Evaluating the circulation of Ehrlichia canis and Rickettsia spp. in domestic dogs from a semiarid region in Brazil.

Tick-borne diseases are important for animal and human health, because they can cause death if not diagnosed and treated early. Canine monocytic ehrlichiosis (CME) can cause high morbidity in dog populations. Rocky Mountain Spotted Fever (RMSF) is among the most virulent infectious in humans; dogs are also susceptible to infection. The aims of this study were to evaluate the presence of Ehrlichia canis and Rickettsia spp. infections in domestic dogs, and to identify tick species parasitizing dogs among urban areas of two municipalities (Sobral and Alcântaras) in the Ceará State, Northeastern Brazil. A total of 208 domiciled dogs was sampled. After clinical evaluation, blood samples and ticks were collected and submitted to Real-Time Polymerase Chain Reaction (RT-PCR) targeting E. canis DNA. Serum samples were screened by Indirect Immunofluorescence Assays (IFA) for antibodies against different strains of Rickettsia spp. previously recognized in Brazil. The results of this study indicate the molecular detection of E. canis in the state of Ceará, Brazil, where the proportion of canine infection in Sobral (9.9%) was higher than in Alcântaras (5.6%). Rhipicephalus sanguineus sensu lato was the prevalent tick species infesting the dogs in both municipalities (43.5 and 53.3%, respectively). Our serological results indicate that dogs of the study area were at low risk of exposure to these tick-borne Rickettsia spp. of the spotted fever group. Our study offers epidemiological data of these diseases to better understanding Rickettsiales epidemic and enzootic cycles in the Brazilian semiarid region, improving prevention and control measures.

Diagnosis of visceral leishmaniasis in Ceará state, Brazil: A flow analysis of cases between 2007 and 2021.

OBJECTIVES: To analyse the flow of cases of visceral leishmaniasis (VL) in the state of Ceará, Brazil, between 2007 and 2021. METHODS: An ecological study was conducted using a spatial approach of newly confirmed cases of VL recorded in the Notifiable Diseases Information System. We identified individuals whose municipality of diagnosis differed from that of their residence. Flow maps, constructed using Tabwin 32 and ArcMap 9.2, allowed for the identification of the volume of traffic between the municipality of residence and that of initial care. RESULTS: There were 6775 confirmed VL cases. As a flow indicator, 178 counties had at least one resident diagnosed in another municipality in Ceará, with 2491 VL cases and an average trip of 79 km. The largest hub for receiving cases for diagnosis was the capital Fortaleza (1478 patients from 129 other municipalities), followed by Sobral, located in the northwestern region of Ceará (599 from 55 municipalities), and Barbalha, in the southern region (171 from 29 municipalities). In this southern region, 25 municipalities moved 55 people for treatment to Juazeiro do Norte and 11 municipalities moved 39 patients to Crato. A total of 255 patients with VL from 11 municipalities in other Brazilian states, mainly from the Northeast and North, were observed and notified in health services in Ceará. CONCLUSIONS: The major centres of VL diagnosis outside residence were in the cities of Fortaleza, Sobral, Barbalha, Juazeiro do Norte and Crato. There was also an outflow of cases from other municipalities located in the northeastern and northern regions of Brazil. The flows were more intense during the first triennium of the analysis and milder from 2019 to 2021. Understanding the diagnostic flow of VL helps in decision making and the development of public policies to improve the lives of the population.

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

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

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

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

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

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

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

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

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

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

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

Risk areas for Human Visceral Leishmaniosis 2007-2018: A temporal and spatial analysis in Ceará, Brazil.

Visceral leishmaniasis (VL) is considered as an important tropical disease because it rapidly spreads across a wide geographical area. This study aimed to analyse the temporal and spatial patterns of incidence, mortality and case fatality rates due to human VL in Ceará, Brazil, from 2007 to 2018. This is an ecological study involving time series and spatial analyses, and data were obtained from human VL notifications. Temporal trend analysis was carried out using the Joinpoint Regression Program. SaTScan 9.6 was used for conducting spatial analyses, and ArcMap 9.2 was used for building maps. There were 6,066 incident cases and 516 deaths due to human VL. There was an increasing trend in the incidence rate from 2007 to 2014 (annual per cent change [APC] = 3.8; 95% confidence interval [CI]:0.5 to 7.3; p = .031). Mortality (APC = -0.3; 95%CI: -2.5 to 1.9; p = .765) and VL case fatality rates (APC = -3.0; 95%CI: -4.3 to -1,7; p = .188) showed non-significant decline. The incidence rates were higher in the northwest and south regions of the state, with 11 high incidence rate clusters from 2007 to 2010, seven clusters in 44 municipalities from 2011 to 2014, and six clusters in 49 municipalities from 2015 to 2018. During 2007-2010, only one significant mortality rate cluster was identified in the southern region (relative risk [RR] = 7.6); during 2011-2014, two clusters in the northwest region were identified (RR=3.9 and RR=4.6). In the last period, a cluster of 11 municipalities in the southern region was identified (RR = 4.2). Mortality rate clusters were identified in the centre-south (2007-2010), northwest and south (both from 2011 to 2018). VL has a heterogeneous distribution, with maintenance of clusters with high incidence and mortality rates, as well as case fatality rates in municipalities in the northwest and south regions. These clusters present areas with the greatest risk of transmission of human VL.

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

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

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

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

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

Human visceral leishmaniasis: epidemiological, temporal and spacial aspects in Northeast Brazil, 2003-2017.

Visceral leishmaniasis is a highly lethal zoonosis transmitted by a sandfly. It is caused by a Leishmania protozoan parasite and dogs are the main reservoir. Ceara State is endemic to visceral leishmaniasis and it is considered a high risk transmission area. Temporal and spatial epidemiological studies have been used as tools to analyze the distribution and frequency of human visceral leishmaniasis (HVL). This study aimed to characterize HVL in its epidemiological andtemporal aspects in Ceara State, from 2003 to 2017, as this is a neglected disease and a public health problem. This is an ecological study carried out with HVL confirmed cases in Ceara, using three blocks of years (2003 to 2007, 2008 to 2012 and 2013 to 2017). The disease presented an endemic behavior, affecting mainly male residents in the urban area, especially children under five and young adults between 30 and 49 years old. HVL is recorded in all the municipalities, for more than 10 years, with a growing trend and territorial expansion to the Central and Eastern regions of the State. The results of this study indicated the increase in the incidence and lethality, as well as the expansion of leishmaniasis in Ceara State.

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

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

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

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

Programa de Educação para o Trabalho e Vigilância em Saúde / Education for Work and Health Surveillance Program

As iniciativas nacionais que se propõem contribuir para a reorientação da formação e do modelo de atenção nos levaram a descrever a experiência de implantação do Programa de Educação para o Trabalho (PET)-Saúde/Vigilância em Saúde (VS) em Sobral, Ceará. Trata-se de estudo descritivo, do tipo relato de experiência, vivenciado por estudantes dos cursos de enfermagem da Universidade Estadual Vale do Acaraú (UVA) e medicina e odontologia da Universidade Federal do Ceará (UFC), tutores e preceptores do PET-Saúde/VS. As informações foram registradas pelos tutores e preceptores durante as atividades desenvolvidas desde a implantação do programa (julho de 2010). O processo de trabalho desempenhado no PET-Saúde/VS compreende três eixos estruturantes que se intercomunicam, constando vivências teórico-conceituais, vivências no serviço e vivências de pesquisa. Para garantir a interface ensino-serviço e a integração entre as ações de vigilância em saúde e atenção básica, construímos uma 'tecnologia' pedagógica que chamamos de tecnologia de educação permanente na vigilância em saúde. A experiência permitiu aos estudantes uma visão mais ampla, acerca das condições de saúde da população, da importância do conhecimento sobre problemas locais para o trabalho da vigilância em saúde, a fim de prestar assistência qualificada e voltada para a realidade de cada território.

The Brazilian initiatives that propose to contribute to redirecting training and the care model led us to describe the experience of deploying of the Education for Work Program (PET) - Health/Health Surveillance (HS) in Sobral, northeastern Brazil. This is a descriptive, experience-reporting study, experienced by nursing students at the Vale do Acaraú State University (UVA) and medicine and dentistry students at the Federal University of Ceará (UFC), tutors, and PET-Health/HS preceptors. The information was recorded by the tutors and preceptors during the activities undertaken ever since the program was deployed (July 2010). The work process performed under PET-Health/HS comprises three intercommunicating structural axes, consisting of theoretical and conceptual experiences, experiences in service, and research experiences. To ensure the interface between teaching and service and integration between health surveillance and primary care, we built an educational 'technology' we call a permanent education in health surveillance technology. The experience afforded the students a broader view about the population's health conditions and on the importance of understanding local issues for health surveillance in order to provide qualified care targeted at the reality at each territory.