Pediatric neurodevelopment by prenatal Zika virus exposure: a cross-sectional study of the Microcephaly Epidemic Research Group Cohort.

BACKGROUND: The implications of congenital Zika Virus (ZIKV) infections for pediatric neurodevelopment and behavior remain inadequately studied. The aim of this study is to investigate patterns of neurodevelopment and behavior in groups of children with differening severities of ZIKV-related microcephaly and children with prenatal ZIKV exposure in the absence of microcephaly. METHODS: We conducted a cross-sectional study, nested in a cohort, of 274 children (aged 10-45 months) who were born during the peak and decline of the microcephaly epidemic in Northeast Brazil. Participants were evaluated between February 2017 and August 2019 at two tertiary care hospitals in Recife, Pernambuco, Brazil. We analyzed the children in four groups assigned based on clinical and laboratory criteria: Group 1 had severe microcephaly; Group 2 had moderate microcephaly; Group 3 had prenatal ZIKVexposure confirmed by maternal RT-PCR testing but no microcephaly; and Group 4 was a neurotypical control group. Groups were evaluated clinically for neurological abnormalities and compared using the Survey of Wellbeing of Young Children (SWYC), a neurodevelopment and behavior screening instrument validated for use in Brazil. Children with severe delays underwent further evaluation with an adapted version of the SWYC. RESULTS: Based on the SWYC screening, we observed differences between the groups for developmental milestones but not behavior. Among the 114 children with severe microcephaly of whom 98.2% presented with neurological abnormalities, 99.1% were 'at risk of development delay' according to the SWYC instrument. Among the 20 children with moderate microcephaly of whom 60% presented with neurological abnormalities, 65% were 'at risk of development delay'. For children without microcephaly, the percentages found to be 'at risk of developmental delay' were markedly lower and did not differ by prenatal ZIKV exposure status: Group 3 (N = 94), 13.8%; Group 4 (N = 46), 21.7%. CONCLUSIONS: Among children with prenatal ZIKV exposure, we found a gradient of risk of development delay according to head circumference. Children with severe microcephaly were at highest risk for delays, while normocephalic ZIKV-exposed children had similar risks to unexposed control children. We propose that ZIKV-exposed children should undergo first-line screening for neurodevelopment and behavior using the SWYC instrument. Early assessment and follow-up will enable at-risk children to be referred to a more comprehensive developmental evaluation and to multidisciplinary care management.

Participatory Surveillance Based on Crowdsourcing During the Rio 2016 Olympic Games Using the Guardians of Health Platform: Descriptive Study.

BACKGROUND: With the evolution of digital media, areas such as public health are adding new platforms to complement traditional systems of epidemiological surveillance. Participatory surveillance and digital epidemiology have become innovative tools for the construction of epidemiological landscapes with citizens' participation, improving traditional sources of information. Strategies such as these promote the timely detection of warning signs for outbreaks and epidemics in the region. OBJECTIVE: This study aims to describe the participatory surveillance platform Guardians of Health, which was used in a project conducted during the 2016 Olympic and Paralympic Games in Rio de Janeiro, Brazil, and officially used by the Brazilian Ministry of Health for the monitoring of outbreaks and epidemics. METHODS: This is a descriptive study carried out using secondary data from Guardians of Health available in a public digital repository. Based on syndromic signals, the information subsidy for decision making by policy makers and health managers becomes more dynamic and assertive. This type of information source can be used as an early route to understand the epidemiological scenario. RESULTS: The main result of this research was demonstrating the use of the participatory surveillance platform as an additional source of information for the epidemiological surveillance performed in Brazil during a mass gathering. The platform Guardians of Health had 7848 users who generated 12,746 reports about their health status. Among these reports, the following were identified: 161 users with diarrheal syndrome, 68 users with respiratory syndrome, and 145 users with rash syndrome. CONCLUSIONS: It is hoped that epidemiological surveillance professionals, researchers, managers, and workers become aware of, and allow themselves to use, new tools that improve information management for decision making and knowledge production. This way, we may follow the path for a more intelligent, efficient, and pragmatic disease control system.

Time series analysis of dengue surveillance data in two Brazilian cities.

The aim of the study was to evaluate the temporal patterns of dengue incidence from 2001 to 2014 and forecast for 2015 in two Brazilian cities. We analysed dengue surveillance data (SINAN) from Recife, 1.6 million population, and Goiania, 1.4 million population. We used Auto-Regressive Integrated Moving Average (ARIMA) modelling of monthly notified dengue incidence (2001-2014). Forecasting models (95% prediction interval) were developed to predict numbers of dengue cases for 2015. During the study period, 73,479 dengue cases were reported in Recife varying from 11 cases/100,000 inhab (2004) to 2418 cases/100,000 inhab (2002). In Goiania, 253,008 dengue cases were reported and the yearly incidence varied from 293 cases/100,000 inhab (2004) to 3927 cases/100,000 inhab (2013). Trend was the most important component for Recife, while seasonality was the most important one in Goiania. For Recife, the best fitted model was ARIMA (1,1,3)12 and for Goiania Seasonal ARIMA (1,0,2) (1,1,2)12. The model predicted 4254 dengue cases for Recife in 2015; SINAN registered 35,724 cases. For Goiania the model predicted 33,757 cases for 2015; the reported number of cases by SINAN was 74,095, within the 95% prediction interval. The difference between notified and forecasted dengue cases in Recife can be explained by the co-circulation of dengue and Zika virus in 2015. In this year, all cases with rash were notified as "dengue-like" illness. The ARIMA models may be considered a baseline for the time series analysis of dengue incidence before the Zika epidemic.

The impact of an intervention to improve diabetes management in primary healthcare professionals' practices in Brazil.

AIMS: To evaluate the results of a structured intervention in primary healthcare to improve type 2 diabetes management. METHODS: The intervention was implemented in 2011-2012 in two cities in the State of Pernambuco, Brazil, and evaluated in 2013 by interviewing healthcare professionals about their practices in all primary care facilities of these two cities (intervention group), and of two paired control cities (control group). Comparisons between the intervention and control groups were made using standard parametric tests. RESULTS: The percentage of professionals who measured adherence to treatment, developed educational actions to control high-risk situations or prevent complications, or declared that they "explained" the disease to the patients, was higher in the control group (p<0.05). Multidisciplinary involvement, requests for electrocardiograms and referrals to specialists were also more frequent in the control group (p<0.01). The only differences favoring the intervention group were the higher proportion of nurses (p<0.05) and community health workers (p<0.01) trained for diabetes management and a greater frequency of discussing the cases of diabetic patients at team meetings (p<0.01). CONCLUSIONS: These negative results raise questions about the effectiveness of actions aiming to improve diabetes management in primary care, and reinforce the need for careful evaluation of their impact.