Fatal Oropouche Virus Infections in Nonendemic Region, Brazil, 2024.

We report acute Oropouche virus infections in 2 previously healthy women from a nonendemic region of Brazil outside the Amazon Basin. Infections rapidly progressed to hemorrhagic manifestations and fatal outcomes in 4-5 days. These cases highlight the critical need for enhanced surveillance to clarify epidemiology of this neglected disease.

Fetal death as an outcome of acute respiratory distress in pregnancy, during the COVID-19 pandemic: a population-based cohort study in Bahia, Brazil.

BACKGROUND: Fetal loss is one of the most serious adverse outcomes of pregnancy. Since the onset of the COVID-19 pandemic, Brazil has recorded an unprecedented number of hospitalizations of pregnant women due to acute respiratory distress (ARD), thereby, we aimed to assess the risk of fetal deaths associated to ARD during pregnancy in Bahia state, Brazil, in the context of the COVID-19 pandemic. METHODS: This is an observational population-based retrospective cohort study, developed with women at or after 20 weeks of pregnancy, residents in Bahia, Brazil. Women who had acute respiratory distress (ARD) in pregnancy during the COVID-19 pandemic (Jan 2020 to Jun 2021) were considered 'exposed'. Women who did not have ARD in pregnancy, and whose pregnancy occurred before the onset of the COVID-19 pandemic (Jan 2019 to Dec 2019) were considered 'non-exposed'. The main outcome was fetal death. We linked administrative data (under mandatory registration) on live births, fetal deaths, and acute respiratory syndrome, using a probabilistic linkage method, and analyzed them with multivariable logistic regression models. RESULTS: 200,979 pregnant women participated in this study, 765 exposed and 200,214 unexposed. We found four times higher chance of fetal death in women with ARD during pregnancy, of all etiologies (adjusted odds ratio [aOR] 4.06 confidence interval [CI] 95% 2.66; 6.21), and due to SARS-CoV-2 (aOR 4.45 CI 95% 2.41; 8.20). The risk of fetal death increased more when ARD in pregnancy was accompanied by vaginal delivery (aOR 7.06 CI 95% 4.21; 11.83), or admission to Intensive Care Unit (aOR 8.79 CI 95% 4.96; 15.58), or use of invasive mechanical ventilation (aOR 21.22 CI 95% 9.93; 45.36). CONCLUSION: Our findings can contribute to expanding the understanding of health professionals and managers about the harmful effects of SARS-CoV-2 on maternal-fetal health and alerts the need to prioritize pregnant women in preventive actions against SARS-CoV-2 and other respiratory viruses. It also suggests that pregnant women, infected with SARS-CoV-2, need to be monitored to prevent complications of ARD, including a careful assessment of the risks and benefits of early delivery to prevent fetal death.

Cinema:Bandit: a visualization application for beamline science demonstrated on XFEL shock physics experiments.

A new visualization tool, Cinema:Bandit, and its demonstration with a continuous workflow for analyzing shock physics experiments and visually exploring the data in real time at X-ray light sources is presented. Cinema:Bandit is an open-source, web-based visualization application in which the experimenter may explore an aggregated dataset to inform real-time beamline decisions and enable post hoc data analysis. The tool integrates with experimental workflows that process raw detector data into a simple database format, and it allows visualization of disparate data types, including experimental parameters, line graphs, and images. Use of parallel coordinates accommodates the irregular sampling of experimental parameters and allows for display and filtering of both experimental inputs and measurements. The tool is demonstrated on a dataset of shock-compressed titanium collected at the Matter in Extreme Conditions hutch at the Linac Coherent Light Source.

Seroprevalence of Chikungunya Virus after Its Emergence in Brazil.

Chikungunya has had a substantial impact on public health because of the magnitude of its epidemics and its highly debilitating symptoms. We estimated the seroprevalence, proportion of symptomatic cases, and proportion of chronic form of disease after introduction of chikungunya virus (CHIKV) in 2 cities in Brazil. We conducted the population-based study through household interviews and serologic surveys during October-December 2015. In Feira de Santana, we conducted a serologic survey of 385 persons; 57.1% were CHIKV-positive. Among them, 32.7% reported symptoms, and 68.1% contracted chronic chikungunya disease. A similar survey in Riachão do Jacuípe included 446 persons; 45.7% were CHIKV-positive, 41.2% reported symptoms, and 75.0% contracted the chronic form. Our data confirm intense CHIKV transmission during the continuing epidemic. Chronic pain developed in a high proportion of patients. We recommend training health professionals in management of chronic pain, which will improve the quality of life of chikungunya-affected persons.

Maternal and perinatal health indicators in Brazil over a decade: assessing the impact of the COVID-19 pandemic and SARS-CoV-2 vaccination through interrupted time series analysis.

Background: Few studies have evaluated the effects of the Coronavirus disease 2019 (COVID-19) pandemic, caused by the SARS-CoV-2 virus, on maternal and perinatal health at a populational level. We investigated maternal and perinatal health indicators in Brazil, focusing on the effects of the COVID-19 pandemic, and SARS-CoV-2 vaccination campaign for pregnant women. Methods: Utilizing interrupted time series analysis (January 2013-December 2022), we examined Maternal Mortality Ratio, Perinatal Mortality Rate, Preterm Birth Rate, Cesarean Section Rate, and other five indicators. Interruptions occurred at the pandemic's onset (March 2020) and pregnant women's vaccination (July 2021). Results were expressed as percent changes on time series' level and slope. Findings: The COVID-19 onset led to immediate spikes in Maternal Mortality Ratio (33.37%) and Perinatal Mortality Rate (3.20%) (p < 0.05). From March 2020 to December 2022, Cesarean Section and Preterm Birth Rates exhibited upward trends, growing monthly at 0.13% and 0.23%, respectively (p < 0.05). Post start of SARS-CoV-2 vaccination (July 2021), Maternal Mortality Ratio (-34.10%) and Cesarean Section Rate (-1.87%) promptly declined (p < 0.05). Subsequently, we observed a monthly decrease of Maternal Mortality Ratio (-9.43%) and increase of Cesarean Section Rate (0.25%) (p < 0.05), while Perinatal Mortality Rate and Preterm Birth Rate showed a stationary pattern. Interpretation: The pandemic worsened all analyzed health indicators. Despite improvements in Maternal Mortality Ratio, following the SARS-CoV-2 vaccination campaign for pregnant women, the other indicators continued to sustain altered patterns from the pre-pandemic period. Funding: No funding.

Methods to evaluate COVID-19 vaccine effectiveness, with an emphasis on quasi-experimental approaches. / Métodos para avaliação da efetividade de vacinas para COVID-19 com ênfase em abordagens quase-experimentais.

The evaluation of vaccine effectiveness is conducted with real-world data. They are essential to monitor the performance of vaccination programmes over time, and in the context of the emergence of new variants. Until now, the effectiveness of COVID-19 vaccines has been assessed based on classic methods, such as cohort and test-negative case-control studies, which may often not allow for adequate control of inherent biases in the assignment of vaccination campaigns. The aim of this review was to discuss the study designs available to evaluate vaccine effectiveness, highlighting quasi-experimental studies, which seek to mimic randomized trials, by introducing an exogenous component to allocate to treatment, in addition to the advantages, limitations, and applicability in the context of Brazilian data. The use of quasi-experimental approaches, such as interrupted time series, difference-in-differences, propensity scores, instrumental variables, and regression discontinuity design, are relevant due to the possibility of providing more accurate estimates of COVID-19 vaccine effectiveness. This is especially important in scenarios such as the Brazilian, which characterized by the use of various vaccines, with the respective numbers and intervals between doses, applied to different age groups, and introduced at different times during the pandemic.

A avalição da efetividade de vacinas é feita com dados do mundo real e é essencial para monitorar o desempenho dos programas de vacinação ao longo do tempo bem como frente a novas variantes. Até o momento, a avaliação da efetividade das vacinas para COVID-19 tem sido baseada em métodos clássicos como estudos de coorte e caso controle teste-negativo, que muitas vezes podem não permitir o adequado controle dos vieses intrínsecos da alocação das campanhas de vacinação. O objetivo dessa revisão foi discutir os desenhos de estudo disponíveis para avaliação de efetividade das vacinas, enfatizando os estudos quase-experimentais, que buscam mimetizar os estudos aleatorizados ao introduzir um componente exógeno para atribuição ao tratamento, bem como suas vantagens, limitações e aplicabilidade no contexto dos dados brasileiros. O emprego de métodos quase-experimentais, incluindo as séries temporais interrompidas, o método de diferença em diferenças, escore de propensão, variáveis instrumentais e regressão descontínua, são relevantes pela possibilidade de gerar estimativas mais acuradas da efetividade de vacinas para COVID-19 em cenários como o brasileiro, que se caracteriza pelo uso de várias vacinas, com respectivos número e intervalos entre doses, aplicadas em diferentes faixas etárias e em diferentes momentos da pandemia.

Programa Mais Médicos e a atenção ao pré-natal: desfechos obstétricos em três regiões baianas entre 2010 e 2019 / Mais Médicos Program and prenatal care: obstetric outcomes in three bahian regions between 2010-2019 / El Programa Más Médicos y la atención prenatal: resultados obstétricos en tres regiones de bahía entre 2010 y 2019

No Brasil, múltiplas políticas foram desenvolvidas para atender às demandas da saúde materno-infantil. Em 1983, sob pressão do movimento feminista, iniciou-se um programa voltado para a atenção à saúde da mulher "em sua totalidade" ­ o Programa de Assistência Integral à Saúde da Mulher (PAISM). Embora a Constituição Cidadã de 1988 afirme, no artigo 186 dos direitos sociais, que a saúde é um bem universal, essa premissa de fato nunca foi alcançável em todo território brasileiro, apesar de toda a formulação de políticas e estratégias, como o Programa Saúde da Família. Assim, o Programa Mais Médicos pelo Brasil (PMMB) foi estruturado em 2013 na expectativa de fortalecer a Estratégia Saúde da Família, garantindo o acesso universal ao Sistema Único de Saúde (SUS) por meio da Atenção Primária. O objetivo deste trabalho foi estudar o efeito desse programa em nosso país. No Brasil, a razão da mortalidade materna (RMM) passou de aproximadamente 140, em 1990, para 57 óbitos maternos por cem mil nascidos vivos (NV) em 2019. Na Bahia, em 2019, foi registrada uma RMM de 51,2. Em 2020, esse índice alcançou o valor de 81,1. Apesar dos avanços significativos, esses resultados estão ainda distantes da meta dos objetivos de desenvolvimento do milênio (ODM), que foi definida em 35,8 em 2015. Os resultados também demonstram a existência de dificuldades para atingir a meta dos objetivos de desenvolvimento sustentável (ODS), ou seja, trinta por cem mil NV até 2030, conforme o que foi demonstrado na análise dos dados discutidos neste artigo.

In Brazil, multiple policies have been developed to meet the demands of maternal and child health. In 1983, pressured by feminist movement, the country implemented a program to focus on women's health 'in its entirety' ­ the Comprehensive Women's Health Care Program (PAISM). Although the 1988 Citizen Constitution states, in its Article 186, that health is a universal good, this premise has never in fact been achievable throughout Brazil, despite all the policies and strategies developed, such as the Family Health Strategy. As such, the More Doctors Program for Brazil (PMMB) was structured in 2013 to strengthen the Family Health Strategy, ensuring universal access to the Unified Health System (SUS) through Primary Care. Given this context, this study sought to investigate the effect this program had in the country. In Brazil, the maternal mortality ratio (MMR) went from approximately 140 in 1990 to 57 maternal deaths per 100,000 live births (LB) in 2019. In 2019, Bahia recorded an MMR of 51.2. In 2020, this index reached the value of 81.1. Despite significant advances, these findings are still far from the millennium development goals (MDGs) target, which was set at 35.8 in 2015. The results point to difficulties in achieving the Sustainable Development Goals (SDGs) target, that is, 30 per 100,000 LB by 2030.

En Brasil, se han desarrollado múltiples políticas para atender las demandas de salud materno-infantil. En 1983, bajo la presión del movimiento feminista, se inició un programa orientado hacia la salud de la mujer "en su totalidad", el Programa de Acción Integral a la Salud de la Mujer (PAISM). A pesar de que la Constitución de 1988 de Brasil dispone en su artículo 186 sobre los derechos sociales que la salud es un bien universal, esa premisa, de hecho, nunca fue alcanzable en todo el territorio brasileño, incluso con la formulación de políticas y estrategias, como el Programa de Salud Familiar. Así, el Programa Más Médicos para Brasil (PMMB) se estructuró en 2013 con la expectativa de fortalecer la Estrategia de Salud Familiar, garantizando el acceso universal al Sistema Único de Salud (SUS) a través de la Atención Primaria. El objetivo de este trabajo fue evaluar el efecto de este programa en el país. En Brasil, la razón de mortalidad materna (RMM) aumentó de aproximadamente 140 en 1990 para 57 muertes maternas por 100.000 nacidos vivos (NV) en 2019. En Bahía, en 2019 se registró una RMM de 51,2. En 2020 este índice alcanzó el valor de 81,1. A pesar de los avances significativos, estos resultados todavía están lejos de la meta de los Objetivos de Desarrollo del Milenio (ODM), que se fijó en 35,8 en 2015. Los resultados también demuestran las dificultades que existen para alcanzar la meta de los Objetivos de Desarrollo Sostenible (ODS), es decir, de 30 por 100.000 NV para 2030, como lo demuestra el análisis en este artículo.

Síndrome inflamatória multissistêmica pediátrica (SIM-P) na Bahia, em 2020 / Multisystem inflammatory syndrome in children (MIS-C) in Bahia, in 2020 / Síndrome inflamatorio multisistémico pediátrico (SIM-P) en Bahía, 2020

A Síndrome Inflamatória Multissistêmica Pediátrica (SIM-P) é uma nova apresentação clínica em crianças e adolescentes, na faixa etária de zero a 19 anos, temporalmente associada à infecção pelo SAR-CoV-2. O objetivo deste estudo é analisar o perfil epidemiológico dos casos de SIM-P na Bahia. Trata-se de um estudo exploratório descritivo, com revisão de literatura, análise documental e das notificações de SIM-P realizadas no formulário on-line do REDCap, no período de 20 de julho a 4 de dezembro de 2020, considerando a orientação do Ministério da Saúde para a realização de busca ativa de casos desde 26 de fevereiro de 2020, data da confirmação do primeiro caso de Covid-19 no país. Na Bahia, nesse período, foram realizadas 66 notificações, com a confirmação de 42 casos, dos quais três evoluíram para óbito, 38 tiveram alta e um continua internado. As faixas etárias foram agrupadas em intervalos de cinco anos, sendo a faixa de 5 a 9 anos a que concentrou o maior número de casos (N = 20; 47,6%) e a faixa de 15 a 19 anos a que apresentou o menor número (N = 2; 4,8%). A média de idade coincidiu com a mediana, que foi de oito anos. Houve predomínio do sexo masculino, com 25 casos, representando 59,5%. Em relação à análise de ocorrência dos primeiros sintomas, o mês de julho registrou a maior concentração de casos no período estudado (28,6%). As informações obtidas por meio da vigilância da SIM-P são fundamentais para o conhecimento do perfil epidemiológico, podendo contribuir para o melhor manejo clínico dos casos.

Multisystem Inflammatory Syndrome in Children (MIS-C) is a new clinical presentation in children and adolescents aged zero to nineteen, temporarily associated with SARS-CoV-2 infection. This study aims at analyzing the epidemiological profile of MIS-C cases in the state of Bahia. This is an exploratory descriptive study, with a literature review, document analysis and MIS-C notifications made on the REDCap online form, from July 20 to December 4, 2020, considering the guidance of the Ministry of Health to conduct an active search for cases since February 26, 2020, date of confirmation of the first case of Covid-19 in the country. In the state, during this period, 66 notifications were made, with the confirmation of 42 cases, of which three evolved to death, 38 were discharged and one is still hospitalized. The age groups were grouped into five-year intervals, with the range of 5 to 9 years old having the highest number of cases (N = 20; 47.6%) and the range of 15 to 19 years old having the lowest number (N = 2; 4.8%). The mean age coincided with the median, which was 8 years. There was a predominance of boys, with 25 cases, representing 59.5%. Regarding the analysis of the occurrence of the first symptoms, July registered the highest concentration of cases (28.6%). The information obtained by the surveillance of MIS-C is fundamental for the knowledge of the epidemiological profile and may contribute to the better clinical management of cases.

El síndrome inflamatorio multisistémico pediátrico (SIM-P) es una nueva presentación clínica en niños y adolescentes de 0 a 19 años, temporalmente asociada a la infección por SARS-CoV-2. El objetivo de este estudio es analizar el perfil epidemiológico de los casos de SIM-P en Bahía. Este es un estudio exploratorio descriptivo, con revisión de literatura, análisis de documentos y notificaciones SIM-P realizadas en el formulario en línea de REDCap, del 20 de julio al 4 de diciembre de 2020, considerando la orientación del Ministerio de Salud para realizar una búsqueda activa de casos desde el 26 de febrero de 2020, fecha de confirmación del primer caso del covid-19 en el país. En Bahía, durante ese período, se realizaron 66 notificaciones, con la confirmación de 42 casos, de los cuales tres evolucionaron a muerte, 38 fueron dados de alta y uno aún se encuentra hospitalizado. Los grupos de edad se agruparon en intervalos de cinco años, con el rango de 5 a 9 años con el mayor número de casos (N = 20; 47,6%) y el rango de 15 a 19 años con el número más bajo (N = 2; 4,8%). La edad media coincidió con la mediana, que fue de 8 años. Predominó el sexo masculino, con 25 casos, representando el 59,5%. En cuanto al análisis de la ocurrencia de los primeros síntomas, el mes de julio registró la mayor concentración de casos en el período analizado (28,6%). La información obtenida por la vigilancia del SIM-P es fundamental para conocer el perfil epidemiológico, lo que puede contribuir al mejor manejo clínico de los casos.

Métodos para avaliação da efetividade de vacinas para COVID-19 com ênfase em abordagens quase-experimentais / Methods to evaluate COVID-19 vaccine effectiveness, with an emphasis on quasi-experimental approaches

Resumo A avalição da efetividade de vacinas é feita com dados do mundo real e é essencial para monitorar o desempenho dos programas de vacinação ao longo do tempo bem como frente a novas variantes. Até o momento, a avaliação da efetividade das vacinas para COVID-19 tem sido baseada em métodos clássicos como estudos de coorte e caso controle teste-negativo, que muitas vezes podem não permitir o adequado controle dos vieses intrínsecos da alocação das campanhas de vacinação. O objetivo dessa revisão foi discutir os desenhos de estudo disponíveis para avaliação de efetividade das vacinas, enfatizando os estudos quase-experimentais, que buscam mimetizar os estudos aleatorizados ao introduzir um componente exógeno para atribuição ao tratamento, bem como suas vantagens, limitações e aplicabilidade no contexto dos dados brasileiros. O emprego de métodos quase-experimentais, incluindo as séries temporais interrompidas, o método de diferença em diferenças, escore de propensão, variáveis instrumentais e regressão descontínua, são relevantes pela possibilidade de gerar estimativas mais acuradas da efetividade de vacinas para COVID-19 em cenários como o brasileiro, que se caracteriza pelo uso de várias vacinas, com respectivos número e intervalos entre doses, aplicadas em diferentes faixas etárias e em diferentes momentos da pandemia.

Abstract The evaluation of vaccine effectiveness is conducted with real-world data. They are essential to monitor the performance of vaccination programmes over time, and in the context of the emergence of new variants. Until now, the effectiveness of COVID-19 vaccines has been assessed based on classic methods, such as cohort and test-negative case-control studies, which may often not allow for adequate control of inherent biases in the assignment of vaccination campaigns. The aim of this review was to discuss the study designs available to evaluate vaccine effectiveness, highlighting quasi-experimental studies, which seek to mimic randomized trials, by introducing an exogenous component to allocate to treatment, in addition to the advantages, limitations, and applicability in the context of Brazilian data. The use of quasi-experimental approaches, such as interrupted time series, difference-in-differences, propensity scores, instrumental variables, and regression discontinuity design, are relevant due to the possibility of providing more accurate estimates of COVID-19 vaccine effectiveness. This is especially important in scenarios such as the Brazilian, which characterized by the use of various vaccines, with the respective numbers and intervals between doses, applied to different age groups, and introduced at different times during the pandemic.

[Yersinia pestis infection in the State of Bahia: effective control or epidemiological silence?]. / Infecção por Yersinia pestis, no Estado da Bahia: controle efetivo ou silêncio epidemiológico?

INTRODUCTION: From an epidemiological point of view, the plague is still being considered of great importance, because of its high epidemic potential. Despite the absence of cases of human plague in Brazil, its etiologic agent, the bacteria Yersinia pestis, is still deep rooted in its natural environment. The occurrence of positive serology for plague in domestic carnivores in plague areas in Bahia in the past few years implies the need for a more rigorous evaluation in order to verify whether the bacillus of the plague is still active in these areas. METHODS: In this study, the presence of infection caused by Y. pestis was analyzed by seroprevalence tests on humans, dogs and rodents and by the detection of the bacteria in rodents and fleas. A structured questionnaire was used to analyze the association between environmental, socioeconomic and biological factors and seroprevalence in humans. RESULTS: Of the 630 serum samples examined (88 from humans, 480 from dogs and 62 from rodents), all were nonreactive for plague and bacteriological analyses performed on 14 rodents and 2 flea lots showed no signs of the bacteria. CONCLUSIONS: These results cannot confirm the eradication of the disease in the entire State, since the cyclic nature of the plague indicates that it can go silent for long periods and then resurge, affecting large numbers of people. Thus, maintenance of active, permanent surveillance is required for early detection and the development of adequate control measures.

Infecção por Yersinia pestis, no Estado da Bahia: controle efetivo ou silêncio epidemiológico? / Yersinia pestis infection in the State of Bahia: effective control or epidemiological silence?

INTRODUÇÃO: A peste, doença infectocontagiosa milenar, continua sendo considerada da maior importância do ponto de vista epidemiológico devido ao alto potencial epidêmico, estando inclusive sujeita ao Regulamento Sanitário Internacional. Apesar da ausência de casos humanos da doença no Brasil, seu agente etiológico, a bactéria Yersinia pestis, permanece firmemente arraigado em seus focos naturais. A ocorrência de sorologia positiva em carnívoros domésticos de regiões pestígenas da Bahia, nos últimos anos, objetivou a realização deste estudo, que se propõe a verificar a existência de circulação do agente no estado, tendo em vista que fatores condicionantes para a doença são mantidos, oferecendo riscos à população. MÉTODOS: Trata-se de um estudo para verificação da presença de infecção por Y. pestis através do inquérito de soroprevalência em humanos, cães e roedores; e pesquisa da bactéria em roedores e pulgas. Utilizou-se de questionário estruturado para avaliação da associação existente entre fatores ambientais, sócioeconômicos e biológicos e a soroprevalência da infecção em humanos. RESULTADOS: Os 630 soros examinados (88 de humanos, 480 de cães, 62 de roedores) apresentaram-se não reagentes para peste e as análises bacteriológicas realizadas em 14 roedores e dois lotes de pulgas não identificaram a bactéria. CONCLUSÕES: Os resultados não configuram erradicação da doença no estado, pois sua natureza cíclica indica que pode passar longos períodos silente e depois ressurgir acometendo um grande número de pessoas. Portanto, a manutenção da vigilância ativa e permanente se faz necessária para a detecção precoce da doença e desenvolvimento oportuno das medidas de controle pertinentes.

INTRODUCTION: From an epidemiological point of view, the plague is still being considered of great importance, because of its high epidemic potential. Despite the absence of cases of human plague in Brazil, its etiologic agent, the bacteria Yersinia pestis, is still deep rooted in its natural environment. The occurrence of positive serology for plague in domestic carnivores in plague areas in Bahia in the past few years implies the need for a more rigorous evaluation in order to verify whether the bacillus of the plague is still active in these areas. METHODS: In this study, the presence of infection caused by Y. pestis was analyzed by seroprevalence tests on humans, dogs and rodents and by the detection of the bacteria in rodents and fleas. A structured questionnaire was used to analyze the association between environmental, socioeconomic and biological factors and seroprevalence in humans. RESULTS: Of the 630 serum samples examined (88 from humans, 480 from dogs and 62 from rodents), all were nonreactive for plague and bacteriological analyses performed on 14 rodents and 2 flea lots showed no signs of the bacteria. CONCLUSIONS: These results cannot confirm the eradication of the disease in the entire State, since the cyclic nature of the plague indicates that it can go silent for long periods and then resurge, affecting large numbers of people. Thus, maintenance of active, permanent surveillance is required for early detection and the development of adequate control measures.