Public health surveillance through community health workers: a scoping review of evidence from 25 low-income and middle-income countries.

BACKGROUND: The last 3 years have witnessed global health challenges, ranging from the pandemics of COVID-19 and mpox (monkeypox) to the Ebola epidemic in Uganda. Public health surveillance is critical for preventing these outbreaks, yet surveillance systems in resource-constrained contexts struggle to provide timely disease reporting. Although community health workers (CHWs) support health systems in low-income and middle-income countries (LMICs), very little has been written about their role in supporting public health surveillance. This review identified the roles, impacts and challenges CHWs face in public health surveillance in 25 LMICs. METHODS: We conducted a scoping review guided by Arksey and O'Malley's framework. We exported 1,156 peer-reviewed records from Embase, Global Health and PubMed databases. After multiple screenings, 29 articles were included in the final review. RESULTS: CHWs significantly contribute to public health surveillance in LMICs including through contact tracing and patient visitation to control major infectious diseases such as HIV/AIDS, malaria, tuberculosis, Ebola, neglected tropical diseases and COVID-19. Their public health surveillance roles typically fall into four main categories including community engagement; data gathering; screening, testing and treating; and health education and promotion. The use of CHWs in public health surveillance in LMICs has been impactful and often involves incorporation of various technologies leading to improved epidemic control and disease reporting. Nonetheless, use of CHWs can come with four main challenges including lack of education and training, lack of financial and other resources, logistical and infrastructural challenges as well as community engagement challenges. CONCLUSION: CHWs are important stakeholders in surveillance because they are closer to communities than other healthcare workers. Further integration and training of CHWs in public health surveillance would improve public health surveillance because CHWs can provide health data on 'hard-to-reach' populations. CHWs' work in public health surveillance would also be greatly enhanced by infrastructural investments.

Servicios farmacéuticos basados en la atención primaria de salud: Herramienta para la evaluación de la calidad de la prestación de los servicios farmacéuticos en países de la Región de las Américas / Pharmaceutical services based on primary health care: Tool for evaluating the quality of the provision of pharmaceutical services in countries of the Region of the Americas

El presente documento ofrece una herramienta robusta que consta de 79 indicadores, basados en los principios de una atención primaria de salud renovada, y diseñados para ser implementados en los servicios farmacéuticos de la Región. En estas páginas se resume el proceso de desarrollo de estos indicadores, iniciado en el 2019 bajo la dirección y coordinación de la Organización Panamericana de la Salud, con aportes del grupo expertos en el tema, talleres regionales y una prueba piloto en Argentina y Perú en el 2022. Asimismo, se describe el enfoque simplificado de niveles de implementación, que facilita la compresión de los resultados de los indicadores y la toma de decisiones, y además, se incluyen algunos elementos clave para que los países los tengan en cuenta en el momento de implementar esta herramienta. Cada indicador se presenta en su correspondiente ficha técnica, que incluye los elementos configurativos, la clasificación según el grado de complejidad y el ámbito de los servicios farmacéuticos. Esto destaca la importancia de redefinir y evaluar la calidad de los servicios farmacéuticos en todos los niveles de atención de salud.

Assessment of the integrated disease surveillance and response system implementation in health zones at risk for viral hemorrhagic fever outbreaks in North Kivu, Democratic Republic of the Congo, following a major Ebola outbreak, 2021.

BACKGROUND: The Democratic Republic of the Congo (DRC) experienced its largest Ebola Virus Disease Outbreak in 2018-2020. As a result of the outbreak, significant funding and international support were provided to Eastern DRC to improve disease surveillance. The Integrated Disease Surveillance and Response (IDSR) strategy has been used in the DRC as a framework to strengthen public health surveillance, and full implementation could be critical as the DRC continues to face threats of various epidemic-prone diseases. In 2021, the DRC initiated an IDSR assessment in North Kivu province to assess the capabilities of the public health system to detect and respond to new public health threats. METHODS: The study utilized a mixed-methods design consisting of quantitative and qualitative methods. Quantitative assessment of the performance in IDSR core functions was conducted at multiple levels of the tiered health system through a standardized questionnaire and analysis of health data. Qualitative data were also collected through observations, focus groups and open-ended questions. Data were collected at the North Kivu provincial public health office, five health zones, 66 healthcare facilities, and from community health workers in 15 health areas. RESULTS: Thirty-six percent of health facilities had no case definition documents and 53% had no blank case reporting forms, limiting identification and reporting. Data completeness and timeliness among health facilities were 53% and 75% overall but varied widely by health zone. While these indicators seemingly improved at the health zone level at 100% and 97% respectively, the health facility data feeding into the reporting structure were inconsistent. The use of electronic Integrated Disease Surveillance and Response is not widely implemented. Rapid response teams were generally available, but functionality was low with lack of guidance documents and long response times. CONCLUSION: Support is needed at the lower levels of the public health system and to address specific zones with low performance. Limitations in materials, resources for communication and transportation, and workforce training continue to be challenges. This assessment highlights the need to move from outbreak-focused support and funding to building systems that can improve the long-term functionality of the routine disease surveillance system.

Using Social Listening for Digital Public Health Surveillance of Human Papillomavirus Vaccine Misinformation Online: Exploratory Study.

Despite challenges related to the data quality, representativeness, and accuracy of artificial intelligence-driven tools, commercially available social listening platforms have many of the attributes needed to be used for digital public health surveillance of human papillomavirus vaccination misinformation in the online ecosystem.

Servicios farmacéuticos basados en la atención primaria de salud: Herramienta para la evaluación de la calidad de la prestación de los servicios farmacéuticos en países de la Región de las Américas

Este documento ofrece una herramienta robusta que consta de 79 indicadores, basados en los principios de una atención primaria de salud renovada, y diseñados para ser implementados en los servicios farmacéuticos de la Región. En estas páginas se resume el proceso de desarrollo de estos indicadores, iniciado en el 2019 bajo la dirección y coordinación de la Organización Panamericana de la Salud, con aportes del grupo expertos en el tema, talleres regionales y una prueba piloto en Argentina y Perú en el 2022. Asimismo, se describe el enfoque simplificado de niveles de implementación, que facilita la compresión de los resultados de los indicadores y la toma de decisiones, y además, se incluyen algunos elementos clave para que los países los tengan en cuenta en el momento de implementar esta herramienta. Cada indicador se presenta en su correspondiente ficha técnica, que incluye los elementos configurativos, la clasificación según el grado de complejidad y el ámbito de los servicios farmacéuticos. Esto destaca la importancia de redefinir y evaluar la calidad de los servicios farmacéuticos en todos los niveles de atención de salud. Este instrumento será útil para las autoridades sanitarias, al permitir la adaptación según las capacidades y objetivos de cada país. Servirá además como recurso de autoevaluación para los servicios farmacéuticos, al facilitar la formulación de planes de mejora continua. El público destinatario incluye a las autoridades sanitarias, asociaciones y colegios de profesionales farmacéuticos, la academia y todas las personas involucradas en la gestión y seguimiento de la atención de los servicios farmacéuticos.

Public health surveillance and the data, information, knowledge, intelligence and wisdom paradigm / Vigilancia de salud pública y el paradigma de datos, información, conocimiento, inteligencia y sabiduría / Vigilância em saúde pública e o paradigma de dados, informações, conhecimento, inteligência e sabedoria

[ABSTRACT]. This article points out deficiencies in present-day definitions of public health surveillance, which include data collection, analysis, interpretation and dissemination, but not public health action. Controlling a public health problem of concern requires a public health response that goes beyond information dissemination. It is unde- sirable to have public health divided into data generation processes (public health surveillance) and data use processes (public health response), managed by two separate groups (surveillance experts and policy-makers). It is time to rethink the need to modernize the definition of public health surveillance, inspired by the authors’ enhanced Data, Information, Knowledge, Intelligence and Wisdom model. Our recommendations include expanding the scope of public health surveillance beyond information dissemination to comprise actionable knowledge (intelligence); mandating surveillance experts to assist policy-makers in making evidence-informed decisions; encouraging surveillance experts to become policy-makers; and incorporating public health literacy training – from data to knowledge to wisdom – into the curricula for all public health professionals. Work on modernizing the scope and definition of public health surveillance will be a good starting point.

[RESUMEN]. En este artículo se señalan las deficiencias de las definiciones actuales de la vigilancia de salud pública, que incluyen la recopilación, el análisis, la interpretación y la difusión de los datos, pero no las medidas de salud pública. El control de un problema de salud pública de interés exige una respuesta de salud pública que vaya más allá de la difusión de información. No es deseable que la salud pública esté dividida por un lado en procesos de generación de datos (vigilancia de salud pública) y por otro en procesos de uso de datos (respuesta de salud pública), gestionados por dos grupos diferentes (expertos en vigilancia y responsables de la formulación de políticas). Ha llegado el momento de replantear la necesidad de modernizar la definición de la vigilancia de salud pública tomando como referencia el modelo mejorado de Datos, Información, Cono- cimiento, Inteligencia y Sabiduría de los autores. Entre las recomendaciones que se proponen se encuentran las de ampliar el alcance de la vigilancia de salud pública más allá de la difusión de información para que incluya también el conocimiento aplicable (inteligencia); instar a los expertos en vigilancia a que presten ayuda a los responsables de la formulación de políticas en la toma de decisiones basadas en la evidencia; alentar a los expertos en vigilancia a que se conviertan en responsables de la formulación de políticas; e incorporar la formación en conocimientos básicos de salud pública (desde los datos hasta los conocimientos y la sabiduría) en los planes de estudio de todos los profesionales de la salud pública. Un buen punto de partida será trabajar en la modernización del alcance y la definición de la vigilancia de salud pública.

[RESUMO]. Este artigo aponta deficiências nas definições atuais de vigilância em saúde pública, que incluem coleta, análise, interpretação e disseminação de dados, mas não ações de saúde pública. O controle de um prob- lema preocupante de saúde pública exige uma resposta de saúde pública que vá além da disseminação de informações. A saúde pública não deve ser dividida em processos de geração de dados (vigilância em saúde pública) e processos de uso de dados (resposta de saúde pública) gerenciados por dois grupos distintos (especialistas em vigilância e formuladores de políticas). É hora de repensar a necessidade de modernizar a definição de vigilância em saúde pública, inspirada no modelo aprimorado de Dados, Informações, Con- hecimento, Inteligência e Sabedoria dos autores. Nossas recomendações incluem: expansão do escopo da vigilância em saúde pública para além da disseminação de informações, de modo a abranger conhecimentos acionáveis (inteligência); obrigatoriedade de que os especialistas em vigilância auxiliem os formuladores de políticas na tomada de decisões baseadas em evidências; incentivo para que os especialistas em vigilân- cia se tornem formuladores de políticas; e incorporação de capacitação em letramento em saúde pública (partindo dos dados para o conhecimento e em seguida para a sabedoria) nos currículos de todos os profis- sionais de saúde pública. O trabalho de modernizar o escopo e a definição de vigilância em saúde pública será um bom ponto de partida.

Avaliação da Cooperação Técnica desenvolvida entre o Ministério da Saúde e a Organização Pan-Americana de Saúde/Organização Mundial da Saúde (OPAS/OMS) 75º Termo de Cooperação Técnica Projeto “Fortalecimento da Gestão do Sistema Nacional de Vigilância em Saúde”

A Vigilância em Saúde desempenha papel estratégico já que pressupõe o acompanhamento e análise permanentes da situação de saúde da população visando, direcionar ações para controlar determinantes, riscos e danos à saúde da população, garantindo-se a integralidade da atenção individual e coletiva dos problemas de saúde. Abrange a Vigilância Epidemiológica das doenças transmissíveis e não transmissíveis, a Vigilância em Saúde Ambiental em Saúde e a Vigilância em Saúde do Trabalhador. A Política Nacional de Vigilância em Saúde (PNVS), instituída em 2018 por meio da Resolução CNS nº 588, norteia o planejamento das ações de vigilância em saúde nas três esferas de gestão do SUS, caracterizado pela definição das responsabilidades, princípios, diretrizes e estratégias dessa vigilância. A importância desse tema tornou o processo de gestão em Vigilância em Saúde ainda mais aprimorado e eficiente, com o alcance dos objetivos e uso racional de recursos, aprimorando a relação custo-efetividade das ações, programas e políticas. A finalidade e objetivos do TC 75 foram alinhados ao plano estratégico de cooperação técnica da OPAS/OMS e com os Objetivos de Desenvolvimento do Milênio (ODM).

Tuberculosis surveillance and monitoring in Europe 2024 – 2022 data

This report provides an overview of the latest tuberculosis (TB) epidemiological situation and is published jointly by the WHO Regional Office for Europe and the European Centre for Disease Prevention and Control. In 2022, a little over 170 000 incident TB cases were notified in countries of the WHO European Region, a slight increase from 2021. The increase in 2022 is likely due to a good recovery after the COVID-19 pandemic in access to and provision of TB services in many countries and the introduction of active TB case-finding activities. Despite the notable progress achieved in the fight against TB, countries still face various challenges in reaching the goal of ending the TB epidemic in the WHO European Region. Monitoring progress towards the targets of the new Tuberculosis action plan for the WHO European Region 2023–2030 is difficult due to limited or no reporting on some indicators. Further improvement of data completeness and representativeness should be the focus for all countries.

Privacidade e confidencialidade dos dados de pessoas idosas frente às tecnologias de monitoramento em saúde / Privacidad y confidencialidad de los datos de las personas mayores frente a las tecnologías de vigilancia de la salud / Privacitat i confidencialitat de les dades de las persones grans davant les tecnologies de vigilància de la salut / Privacy and data confidentiality of older people in the face of health monitoring technologies

O presente artigo discute os avanços e desafios das tecnologias de monitoramento em saúde de pessoas idosas e suas implicações na privacidade e confidencialidade dos dados coletados. Trata-se de estudo exploratório, fundamentado na literatura, com síntese narrativa. O texto contextualiza as demandas decorrentes do envelhecimento populacional e o uso de sensores e de outros dispositivos eletrônicos no monitoramento de atividades diárias de pessoas idosas em ambientes internos e externos. É importante ressaltar que os benefícios oferecidos pelas tecnologias não devem comprometer a privacidade e a confidencialidade dos dados. Para garantir isso, é necessário aprimorar os mecanismos regulatórios, estabelecendo padrões de segurança e princípios éticos para a proteção de dados pessoais, respeitando a privacidade e a confidencialidade dos dados.(AU)

L'article present discuteix els avenços i reptes de les tecnologies de monitoratge en salut de les persones majors i les seves implicacions en la privacitat i confidencialitat de les dades recopilades. Es tracta d'un estudi exploratori, fonamentat en la literatura, amb una síntesi narrativa. El text contextualitza les demandes derivades de l'envelliment de la població i l'ús de sensors i d'altres dispositius electrònics en el monitoratge de les activitats quotidianes de les persones majors en ambients interns i externs. És important destacar que els beneficis oferts per les tecnologies no han de comprometre la privacitat i la confidencialitat de les dades. Per garantir-ho, és necessari millorar els mecanismes reguladors, establint estàndards de seguretat i principis ètics pera la protecció de dades personals, respectant la privacitat i la confidencialitat de les dades.(AU)

El presente artículo discute los avances y desafíos de las tecnologías de monitorización en salud de personas mayores y sus implicaciones en la privacidad y confidencialidad de los datos recolectados. Se trata de un estudio exploratorio, fundamentado en la literatura, con síntesis narrativa. El texto contextualiza las demandas derivadas del envejecimiento poblacional y el uso de sensores y otros dispositivos electrónicos en la monitorización de actividades diarias de personas mayores en ambientes internos y externos. Es importante resaltar que los beneficios ofrecidos por las tecnologías no deben comprometer la privacidad y confidencialidad de los datos. Para garantizar esto, es necesario mejorar los mecanismos reguladores, estableciendo estándares de seguridad y principios éticos para la protección de datos personales, respetando la privacidad y confidencialidad de los dato.(AU)

This article discusses the advances and challenges of health monitoring technologies for elderly individuals and their implications on the privacy and confidentiality of collected data. It is an exploratory study grounded in the literature, with a narrative synthesis. The text contextualizes the demands arising from the aging population and the use of sensors and other electronic devices in monitoring daily activities of elderly people in both indoor and outdoor environments. It is important to emphasize that the benefits offered by these technologies should not compromise the privacy and confidentiality of the data. To ensure this, it is necessary to enhance regulatory mechanisms by establishing security standards and ethical principles for the protection of personal data, while respecting privacy and data confidentiality.(AU)

Optimal environmental testing frequency for outbreak surveillance.

Public health surveillance for pathogens presents an optimization problem: we require enough sampling to identify intervention-triggering shifts in pathogen epidemiology, such as new introductions or sudden increases in prevalence, but not so much that costs due to surveillance itself outweigh those from pathogen-associated illness. To determine this optimal sampling frequency, we developed a general mathematical model for the introduction of a new pathogen that, once introduced, increases in prevalence exponentially. Given the relative cost of infection vs. sampling, we derived equations for the expected combined cost per unit time of disease burden and surveillance for a specified sampling frequency, and thus the sampling frequency for which the expected total cost per unit time is lowest.

Enhancing the notification system for surveillance of infectious diseases in Qatar during the FIFA World Cup 2022: project overview.

BACKGROUND: In 2022, the Surveillance Department of the Ministry of Public Health in Qatar adopted an integrated project called the Notification Enhancement Project (NEP) to enhance the infectious disease notification system. Efficient surveillance and notification promote early alerts and allow immediate interference in reducing morbidity and mortality from outbreaks. The project was designed to improve the knowledge, attitudes, practices, and notification processes of healthcare workers in Qatar by increasing their reporting rates. METHODS: The strategy for comprehensively enhancing notifications was based on the observation and evaluation of the current notification system, the implementation of interventions, and post-evaluation follow-up. To implement the project, we relied on three aspects: effective methods used in previous relevant studies through a literature review, feedback received from healthcare workers, and suggestions from public health surveillance experts from the Ministry of Public Health, Qatar. A preassessment was conducted through an online survey by the Ministry of Public Health. The effectiveness of the different interventions was assessed by analyzing the data of notified patients reported through the Disease Surveillance and Reporting Electronic System. Pre- and postintervention assessments were performed by comparing the percentage of patients notified by healthcare providers with that of patients confirmed by healthcare providers in the laboratory to compare the notification rates over three time periods between January and December 2022. RESULTS: There was significant improvement in the infectious disease notification process. A comparison before and after the implementation of the interventions revealed an increase in the communicable disease notification rate among healthcare workers. Pre- and postintervention data were compared. Infectious disease notification activities by healthcare workers increased from 2.5% between January and May 2022 to 41.4% between November and December 2022. CONCLUSION: This study highlights the efficiency of different interventions in correcting the underreporting of infectious diseases. Our findings suggest that implementing the Notification Enhancement Project significantly improves notification rates. We recommend continuing interventions through constant education and training, maintaining solid communication with HCWs through regular reminder emails and feedback, periodic assessment of the electronic notification system, and engagement of healthcare workers and other stakeholders to sustain and expand progress achieved through continuous evaluation.

Early detection of new pandemic waves. Control chart and a new surveillance index.

The COVID-19 pandemic highlights the pressing need for constant surveillance, updating of the response plan in post-peak periods and readiness for the possibility of new waves of the pandemic. A short initial period of steady rise in the number of new cases is sometimes followed by one of exponential growth. Systematic public health surveillance of the pandemic should signal an alert in the event of change in epidemic activity within the community to inform public health policy makers of the need to control a potential outbreak. The goal of this study is to improve infectious disease surveillance by complementing standardized metrics with a new surveillance metric to overcome some of their difficulties in capturing the changing dynamics of the pandemic. At statistically-founded threshold values, the new measure will trigger alert signals giving early warning of the onset of a new pandemic wave. We define a new index, the weighted cumulative incidence index, based on the daily new-case count. We model the infection spread rate at two levels, inside and outside homes, which explains the overdispersion observed in the data. The seasonal component of real data, due to the public surveillance system, is incorporated into the statistical analysis. Probabilistic analysis enables the construction of a Control Chart for monitoring index variability and setting automatic alert thresholds for new pandemic waves. Both the new index and the control chart have been implemented with the aid of a computational tool developed in R, and used daily by the Navarre Government (Spain) for virus propagation surveillance during post-peak periods. Automated monitoring generates daily reports showing the areas whose control charts issue an alert. The new index reacts sooner to data trend changes preluding new pandemic waves, than the standard surveillance index based on the 14-day notification rate of reported COVID-19 cases per 100,000 population.

The importance of meropenem resistance, rather than imipenem resistance, in defining carbapenem-resistant Enterobacterales for public health surveillance: an analysis of national population-based surveillance.

BACKGROUND: In Japan, carbapenem-resistant Enterobacterales (CRE) infections were incorporated into the National Epidemiological Surveillance of Infectious Diseases (NESID) in 2014, necessitating mandatory reporting of all CRE infections cases. Subsequently, pathogen surveillance was initiated in 2017, which involved the collection and analysis of CRE isolates from reported cases to assess carbapenemase gene possession. In this surveillance, CRE is defined as (i) minimum inhibitory concentration (MIC) of meropenem ≥2 mg/L (MEPM criteria) or (ii) MIC of imipenem ≥2 mg/L and MIC of cefmetazole ≥64 mg/L (IPM criteria). This study examined whether the current definition of CRE surveillance captures cases with a clinical and public health burden. METHODS: CRE isolates from reported cases were collected from the public health laboratories of local governments, which are responsible for pathogen surveillance. Antimicrobial susceptibility tests were conducted on these isolates to assess compliance with the NESID CRE definition. The NESID data between April 2017 and March 2018 were obtained and analyzed using antimicrobial susceptibility test results. RESULTS: In total, 1681 CRE cases were identified during the study period, and pathogen surveillance data were available for 740 (44.0%) cases. Klebsiella aerogenes and Enterobacter cloacae complex were the dominant species, followed by Klebsiella pneumoniae and Escherichia coli. The rate of carbapenemase gene positivity was 26.5% (196/740), and 93.4% (183/196) of these isolates were of the IMP type. Meanwhile, 315 isolates were subjected to antimicrobial susceptibility testing. Among them, 169 (53.7%) fulfilled only the IPM criteria (IPM criteria-only group) which were susceptible to meropenem, while 146 (46.3%) fulfilled the MEPM criteria (MEPM criteria group). The IPM criteria-only group and MEPM criteria group significantly differed in terms of carbapenemase gene positivity (0% vs. 67.8%), multidrug resistance rates (1.2% vs. 65.8%), and mortality rates (1.8% vs 6.9%). CONCLUSION: The identification of CRE cases based solely on imipenem resistance has had a limited impact on clinical management. Emphasizing resistance to meropenem is crucial in defining CRE, which pose both clinical and public health burden. This emphasis will enable the efficient allocation of limited health and public health resources and preservation of newly developed antimicrobials.

Incidence of childhood cancer in Latin America and the Caribbean: coverage, patterns, and time trends / Incidencia del cáncer infantil en América Latina y el Caribe: cobertura de los registros, patrones y tendencias a lo largo del tiempo / Incidência de câncer infantil na América Latina e no Caribe: cobertura, padrões e tendências temporais

[ABSTRACT]. Objective. To provide a comprehensive overview of geographical patterns (2001–2010) and time trends (1993–2012) of cancer incidence in children aged 0–19 years in Latin America and the Caribbean (LAC) and interpret the findings in the context of global patterns. Methods. Geographical variations in 2001–2010 and incidence trends over 1993–2012 in the population of LAC younger than 20 years were described using the database of the third volume of the International Incidence of Childhood Cancer study containing comparable data. Age-specific incidence per million person-years (ASR) was calculated for population subgroups and age-standardized (WSR) using the world standard population. Results. Overall, 36 744 unique cases were included in this study. In 2001–2010 the overall WSR in age 0–14 years was 132.6. The most frequent were leukemia (WSR 48.7), central nervous system neoplasms (WSR 23.0), and lymphoma (WSR 16.6). The overall ASR in age group 15–19 years was 152.3 with lymphoma rank- ing first (ASR 30.2). Incidence was higher in males than in females, and higher in South America than in Central America and the Caribbean. Compared with global data LAC incidence was lower overall, except for leukemia and lymphoma at age 0–14 years and the other and unspecified tumors at any age. Overall incidence at age 0–19 years increased by 1.0% per year (95% CI [0.6, 1.3]) over 1993–2012. The included registries covered 16% of population aged 0–14 years and 10% of population aged 15–19 years. Conclusions. The observed patterns provide a baseline to assess the status and evolution of childhood can- cer occurrence in the region. Extended and sustained support of cancer registration is required to improve representativeness and timeliness of data for childhood cancer control in LAC.

[RESUMEN]. Objetivo. Presentar un panorama integral de los patrones geográficos (2001 a 2010) y las tendencias a lo largo del tiempo (1993 a 2012) de la incidencia de cáncer en la población infantil de 0 a 19 años en América Latina y el Caribe e interpretar los resultados en el contexto de los patrones mundiales. Métodos. Se describen las diferencias geográficas en el período 2001-2010 y las tendencias de la incidencia entre 1993 y el 2012 correspondientes a la población menor de 20 años de América Latina y el Caribe, mediante el empleo de la base de datos del tercer volumen del estudio de Incidencia Internacional del Cáncer Infantil, (IICC, por su sigla en inglés), que contiene datos comparables. Se calculó la tasa de incidencia específica para la edad (TEE) por millón de años-persona para los diversos subgrupos poblacionales y la tasa de incidencia mundial estandarizada según la edad (TEM) utilizando la población estándar mundial. Resultados. El estudio incluyó un total de 36 744 casos únicos. En el período del 2001 al 2010, la TEM general en la franja etaria de 0 a 14 años fue de 132,6. Los cánceres más frecuentes fueron la leucemia (TEM 48,7), las neoplasias del sistema nervioso central (TEM 23,0) y el linfoma (TEM 16,6). La TEE general en la franja etaria de 15 a 19 años fue de 152,3, con el linfoma como cáncer más frecuente (TEE 30,2). La incidencia fue mayor en el sexo masculino que en el femenino, y fue más alta en América del Sur que en Centroamérica y el Caribe. En comparación con los datos mundiales, en América Latina y el Caribe la incidencia fue, en general, menor, excepto en el caso de leucemia y el linfoma en la franja etaria de 0–14 años y los cánceres classificados como otros tumores y tumores sin especificar en todas las edades. La incidencia general en la franja etaria de 0-19 años aumentó en un 1,0 % al año (IC del 95 % [0,6, 1,3]) entre 1993 y el 2012. La cobertura de los registros incluidos fue de un 16% de la población de 0 a 14 años y de un 10% de la de 15 a 19 años. Conclusiones. Los patrones observados proporcionan un valor de referencia para evaluar el estado y la evolución de la incidencia del cáncer infantil en la Región. Es necesario contar con un apoyo mayor y más sostenido para el registro del cáncer a fin de mejorar la representatividad y la oportunidad de los datos relativos al control del cáncer infantil en América Latina y el Caribe.

[RESUMO]. Objetivo. Apresentar uma visão abrangente dos padrões geográficos (2001 a 2010) e das tendências temporais (1993 a 2012) da incidência de câncer em crianças e jovens de 0 a 19 anos na América Latina e no Caribe (ALC) e interpretar os resultados no contexto de padrões mundiais. Métodos. Foram descritas variações geográficas de 2001 a 2010 e tendências de incidência de 1993 a 2012 na população com menos de 20 anos da ALC usando informações comparáveis da base de dados do terceiro volume do estudo International Incidence of Childhood Cancer. Foram calculadas taxas de incidência específica por idade por milhão de pessoas-ano (ASR, na sigla em inglês) para subgrupos populacionais e taxas padronizadas por idade usando a população padrão mundial (WSR, na sigla em inglês). Resultados. No total, foram incluídos 36 744 casos únicos. No período de 2001 a 2010, a WSR para todos os tumores combinados na faixa etária de 0 a 14 anos foi de 132,6. Os diagnósticos mais frequentes foram leucemia (WSR de 48,7), neoplasias do sistema nervoso central (WSR de 23,0) e linfoma (WSR de 16,6). A ASR para todos os tumores combinados na faixa etária de 15 a 19 anos foi de 152,3, e a maior taxa foi a de linfoma (ASR de 30,2). A incidência foi maior no sexo masculino do que no sexo feminino e maior na América do Sul do que na América Central e no Caribe. De modo geral, em comparação com as estimativas mundiais, a incidência na ALC foi menor, exceto para leucemia e linfoma entre 0 e 14 anos e para outros tumores e tumores não especificados em qualquer idade. A taxa de incidência na faixa etária de 0 a 19 anos aumentou em 1,0% ao ano (IC de 95% [0,6, 1,3]) entre 1993 e 2012. Os registros incluídos cobriam 16% da população de 0 a 14 anos e 10% da população de 15 a 19 anos. Conclusões. Os padrões observados servem de referência para avaliar o status e a evolução da ocorrência de câncer infantil na região. É necessário garantir um apoio ampliado e consistente aos registros de câncer para aprimorar a representatividade e a disponibilidade das informações em tempo adequado para o controle do câncer infantil na ALC.

Factores sociodemográficos y ambientales relacionados con el uso de mascarillas en la población durante la pandemia por la COVID-19 / Sociodemographic and environmental factors associated with mask use during the COVID-19 pandemic

Fundamentos: Durante la pandemia de la COVID-19 se implementaron medidas de prevención con el propósito de reducir su transmisión comunitaria. El grado de cumplimiento con estas medidas estuvo influenciado por diversos factores sociodemográficos y ambientales. Sin embargo, existe escasa literatura científica que aborde el cumplimiento de las medidas preventivas en la población general. El objetivo de este estudio fue analizar la asociación entre factores sociodemográficos y ambientales, así como la adhesión al uso de mascarillas en contactos estrechos. Métodos: Se realizó un estudio transversal con 1.778 individuos, identificados mediante el rastreo de contactos estrechos de personas con SARS-CoV-2 por la Central de Coordinación de la COVID-19 de Mallorca, entre febrero y junio de 2021. Se realizó un análisis descriptivo y se utilizó un modelo de regresión logística para determinar los factores asociados al incumplimiento del uso de mascarillas.Resultados: La edad media de los participantes fue de 42,8±17,4 años (53,6% de mujeres). El 60,8% (IC 95%: 57,8-62,3) de los contactos estrechos no utilizó mascarilla durante su contacto. No se observaron diferencias estadísticamente significativas en función del sexo o grupo etario (p=0,497 y p=0,536, respectivamente). Las situaciones de mayor incumplimiento con el uso de mascarillas se dieron en el entorno domiciliario, espacios cerrados sin ventilación y al mantener distancias cortas (p<0,001). Conclusiones: Nuestros hallazgos indican una menor adhesión al uso de mascarillas en escenarios de mayor riesgo. Frente a futuras situaciones de crisis sanitaria, se deberían diseñar intervenciones que realcen la conciencia sobre los riesgos y que promuevan una mayor adhesión a medidas de prevención y control.(AU)

Background: During COVID-19 pandemic, prevention measures were implemented to mitigate the community transmission of SARS-CoV-2. Compliance with these measures was influenced by several sociodemographic and environmental factors. However, literature addressing compliance with these prevention measures among the general population remains limited. The study aimed to assess the association of sociodemographic and environmental factors and mask usage during close contact situations. Methods: A cross-sectional study was conducted with a sample of 1,778 individuals identified through close contact tracing of indivi-duals diagnosed with SARS-CoV-2 by the COVID-19 Coordination Center of Mallorca, from February to June 2021. A descriptive analysis was conducted, and a logistic regression model was utilized to evaluate factors associated with mask non-compliance. Results: The mean age of the participants was 42.8±17.4 years, with 53.6% being female. Among close contacts, 60.8% (95% CI: 57.8-62.3) did not use masks during their contact. No significant differences were observed between genders or across age groups (p=0.497 and p=0.536, respectively). Factors linked to mask non-compliance included the home setting, indoor spaces without venti-lation, and closer physical distances (p<0.001). Conclusions: Our findings indicate that mask adherence was notably lower among close contacts exposed to higher risk. In future public health crises, interventions should be developed to raise awareness about risks and promote adherence to preventive and control measures.(AU)

Developing public health surveillance dashboards: a scoping review on the design principles.

BACKGROUND: Public Health Dashboards (PHDs) facilitate the monitoring and prediction of disease outbreaks by continuously monitoring the health status of the community. This study aimed to identify design principles and determinants for developing public health surveillance dashboards. METHODOLOGY: This scoping review is based on Arksey and O'Malley's framework as included in JBI guidance. Four databases were used to review and present the proposed principles of designing PHDs: IEEE, PubMed, Web of Science, and Scopus. We considered articles published between January 1, 2010 and November 30, 2022. The final search of articles was done on November 30, 2022. Only articles in the English language were included. Qualitative synthesis and trend analysis were conducted. RESULTS: Findings from sixty-seven articles out of 543 retrieved articles, which were eligible for analysis, indicate that most of the dashboards designed from 2020 onwards were at the national level for managing and monitoring COVID-19. Design principles for the public health dashboard were presented in five groups, i.e., considering aim and target users, appropriate content, interface, data analysis and presentation types, and infrastructure. CONCLUSION: Effective and efficient use of dashboards in public health surveillance requires implementing design principles to improve the functionality of these systems in monitoring and decision-making. Considering user requirements, developing a robust infrastructure for improving data accessibility, developing, and applying Key Performance Indicators (KPIs) for data processing and reporting purposes, and designing interactive and intuitive interfaces are key for successful design and development.

Atualização epidemiológica: circulação do SARS-CoV-2 e de outros vírus respiratórios nas Américas

A Organização Pan-Americana da Saúde (OPAS) publicou esta semana uma atualização epidemiológica sobre os vírus respiratórios na Região das Américas. A atualização fornece recomendações para manter a vigilância desses vírus e fortalecer a resposta dos sistemas de saúde, especialmente devido aos atuais surtos de outras doenças transmissíveis.

Estratificação de áreas de risco de transmissão de sarampo: uma revisão sistemática

[RESUMO]. Objetivo. Realizar uma revisão sistemática de publicações científicas que abordaram experiências de aplicação de métodos de estratificação para definir áreas de risco de transmissão de sarampo. Método. Foram selecionados artigos publicados nos idiomas inglês, português e espanhol em periódicos indexados nas bases SciELO, PubMed e LILACS. A busca utilizou os descritores risk assessment AND measles, sem delimitação de período. Foram excluídos editoriais, artigos de opinião, estudos observacionais de nível individual e publicações que não tratavam da aplicação de métodos de estratificação de áreas de risco de transmissão de sarampo. As informações de ano de publicação, autoria, país de realização do estudo, objetivo, escala geográfica, método utilizado, indicadores e limitações foram extraídas por meio de formulário. Resultados. Foram selecionados 13 artigos publicados entre 2011 e 2022 em nove países das seis regiões da Organização Mundial da Saúde (OMS). Desses, 10 tiveram como referência a ferramenta Measles Risk Assessment Tool desenvolvida pela OMS/Centers for Disease Control and Prevention. Apenas um estudo adaptou a ferramenta ao contexto local. Os indicadores utilizados para a estratificação de risco enfocaram uma combinação das dimensões imunidade populacional, qualidade dos sistemas de vigilância e situação epidemiológica. Como dificuldades para a estratificação de risco, destaca-se a produção sistemática de dados com cobertura e qualidade adequadas. Conclusão. As estratégias de estratificação do risco de transmissão de sarampo parecem ser ainda pouco difundidas, especialmente na escala local. Reitera-se a necessidade de estímulo à capacitação de recursos humanos para processamento e interpretação das análises de risco nas rotinas dos serviços de vigilância.

[ABSTRACT]. Objective. To perform a systematic review of scientific publications addressing the use of stratification methods to define risk areas for measles transmission. Method. Articles published in English, Portuguese, and Spanish in journals indexed in the SciELO, PubMed, and LILACS databases were selected. The search terms risk assessment AND measles were used without date limits. Editorials, opinion articles, individual-level observational studies, and publications that did not focus on the application of methods to stratify measles transmission risk areas were excluded. Year of publication, authorship, country where the study was performed, objective, geographic level of analysis, method used, indicators, and limitations were recorded in a data form. Results. Thirteen articles published between 2011 and 2022 in nine countries from the six World Health Organization (WHO) regions were selected. Of these, 10 referred to the Measles Risk Assessment Tool developed by the WHO/Centers for Disease Control and Prevention. Only one study adapted the tool to the local context. The risk stratification indicators used in the selected studies focused on a combination of the following dimensions: population immunity, quality of surveillance systems, and epidemiologic status. The systematic output of data with adequate quality and coverage was a noteworthy aspect hindering risk stratification. Conclusion. There seems to be limited dissemination of measles risk stratification strategies, especially at local levels. The need to train human resources to process and interpret risk analyses as part of the routine of surveillance services is emphasized.

[RESUMEN]. Objetivo. Realizar una revisión sistemática de las publicaciones científicas en las que se han abordado experiencias de aplicación de métodos de estratificación para definir las zonas de riesgo de transmisión del sarampión. Método. Se seleccionaron artículos publicados en español, inglés o portugués en revistas indizadas en las bases de datos SciELO, PubMed y LILACS. En la búsqueda se utilizaron los descriptores "risk assessment" y "measles", sin limitaciones en la fecha de publicación. Se excluyeron editoriales, artículos de opinión, estudios de observación de pacientes individuales y publicaciones que no tratasen de la aplicación de métodos de estratificación de zonas de riesgo de transmisión del sarampión. Se empleó un formulario para extraer la información sobre año de publicación, autoría, país de realización del estudio, objetivo, escala geográfica, método utilizado, indicadores y limitaciones. Resultados. Se seleccionaron 13 artículos publicados entre el 2011 y el 2022 en nueve países de las seis regiones de la Organización Mundial de la Salud (OMS). En 10 de ellos se utilizó como referencia la herramienta de evaluación del riesgo de sarampión creada por la OMS y los Centros para el Control y la Prevención de Enfermedades de Estados Unidos. Solamente en un estudio se adaptó la herramienta al contexto local. Los indicadores utilizados para la estratificación del riesgo se basaron en una combinación de las dimensiones de inmunidad poblacional, calidad de los sistemas de vigilancia y situación epidemiológica. Entre las dificultades de la estratificación del riesgo se destaca la de generación sistemática de datos con una cobertura y calidad adecuadas. Conclusiones. Las estrategias de estratificación del riesgo de transmisión del sarampión siguen sin estar, al parecer, muy extendidas, en especial a nivel local. Cabe reiterar la necesidad de fomentar la capacitación de recursos humanos para procesar e interpretar los análisis de riesgo en las operaciones habituales de los servicios de vigilancia.

A response playbook for early detection and population surveillance of new SARS-CoV-2 variants in a regional public health laboratory.

BACKGROUND: Timely genomic surveillance is required to inform public health responses to new SARS-CoV-2 variants. However, the processes involved in local genomic surveillance introduce inherent time constraints. The Regional Innovative Public Health Laboratory in Chicago developed and employed a genomic surveillance response playbook for the early detection and surveillance of emerging SARS-CoV-2 variants. METHODS: The playbook outlines modifications to sampling strategies, laboratory workflows, and communication processes based on the emerging variant's predicted viral characteristics, observed public health impact in other jurisdictions and local community risk level. The playbook outlines procedures for implementing and reporting enhanced and accelerated genomic surveillance, including supplementing whole genome sequencing (WGS) with variant screening by quantitative PCR (qPCR). RESULTS: The ability of the playbook to improve the response to an emerging variant was tested for SARS-CoV-2 Omicron BA.1. Increased submission of clinical remnant samples from local hospital laboratories enabled detection of a new variant at an average of 1.4% prevalence with 95% confidence rather than 3.5% at baseline. Genotyping qPCR concurred with WGS lineage assignments in 99.9% of 1541 samples with results by both methods, and was more sensitive, providing lineage results in 90.4% of 1833 samples rather than 85.1% for WGS, while significantly reducing the time to lineage result. CONCLUSIONS: The genomic surveillance response playbook provides a structured, stepwise, and data-driven approach to responding to emerging SARS-CoV-2 variants. These pre-defined processes can serve as a template for other genomic surveillance programs to streamline workflows and expedite the detection and public health response to emerging variants. Based on the processes piloted during the Omicron BA.1 response, this method has been applied to subsequent Omicron subvariants and can be readily applied to future SARS-CoV-2 emerging variants and other public health surveillance activities.

Rapidly scalable and low-cost public health surveillance reporting system for COVID-19.

OBJECTIVE: Data-driven innovations are essential in strengthening disease control. We developed a low-cost, open-source system for robust epidemiological intelligence in response to the COVID-19 crisis, prioritising scalability, reproducibility and dynamic reporting. METHODS: A five-tiered workflow of data acquisition; processing; databasing, sharing, version control; visualisation; and monitoring was used. COVID-19 data were initially collated from press releases and then transitioned to official sources. RESULTS: Key COVID-19 indicators were tabulated and visualised, deployed using open-source hosting in October 2022. The system demonstrated high performance, handling extensive data volumes, with a 92.5% user conversion rate, evidencing its value and adaptability. CONCLUSION: This cost-effective, scalable solution aids health specialists and authorities in tracking disease burden, particularly in low-resource settings. Such innovations are critical in health crises like COVID-19 and adaptable to diverse health scenarios.