Informe dos dez anos de Cooperação Técnica do TC 72. Fortalecimento do Sistema Nacional de Vigilância em Saúde aprimorando a capacidade de gestão do Sistema Único de Saúde para a redução da morbimortalidade das Zoonoses, Doenças de Transmissão Vetorial, Hídrica e Alimentar

O presente documento analisa o contexto do Termo de Cooperação (TC) no 72, celebrado entre a OPAS, por meio do seu Centro Pan-Americano de Febre Aftosa e Saúde Pública Veterinária (PANAFTOSA/SPV-OPAS/OMS) e o Ministério da Saúde (MS) do Brasil, através da Secretaria de Vigilância em Saúde (SVS), assinado em dezembro de 2011, com o objetivo de fortalecer o Sistema Nacional de Vigilância em Saúde (SNVS) aprimorando a capacidade de gestão do Sistema Único de Saúde (SUS) para a redução da morbimortalidade das Zoonoses e das Doenças de Transmissão Vetorial, Hídrica e Alimentar, no período de 10 anos de sua vigência, até 2021. Na implementação de ações e medidas, a contínua avaliação de resultados não só verificam o nível de avanço de planos de trabalho, como também identificam meios a serem seguidos ou novos caminhos para alcançar os resultados incialmente esperados. Neste documento, uma análise retrospectiva dos resultados obtidos com o TC 72 será realizada visando a identificação de lições aprendidas, desafios superados e perspectivas para o futuro. Sendo assim, no âmbito de um TC, a avaliação continuada das atividades executadas e respectivos resultados alcançados permitirá identificar soluções eficazes que geraram conhecimento e capacidades, fortalecendo e gerando avanços para a saúde da população brasileira.

Changes in access to water and incidence of waterborne diseases after the Vale dam collapse in Brumadinho (MG), Brazil.

OBJECTIVE: To describe, within the Human Rights to Water and Sanitation (HRWS) framework, the access to water supply services and the incidence of waterborne diseases in the communities affected by the dam disaster in Brumadinho (MG), Brazil. METHODS: A quantitative and qualitative methodology was used, having as variables information on access to water supply services and waterborne diseases. The primary data were extracted from the "Brumadinho Health Project", using a sample stratum with 981 people interviewed, totaling 92.5% of the eligible population in the affected communities of Córrego do Feijão and Parque da Cachoeira. The secondary data from Brumadinho was extracted from the project "Sanitation conditions and the River Basin of the B1 River Basin of Mineradora Vale between 2017 and 2020", available in public databases between 2017 and 2020, and qualitative data was collected in 2022 through individual interviews with health professional also live in the communities. RESULTS: With regard to access to water supply services, the results of this combined data analysis indicate that the HRWS is being neglected, especially with regard to availability, accessibility, acceptability and quality of water. The study also shows a significant increase in the incidence of waterborne diseases in the region after the disaster. CONCLUSION: It is necessary to use the HRWS as the basis to the implementation of public policies aiming to reduce vulnerability in access to water supply services.

Impacto da privatização da água e do esgoto nas tarifas e no acesso aos serviços no Brasil / The impact of water and sewer privatization on tariffs and access in Brazil / El impacto de la privatización del agua y del alcantarillado en las tarifas y en el acceso a los servicios en Brasil

Resumo Este trabalho se propõe a verificar o impacto das concessões à iniciativa privada dos serviços de saneamento sobre o acesso à água e ao esgoto tratados, bem como sobre as tarifas cobradas por esses serviços. O presente estudo se faz relevante à luz das recentes alterações legislativas no setor, à guisa da Lei n. 14.026/2020, e da necessidade de universalização do saneamento. Como método, foi utilizado o modelo diferenças em diferenças, para dados de 3.536 municípios brasileiros retirados do Sistema Nacional de Informações sobre Saneamento (SNIS), abrangendo o período de 1998 a 2019. Os resultados mostram impacto positivo e estatisticamente significativo dos prestadores privados (em relação aos públicos) sobre o acesso aos serviços de água, esgoto e tratamento de esgoto. Ademais, foi observado impacto positivo e estatisticamente significativo na tarifa praticada quando da concessão à iniciativa privada dos serviços, em comparação aos preços cobrados por prestadores públicos.

Abstract This paper aims to verify the impact of water and sewer services privatization on access and the tariffs charged for them. This paper is relevant mainly due to the sector's recent legal changes that resulted in Law n. 14.026/2020 and the need to universalize sanitation services in Brazil. The differences-in-differences method was employed to estimate the impact, using data from 3.536 Brazilian municipalities extracted from SNIS, the Brazilian National Sanitation Information System, for the years 1998-2019. The results show private sector operators' positive and statistically significant impact (compared to their public peers) on water and sewage services - including sewer treatment. Also, it detected a positive and statistically significant effect on the tariffs charged for those services once privatization occurs, compared to the prices charged by public sector operators.

Resumen Este trabajo se propone evaluar el impacto de las concesiones a la iniciativa privada de los servicios de saneamiento en el acceso al agua y al alcantarillado y su tratamiento, así como en las tarifas que se cobren por estos servicios. El trabajo se hace relevante a la luz de los recientes cambios legislativos en el sector, como la Ley n.o 14.026 de 2020 y de la necesidad de universalizar el saneamiento. Para el análisis se utilizó el modelo de diferencias con datos de 3536 municipios brasileños extraídos del Sistema Nacional de Información sobre Saneamiento (SNIS) que cubren el período 1998-2019. Los resultados indicaron un impacto positivo y estadísticamente significativo de los proveedores privados (en relación con los públicos) en el acceso a los servicios de agua, alcantarillado y tratamiento del alcantarillado. Además, se observó un impacto positivo y estadísticamente significativo en la tarifa cuando los servicios se concesionaron a la iniciativa privada en comparación con los precios que cobraban los proveedores públicos.

Caracterização fenotípica e molecular de isolados de Salmonella spp. e Escherichia coli Patogênica Extraintestinal resistentes às polimixinas / Phenotypic and molecular characterization of Salmonella spp. and extraintestinal pathogenic Escherichia coli resistant to polymyxins

A resistência antimicrobiana está se tornando um grande desafio para saúde pública devido ao aumento da resistência aos beta-lactâmicos em geral. Os isolados de Salmonella spp. e Escherichia coli são os mais frequentes agentes causadores de doenças de transmissão hídrica e alimentar, mas também podem causar doenças invasivas graves, principalmente em imunodeprimidos, idosos e crianças. Ambos os patógenos vêm apresentando perfis de resistência as principais classes de antibióticos, nestes casos é necessária a busca de uma nova opção terapêutica, como por exemplo, as polimixinas. Em 2015, surgiu o primeiro relato da resistência às polimixinas mediado pelo gene mcr (mobile colistin resistance), que se disseminou por diversos continentes e ocasionou uma grande preocupação global em saúde pública. O objetivo deste trabalho foi identificar e caracterizar os mecanismos que medeiam à resistência à polimixinas em cepas de Salmonella spp. e E. coli Patogênica extraintestinal (ExPEC). Foi realizado a triagem pelo teste da gota e teste da CIM frente a colistina e polimixina B no total de 1026 isolados de Salmonella enterica e 159 isolados de ExPEC. Nos isolados resistentes foi verificado a presença de mutações nos genes (pmrA/B, phoP/Q) associados à resistência às polimixinas, e através da PCR foi feita a identificação dos genes de resistência plasmidial (mcr). Das 124 cepas de Salmonella resistentes a colistina e polimixina B, apenas um isolado foi positivo para o gene mcr-1, e este gene foi detectado em um plasmídeo do grupo IncX4. A cepa 2018.466 foi caracterizada como S. Choleraesuis proveniente de sangue de origem humana. Foram identificados 44 isolados de Salmonella spp. apresentando mutações em pmrA e pmrB. Dos 56 isolados de ExPEC resistentes a colistina, 21 isolados apresentaram o gene mcr-1. Este gene foi detectado em plasmídeos do grupo IncX4 (n=17) e em plasmídeos do grupo IncF (n=4). Cinco isolados de E.coli não apresentaram mutações nos genes estudados,sendo que três eram positivos para o gene mcr-1, enquanto as demais cepas apresentaram mutações em pmrA/B e phoP/Q. A tipagem pela PFGE foi realizada nos isolados de E.coli positivos para o gene mcr-1, com o objetivo de verificar a diversidade genética encontrada entre elas. Foram identificados 18 perfis genéticos, sem um clone principal...(AU)

Antimicrobial resistance is becoming a major public health challenge due to increasing resistance to beta-lactams in general. Salmonella spp. and Escherichia coli are the most frequent causative agents of diseases transmitted by water and food, but they can also cause serious invasive diseases, especially in immunosuppressed individuals, the elderly and children. Both pathogens have shown resistance profiles to the main classes of antibiotics, in these cases it is necessary to search for a new therapeutic option, such as polymyxins. In 2015, the first report of resistance to polymyxins mediated by the mcr gene (mobile colistin resistance) appeared, which spread across several continents and caused a major global concern in public health. The objective of this work was to identify and characterize the mechanisms that mediate resistance to polymyxins in strains of Salmonella spp. and extraintestinal pathogenic E. coli (ExPEC). Screening by drop test and MIC test against colistin and polymyxin B was performed on a total of 1026 Salmonella enterica isolates and 159 ExPEC isolates. In the resistant isolates, the presence of mutations in the genes (pmrA/B, phoP/Q) associated with resistance to polymyxins was verified, and through PCR the plasmid resistance genes (mcr) were identified. Of the 124 Salmonella strains resistant to colistin and polymyxin B, only one isolate was positive for the mcr-1 gene, and this gene was detected in a plasmid from the IncX4 group. Strain 2018.466 was characterized as S. Choleraesuis from blood of human origin. Forty-four Salmonella spp. showing mutations in pmrA and pmrB. Of the 56 colistin-resistant ExPEC isolates, 21 isolates harbored the mcr-1 gene. This gene was detected in plasmids from the IncX4 group (n=17) and in plasmids from the IncF group (n=4). Five E.coli isolates did not show mutations in the genes studied, three of which were positive for the mcr-1 gene, while the other strains showed mutations in pmrA/B and phoP/Q. Typing by PFGE was performed on E.coli isolates positive for the mcr-1 gene, with the objective of verifying the genetic diversity found among them. Eighteen genetic profiles were identified, without a main clone...(AU)

Ministry of Health & Wellness Advises on Vector and Waterborne Diseases Due to Flooding October 12, 2022 / Ministry of Health & Wellness Advises on Vector and Waterborne Diseases Due to Flooding October 12, 2022

The Ministry of Health & Wellness advises that flood waters can be the source of many infectious diseases, chemical hazards, and injuries and, therefore, urges the public to avoid walking, working, or playing in floodwaters. Exposure to contaminated floodwater can cause wound infections, skin rashes, stomach illnesses, tetanus, and waterborne diseases such as typhoid fever, cholera, leptospirosis, and hepatitis A.

Epidemiological and immunological gains from solar water disinfection: Fact or wishful thinking?

OBJECTIVE: There is still no consensus on the impact of using solar disinfection (SODIS) to reduce the prevalence of waterborne gastrointestinal diseases. The reported reduction in diarrhoea prevalence among SODIS users has been attributed to the consumption of water free of viable pathogens. However, it has also been suggested that ingestion of SODIS-inactivated pathogens may induce protective immunological changes that may also contribute to a reduction in the frequency of diarrhoea. The present study aimed to critically review the epidemiological and immunological gains of using SODIS. METHODS: We critically reviewed 22 articles published in English, selected from 2118 records systematically retrieved from the databases. RESULTS: All trials (except one) reported a significant reduction in diarrhoea prevalence among children using SODIS, but some of the data from trials report contrary findings. All in vitro and in vivo assays indicate that SODIS-inactivated pathogenic bacteria have the potential to induce immunological alterations that may result in protective immunological effects. Studies with a low risk of bias are still awaited to confirm the ability to use SODIS to reduce the prevalence of diarrhoea. CONCLUSION: Reducing the prevalence of diarrhoea depends on the success of SODIS delivery strategies in inducing behavioural changes in communities that result in the production of SODIS-compliant outcomes. The results of trials reporting a reduction in the prevalence of diarrhoea due to the use of SODIS seem to support the hypothesis of the contribution of the protective immunological effect against diarrhoea in SODIS users.

Use of laboratory methodologies to confirm an outbreak of acute diarrheal disease caused by multiple pathogens / Uso de metodologias laboratoriais para confirmação de surto de doença diarreica aguda causada por múltiplos patógenos

The aim of this study was to investigate an outbreak caused by protozoa, which occurred in a municipality in the Brazil southern region. The investigations were carried out analyzing 47 fresh stool samples and 26 water samples by parasitological and molecular methods, as well as, direct immunofluorescence. After the filtrations of water samples and purification of stool samples, the concentrates were evaluated microscopically for presence of parasites. Molecular analyses were performed by polymerase chain reaction (PCR) for DNA detection of Giardia spp., Cryptosporidium parvum, C. hominis and Cyclospora cayetanensis. Out of 26 water samples, 30.8% (8/26) had waterborne protozoa and C. cayetanensis was the most prevalent (15.5%). Out of the 47 stool samples, 23.4% (11/47) were infected with C. cayetanensis and Giardia spp. The results showed that backwash water samples from filters of the Water Treatment Station were contaminated with C. cayetanensis, C. hominis and Giardia spp., suggesting the contamination of water sources with human waste brought by sewage. These results show the importance of protozoa investigation in water and stool samples by laboratory methodologies principally in outbreaks causing acute diarrheal disease (AU).

O objetivo do presente estudo foi investigar um surto causado por protozoários, ocorrido em um município da região sul do Brasil. As investigações foram realizadas analisando 47 amostras de fezes frescas e 26 amostras de água por métodos parasitológicos, moleculares e de imunofluorscência direta. Após as filtrações das amostras de água e purificação das amostras de fezes, os concentrados foram avaliados microscopicamente a procura de parasitas. A seguir, foram analisadas, pela reação em cadeia da polimerase (PCR), a detecção de DNA de Giardia spp., Cryptosporidium parvum, C. hominis e Cyclospora cayetanensis. Das 26 amostras de água, 30,8% (8/26) apresentaram protozoários de veiculação hídrica, sendo que, C. cayetanensis foi o mais prevalente (15,5%). Das 47 amostras de fezes, 23,4% (11/47) estavam infectadas por C. cayetanensis e Giardia spp. Os resultados mostraram que as águas de retrolavagem dos filtros da Estação de Tratamento de Água estavam contaminadas com C. cayetanensis, C. hominis e Giardia spp. sugerindo a contaminação dos mananciais com dejetos humanos trazidos pelo esgoto. Estes resultados mostram a importância da investigação de protozoários em água e fezes por metodologias laboratoriais, principalmente em surtos que causam doença diarreica aguda (AU).

Cryptosporidiosis outbreak in Amazonia, French Guiana, 2018.

BACKGROUND: Cryptosporidiosis outbreaks in South America are poorly documented. In March 2018, 51 cases of cryptosporidiosis were reported in Maripasoula, a village located in a remote forest area along the border between Surinam and French Guiana. METHOD: To identify the origin of the epidemic, we performed epidemiological, microbiological, and environmental investigations. Only the cases involving diarrhoea and Cryptosporidium-positive stool were considered as bona fide, while cases involving diarrhoea and close contact with a confirmed case were classified as "possible". RESULTS: We identified 16 confirmed cases and 35 possible ones. Confirmed cases comprised nine children (median age of 18 months, range: 6-21), one immunocompromised adult and six soldiers. One child required a hospitalisation for rehydration. All 16 Cryptosporidium stools were PCR positive, and sequencing of the gp60 gene confirmed only one Cryptosporidium hominis subtype IbA10G2. Tap water consumption was the only common risk factor identified. Contamination of the water network with Cryptosporidium parvum subtype IIdA19G2 was found. CONCLUSION: Water quality is a major public health issue in Amazonian French Guiana, especially for population at risk (children, people with comorbidity, travelers). For them, alternative water supply or treatment should be implemented.

Waterborne diseases and ethnic-related disparities: A 10 years nationwide mortality and burden of disease analysis from Ecuador.

Background: Despite worldwide progress in terms of clean water supply, sanitation, and hygiene knowledge, some middle and most of low-income countries are still experiencing many diseases transmitted using unsafe water and the lack of sanitation. Methods: To understand the impact of all waterborne diseases (WBD) registered in Ecuador. We performed a population-based analysis of all cases and deaths due to WBD in Ecuador based on the national public databases of hospital discharges as a proxy of incidence, in-hospital mortality, and countrywide general mortality rates from 2011 to 2020. Results: In Ecuador, mestizos (mixed European and Indigenous American ancestry) had the greatest morbidity rate (141/100,000), followed by indigenous (63/100,000) and self-determined white patients (21/100,000). However, in terms of mortality, indigenous population have the greatest risk and rates, having a 790% additional mortality rate (2.6/100,000) than the reference group (self-determined white populations) at 0.29/100,000. The burden of disease analysis demonstrated that indigenous had the highest burden of disease caused by WBD with 964 YLL per every 100,000 people while mestizos have 360 YYL per 100,000 and self-determined white Ecuadorians have 109 YYL per 100,000. Conclusions: In Ecuador, waterborne diseases (WBD) are still a major public health problem. We found that indigenous population had higher probability of getting sick and die due to WBD than the rest of the ethnic groups in Ecuador. We also found that younger children and the elderly are more likely to be admitted to the hospital due to a WBD. These epidemiological trends are probably associated with the lower life expectancy found among Indigenous than among the rest of the ethnic groups, who die at least, 39 years earlier than the self-determined white populations, 28 years earlier than Afro-Ecuadorians and 12 years earlier than the mestizos.

Physicochemical, microbiological and parasitological analysis of water for human consumption in a quilombola community in Alagoas / Análise físico-química, microbiológica e parasitológica da água para consumo humano em comunidade quilombola em Alagoas

Water is the indispensable natural resource for all living beings. For human consumption, it must be potable, so as not to pose a risk to health, and can be used for ingestion, food preparation and personal hygiene. Knowing this importance, this study aimed to carry out physical-chemical, microbiological and parasitological analyzes of water for human consumption in a quilombola community of Santa Luzia do Norte in Alagoas. A cross-sectional, experimental and quantitative study was carried out between January and December 2019. The physical-chemical parameters of residual chlorine, turbidity, fluoride, fluoridation, color and pH were analyzed, microbiological analyses were based on the research of total and thermotolerant coliforms (E. coli) and parasitological analyses were performed based on the research of protozoa and intestinal helminths. Some physical-chemical parameters (turbidity and pH) were observed outside the limits required by the Ministry of Health, and the presence of total coliforms in some of the analyzed samples (17.85%), characterizing this community at risk related to waterborne diseases. The samples analyzed did not present infecting forms of parasitic species. Regarding the variables evaluated, the results found showed that the lack of adequate basic sanitation affects the quality of water used for human consumption by the quilombola population of Santa Luzia do Norte-AL.(AU)

A água é o recurso natural indispensável a todos os seres vivos. Para consumo humano, deve ser potável, de modo a não oferecer risco à saúde, podendo ser usada para ingestão, preparação de alimentos e higiene pessoal. Sabendo dessa importância, este estudo teve como objetivo realizar análises físico-químicas, microbiológicas e parasitológicas da água para consumo humano em uma comunidade quilombola de Alagoas. Foi realizado um estudo transversal, do tipo experimental e quantitativo, realizado na comunidade quilombola de Santa Luzia do Norte-AL, entre janeiro a dezembro de 2019. Foram analisados os parâmetros físico-químico de cloro residual, turbidez, fluoreto, fluoretação, cor e pH, as análises microbiológicas foram baseadas na pesquisa de coliformes totais e termotolerantes (E. coli) e as análise parasitológicas foram realizadas com base na pesquisa de protozoários e helmintos intestinais. E a pesquisa de protozoários oportunistas pelo método de Ziehl-Neelsen modificado. Foi observado alguns parâmetros físico-químicos (turbidez e pH) fora dos limites exigidos pelo Ministério da Saúde, e a presença de coliformes totais em algumas das amostras analisadas (17,85%), caracterizando esta comunidade em situação de risco relacionado às doenças de veiculação hídrica. As amostras analisadas não apresentaram formas infectantes das espécies parasitárias. Em relação às variáveis avaliadas, os resultados encontrados demonstraram que a falta de saneamento básico adequado afeta a qualidade da água utilizada para consumo humano pela população quilombola de Santa Luzia do Norte-AL.(AU)

Investment in drinking water and sanitation infrastructure and its impact on waterborne diseases dissemination: The Brazilian case.

Investment in sanitation and drinking water infrastructure is essential for universal access to these services in developing countries. Universal coverage of water and sanitation services (WSS) can prevent the dissemination of waterborne diseases and mitigate their adverse effects. These diseases are responsible for many deaths worldwide, especially among the disadvantaged population and children. A causal effect can be established between WSS investment and hospital admissions due to waterborne diseases. Therefore, we considered an innovative network-DEA approach that models the link between serially connected subsystems (upstream investment and downstream hospitalizations). This approach allowed us: to measure the efficiency of both subsystems; estimate the amount of (efficient) investment necessary to universalize the access to proper WSS infrastructure; and mitigate hospital admissions due to waterborne diseases. We used the Brazil case study to test our model. On average, Brazilian states could increase the number of people not requiring hospitalizations due to waterborne diseases by 157 thousand per R$100 million invested in sanitation and 26 thousand per R$100 million invested in drinking water. Our results suggest that relatively small (efficient) investment in those two infrastructure types has a massive impact on hospitalizations. This impact would be more significant than the investment in WSS coverage. Therefore, if safely managed, WSS would cover all citizens, and Brazil would come closer to developed countries.

Vigilância epidemiológica das doenças de transmissão hídrica e alimentar: manual de treinamento / Epidemiological surveillance of water and foodborne diseases: training manual

Este Manual é um instrumento que subsidia o treinamento em vigilância epidemiológica das doenças de transmissão hídrica e alimentar (VE-DTHA), direcionado para profissionais de saúde que atuam na investigação de surtos ou de casos de doenças de notificação compulsória relacionadas à transmissão hídrica e alimentar.

Wastewater-Based Epidemiology (WBE) and Viral Detection in Polluted Surface Water: A Valuable Tool for COVID-19 Surveillance: A Brief Review

SARS-COV-2 is the causative agent of the current COVID-19 pandemic. Disease clinical manifestations range from asymptomatic to severe multiple organ damage. SARS-CoV-2 uses ACE2 as a cellular receptor, which is abundantly expressed in the small intestine, allowing viral replication in the gastrointestinal tract. Viral RNA has been detected in the stool of COVID-19 patients and viable viruses had been isolated in some of these samples. Thus, a putative role of SARS-CoV-2 fecal-oral transmission has been argued. SARS-CoV-2 is shed in human excreta and further disposed in the sewerage or in the environment, in poor basic sanitation settings. Wastewater-based epidemiology (WBE) is a valuable population level approach for monitoring viral pathogens and has been successfully used in di_erent contexts. This review summarizes the current global experience on SARS-CoV-2 WBE in distinct continents and viral detection in polluted surface water. The advantages and concerns of this strategy for SARS-CoV-2 surveillance are discussed. Outcomes suggest that WBE is a valuable early warning alert and a helpful complementary surveillance tool to subside public health response, to tailor containment and mitigation measures and to determine target populations for testing. In poor sanitation settings, contaminated rivers could be alternatively used as a source for environmental surveillance.

Enfermedades de transmisión hídricas en el cantón Penipe, Ecuador 2016-2017 / Waterborne diseases in cantón Penipe, Ecuador, 2016-2017

Introducción: La reemergencia y el control de algunas enfermedades de transmisión hídrica continúan siendo motivos de interés para los gobiernos sanitarios. Objetivo: Desarrollar acciones intersectoriales dirigidas al mejoramiento de la situación ambiental, el saneamiento básico y la calidad del agua. Métodos: Se desarrolló una investigación-acción participativa, con enfoque mixto. Se conformó un equipo multidisciplinario integrado por profesionales de la salud, miembros de la comunidad y del Gobierno Autónomo Descentralizado de Penipe, Chimborazo, Ecuador. La población estuvo constituida por 2089 habitantes que residían de forma permanente en el área urbana de la cabecera cantonal durante septiembre de 2016 y septiembre de 2017. La muestra (494 personas) se seleccionó por muestreo no probabilístico, la integraron individuos con edades entre 15 y 60 años, mentalmente aptos y que en el momento de la aplicación del instrumento se encontraban en su vivienda. Estas personas ofrecieron su consentimiento informado de participación y declararon residir de forma permanente en esa localidad. Para la recolección de los datos se empleó un cuestionario diseñado y validado por criterio de especialistas. Resultados: Predominaron las féminas de 21-30 años de edad y la autoidentificación étnica de mestiza. El consumo de agua hervida y su cloración constituyeron las prácticas más referidas por los encuestados, lo que resulta insuficiente para evitar la transmisibilidad de las enfermedades de transmisión hídrica. Conclusiones: La presencia de las enfermedades de transmisión hídricas en el cantón Penipe, Ecuador es un problema de la salud pública local que aún no ha sido resuelto, lo que justifica una intervención intersectorial que permita una educación para la salud incluyente, renovada y de carácter comunitario(AU)

Introduction: Re-emergence and control of some waterborne diseases are still an interest for sanitary governments. Objective: To develop intersectoral actions addressed to the improvement of the environmental situation, the basic sanitation and water quality. Methods: It was developed a participative research-action, with mixed approach. It was formed a multidisciplinary team made up by health professionals, members of the community and the Decentralized Autonomous Government of Penipe, Cimborazo, Ecuador. The population was formed by 2089 inhabitants living permanently in the urban area of the cantonal administrative center in the period from September 2016 to September 2017. The sample (494 people) was selected by non-probabilistic sampling, and it was made up by individuals in the ages from 15 to 60 years, mentally fit and that at the moment of the instrument's implementation were at their house. These people gave their informed consent for participating and declared to live permanently in that area. For data collection, it was used the questionnaire designed and validated by specialists criterion. Results: Females in the ages from 21 to 30 years and the ethnic auto-identification as mixed race predominated. Consumption of boiled water and its chlorination were the most common practices referred by those polled, which is insufficient to avoid transmissibility of waterborne diseases. Conclusions: The presence of water transmission diseases in cantón Penipe, in Ecuador is an unsolved local public health problem which justifies an intersectoral intervention that allows an inclusive, renewed and community focused health education(AU)

Perfil epidemiológico dos surtos de Doenças de Transmissão Hídricas e Alimentares (DTHA) no município de Gravataí/RS entre 2008 e 2018 / Epidemiological Profile of Outbreaks of Water and Food Transmission Diseases (DTHA) in the Municipality of Gravataí / RS between 2008 and 2018

É considerado surto de Doença de Transmissão Hídricas e Alimentares (DTHA) quando duas ou mais pessoas apresentam sinais e sintomas semelhantes após ingerirem alimentos e/ou água da mesma origem. A prevenção das DTHA baseia-se no consumo de água e alimentos seguros. O objetivo deste trabalho foi descrever o perfil dos surtos de DTHA no município de Gravataí/RS. A metodologia utilizada foi descritiva exploratória, com abordagem quantitativa por meio da análise dos casos investigados. A coleta de dados e informações foi realizada por meio dos dados locais contidos no SINAN (Sistema de Informação de Agravos de Notificação). Foram investigados, entre os anos de 2008 e 2018, 13 notificações de surtos de DTHA no município. Destes, seis (6) (46%) foram ocasionados por meio de bactérias, um (1) (8%) foi por cucurbitacina (composto bioquímico produzido por algumas plantas para sua defesa) e seis (6) (46%) não foram possíveis de serem identificados. Dentre os agentes etiológicos identificados como bactérias, um (1) (8%) foi Bacillus cereus, três (3) (23%) foram Clostridium perfringens e dois (2) (15%) foram Staphylococcus aureus. Foi verificado que os alimentos mais envolvidos foram os de origem animal e produtos de panificação (80%). Entre os fatores causais, os mais encontrados foram a conservação inadequada e/ou deficiente dos alimentos (69%) e a manipulação e/ou preparação inadequada (54%). No que diz respeito aos locais de preparo e ingestão dos alimentos envolvidos, verificou-se que os comércios de alimentos e as residências, respectivamente, foram os lugares mais reincidentes. Entre as faixas etárias e os sexos atingidos, os mais frequentes foram entre 20 e 49 anos (40%) e os homens (60%), respectivamente. Os sinais e sintomas mais frequentes foram náuseas (60%) e diarreia (59%). Esse estudo aponta para a necessidade de a estruturar orientações educativas mais direcionadas pela Vigilância em Saúde para evitar novos casos de DTHA.

It is considered an outbreak of Water and Food Transmission Disease (DTHA) when two or more people show similar signs and symptoms after eating food and / or water from the same source. The prevention of DTHA is based on the consumption of water and safe food. The objective of this work was to describe the profile of DTHA outbreaks in the city of Gravataí / RS. The methodology used was exploratory descriptive, with a quantitative approach through the analysis of the investigated cases. The collection of data and information was carried out using local data contained in SINAN (Notifiable Diseases Information System). Between 2008 and 2018, 13 notifications of DTHA outbreaks in the municipality were investigated. Of these, six (6) (46%) were caused by bacteria, one (1) (8%) was caused by cucurbitacin (biochemical compound produced by some plants for their defense) and six (6) (46%) were not possible to be identified. Among the etiologic agents identified as bacteria, one (1) (8%) was Bacillus cereus, three (3) (23%) were Clostridium perfringens and two (2) (15%) were Staphylococcus aureus. It was found that the foods most involved were those of animal origin and bakery products (80%). Among the causal factors, the most found were inadequate and / or deficient food conservation (69%) and inadequate handling and / or preparation (54%). With regard to the places of preparation and ingestion of the food involved, it was found that food stores and homes, respectively, were the most recurrent places. Among the age groups and sexes affected, the most frequent were between 20 and 49 years old (40%) and men (60%), respectively. The most frequent signs and symptoms were nausea (60%) and diarrhea (59%). This study points to the need to structure educational guidelines more directed by Health Surveillance to avoid new cases of DTHA.