for the epidemic and endemic periods, respectively; annual capital cost was R$683,315 (US$410,301); approximately 82%, 15% and 3% of the total cost were from municipal, federal and state level funding sources, respectively. CONCLUSION: estimated incremental costs resulting from dengue epidemics provide information to support planning of dengue prevention and control activities.
OBJETIVO: estimar los costos del Programa Municipal de Control de Dengue en el municipio de Goiânia-GO, Brasil. MÉTODOS: estudio de costos del programa teniendo en cuenta períodos epidémicos (octubre/2009-abril/2010) y endémicos (mayo-septiembre/2010) de la transmisión de dengue; dentro de la perspectiva del Sistema Único de Salud (SUS); los componentes de los costos analizados fueron recursos humanos, capacitación, infraestructura, equipo de oficina, transporte, equipo de protección personal, equipo de campo, materiales de laboratorio, insecticidas y movilización social, teniendo en cuenta los costos de capital (inversión) y recurrentes. RESULTADOS: el valor mensual de costos recurrentes fue R$1.355.760 (US$814,075) y R$981.100 (US$589,108), en los períodos epidémicos y endémicos, respectivamente; los costos de capital durante el periodo de estudio fueron R$683,315 (US$410,301); alrededor de 82%, 15% y 3% de los costos totales fueron de fuente municipal, federal y estatal, respectivamente. CONCLUSIÓN: el conocimiento de los costos adicionales resultantes de las epidemias de dengue puede apoyar a una mejor planificación de las actividades de prevención y control del dengue.