Emergence of Neisseria meningitidis W South American sublineage strain variant in Brazil: disease and carriage.

Introduction. Invasive meningococcal disease is a major health problem, impacting morbidity and mortality worldwide. Exploratory genomics has revealed insights into adaptation, transmissibility and virulence to elucidate endemic, outbreaks or epidemics caused by Neisseria meningitidis serogroup W (MenW) strains.Gap Statement. Limited information on the genomics of Neisseria meningitis serogroup W ST11/cc11 is available from emerging countries, especially in contemporary isolates.Aim. To (i) describe the antigenic diversity and distribution of genetic lineages of N. meningitidis serogroup W circulating in Brazil; (ii) study the carriage prevalence of hypervirulent clones in adolescents students and (iii) analyse the potential risk factors for meningococcal carriage.Methodology. Using whole-genome sequencing, we analysed the genomic diversity of 92 invasive N. meningitidis serogroup W isolates circulating in Brazil from 2016 to 2019. A cross-sectional survey of meningococcal carriage was conducted in 2019, in the city of Florianópolis, Brazil, among a representative sample of 538 students.Results. A predominance (58.5 %, 41/82) of ST11/cc11 presenting PorB2-144, PorA VR1-5, VR2-2, FetA 1-1, and a novel fHbp peptide 1241 was found on invasive N. meningitidis W isolates, on the other hand, a high diversity of clonal complexes was found among carriage isolates. The overall carriage rate was 7.5 % (40/538). A total of 28 of 538 swab samples collected were culture positive for N. meningitidis, including four serogroup/genogroup B isolates (14.8 %;4/27), 1 serogroup/genogroup Y isolate (3.7 %;1/27), 22 (81.5 %; 22/27) non-groupable isolates. No MenW isolate was identified among carriages isolates.Conclusion. This report describes the emergence of the new MenW ST11/cc11 South America sublineage variant, named here, 2016 strain, carrying a novel fHbp peptide 1241, but its emergence, was not associated with an increased MenW carriage prevalence. Continuous surveillance is necessary to ascertain the role of this sublineage diversification and how its emergence can impact transmission.

Emergence of Neisseria meningitidis W South American sublineage strain variant in Brazil: disease and carriage

Introduction. Invasive meningococcal disease is a major health problem, impacting morbidity and mortality worldwide. Exploratory genomics has revealed insights into adaptation, transmissibility and virulence to elucidate endemic, outbreaks or epidemics caused by Neisseria meningitidis serogroup W (MenW) strains.Gap Statement. Limited information on the genomics of Neisseria meningitis serogroup W ST11/cc11 is available from emerging countries, especially in contemporary isolates.Aim. To (i) describe the antigenic diversity and distribution of genetic lineages of N. meningitidis serogroup W circulating in Brazil; (ii) study the carriage prevalence of hypervirulent clones in adolescents students and (iii) analyse the potential risk factors for meningococcal carriage.Methodology. Using whole-genome sequencing, we analysed the genomic diversity of 92 invasive N. meningitidis serogroup W isolates circulating in Brazil from 2016 to 2019. A cross-sectional survey of meningococcal carriage was conducted in 2019, in the city of Florianópolis, Brazil, among a representative sample of 538 students.Results. A predominance (58.5 %, 41/82) of ST11/cc11 presenting PorB2-144, PorA VR1-5, VR2-2, FetA 1-1, and a novel fHbp peptide 1241 was found on invasive N. meningitidis W isolates, on the other hand, a high diversity of clonal complexes was found among carriage isolates. The overall carriage rate was 7.5 % (40/538). A total of 28 of 538 swab samples collected were culture positive for N. meningitidis, including four serogroup/genogroup B isolates (14.8 %;4/27), 1 serogroup/genogroup Y isolate (3.7 %;1/27), 22 (81.5 %; 22/27) non-groupable isolates. No MenW isolate was identified among carriages isolates.Conclusion. This report describes the emergence of the new MenW ST11/cc11 South America sublineage variant, named here, 2016 strain, carrying a novel fHbp peptide 1241, but its emergence, was not associated with an increased MenW carriage prevalence. Continuous surveillance is necessary to ascertain the role of this sublineage diversification and how its emergence can impact transmission.

Structure and work process for implementing medical teleconsultation in the Brazilian National Health System, a cross-sectional study using 2017-2018 data. / Estrutura e processo de trabalho para implantação da teleconsulta médica no Sistema Único de Saúde do Brasil, um estudo transversal com dados de 2017-2018.

OBJECTIVE: To compare the structure and the work process in Primary Care for implementing medical teleconsultation in municipalities in different regions and with different population sizes (<25,000; 25,000-100,000; >100,000 inhabitants). METHODS: Cross-sectional study, with descriptive and bivariate analysis, using data from 2017-2018 to assess the availability of computers with internet access, webcam, microphone, speaker, as well as to assess the work processes (use of Telehealth, service supply and demand control center, and communication flow). RESULTS: 30,346 primary health centers and 38,865 teams were evaluated. Presence of teleconsultation equipment in the health centers ranged from 1.2% in large northern municipalities to 26.7% in small southern municipalities. Established work process ranged from 10.7% in small northern municipalities to 39.5% in large southern municipalities. Compared to the South, medium-sized municipalities in the North (OR=0.14 - 95%CI 0.11;0.17) and Northeast (OR=0.21 - 95%CI 0.18;0.25) regions were less likely to have the necessary equipment. CONCLUSION: Significant regional inequalities call for investments in Digital Health.

Factors associated with cesarean delivery in adult nulliparous women

The aim of this study was to analyze the sociodemographic factors associated with cesarean section in adult women with conditions favorable for normal delivery and to identify the groups most likely to undergo this surgery inthe state of Santa Catarina (SC). A case control study with microdata from the Sistema de Informação de Nascidos Vivos on 7,065 women for 2016 in SC. A relationship between cesarean section and sociodemographic variables was analyzed by logistic regression where we calculated the Adjusted Odds Ratio (AOR), confidence interval and p-value. The probability of cesarean section for each group of women (called "interaction") was also calculated. Among women with more favorable conditions for normal childbirth, the prevalence of cesarean section was 41.1%. Lower chance of cesarean section was found for women without partners (AOR: 0.79 [0.71-0.87]), up to 8 years of schooling (AOR: 0.56 [0.47-0.66]), with up to 2 prenatal visits (AOR: 0.46 [0.23-0.90]). The most likely group of women (51.4% [49.3-53.4]) to undergo cesarean section are women who perform 7 to 15 prenatal visits and have 12 or more years of schooling. A cesarean section occurs with women who have greater access to education and prenatal care and those who have partners, even though the aspects favor normal childbirth, suggesting that this does not seem to be a decision only by women.

Estrutura e processo de trabalho para implantação da teleconsulta médica no Sistema Único de Saúde do Brasil, um estudo transversal com dados de 2017-2018 / Estructura y proceso de trabajo para implantar la teleconsulta médica en el Sistema de Salud Único en Brasil, un estudio transversal con datos de 2017-2018 / Structure and work process for implementing medical teleconsultation in the Brazilian National Health System, a cross-sectional study using 2017-2018 data

Objetivo: Comparar estrutura e processo de trabalho na Atenção Básica para implantação da teleconsulta médica em municípios de diferentes regiões e portes populacionais (mil habitantes: <25; 25-100; >100). Métodos: Estudo transversal, com análise descritiva e bivariada, sobre dados de 2017-2018, para avaliar disponibilidade de computador com internet, câmera, microfone e caixa de som, e processo de trabalho das equipes (utilizar Telessaúde, central de regulação e fluxo de comunicação). Resultados: Analisadas 30.346 UBS e 38.865 equipes, a presença de equipamentos para teleconsulta entre UBS variou de 1,2% em municípios grandes do Norte a 26,7% em municípios pequenos do Sul. O processo de trabalho variou de 10,7% em municípios pequenos do Norte a 39,5% em municípios grandes do Sul. Comparados ao Sul, municípios médios do Norte (OR=0,14 - IC95% 0,11;0,17) e do Nordeste (OR=0,21 - IC95% 0,18;0,25) tiveram menores chances de dispor dos equipamentos necessários. Conclusão: Significativas desigualdades regionais recomendam investimentos em Saúde Digital.

Objetivo: Comparar estructura y proceso de trabajo en atención primaria para implementar la teleconsulta médica en municipios de diferentes regiones y tamaños (mil habitantes: <25; 25-100; >100). Métodos: Estudio transversal, con análisis descriptivo y bivariado, datos de 2017-2018 para evaluar la disponibilidad de computadora con internet, cámara, micrófono, altavoz y proceso de trabajo (uso de Telesalud, centro de regulación central y flujo de comunicación). Resultados: Se analizaron 30.346 unidades y 38.865 grupos. La presencia de equipos de teleconsulta osciló entre 1,2% en los grandes municipios del Norte y 26,7% en pequeños municipios del Sur. El proceso de trabajo osciló entre 10,7% en pequeños municipios del Norte y 39,5% en grandes municipios del Sur. En comparación con el Sur, municipios medianos del Norte (OR=0,14 - IC95% 0,11;0,17) y Nordeste (OR=0,21 - IC95% 0,18;0,25) tenían menos probabilidades de contar con los equipos necesarios. Conclusión: Existe la necesidad de inversiones en Salud Digital, con desigualdades regionales relevantes.

Objective: To compare the structure and the work process in Primary Care for implementing medical teleconsultation in municipalities in different regions and with different population sizes (<25,000; 25,000-100,000; >100,000 inhabitants). Methods: Cross-sectional study, with descriptive and bivariate analysis, using data from 2017-2018 to assess the availability of computers with internet access, webcam, microphone, speaker, as well as to assess the work processes (use of Telehealth, service supply and demand control center, and communication flow). Results: 30,346 primary health centers and 38,865 teams were evaluated. Presence of teleconsultation equipment in the health centers ranged from 1.2% in large northern municipalities to 26.7% in small southern municipalities. Established work process ranged from 10.7% in small northern municipalities to 39.5% in large southern municipalities. Compared to the South, medium-sized municipalities in the North (OR=0.14 - 95%CI 0.11;0.17) and Northeast (OR=0.21 - 95%CI 0.18;0.25) regions were less likely to have the necessary equipment. Conclusion: Significant regional inequalities call for investments in Digital Health.

Nível de estresse percebido em estudantes de enfermagem em uma universidade pública do Brasil / Nivel de estrés percibido en estudiantes de enfermería de una universidad pública de Brasil / Perceived stress level of nursing students at a public university in Brazil

RESUMO Objetivo: identificar os níveis de estresse percebido em estudantes de graduação em Enfermagem em uma universidade pública no Sul do Brasil. Método: estudo descritivo, transversal, de abordagem quantitativa. Os dados foram coletados entre dezembro de 2018 e março de 2019, por meio de escala tipo Likert. Resultados: participaram do estudo 164 estudantes de Enfermagem de diferentes fases da graduação de uma instituição pública do Sul do país. Projetaram-se domínios a partir das questões da PSS-10, confluindo sentimentos positivos e negativos. Os estudantes, em geral, alcançaram nível médio de estresse percebido (25,4). Nos domínios positivos a média estabelecida foi de 1,8 e nos negativos foi de três. Os estudantes da segunda, quarta e sexta fases alcançaram níveis mais elevados na comparação com a média geral. Já os estudantes da nona fase obtiveram a menor média de estresse. Conclusão: a universidade não é a única fonte de estresse para os acadêmicos de Enfermagem, porém há de se considerar que os estressores estão presentes durante a formação. O nível de estresse é um indicador importante de saúde mental entre os acadêmicos.

RESUMEN Objetivo: identificar los niveles de estrés percibido en estudiantes de licenciatura en Enfermería de una universidad pública del sur de Brasil. Método: estudio descriptivo, transversal con enfoque cuantitativo. Los datos se recolectaron entre diciembre de 2018 y marzo de 2019, utilizando una escala Likert. Resultados: participaron del estudio 164 estudiantes de Enfermería de diferentes etapas de egreso de una institución pública del sur del país. Los dominios se proyectaron a partir de los problemas de PSS-10, combinando sentimientos positivos y negativos. Los estudiantes, en general, alcanzaron un nivel medio de estrés percibido (25,4). En los dominios positivos, el promedio establecido fue de 1.8 y en los dominios negativos fue de tres. Los estudiantes de la segunda, cuarta y sexta fase alcanzaron niveles más altos en comparación con el promedio general. Los estudiantes de la novena fase, por otro lado, tuvieron el estrés promedio más bajo. Conclusión: la universidad no es la única fuente de estrés para los estudiantes de enfermería, pero se debe considerar que los factores estresantes están presentes durante la formación. El nivel de estrés es un indicador importante de la salud mental entre los académicos.

ABSTRACT Objective: to identify the levels of stress perceived in undergraduate Nursing students at a public university in southern Brazil. Method: a descriptive, cross-sectional study with a quantitative approach. Data were collected between December 2018 and March 2019, using a Likert scale. Results: the participants of the study were 164 Nursing students from different stages of graduation from a public institution in the south of the country. Domains were projected from the PSS-10 issues, conflating positive and negative feelings. The students, in general, reached a mean level of perceived stress (25.4). In the positive domains, the established mean was 1.8 and in the negative domains, it was three. Students in the second, fourth and sixth stages reached higher levels when compared to the general mean. The students in the ninth stage, on the other hand, had the lowest mean of stress. Conclusion: the university is not the only source of stress for Nursing students, but it must be considered that stressors are present during training. The level of stress is an important indicator of mental health among students.

Structure and working process to implement medical teleconsultation in the Unified Health System in Brazil, a cross sectional study using data from 2017-2018 / Estructura y proceso de trabajo para la aplicación de la teleconsulta médica en el Sistema de Salud Único en Brasil, un estudio transversal con datos de 2017-2018 / Estrutura e processo de trabalho para implantação da teleconsulta médica no Sistema Único de Saúde do Brasil, um estudo transversal com dados de 2017-2018

Objective: To compare structure and working process at primary care to implement medical teleconsultation in municipalities of different regions and population sizes (thousand inhabitants: <25; 25-100; >100). Methods: Cross-sectional study, with descriptive and bivariate analysis, using data from 2017-2018 to assess the availability of a computer with internet access, webcam, microphone, speaker and teams working processes (telehealth use, and existence of central regulation and communication between the teams). Results: 30,346 health units and 38,865 teams were evaluated. The presence of teleconsultation equipment in the units ranged from 1.2% in large northern municipalities to 26.7% in small southern municipalities. The working process to implement teleconsultation ranged from 10.7% in small northern municipalities to 39.5% in large southern municipalities. Compared to the South, medium municipalities in the North (OR=0.14 ­ CI95% 0.11;0.17) and Northeast (OR=0.21 ­ CI95% 0.18;0.25) regions were less likely to have necessary equipment. Conclusion: Investments in Digital Health are needed, with significant regional inequalities.

Objetivo: Comparar estrutura e processo de trabalho na Atenção Básica para implantação da teleconsulta médica em municípios de diferentes regiões e portes populacionais (mil habitantes: <25; 25-100; >100). Métodos: Estudo transversal, com análise descritiva e bivariada, sobre dados de 2017-2018, para avaliar disponibilidade de computador com internet, câmera, microfone e caixa de som, e processo de trabalho das equipes (utilizar Telessaúde, central de regulação e fluxo de comunicação). Resultados: Analisadas 30.346 UBS e 38.865 equipes, a presença de equipamentos para teleconsulta entre UBS variou de 1,2% em municípios grandes do Norte a 26,7% em municípios pequenos do Sul. O processo de trabalho variou de 10,7% em municípios pequenos do Norte a 39,5% em municípios grandes do Sul. Comparados ao Sul, municípios médios do Norte (OR=0,14 ­ IC95% 0,11;0,17) e do Nordeste (OR=0,21 ­ IC95% 0,18;0,25) tiveram menores chances de dispor dos equipamentos necessários. Conclusão: Significativas desigualdades regionais recomendam investimentos em Saúde Digital.

Adequacy of risk classification protocols for COVID-19 to WHO guidelines: a proposed instrument / Adequação de protocolos de classificação de risco para COVID-19 às orientações da OMS: uma proposta de instrumento

Objective: This article proposes to create an instrument to analyze the adequacy of risk classification protocols for COVID-19 to the guidelines of the World Health Organization (WHO) and analyzes the protocol used by Santa Catarina. Method: The descriptive research was composed of three parts: 1) extraction of information regarding risk analysis and COVID-19 from WHO documents; 2) elaboration of an instrument to analyze the adequacy of risk classification protocols for COVID-19 to the WHO guidelines; 3) application of the instrument to the protocol used in the state of Santa Catarina. Results: Five WHO documents were reviewed. The built instrument included five dimensions: risk assessment itself, exposure assessment, context assessment, risk characterization and reliability. Partial information regarding the risk assessment itself and reliability was found in the Santa Catarina government protocol. No information was found regarding the other dimensions. Discussion: The mismatch between the matrix used by the state of Santa Catarina and the WHO risk analysis guidelines is huge. Thus, without an adequate analysis of these factors, the entire strategy for implementing actions can be compromised, exposing the population of the state to risk.

Objetivo: Este artigo propõe criar um instrumento para analisar a adequação de protocolos de classificação de risco para COVID-19 às orientações da Organização Mundial de Saúde (OMS) e analisa o protocolo utilizado por Santa Catarina. Método: A pesquisa descritiva foi composta de três partes: 1) extração de informações concernentes à análise de risco e à COVID-19 dos documentos da OMS; 2) elaboração de instrumento para análise da adequação de protocolos de classificação de risco para COVID-19 às orientações da OMS; 3) aplicação do instrumento ao protocolo utilizado no estado de Santa Catarina. Resultados: Cinco documentos da OMS foram revistos. O instrumento construído contemplou cinco dimensões: avaliação do risco em si, avaliação da exposição, avaliação do contexto, caracterização do risco e confiabilidade. Informações parciais com relação à avaliação do risco em si e à confiabilidade foram encontradas no protocolo do governo catarinense. Não foram encontradas informações com relação às demais dimensões. Discussão: O desencontro entre a matriz utilizada pelo estado de Santa Catarina e as orientações para análise de risco da OMS são grandes. Assim, sem uma análise adequada desses fatores toda a estratégia de implementação de ações pode ser comprometida, expondo a população do estado a risco.

Intercensal Brazilian municipality stratificatation updating for health performance evaluation, 2015. / Atualização intercensitária de estratificação de municípios brasileiros para avaliação de desempenho em saúde, 2015.

OBJECTIVE: to describe updating of stratification of the Brazilian municipalities in order to evaluate health performance. METHODS: this was a descriptive and methodological study with stratification of municipalities according to population size and conditions influencing health management, using data from the intercensal period (2015) and showing classification variations compared with the census period (2010); the original data on demographic characteristics, funding capacity and population purchasing power were adjusted for the year 2015 based on a baseline study conducted with census data. RESULTS: some 15% of the municipalities were reclassified in the intercensal period, with the main factors of change being the conditions influencing health management. CONCLUSION: the need for intercensal updating of this form of classification was confirmed, given that the socioeconomic conditions of the municipalities vary in the five-year period; Primary Health performance evaluation should consider updated stratifications that include management conditions for the purpose of classification.

Papilomavírus humano (HPV) e o câncer do colo do útero

Unidade 1 do curso Vacinação contra o papilomavírus humano do PROVAB que demonstra conceitos básicos sobre a etiologia do HPV, o contágio, o diagnóstico, o tratamento e a prevenção assim como possibilita identificar a prevalência de câncer no mundo, no país e no seu território e reconhecer sua relação com o vírus do papiloma humano.

Vacinação contra o HPV

Unidade 2 do curso Vacinação contra o papilomavírus humano do PROVAB que informa sobre a importância e o papel da vacina HPV na redução de casos de câncer de colo de útero e dos óbitos pela doença, as principais características da vacina HPV como também possibilita identificar as principais ações para a operacionalização da vacinação HPV.

Registro nominal de vacina

Unidade 3 do curso Vacinação contra o papilomavírus humano do PROVAB que apresenta como realizar o registro nominal da vacinação, o acompanhamento da cobertura vacinal, o registro da segunda dose assim como possibilita como informar o total de meninas vacinadas no sistema de informação.

Vacinação contra o papilomavírus humano

Curso do PROVAB que apresenta a oportunidade de entender os aspectos relacionados ao vírus HPV, bem como sua relação com o câncer do colo do útero, as ações para operacionalizar a campanha de vacinação contra o HPV e os aspectos relacionados ao registro nominal da vacinação e à cobertura vacinal.

Adoecimento por coqueluche e número de doses administradas de vacinas Pertussis: estudo de caso-controle / Pertussis and number of doses of vaccine administered: a case control study

Objetivo: estimar as chances de adoecimento por coqueluche segundo número de doses de vacinas Pertussis administradas e idade, no Brasil. Métodos: estudo de caso-controle utilizando dados do Sistema de Informação de Agravos de Notificação (Sinan) no período 2007-2011; considerou-se como casos aqueles notificados com coqueluche confirmada, e como controles, aqueles descartados; foram calculadas as odds ratio (OR) e respectivos intervalos de confiança de 95 por cento (IC95 por cento). Resultados: foram incluídos 5.389 casos e 10.689 controles; entre 7-12 meses de idade, a chance de adoecimento foi maior com 1 dose administrada [OR:2,1(IC95 por cento:1,3-3,4)], comparativamente às 3 doses esperadas; entre 1-3 anos, essa chance foi maior sem reforço vacinal [OR 1 dose: 2,4(IC95 por cento:1,6-3,8); OR 2 doses:3,6(IC95 por cento:2,2-6,1); OR 3 doses:1,6(IC95 por cento:1,3-2,2); OR Ø dose:2,8(IC95 por cento:1,7-4,8)], quando este era esperado; entre 7-15 anos, foi maior com 1 reforço [OR:1,6(IC95 por cento:1,2-2,3)], quando 2 eram esperados. Conclusão: o esquema vacinal incompleto aumenta as chances de adoecimento por coqueluche em todas as idades estudadas.

Objective: estimate the likelihood of pertussis according to number of vaccine doses received and age. Methods: Case-control study using 2007-2011 SINAN data. "Cases" were considered to be confirmed reported pertussis cases. "Controls" were the discarded cases. Results: 5,389 cases and 10,689 controls were included. In those aged 7-12 months, cases were twice as likely [OR:2.1 (95 per cent CI: 1.3-3.4)] when only 1 instead of 3 doses had been administered. In 1-3 year--olds, likelihood was greater in those not having boosters (1 booster expected) [OR 1 dose: 2.4 (95 per cent CI:1.6-3.8); OR 2 doses: 3.6 (95 per cent CI: 2.2-6.1); OR 3 doses: 1.6 (95 per cent CI:1.3-2.2); OR Ø dose: 2.8 (95 per cent CI:1.7-4.8)]. In 7-15 year-olds, cases were 60 per cent more likely in those having had 1 booster instead of 2 [OR:1.6 (95 per cent CI:1.2-2.3)]. Conclusion: incomplete immunization increases likelihood of contracting pertussis in all age groups studied, mainly 7-15 years.

Risk factors associated with hantavirosis fatality: a regional analysis from a case-control study in Brazil.

INTRODUCTION: In Brazil, hantavirus cardiopulmonary syndrome (HCPS) has a high lethality rate that varies by region. This study aimed to identify the risk factors associated with fatal hantavirosis. METHODS: This study was a case-control study that included all laboratory confirmed cases of hantavirosis. The cases were stratified by the different Brazilian regions using data from the Notifiable Diseases Information System. "Cases" were patients who progressed to death, whereas "controls" were patients who were cured. The odds ratio (OR) and the adjusted OR were calculated. RESULTS: Overall, 158 cases and 281 controls were included in this study. In the Midwest region, the cases were 60% less likely to present with flank pain, and the time between the beginning of symptoms and death was shorter than the time between the beginning of symptoms and a cure. In the Southeast region, the cases were 60% less likely to present with thrombocytopenia or reside in rural areas compared to those who progressed to a cure. Additionally, the cases sought medical assistance, notification and investigation more quickly than the controls. In the Southern region, the cases that died were 70% less likely to be male compared to the controls. CONCLUSIONS: HCPS manifests with nonspecific symptoms, and there are few published studies related to the condition, so determining a patient's therapeutic strategy is difficult. This study presents findings from different Brazilian regions and highlights the need for further investigations to improve comprehension about regional risk factors associated with hantavirosis and to reduce morbimortality.

Risk factors associated with hantavirosis fatality: a regional analysis from a case-control study in Brazil

Introduction: In Brazil, hantavirus cardiopulmonary syndrome (HCPS) has a high lethality rate that varies by region. This study aimed to identify the risk factors associated with fatal hantavirosis. Methods: This study was a case-control study that included all laboratory confirmed cases of hantavirosis. The cases were stratified by the different Brazilian regions using data from the Notifiable Diseases Information System. “Cases” were patients who progressed to death, whereas “controls” were patients who were cured. The odds ratio (OR) and the adjusted OR were calculated. Results: Overall, 158 cases and 281 controls were included in this study. In the Midwest region, the cases were 60% less likely to present with flank pain, and the time between the beginning of symptoms and death was shorter than the time between the beginning of symptoms and a cure. In the Southeast region, the cases were 60% less likely to present with thrombocytopenia or reside in rural areas compared to those who progressed to a cure. Additionally, the cases sought medical assistance, notification and investigation more quickly than the controls. In the Southern region, the cases that died were 70% less likely to be male compared to the controls. Conclusions: HCPS manifests with nonspecific symptoms, and there are few published studies related to the condition, so determining a patient's therapeutic strategy is difficult. This study presents findings from different Brazilian regions and highlights the need for further investigations to improve comprehension about regional risk factors associated with hantavirosis and to reduce morbimortality. .