Household rat infestation in urban slum populations: Development and validation of a predictive score for leptospirosis.

Domestic rats are the principal reservoir for urban leptospirosis. However, few studies have identified infestation markers in slums and evaluated their predictivity for leptospirosis risk. We compared households with leptospirosis cases in Salvador, Brazil between 2007 and 2009 and their neighbors using a case control design, surveying for rodent infestation signs and environmental characteristics. With the 2007-2008 data, a conditional logistic regression modeling identified the peridomiciliar presence of rodent burrows (OR, 3.30; 95% CI, 1.50-7.26), rat feces (2.86; 1.24-6.59), runs (2.57; 1.06-6.22), households bordering abandoned houses (2.48; 1.04-6.02), and unplastered walls (2.22; 1.02-6.02) as risk factors and developed a predictive score for leptospirosis. With an independent data set from 2009, a receiver operating characteristic (ROC) curve analysis evaluated the prediction score performance, with the area under the curve being 0.70 (95% CI, 0.64-0.76) for score development and 0.71 (0.65-0.79) for validation. Results indicate that high proportions of urban slum households are infested with R. norvegicus. The score performed well when identifying high-risk households within slums. These findings need confirmation in other urban centers, but suggest that community-based screening for rodent infestation can allow to target rodent and environmental control measures in populations at highest risk for leptospirosis.

Projection of COVID-19 intensive care hospitalizations in the Federal District, Brazil: an analysis of the impact of social distancing measures. / Projeção de internações em terapia intensiva pela COVID-19 no Distrito Federal, Brasil: uma análise do impacto das medidas de distanciamento social.

OBJECTIVE: To build scenarios and analyze the impact of social distancing policies on the spread of COVID-19 and the need for intensive care unit beds. METHODS: Three dissemination scenarios were built according to level of adherence to social distancing measures in the context of Brazil's Federal District, based on a dynamic transition compartmental model and Monte Carlo simulations. The model's parameter values were based on official sources, indexed bibliographic databases and public data repositories. RESULTS: The favorable scenario, with constant 58% adherence to social distancing, estimated a peak of 189 (interquartile range [IQR]: 57 - 394) ICU hospitalizations on March 3rd2021. Absence of social distancing would result in an unfavorable scenario with a peak of 6,214 (IQR: 4,618 - 8,415) ICU hospitalizations probably as soon as July 14th2020. CONCLUSION: The projections indicate the high impact of social distancing measures and emphasize the applicability of public indicators for COVID-19 monitoring.

Demand for ICU beds by COVID-19 in the Federal District, Brazil: an analysis of the impact of social distance measures with Monte Carlo simulations / Demanda de camas de UCI por COVID-19 en el Distrito Federal, Brasil: un análisis del impacto de las medidas de distancia social con simulaciones de Monte Carlo / Demanda por leitos de UTI pela COVID-19 no Distrito Federal, Brasil: uma análise do impacto das medidas de distanciamento social com simulações de Monte Carlo

Objectives: to analyze the impact of social distance policies on the spread of COVID-19 and the need for beds in intensive care units. Methods: based on a dynamic transition compartmental model and Monte Carlo simulations, propagation scenarios were built according to the level of adherence of the social distance measures in the context of the Federal District, Brazil. The parameter values ​​were based on official sources, indexed databases and public data repositories. Results: maintaining adherence to the 58% isolation level was the only favorable scenario, with a peak of up to 792 (IQR: 447 to 1,262) ICU admissions between 11/05/2020 and 1/15/2021. The absence of social distance would imply a peak of up to 7,331 (IQR: 5,427 to 9,696) ICU admissions. Conclusion: the projections corroborate the positive effect of social distance measures and the applicability of indicators in their monitoring.

Objetivos: analizar el impacto de las políticas de distancia social en la propagación de COVID-19 y la necesidad de camas en unidades de cuidados intensivos. Métodos: con un modelo de transición dinámica y simulaciones de Monte Carlo, los escenarios de propagación se construyeron de acuerdo con el nivel de adherencia de las medidas de distancia social en el Distrito Federal, Brasil. Los parámetros se basaron en fuentes oficiales, bases de datos indexadas y repositorios de datos. Resultados: mantener la adherencia al nivel de aislamiento del 58% fue el único escenario favorable, con un pico de hasta 792 (IQR: 447 a 1,262) admisiones en la UCI entre el 11/05/2020 y el 15/1/2021. La ausencia de distancia implicaría un pico de 7,331 (IQR: 5,427 a 9,696) admisiones en la UCI. Conclusión: las proyecciones corroboran el efecto positivo de las medidas de distancia social y la aplicabilidad de los indicadores en su seguimiento.

Objetivos: analisar o impacto das políticas de distanciamento social sobre a propagação da COVID-19 e a necessidade de leitos de unidades de terapia intensiva. Métodos: com um modelo compartimental de transição dinâmica e simulações de Monte Carlo foram construídos cenários de propagação de acordo com o nível de adesão das medidas de distanciamento social no contexto do Distrito Federal, Brasil. Os valores dos parâmetros foram baseados em fontes oficiais, bases indexadas e repositórios públicos de dados. Resultados: a manutenção da adesão ao nível de 58% de isolamento foi o único cenário favorável, com um pico de até 792 (IQR: 447 a 1.262) internações em UTI entre 05/11/2020 e 15/01/2021. A ausência do distanciamento implicaria um pico de até 7.331 (IQR: 5.427 a 9.696) internações em UTI. Conclusão: as projeções corroboram o efeito positivo das medidas de distanciamento social e a aplicabilidade de indicadores no seu monitoramento.

Projeção de internações em terapia intensiva pela COVID-19 no Distrito Federal, Brasil: uma análise do impacto das medidas de distanciamento social / Proyección de hospitalizaciones en cuidados intensivos por COVID-19 en el Distrito Federal, Brasil: un análisis del impacto de las medidas de distanciamiento social / Projection of COVID-19 intensive care hospitalizations in the Federal District, Brazil: an analysis of the impact of social distancing measures

Objetivo: Construir cenários e analisar o impacto das políticas de distanciamento social na propagação da COVID-19 e a necessidade de leitos de unidades de terapia intensiva (UTI). Métodos: Sobre modelo compartimental de transição dinâmica e simulações de Monte Carlo, construíram-se três cenários de propagação conforme o nível de adesão às medidas de distanciamento social no Distrito Federal, Brasil. Os valores dos parâmetros do modelo fundamentaram-se em fontes oficiais, bases com indexação bibliográfica e repositórios públicos de dados. Resultados: O cenário favorável, com manutenção constante de 58% de adesão ao distanciamento social, estimou pico de 189 (intervalo interquartil [IIQ]: 57 a 394) internações-UTI em 7/3/2021. A ausência do distanciamento implicaria grave cenário, com pico de 6.214 (IIQ: 4.618 a 8.415) internações-UTI já na data provável de 14/7/2020. Conclusão: as projeções indicam alto impacto das medidas de distanciamento social e reforçam a aplicabilidade de indicadores públicos no monitoramento da COVID-19.

Objetivo: Construir escenarios y analizar el impacto de las políticas de distanciamiento social en la propagación de Covid-19 y la necesidad de camas en unidades de cuidados intensivos (UCI). Métodos: Con un modelo compartimental de transición dinámica y simulaciones de Monte Carlo, los escenarios de propagación se construyeron de acuerdo al nivel de adhesión de las medidas de distanciamiento social en el Distrito Federal, Brasil. Los parámetros se basaron en fuentes oficiales, bases de datos indexadas y repositorios de datos. Resultados: La adhesión al nivel de distanciamiento social con manutención constante de 58% fue el único escenario favorable, con un pico de 189 (intervalo intercuartil IIC: 57 a 394) admisiones en la UCI el 7/3/2021. La ausencia de distanciamiento implicaría en grave escenario, con un pico de 6.214 (IIC: 4.618 a 8.415) admisiones en UCI ya en la fecha probable de 14/7/2020. Conclusión: Las proyecciones muestran el alto impacto de las medidas de distanciamiento social y la aplicabilidad de indicadores públicos en el monitoreo.

Objective: To build scenarios and analyze the impact of social distancing policies on the spread of COVID-19 and the need for intensive care unit beds. Methods: Three dissemination scenarios were built according to level of adherence to social distancing measures in the context of Brazil's Federal District, based on a dynamic transition compartmental model and Monte Carlo simulations. The model's parameter values were based on official sources, indexed bibliographic databases and public data repositories. Results: The favorable scenario, with constant 58% adherence to social distancing, estimated a peak of 189 (interquartile range [IQR]: 57 - 394) ICU hospitalizations on March 3rd2021. Absence of social distancing would result in an unfavorable scenario with a peak of 6,214 (IQR: 4,618 - 8,415) ICU hospitalizations probably as soon as July 14th2020. Conclusion: The projections indicate the high impact of social distancing measures and emphasize the applicability of public indicators for COVID-19 monitoring.

Epidemiological profile of health consultations during the Mozambique 9th National Cultural Festival, August 2016.

INTRODUCTION: The use of mass gatherings as spaces to practice health surveillance has been growing in recent years. In Mozambique, the 9th National Festival of Culture in 2016 was selected for this practice. A specific public health surveillance system to facilitate rapid detection of outbreaks and other health-related events was implemented for this event with real time data collection and analysis. METHODS: A descriptive epidemiological evaluation of all the health consultations that occurred in fixed posts prepared for the event was conducted. The data were collected through electronic mobile system (tablets) in real time, with the aid of a form designed for this purpose and sent directly to the incident command system (ICS). RESULTS: During the event, a total of 355 patients were assisted, 52.3% were female, 87.0% were from Beira city and the artists were the group that most frequently sought health care at 59.4%. The largest number of visits took place on the third day (36.4%). People over 45 years of age were the age group that most frequently sought health care (30.8%). The main provisional diagnoses of those who were attended to during the festival was arterial hypertension (20.3%), followed by febrile syndrome (19.0%), with falls being the most frequent causes of trauma during the festival (60.0%). CONCLUSION: The system of monitoring in real time using mobile technologies proved to be efficient for the monitoring of the main health events during the mass gatherings. This profile of health consultations encourages the health sector to plan strategies and actions geared to the reality of care for this type of event.

Profile of demand and Continuous Cash Benefits (BCP) granted to children diagnosed with microcephaly in Brazil. / Perfil da demanda e dos Benefícios de Prestação Continuada (BPC) concedidos a crianças com diagnóstico de microcefalia no Brasil.

The Brazilian Federal Constitution of 1988 introduced the Continuous Cash Benefits (BCP), allowing the inclusion of people with disabilities. This is a descriptive study with aggregate municipal data about the time and geographic distribution of the incidence of microcephaly related to the Zika virus in Brazil and data of the BCP grants to children diagnosed with microcephaly. Data on the demand and BCP grants to children with microcephaly since 2009 are shown. Cases of microcephaly and/or central nervous system disorders were obtained from the Ministry of Health and totaled 2,366 confirmed cases from January 1, 2015 to December 31, 2016. The historical series of BCP granted from 2009 to 2016 was based on data from the National Institute of Social Security and showed, until 2014, a baseline with an average of 200 annual benefits for children younger than 48 months with microcephaly. In 2016, grants increased eight times, reaching 1,603 benefits granted to children of 731 municipalities spread in the 27 States. The Northeast accounted for 73% of the BCPs granted, however, this was less than 65% of the demand for incident cases. The implementation of the integrated referral system, including active search, should be strengthened to ensure access to all children entitled to BCP.

A Constituição Federal de 1988 introduziu o Benefício de Prestação Continuada (BPC) possibilitando a inclusão de pessoas com deficiência. Estudo descritivo, com dados municipais agregados, da distribuição temporal e geográfica da incidência de microcefalia relacionada ao Zika vírus no Brasil e dados das concessões de BPC a crianças com diagnóstico de microcefalia. Apresentam-se dados sobre a demanda e a concessão do BPC para crianças com microcefalia desde 2009. Os casos de microcefalia e/ou alteração do sistema nervoso central foram obtidos do Ministério da Saúde e totalizaram 2.366 casos confirmados de 01/01/2015 a 31/12/2016. A série histórica da concessão de BPC de 2009 a 2016 foi elaborada a partir de dados do Instituto Nacional do Seguro Social e mostrou, até 2014, uma linha de base com a média de 200 benefícios anuais para crianças menores de 48 meses com microcefalia. Em 2016 as concessões aumentaram oito vezes atingindo 1.603 benefícios concedidos a crianças de 731 municípios, das 27 Unidades da Federação. A Região Nordeste concentrou 73% dos BPC concedidos, mas, ainda assim, isto representou menos do que 65% da demanda de casos incidentes. É preciso reforçar a implementação do sistema de referência integrado, inclusive com busca ativa, para que todas as crianças com direito ao BPC tenham acesso.

Perfil da demanda e dos Benefícios de Prestação Continuada (BPC) concedidos a crianças com diagnóstico de microcefalia no Brasil / Profile of demand and Continuous Cash Benefits (BCP) granted to children diagnosed with microcephaly in Brazil

Resumo A Constituição Federal de 1988 introduziu o Benefício de Prestação Continuada (BPC) possibilitando a inclusão de pessoas com deficiência. Estudo descritivo, com dados municipais agregados, da distribuição temporal e geográfica da incidência de microcefalia relacionada ao Zika vírus no Brasil e dados das concessões de BPC a crianças com diagnóstico de microcefalia. Apresentam-se dados sobre a demanda e a concessão do BPC para crianças com microcefalia desde 2009. Os casos de microcefalia e/ou alteração do sistema nervoso central foram obtidos do Ministério da Saúde e totalizaram 2.366 casos confirmados de 01/01/2015 a 31/12/2016. A série histórica da concessão de BPC de 2009 a 2016 foi elaborada a partir de dados do Instituto Nacional do Seguro Social e mostrou, até 2014, uma linha de base com a média de 200 benefícios anuais para crianças menores de 48 meses com microcefalia. Em 2016 as concessões aumentaram oito vezes atingindo 1.603 benefícios concedidos a crianças de 731 municípios, das 27 Unidades da Federação. A Região Nordeste concentrou 73% dos BPC concedidos, mas, ainda assim, isto representou menos do que 65% da demanda de casos incidentes. É preciso reforçar a implementação do sistema de referência integrado, inclusive com busca ativa, para que todas as crianças com direito ao BPC tenham acesso.

Abstract The Brazilian Federal Constitution of 1988 introduced the Continuous Cash Benefits (BCP), allowing the inclusion of people with disabilities. This is a descriptive study with aggregate municipal data about the time and geographic distribution of the incidence of microcephaly related to the Zika virus in Brazil and data of the BCP grants to children diagnosed with microcephaly. Data on the demand and BCP grants to children with microcephaly since 2009 are shown. Cases of microcephaly and/or central nervous system disorders were obtained from the Ministry of Health and totaled 2,366 confirmed cases from January 1, 2015 to December 31, 2016. The historical series of BCP granted from 2009 to 2016 was based on data from the National Institute of Social Security and showed, until 2014, a baseline with an average of 200 annual benefits for children younger than 48 months with microcephaly. In 2016, grants increased eight times, reaching 1,603 benefits granted to children of 731 municipalities spread in the 27 States. The Northeast accounted for 73% of the BCPs granted, however, this was less than 65% of the demand for incident cases. The implementation of the integrated referral system, including active search, should be strengthened to ensure access to all children entitled to BCP.

Sistema Gerenciador de Ambiente Laboratorial - GAL: Avaliação de uma ferramenta para a vigilância sentinela de síndrome gripal, Brasil, 2011-2012 / Sistema Gerenciador de Ambiente Laboratorial- GAL: Evaluación de una herramienta para la vigilancia centinela del síndrome gripal, Brasil, 2011-201 / Laboratory Environment Management System - GAL: Assessment of a tool for sentinel surveillance of influenza-like illness, Brazil, 2011-2012

OBJETIVO: avaliar o sistema Gerenciador de Ambiente Laboratorial (GAL) como fonte de dados para a Vigilância Sentinela da Síndrome Gripal (VSSG), no Brasil, nos anos de 2011 e 2012. MÉTODOS: estudo de avaliação do GAL a partir da análise dos atributos simplicidade, flexibilidade, qualidade dos dados, aceitabilidade, representatividade, oportunidade, estabilidade do sistema e sua utilidade para a VSSG, com base no guia de avaliação de sistema de vigilância em saúde pública do Centers for Disease Control and Prevention (Atlanta/GA, Estados Unidos). RESULTADOS: nos anos de 2011 e 2012, foram registrados 13.765 exames de vírus respiratórios. O GAL mostrou-se simples de estrutura, flexível às mudanças, com boa qualidade de dados, aceitabilidade e oportunidade no acesso aos resultados dos exames, tendo sido representativo e estável em 23 estados. CONCLUSÃO: o sistema é útil no atendimento aos objetivos da VSSG; contudo, recomenda-se realizar ajustes e incentivar a adesão dos estados que não o utilizam.

OBJETIVO: evaluar el Sistema Gerenciador de Ambiente Laboratorial (GAL) como fuente de datos para la vigilancia centinela de la enfermedad tipo influenza (VCETI). MÉTODOS: estudio de evaluación de GAL a partir del análisis de los atributos simplicidad, flexibilidad, calidad de datos, aceptabilidad, representatividad, oportunidad, estabilidad del sistema y su utilidad para VCETI, utilizando los criterios de la guía de evaluación del Centers for Disease Control and Prevention (Atlanta/GA, EUA). RESULTADOS: el análisis utilizó datos de 2011-2012, en total 13.765 exámenes de virus respiratorios. El GAL demostró tener una estructura simple, flexibilidad al cambio, buena calidad de datos, aceptabilidad y oportunidad en el acceso a los resultados de las pruebas, siendo representativo y estable en 23 de los 27 estados. CONCLUSIÓN: el sistema es útil en el cumplimiento de los objetivos de la vigilancia, sin embargo, se recomienda hacer ajustes y fomentar la adhesión de los Estados que no lo utilizan.

OBJECTIVE: to evaluate the Brazilian Laboratorial Environment Management System (GAL) as a data source for the Sentinel Surveillance of Influenza-Like Illness (SSILI). METHODS: this is an evaluation study of GAL, through the analysis of its simplicity, flexibility, data quality, acceptability, representativeness, timeliness, stability and usefulness for SSILI, based on the guide for system evaluation in public health of the Centers for Disease Control and Prevention (Atlanta/GA, USA). RESULTS: in 2011 and 2012, a total of 13,765 exams for respiratory viruses were registered. GAL presented simple structure, flexibility to changes, good data quality, acceptability and timeliness in the access to test results, being representative and stable in 23 Brazilian states. CONCLUSION: the system is useful in meeting the goals of SSILI; however, there are some recommendations for adjustments and for encouraging the adherence by the states that do not use the system yet.

Laboratory Environment Management System - GAL: Assessment of a tool for sentinel surveillance of influenza-like illness, Brazil, 2011-2012. / Sistema Gerenciador de Ambiente Laboratorial - GAL: Avaliação de uma ferramenta para a vigilância sentinela de síndrome gripal, Brasil, 2011-2012.

OBJECTIVE: to evaluate the Brazilian Laboratorial Environment Management System (GAL) as a data source for the Sentinel Surveillance of Influenza-Like Illness (SSILI). METHODS: this is an evaluation study of GAL, through the analysis of its simplicity, flexibility, data quality, acceptability, representativeness, timeliness, stability and usefulness for SSILI, based on the guide for system evaluation in public health of the Centers for Disease Control and Prevention (Atlanta/GA, USA). RESULTS: in 2011 and 2012, a total of 13,765 exams for respiratory viruses were registered. GAL presented simple structure, flexibility to changes, good data quality, acceptability and timeliness in the access to test results, being representative and stable in 23 Brazilian states. CONCLUSION: the system is useful in meeting the goals of SSILI; however, there are some recommendations for adjustments and for encouraging the adherence by the states that do not use the system yet.

Investigation of an outbreak of bloody diarrhea complicated with hemolytic uremic syndrome.

In July-August 2009, eight patients with bloody diarrhea complicated by hemolytic uremic syndrome (HUS) were admitted to hospitals in Tbilisi, Georgia. We started active surveillance in two regions for bloody diarrhea and post-diarrheal HUS. Of 25 case-patients who developed HUS, including the initial 8 cases, half were ⩾15 years old, 67% were female and seven (28%) died. No common exposures were identified. Among 20 HUS case-patients tested, Shiga toxin was detected in the stools of 2 patients (one with elevated serum IgG titers to several Escherichia coli serogroups, including O111 and O104). Among 56 persons with only bloody diarrhea, we isolated Shiga toxin-producing E. coli (STEC) O104:H4 from 2 and Shigella from 10; 2 had serologic evidence of E. coli O26 infection. These cases may indicate a previously unrecognized burden of HUS in Georgia. We recommend national reporting of HUS and improving STEC detection capacity.

Avaliação do Sistema Nacional de Vigilância Epidemiológica da Leptospirose - Brasil, 2007. / Evaluation of the SNVE (Brazilian National Epidemiological Surveillance System) for Leptospirosis - Brazil, 2007.

A leptospirose é uma zoonose febril, aguda, que pode cursar desde a forma inaparente até grave com letalidade em torno de 12%. É doença de notificação obrigatória desde 1993, sendo os casos suspeitos notificados no Sinan desde 1997. Os objetivos do Sistema de Vigilância Epidemiológica da Leptospirose (SNVE-Lepto) incluem monitorar o agravo de forma a reduzir a letalidade da doença e implementar ações de prevenção e controle da enfermidade. A avaliação contínua do sistema, baseada em critérios de utilidade e qualidade, promove sua melhoriagerando como resposta ações que propiciem aprimoramento da compreensão do agravo. Dessa forma, os objetivos deste trabalho foram avaliar os atributos qualitativos, quantitativos e utilidade e as mudanças do sistema de informação do SINAN Web para SINAN Net. A fonte dosdados foi o banco de dados Sinan/2006 e 2007. Os resultados evidenciaram que o SNVE-Lepto 2007 foi considerado complexo, flexível, com boa qualidade dados e baixa representatividade.Baixa oportunidade, aceitabilidade, sensibilidade e utilidade. Assim, recomendamos reestruturar a ficha de investigação reduzindo o número de campos e variáveis; estimular a completitude das variáveis acrescidas em 2007; estimular a digitação mais precoce dos casos a fim de detectarsurtos precocemente.

Leptospirosis is an acute zoonosis which can present itself from asymptomatic to severe forms, with lethality around 12% in Brazil. Since 1993, it is branded as a communicable disease, and since 1997 the suspect cases are reported to the Sistema Nacional de Agravos de Notificação (Brazilian national communicable diseases system - SINAN). The main goals of the Sistema Nacional de Vigilância Epidemiológica for leptospirosis (Brazilian national epidemiological surveillance system - SNVE Lepto) includes reducing the lethality rate of the disease andimplement preventive and control measures. The continuous assessment of the system, based on usefulness and quality criteria promote its improvement and better understanding on the disease. This way, the objectives of this study were to evaluate the quantitative and qualitative aspects, and the usefulness of the SNVE Lepto, along with the changes in the information system (SINAN-Web to SINAN-Net). The data source was the SINAN database in the years 2006 and 2007. The results shown that the SNVE Lepto was considered complex, flexible, with good data quality, low representativeness, timeliness, acceptability, sensitivity and usefulness. Thus, we suggest reducing the number of variables on the investigation form; stimulate the completeness of variables added in 2007 and encourage the early data entry of the reported cases and outbreaks in the SINAN.