An assessment of the public health surveillance strategy based on molecular testing during three major pandemic waves of COVID-19 in Brazil.

A national laboratory-based surveillance system was adapted to monitor the situation of SARS-CoV-2 in Brazil. The objective of the study was to compare the challenges in implementing COVID-19 surveillance strategies based on the Ministry of Health's (MoH) distribution of RT-PCR tests to different types of laboratories. This retrospective study analyzed the MoH's testing policies and distribution of RT-PCR tests to laboratories during the first, second, and third waves. Recipient laboratories were divided into groups: public health laboratories that belonged to the national network of public health laboratories (Group 1); public laboratories granted authorization during the pandemic (Group 2); and High-Capacity Testing Centers (Group 3). We analyzed the timing and duration of COVID-19 testing policies and the allocation of tests to laboratories by group and wave. Using t-tests, we analyzed the difference in the weekly average of tests distributed to labs by group and using Pearson's correlation coefficient, analyzed the test distribution according to infection and death rates. Between epiweek 9, 2020, and epiweek 22, 2022, the MoH distributed an average of 263,004 RT-PCR tests per week. The weekly average of tests distributed was highest in the second wave (310,327 tests), followed by the first (218,005 tests) and third waves (201,226 tests). There was a significant increase in the mean weekly tests distributed in the second wave compared to the first and third waves (p = 0.047; IC 8.29-1110.71). We found a significant difference between the weekly average of tests distributed in the first and second wave (p < 0.001; IC -209.83-76.20) to Group 2. Group 3 received the second-highest number of tests from the MoH overall, with a reduction during the third wave to first-wave levels. The distribution of RT-PCR tests was not correlated with the case and death incidence.

Early response to COVID-19 in Brazil: The impact of a targeted approach to suspected cases and on epidemiological surveillance efforts.

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) entered Brazil before travel restrictions and border closures were imposed. This study reports the characteristics of suspected and confirmed coronavirus disease 2019 (COVID-19) cases among symptomatic international travelers in Brazil and their contacts. Methods: The REDCap platform developed by the Brazilian Ministry of Health was analyzed to identify and investigate suspected cases of COVID-19 recorded during the period January 1 to March 20, 2020. The impact of Brazil's targeted approach to suspected cases from specific countries on epidemiological surveillance efforts during the early stages of the COVID-19 pandemic were analyzed. Results: Based on molecular RT-PCR tests, there were 217 (4.2%) confirmed, 1030 (20.1%) unconfirmed, 722 (14.1%) suspected, and 3157 (61.6%) non-investigated cases among travelers returning from countries included on the alert list for surveillance, as defined by the Ministry of Health. Among the 3372 travelers who went to countries not included on the alert list, there were 66 (2.0%) confirmed, 845 (25.3%) unconfirmed, 521 (15.6%) suspected, and 1914 (57.2%) non-investigated cases. A comparison of the characteristics of confirmed cases returning from alert and non-alert countries did not reveal a statistically significant difference in symptoms. Almost half of the hospitalized travelers with known travel dates and hospitalization status (53.6%) were inbound from countries not included on the alert list, and RT-PCR tests were reported for only 30.5%. Conclusions: Policies adopted at entry points to contain the introduction of SARS-CoV-2 in Brazil were not ideal. An analysis of the early response shows that surveillance of travelers, including testing strategies, data standards, and reporting systems, was insufficient.

Evaluation of the effectiveness of surveillance policies to control the COVID-19 pandemic in São Paulo, Brazil.

BACKGROUND: Surveillance efforts are essential to pandemic control, especially where the state is the primary health provider, such as Brazil. When public health testing guidelines limit molecular tests, there are reductions in detection efforts aimed at early recognition, isolation, and treatment of those infected with the virus. This study evaluates the effectiveness of surveillance policies to control the COVID-19 pandemic in São Paulo. METHODS: We conducted an interrupted time series analysis with a segmented regression model to analyze if changes in the state's guidelines improved RT-PCR testing outcomes in Brazil's most affluent and largest state, São Paulo. Anonymized daily data on the RT-PCR tests conducted in public laboratories belonging to the state-wide network from March 1, 2020 to June 5, 2021 were extracted from the Sao Paulo State open-source database, while the data on the genomic sequences were obtained from GISAID. We then aggregated these data for the 17 regional health departments in the state to evaluate regional-level outcomes. RESULTS: The public health system restricted RT-PCR testing to hospitalized cases in the first months. Testing was expanded to permit symptomatic testing of non-hospitalized persons only in July 2020, but a statistically significant increase in surveillance efforts was not observed. Case definition was expanded to allow case confirmation based on clinical, laboratory and image data criteria other than an RT-PCR test without increasing the testing effort for asymptomatic suspicious cases in September 2020. There was an increase in the mean volume of testing in each RHD, but the test positivity rate increased due to insufficient testing expansion. Results also show an uneven improvement in testing outcomes following these changes across the state's regional health departments. CONCLUSIONS: Evidence suggests that lower RT-PCR testing and genomic surveillance efforts are associated with areas characterized by a higher population concentration and a greater population reliance on the public health system. Our results highlight the need to structure health surveillance and information systems for disease control and prevention in emergency settings considering local demographics and vulnerabilities. In high prevalence settings, efforts at identifying and including vulnerable populations in routine and enhanced surveillance programs during COVID-19 must be significantly improved.

Concordancia entre conocimiento y realización de técnica aséptica en medicamentos por vía intravenosa / Concordance between knowledge and performance of aseptic technique on preparing intravenous medications

Introducción: La técnica aséptica en preparación de medicamentos intravenosos es en 90% de los casos responsabilidad de la enfermera, a medida que avanza la farmacología, la enfermera se enfrenta a un proceso complejo con mayores requerimientos para ejecutar en forma adecuada, segura y oportuna esta actividad. Objetivo: Identificar la concordancia entre conocimiento y realización de la técnica aséptica en la preparación de medicamentos por vía intravenosa. Metodología: Estudio transversal analítico. Mediante un muestreo por conveniencia, se reclutaron 54 enfermeras intensivistas y 19 médicos residentes de anestesia. Variables dependientes: Conocimiento y realización de la técnica aséptica en la preparación de medicamentos intravenosos. Se utilizó una guía de verificación y posteriormente se aplicaron los cuestionarios, bajo los lineamientos de la declaración de Helsinki. Resultados: El 43% de las enfermeras labora en turno vespertino y 89% de los médicos residentes se encontraban rotando en el turno matutino. Del total, 38 personas tienen conocimiento en relación al lavado de manos, 47% no lo realiza. Con una concordancia mediana de 37 personas que tienen conocimiento sobre la utilización del alcohol como bacteriostático, 56% no lo utiliza. De 47 personas que tienen conocimiento con respecto a la limpieza de frascos ámpulas en la preparación de medicamentos, 64% no lo realiza. Discusión: Los resultados obtenidos en este estudio son bastante desfavorables ya que sólo en el lavado de manos se encontró una concordancia mediana y en los otros aspectos estudiados existe discordancia; es preocupante que una práctica tan común y aparentemente sencilla no se lleve a cabo.

Introduction: Aseptic technique on preparing intravenous medications is in a 90% of the cases a nurse responsibility, as pharmacology takes advances, nurses are facing a complex process with major requirements to perform this task in a right, safety, and on time way. Objective: To identify the concordance between knowledge and performance of aseptic technique in preparation of intravenous medications. Methodology: Transversal, analytic study. Throughout sampling for convenience, 54 critical care nurses, and 19 doctors with anesthesia residency were studied. Dependent variables: knowledge and performance of aseptic technique in the preparation of intravenous medications. A verification guide was utilized and later on questionnaires were surveyed under the amendments of Helsinki Declaration. Results: 43% nurses were working in evening shift and 89% of the doctors with residency were floating in the morning shift. It was observed that 38 people had knowledge in relation to hand washing, 47% do not perform it. With a medium concordance, 37 people have knowledge on the use of the alcohol as bacteriostatic, 56% do not use it. From 47 people who have knowledge regarding to vial's cleaning in preparing medications, 64% do not perform it. Discussion: Results obtained in this study are quite unfavorable since only in hand washing it was found a medium concordance and in the others variables it was a discordance; it is a concern that such a common practice and apparently simple practice is not performed up by nurses and doctors.

Regulation of Raoultella terrigena comb.nov. phytase expression.

Phytases catalyze the release of phosphate from phytate (myo-inositol hexakisphosphate) to inositol polyphosphates. Raoultella terrigena comb.nov. phytase activity is known to increase markedly after cells reach the stationary phase. In this study, phytase activity measurements made on single batch cultures indicated that specific enzyme activity was subject to catabolite repression. Cyclic AMP (cAMP) showed a positive effect in expression during exponential growth and a negative effect during stationary phase. RpoS exhibited the opposite effect during both growth phases; the induction to stationary phase decreased twofold in the rpoS::Tn10 mutant, but the effect of RpoS was not clearly determined. Two phy::MudI1734 mutants, MW49 and MW52, were isolated. These formed small colonies in comparison with the MW25 parent strain when plated on Luria-Bertani (LB) or LB supplemented with glucose. They did not grow in minimal media or under anaerobiosis, but did grow aerobically on LB and LB glucose at a lower rate than did MW25. The beta-galactosidase activity level in these mutants increased three to four fold during stationary growth in LB glucose and during anaerobiosis. Addition of cAMP during the exponential growth of MW52 on LB glucose provoked a decrease in beta-galactosidase activity during the stationary phase, confirming its negative effect on phytase expression during stationary growth.