Government Efforts Leverage Effective Combating Against Dengue in Brazil / Esforços Governamentais Alavancam Combate Efetivo à Dengue no Brasil

Dengue has evolved from a disease restricted to a few countries into a serious global public health issue, affecting over 120 countries in recent years. In Brazil, after its reintroduction in 1981, the country has faced several epidemics, with over 16 million cases registered to date. In 2023, under the influence of the El Niño climatic phenomenon, one of the largest epidemics occurred in the country, with over 1.6 million cases reported. High temperatures and precipitation in line with the simultaneous circulation of all four serotypes of the dengue virus increased the risk of disease spread in 2024, especially in populations without immunity to some of the serotypes. In such a scenario, the Ministry of Health undertook various actions to address the situation, including the establishment of a National Arbovirus Situation Room and an Emergency Operations Commitee, financial support to assist states and municipalities in contingency actions for disease surveillance and prevention, with an emphasis on combating arboviruses, and investments in innovations for dengue control, such as vaccination and the Wolbachia method. However, the number of notified dengue cases in the first trimester of 2024 supplanted the whole year of 2023, highlighting the need for a more effective monitoring of the epidemiological situation for early outbreak detection and the preparation of health services for the care of cases with signs of severity. After more than 40 years of recurrent dengue epidemics, the effective control of dengue requires sustained preventive actions using innovative strategies, with coordinated efforts at all levels of health management, along with active participation of the population. Structural actions to improve basic sanitation coverage and to mitigate the effects of climate change are critical conditions for reducing the burden of dengue in the population.

A dengue evoluiu de uma doença restrita a alguns países para um grave problema global de saúde pública, atingindo mais de 120 países nos últimos anos. No Brasil, após sua reintrodução em 1981, o país enfrentou diversas epidemias, com mais de 16 milhões de casos registrados até o momento. Em 2023, sob a vigência do fenômeno climático El Niño registrou-se uma das maiores epidemias de dengue no país, com mais de 1,6 milhões de casos notificados. Temperaturas e pluviosidade mais elevadas em conjunto com a circulação simultânea dos quatro sorotipos do vírus da dengue aumentaram ainda mais o risco de disseminação da doença em 2024, especialmente em populações sem imunidade para alguns dos sorotipos. Diante deste quadro, o Ministério da Saúde promoveu várias ações para enfrentar a situação, incluindo a instalação de uma Sala Nacional de Arboviroses e um Comitê de Operações de Emergência, repasses financeiros para apoiar estados e municípios em ações contingenciais de vigilância e prevenção de doenças, com ênfase no enfrentamento das arboviroses e investimentos em inovações para o controle da dengue, como vacinação e o método Wolbachia. Ainda assim, o primeiro trimestre de 2024 registrou um número de casos suspeitos de dengue superior ao de 2023, destacando a necessidade de aprimoramentos no monitoramento da situação epidemiológica para detecção precoce de epidemias e da preparação dos serviços de saúde para o cuidado dos casos com sinais de gravidade. Após mais de 40 anos de epidemias recorrentes, o controle efetivo da dengue no país requer ações sustentadas de prevenção por meio de estratégias inovadoras, envolvendo esforços coordenados de todas as esferas da gestão em saúde, juntamente com a participação ativa da população. Ações estruturais para a melhoria na cobertura de saneamento básico e para mitigação dos efeitos das mudanças climá

Retrospective molecular investigation of Mayaro and Oropouche viruses at the human-animal interface in West-central Brazil, 2016-2018.

Mayaro virus (MAYV, Togaviridae) and Oropouche orthobunyavirus (OROV, Peribunyaviridae) are emerging enzootic arboviruses in Latin America. Outbreaks of febrile illness associated with MAYV and OROV have been reported among humans mainly in the northern region of Brazil since the 1980s, and recent data suggest these viruses have circulated also in more populated areas of western Brazil. MAYV shares mosquito vectors with yellow fever virus and it has been historically detected during yellow fever epidemics. Aiming to investigate the transmission of OROV and MAYV at the human-animal interface during a yellow fever, chikungunya and Zika outbreaks in Brazil, we conducted a retrospective molecular investigation in 810 wild and domestic animals, 106 febrile patients, and 22.931 vectors collected from 2016 to 2018 in Cuiaba and Campo Grande metropolitan regions, western Brazil. All samples tested negative for OROV and MAYV RNA by RT-qPCR. Findings presented here suggest no active circulation of MAYV and OROV in the sampled hosts. Active surveillance and retrospective investigations are instrumental approaches for the detection of cryptic and subclinical activity of enzootic arboviruses and together serve as a warning system to implement appropriate actions to prevent outbreaks.

A Chikungunya Virus Multiepitope Recombinant Protein Expressed from the Binary System Insect Cell/Recombinant Baculovirus Is Useful for Laboratorial Diagnosis of Chikungunya.

Chikungunya virus (CHIKV) is an arbovirus currently distributed worldwide, causing a disease that shares clinical signs and symptoms with other illnesses, such as dengue and Zika and leading to a challenging clinical differential diagnosis. In Brazil, CHIKV emerged in 2014 with the simultaneous introduction of both Asian and East/Central/South African (ECSA) genotypes. Laboratorial diagnosis of CHIKV is mainly performed by molecular and serological assays, with the latter more widely used. Although many commercial kits are available, their costs are still high for many underdeveloped and developing countries where the virus circulates. Here we described the development and evaluation of a multi-epitope recombinant protein-based IgG-ELISA (MULTREC IgG-ELISA) test for the specific detection of anti-CHIKV antibodies in clinical samples, as an alternative approach for laboratorial diagnosis. The MULTREC IgG-ELISA showed 86.36% of sensitivity and 100% of specificity, and no cross-reactivity with other exanthematic diseases was observed. The recombinant protein was expressed from the binary system insect cell/baculovirus using the crystal-forming baculoviral protein polyhedrin as a carrier of the target recombinant protein to facilitate recovery. The crystals were at least 10 times smaller in size and had an amorphous shape when compared to the polyhedrin wild-type crystal. The assay uses a multi-epitope antigen, representing two replicates of 18 amino acid sequences from the E2 region and a sequence of 17 amino acids from the nsP3 region of CHIKV. The recombinant protein was highly expressed, easy to purify and has demonstrated its usefulness in confirming chikungunya exposure, indeed showing a good potential tool for epidemiological surveillance.

Retrospective Investigation in Horses with Encephalitis Reveals Unnoticed Circulation of West Nile Virus in Brazil.

During these past years, several studies have provided serological evidence regarding the circulation of West Nile virus (WNV) in Brazil. Despite some reports, much is still unknown regarding the genomic diversity and transmission dynamics of this virus in the country. Recently, genomic monitoring activities in horses revealed the circulation of WNV in several Brazilian regions. These findings on the paucity of genomic data reinforce the need for prompt investigation of WNV infection in horses, which may precede human cases of encephalitis in Brazil. Thus, in this study, we retrospectively screened 54 suspicious WNV samples collected between 2017 and 2020 from the spinal cord and brain of horses with encephalitis and generated three new WNV genomes from the Ceará and Bahia states, located in the northeastern region of Brazil. The Bayesian reconstruction revealed that at least two independent introduction events occurred in Brazil. The first introduction event appears to be likely related to the North American outbreak, and was estimated to have occurred in March 2013.The second introduction event appears to have occurred in September 2017 and appears to be likely related to the South American outbreak. Together, our results reinforce the importance of increasing the priority of WNV genomic monitoring in equines with encephalitis in order to track the dispersion of this emerging pathogen through the country.

Genomic epidemiology of the SARS-CoV-2 epidemic in Brazil

The high numbers of COVID-19 cases and deaths in Brazil have made Latin America an epicentre of the pandemic. SARS-CoV-2 established sustained transmission in Brazil early in the pandemic, but important gaps remain in our understanding of virus transmission dynamics at a national scale. We use 17,135 near-complete genomes sampled from 27 Brazilian states and bordering country Paraguay. From March to November 2020, we detected co-circulation of multiple viral lineages that were linked to multiple importations (predominantly from Europe). After November 2020, we detected large, local transmission clusters within the country. In the absence of effective restriction measures, the epidemic progressed, and in January 2021 there was emergence and onward spread, both within and abroad, of variants of concern and variants under monitoring, including Gamma (P.1) and Zeta (P.2). We also characterized a genomic overview of the epidemic in Paraguay and detected evidence of importation of SARS-CoV-2 ancestor lineages and variants of concern from Brazil. Our findings show that genomic surveillance in Brazil enabled assessment of the real-time spread of emerging SARS-CoV-2 variants.

[Evolution of HIV infection in indigenous peoples in Central Brazil]. / Evolução da infecção pelo HIV entre os povos indígenas do Brasil Central.

Distribution of the AIDS epidemic in Brazil is associated with a wide range of factors that determine different population groups' greater or lesser vulnerability. The study's objective was to analyze clinical and laboratory characteristics of HIV/AIDS in individuals 13 years or older and the evolution to death in the indigenous population assisted by the Special Indigenous Health District of the State of Mato Grosso do Sul, Brazil. A descriptive and retrospective study was performed on the clinical conditions and evolution of the disease from 2001 to 2014, based on three secondary databases. The study assessed time in progression to AIDS, time in progression to death, viral load, CD4+ T-lymphocyte count, and survival time. A total of 103 cases of HIV infection were identified, of which 48.5% progressed to AIDS, 60% in less than a year since diagnosis. Forty deaths were recorded, 77.5% of which due to HIV infection. Of those who died, only 30% had survived for more than a year. The study suggests that diagnosis of HIV infection occurred in advanced stages of the disease (i.e., late), and points to deficient diagnostic coverage. Rapid progression to death and short survival time are indicative of insufficient access to specialized health services, as well as disconnection and deficient collaboration between the Indigenous Health District, municipalities, and the state.

A distribuição da epidemia de aids no Brasil está associada a uma ampla gama de fatores que definem maior ou menor vulnerabilidade de grupos populacionais. O estudo teve como objetivo analisar as características clínicas e laboratoriais dos casos de infecção pelo HIV/aids em indivíduos com 13 anos de idade ou mais, e sua evolução para o óbito na população indígena assistida pelo Distrito Sanitário Especial Indígena de Mato Grosso do Sul. Realizou-se um estudo descritivo e retrospectivo sobre a condição clínica e evolução da doença entre 2001 e 2014, a partir de três bases de dados secundários. Foram avaliados o tempo de evolução para a aids, o tempo de evolução ao óbito, a carga viral, a contagem de linfócitos T-CD4+ e o tempo de sobrevida. Foram identificados 103 casos de infecção pelo HIV, dos quais 48,5% evoluíram para aids, sendo 60% em menos de um ano desde o diagnóstico. Foram registrados 40 óbitos, sendo 77,5% em decorrência da infecção pelo HIV. Desses que morreram, apenas 30% tiveram sobrevida maior do que um ano. Este estudo sugere que o diagnóstico da infecção pelo HIV se deu nas fases avançadas da doença, revelando-se tardio e apontando uma cobertura diagnóstica deficiente. A rápida evolução ao óbito e curto período de sobrevida também podem indicar fragilidade no acesso aos serviços de saúde de referência, assim como desarticulação e pactuações insuficientes entre Distrito, municípios e estado.

La distribución de la epidemia de sida en Brasil está asociada a una amplia gama de factores que definen mayor o menor vulnerabilidad de grupos poblacionales. El objetivo del estudio fue analizar las características clínicas y de laboratorio de los casos de infección por el VIH/sida en individuos con 13 años de edad o más, y su evolución hacia el óbito en la población indígena, asistida por el Distrito Sanitario Especial Indígena de Mato Grosso do Sul. Se realizó un estudio descriptivo y retrospectivo sobre la condición clínica y la evolución de la enfermedad entre 2001 y 2014, a partir de tres bases de datos secundarios. Se evaluó el tiempo de evolución para el sida, el tiempo de evolución para el óbito, la carga viral, el cálculo de linfocitos T-CD4+ y el tiempo de supervivencia. Se identificaron 103 casos de infección por VIH, de los cuales un 48,5% evolucionaron hacia sida, siendo 60% en menos de un año desde el diagnóstico. Se registraron 40 óbitos, siendo un 77,5% derivados de la infección por VIH. De esos que murieron, solamente un 30% tuvieron una supervivencia mayor que un año. Este estudio sugiere que el diagnóstico de la infección por VIH se produjo en fases avanzadas de la enfermedad, revelándose tardío y apuntando una cobertura diagnóstica deficiente. La rápida evolución al óbito y corto período de supervivencia, también pueden indicar fragilidad en el acceso a los servicios de salud de referencia, así como la descoordinación y acuerdos insuficientes entre distrito, municipios y estado.

Evolução da infecção pelo HIV entre os povos indígenas do Brasil Central / Evolution of HIV infection in indigenous peoples in Central Brazil / Evolución de la infección por VIH entre los pueblos indígenas de Brasil Central

A distribuição da epidemia de aids no Brasil está associada a uma ampla gama de fatores que definem maior ou menor vulnerabilidade de grupos populacionais. O estudo teve como objetivo analisar as características clínicas e laboratoriais dos casos de infecção pelo HIV/aids em indivíduos com 13 anos de idade ou mais, e sua evolução para o óbito na população indígena assistida pelo Distrito Sanitário Especial Indígena de Mato Grosso do Sul. Realizou-se um estudo descritivo e retrospectivo sobre a condição clínica e evolução da doença entre 2001 e 2014, a partir de três bases de dados secundários. Foram avaliados o tempo de evolução para a aids, o tempo de evolução ao óbito, a carga viral, a contagem de linfócitos T-CD4+ e o tempo de sobrevida. Foram identificados 103 casos de infecção pelo HIV, dos quais 48,5% evoluíram para aids, sendo 60% em menos de um ano desde o diagnóstico. Foram registrados 40 óbitos, sendo 77,5% em decorrência da infecção pelo HIV. Desses que morreram, apenas 30% tiveram sobrevida maior do que um ano. Este estudo sugere que o diagnóstico da infecção pelo HIV se deu nas fases avançadas da doença, revelando-se tardio e apontando uma cobertura diagnóstica deficiente. A rápida evolução ao óbito e curto período de sobrevida também podem indicar fragilidade no acesso aos serviços de saúde de referência, assim como desarticulação e pactuações insuficientes entre Distrito, municípios e estado.

Distribution of the AIDS epidemic in Brazil is associated with a wide range of factors that determine different population groups' greater or lesser vulnerability. The study's objective was to analyze clinical and laboratory characteristics of HIV/AIDS in individuals 13 years or older and the evolution to death in the indigenous population assisted by the Special Indigenous Health District of the State of Mato Grosso do Sul, Brazil. A descriptive and retrospective study was performed on the clinical conditions and evolution of the disease from 2001 to 2014, based on three secondary databases. The study assessed time in progression to AIDS, time in progression to death, viral load, CD4+ T-lymphocyte count, and survival time. A total of 103 cases of HIV infection were identified, of which 48.5% progressed to AIDS, 60% in less than a year since diagnosis. Forty deaths were recorded, 77.5% of which due to HIV infection. Of those who died, only 30% had survived for more than a year. The study suggests that diagnosis of HIV infection occurred in advanced stages of the disease (i.e., late), and points to deficient diagnostic coverage. Rapid progression to death and short survival time are indicative of insufficient access to specialized health services, as well as disconnection and deficient collaboration between the Indigenous Health District, municipalities, and the state.

La distribución de la epidemia de sida en Brasil está asociada a una amplia gama de factores que definen mayor o menor vulnerabilidad de grupos poblacionales. El objetivo del estudio fue analizar las características clínicas y de laboratorio de los casos de infección por el VIH/sida en individuos con 13 años de edad o más, y su evolución hacia el óbito en la población indígena, asistida por el Distrito Sanitario Especial Indígena de Mato Grosso do Sul. Se realizó un estudio descriptivo y retrospectivo sobre la condición clínica y la evolución de la enfermedad entre 2001 y 2014, a partir de tres bases de datos secundarios. Se evaluó el tiempo de evolución para el sida, el tiempo de evolución para el óbito, la carga viral, el cálculo de linfocitos T-CD4+ y el tiempo de supervivencia. Se identificaron 103 casos de infección por VIH, de los cuales un 48,5% evolucionaron hacia sida, siendo 60% en menos de un año desde el diagnóstico. Se registraron 40 óbitos, siendo un 77,5% derivados de la infección por VIH. De esos que murieron, solamente un 30% tuvieron una supervivencia mayor que un año. Este estudio sugiere que el diagnóstico de la infección por VIH se produjo en fases avanzadas de la enfermedad, revelándose tardío y apuntando una cobertura diagnóstica deficiente. La rápida evolución al óbito y corto período de supervivencia, también pueden indicar fragilidad en el acceso a los servicios de salud de referencia, así como la descoordinación y acuerdos insuficientes entre distrito, municipios y estado.

Update on the treatment of musculoskeletal manifestations in chikungunya fever: a guideline.

Since the emergence of the chikungunya virus in Brazil in 2014, more than 700,000 cases have been reported throughout the country, corresponding to one-third of all cases reported in the Americas. In addition to its high attack rates, resulting in hundreds of thousands of cases, the disease has high chronicity rates with persistent joint manifestations for more than 3 months, which can spread to more than half of the patients affected in the acute phase. Pain associated with musculoskeletal manifestations, often disabling, has an effect on patients' quality of life at different stages of the disease. Currently, the challenge faced by specialists is identifying the best therapy to be instituted for symptom relief despite the limited number of published intervention studies. In 2016, a multidisciplinary group published pharmacological treatment protocols for pain in patients with chikungunya, which was incorporated into the guidelines for clinical management of the Brazilian Ministry of Health in 2017; in that same year, a consensus was published by the Brazilian Society of Rheumatology about diagnosis and treatment. After 5 years of experience with chikungunya epidemics, in 2019, specialists involved in the protocols of the Brazilian Society of Rheumatology and Brazilian Ministry of Health prepared an update with the main objective of developing flowcharts for the therapeutic approach of musculoskeletal manifestations in adult patients to enable specialists at different levels of healthcare to spread and apply this guideline in a systematic and simplified manner.

A clinical scoring system to predict long-term arthralgia in Chikungunya disease: A cohort study.

BACKGROUND: Chikungunya virus (CHIKV) has caused worldwide epidemics that impose a major burden on health systems. Approximately half of infected individuals develop chronic debilitating arthralgia, affecting their quality of life. Here, we identified the relevant clinical and demographic variables in the acute phase of CHIKV infection prospectively linked to chronic arthralgia to elaborate a prognostic scoring system. METHODS: Acute CHIKV infection cases (n = 134) confirmed by serology or molecular test were examined <10 days of disease onset and followed for one year to evaluate for disease progression. Potential risk factors for chronic arthralgia were evaluated by multivariate analysis to develop a prognostic scoring system, which was subsequently tested in an independent validation cohort consisting of 42 individuals. RESULTS: A total of 107 out of 134 (80%) acute CHIKV-confirmed cases from the derivation cohort were re-examined one year after enrollment. Chronic arthralgia post-CHIKV infection was diagnosed in 64 (60%). Five of the 12 parameters evaluated in the acute phase were statistically associated with persistent arthralgia and were further tested by Bayesian analysis. These variables were weighted to yield a prognosis score denominated SHERA (Sex, Hypertension, Edema, Retroocular pain, Age), which exhibited 81.3% accuracy in predicting long-term arthralgia post-CHIKV infection in the derivation cohort, and 76.5% accuracy in the validation cohort. CONCLUSIONS: The simplified and externally validated prognostic scoring system, SHERA, is a useful method to screen acutely CHIKV-infected patients at elevated risk of chronic arthralgia who will benefit from specific interventions. This tool could guide public health policies, particularly in resource-constrained settings.

Update on the treatment of musculoskeletal manifestations in chikungunya fever: a guideline

Abstract Since the emergence of the chikungunya virus in Brazil in 2014, more than 700,000 cases have been reported throughout the country, corresponding to one-third of all cases reported in the Americas. In addition to its high attack rates, resulting in hundreds of thousands of cases, the disease has high chronicity rates with persistent joint manifestations for more than 3 months, which can spread to more than half of the patients affected in the acute phase. Pain associated with musculoskeletal manifestations, often disabling, has an effect on patients' quality of life at different stages of the disease. Currently, the challenge faced by specialists is identifying the best therapy to be instituted for symptom relief despite the limited number of published intervention studies. In 2016, a multidisciplinary group published pharmacological treatment protocols for pain in patients with chikungunya, which was incorporated into the guidelines for clinical management of the Brazilian Ministry of Health in 2017; in that same year, a consensus was published by the Brazilian Society of Rheumatology about diagnosis and treatment. After 5 years of experience with chikungunya epidemics, in 2019, specialists involved in the protocols of the Brazilian Society of Rheumatology and Brazilian Ministry of Health prepared an update with the main objective of developing flowcharts for the therapeutic approach of musculoskeletal manifestations in adult patients to enable specialists at different levels of healthcare to spread and apply this guideline in a systematic and simplified manner.

Epidemiological aspects of HIV infection and AIDS among indigenous populations.

OBJECTIVE: To describe the epidemiological aspects of HIV infection and AIDS among indigenous peoples of the state of Mato Grosso do Sul, Brazil. METHODS: This is a descriptive epidemiological study on the occurrence and distribution of HIV infection and AIDS in the indigenous population assisted by the Distrito Sanitário Especial Indígena (Indigenous Special Health District) Mato Grosso do Sul between 2001 and 2014, based on three secondary databases. Annual rates of HIV and AIDS detection and prevalence were calculated, considering case distribution according to village, Health Base Pole and sociodemographic variables. Accumulated rates of detection, mortality and case fatality were calculated by ethnic group and for the Health Base Pole with the highest number of cases. RESULTS: The HIV detection rate fluctuated between 0.0 and 18.0/100 thousand people in the study period. For AIDS, there was no notification before 2007, but in 2012 its rate reached 16.6/100 thousand. HIV prevalence grew between 2001 and 2011, and it continuously grew for AIDS starting from 2007. The highest HIV detection rates occurred among Guarani peoples (167.1/100 thousand) and for AIDS, among the Kaiowá peoples (79.3/100 thousand); mortality and fatality rates were higher among the Kaiowá. Regarding the Dourados Health Base Pole, the AIDS detection rate increased, and the mortality and fatality rates decreased. CONCLUSIONS: HIV infection and AIDS have been increasing among indigenous peoples, with distribution of the disease mainly in the Health Base Poles of the southern region of the state, where greater economic and social vulnerability are also observed. The endemic character of HIV and AIDS can become epidemic in some years given the existence of cases in other villages in the state. Its occurrence among the Guarani and Kaiowá populations indicates the need for expanded diagnosis, access to treatment and prevention measures.

A computational method for the identification of Dengue, Zika and Chikungunya virus species and genotypes.

In recent years, an increasing number of outbreaks of Dengue, Chikungunya and Zika viruses have been reported in Asia and the Americas. Monitoring virus genotype diversity is crucial to understand the emergence and spread of outbreaks, both aspects that are vital to develop effective prevention and treatment strategies. Hence, we developed an efficient method to classify virus sequences with respect to their species and sub-species (i.e. serotype and/or genotype). This tool provides an easy-to-use software implementation of this new method and was validated on a large dataset assessing the classification performance with respect to whole-genome sequences and partial-genome sequences. Available online: http://krisp.org.za/tools.php.

Different aspects of platelet evaluation in dengue: Measurement of circulating mediators, ability to interact with the virus, the degree of activation and quantification of intraplatelet protein content.

Platelets play a role in hemostasis, coagulation, angiogenesis, inflammation and immune response is one of the most affected cells in dengue. Here we describe some aspects of platelets by observing their specific circulating mediators, the ability to interact with the virus and morphological consequences of this interaction, activation markers and intraplatelet protein contents in dengue. We conducted this study using dengue-patients as well as healthy donors. Immunoenzymatic assay, flow cytometry, transmission electron microscopy and intraplatelet proteins expression assays were carried out. Briefly, we found an increase in sCD62L, NO or TBX2 ratio in platelet count, mostly in patients with the worse clinical outcome. After in vitro DENV infection or during natural infection, platelets underwent morphological alteration with increased expression of platelet activation markers, particularly in natural infections. Analysis of intraplatelet protein contents revealed different angiogenic and inflammatory profiles, maintaining or not extracellular matrix integrity between DF and DFWS patients. Thus, platelets are frequently affected by dengue, either by altering their own functionality, as "carrier" of the virus, or as an antiviral and mediator-secreting effector cell. Thus, strategies aimed at recovering platelet amounts in dengue seem to be essential for a better clinical outcome of the patients.

Epidemiological aspects of HIV infection and AIDS among indigenous populations / Aspectos epidemiológicos da infecção pelo HIV e da aids entre povos indígenas

ABSTRACT OBJECTIVE To describe the epidemiological aspects of HIV infection and AIDS among indigenous peoples of the state of Mato Grosso do Sul, Brazil. METHODS This is a descriptive epidemiological study on the occurrence and distribution of HIV infection and AIDS in the indigenous population assisted by the Distrito Sanitário Especial Indígena (Indigenous Special Health District) Mato Grosso do Sul between 2001 and 2014, based on three secondary databases. Annual rates of HIV and AIDS detection and prevalence were calculated, considering case distribution according to village, Health Base Pole and sociodemographic variables. Accumulated rates of detection, mortality and case fatality were calculated by ethnic group and for the Health Base Pole with the highest number of cases. RESULTS The HIV detection rate fluctuated between 0.0 and 18.0/100 thousand people in the study period. For AIDS, there was no notification before 2007, but in 2012 its rate reached 16.6/100 thousand. HIV prevalence grew between 2001 and 2011, and it continuously grew for AIDS starting from 2007. The highest HIV detection rates occurred among Guarani peoples (167.1/100 thousand) and for AIDS, among the Kaiowá peoples (79.3/100 thousand); mortality and fatality rates were higher among the Kaiowá. Regarding the Dourados Health Base Pole, the AIDS detection rate increased, and the mortality and fatality rates decreased. CONCLUSIONS HIV infection and AIDS have been increasing among indigenous peoples, with distribution of the disease mainly in the Health Base Poles of the southern region of the state, where greater economic and social vulnerability are also observed. The endemic character of HIV and AIDS can become epidemic in some years given the existence of cases in other villages in the state. Its occurrence among the Guarani and Kaiowá populations indicates the need for expanded diagnosis, access to treatment and prevention measures.

RESUMO OBJETIVO Descrever os aspectos epidemiológicos da infecção pelo HIV e da aids entre povos indígenas do Mato Grosso do Sul. MÉTODOS Estudo epidemiológico descritivo sobre ocorrência e distribuição da infecção pelo HIV e aids na população indígena assistida pelo Distrito Sanitário Especial Indígena Mato Grosso do Sul, entre 2001 e 2014, a partir de três bases de dados secundários. Calcularam-se as taxas anuais de detecção e de prevalência de HIV e aids, com distribuição dos casos segundo aldeia, Polo Base e variáveis sociodemográficas. As taxas acumuladas de detecção, mortalidade e letalidade foram calculadas por etnia e para os Polos Base com o maior número de casos. RESULTADOS A taxa de detecção de HIV flutuou entre 0,0 e 18,0/100 mil pessoas no período. Para a aids, não houve notificação antes de 2007, mas em 2012 sua taxa chegou a 16,6/100 mil. A prevalência de HIV indicou crescimento entre 2001 e 2011, e para a aids observou-se aumento contínuo a partir de 2007. As maiores taxas de detecção de HIV ocorreram entre os Guarani (167,1/100 mil) e de aids, entre os Kaiowá (79,3/100 mil); as taxas de mortalidade e letalidade foram superiores entre os Kaiowá. Para o Polo Base de Dourados, observou-se elevação da taxa de detecção de aids e diminuição das taxas de mortalidade e letalidade. CONCLUSÕES A infecção pelo HIV e a aids mostraram-se crescentes entre povos indígenas, com distribuição da doença principalmente nos Polos Base da região sul do estado, onde observa-se também maior vulnerabilidade econômica e social. O caráter endêmico do HIV e da aids pode se tornar epidêmico em alguns anos, considerando a existência de casos em outras aldeias do estado. Sua ocorrência entre os Guarani e Kaiowá sinaliza a necessidade de ampliação do diagnóstico, do acesso ao tratamento e de medidas de prevenção.

National Dengue Control Program implementation evaluation in two border municipalities in Mato Grosso do Sul State, Brazil, 2016. / Avaliação da implantação do Programa de Controle da Dengue em dois municípios fronteiriços do estado de Mato Grosso do Sul, Brasil, 2016.

OBJECTIVE: to evaluate the degree of implementation of the National Dengue Control Program (PNCD) in two border municipalities in Mato Grosso do Sul State (Corumbá and Ponta Porã), Brazil, 2016. METHODS: This was a normative evaluation based on indicators of service structure and work process; questionnaires were answered by health professionals involved in dengue prevention and control; the cut-off points used to determine the degree of implementation were 'implemented' (>75% of the activities implemented), 'partially implemented' (50 to 75%), 'low level of implementation' (25 to 49%), and 'not implemented' (<25%). RESULTS: 383 health professionals participated in this study, 227 of whom were from Corumbá and 156 from Ponta Porã; the degree of PNCD implementation was 63.1% and 66.4% for Corumbá and Ponta Porã, respectively, thus being classified as partially implemented in both municipalities. CONCLUSION: PNCD implementation was partial in both municipalities; problems observed indicate the need for program enhancement.

Yellow fever outbreak in Brazil: the puzzle of rapid viral spread and challenges for immunisation.

We discuss the complex eco-social factors involved in the puzzle of the unexpected rapid viral spread in the ongoing Brazilian yellow fever (YF) outbreak, which has increased the reurbanisation risk of a disease without urban cases in Brazil since 1942. Indeed, this rapid spatial viral dissemination to the Southeast and South regions, now circulating in the Atlantic Forest fragments close to peri-urban areas of the main Brazilian megalopolises (São Paulo and Rio de Janeiro) has led to an exponential increase in the number of yellow fever cases. In less than 18 months, 1,833 confirmed cases and 578 deaths were recorded most of them reported in the Southeast region (99,9%). Large epizooties in monkeys and other non-human primates (NHPs) were communicated in the country with 732 YF virus (YFV) laboratory confirmed events only in the 2017/2018 monitoring period. We also discuss the peculiarities and similarities of the current outbreak when compared with previous great epidemics, examining several hypotheses to explain the recent unexpected acceleration of epizootic waves in the sylvatic cycle of the YFV together with the role of human, NHPs and mosquito mobility with respect to viral spread. We conclude that the most feasible hypothesis to explain this rapidity would be related to human behavior combined with ecological changes that promoted a significant increase in mosquito and NHP densities and their contacts with humans. We emphasize the urgent need for an adequate response to this outbreak such as extending immunisation coverage to the whole Brazilian population and developing novel strategies for immunisation of NHPs confined in selected reserve areas and zoos. Finally, we stress the urgent need to improve the quality of response in order to prevent future outbreaks and a catastrophic reurbanisation of the disease in Brazil and other South American countries. Continuous monitoring of YFV receptivity and vulnerability conditions with effective control of the urban vector Aedes aegypti and significant investments in YF vaccine production capacity and research and development for reduction of adverse effects are of the highest priority.

Yellow fever outbreak in Brazil: the puzzle of rapid viral spread and challenges for immunisation

We discuss the complex eco-social factors involved in the puzzle of the unexpected rapid viral spread in the ongoing Brazilian yellow fever (YF) outbreak, which has increased the reurbanisation risk of a disease without urban cases in Brazil since 1942. Indeed, this rapid spatial viral dissemination to the Southeast and South regions, now circulating in the Atlantic Forest fragments close to peri-urban areas of the main Brazilian megalopolises (São Paulo and Rio de Janeiro) has led to an exponential increase in the number of yellow fever cases. In less than 18 months, 1,833 confirmed cases and 578 deaths were recorded most of them reported in the Southeast region (99,9%). Large epizooties in monkeys and other non-human primates (NHPs) were communicated in the country with 732 YF virus (YFV) laboratory confirmed events only in the 2017/2018 monitoring period. We also discuss the peculiarities and similarities of the current outbreak when compared with previous great epidemics, examining several hypotheses to explain the recent unexpected acceleration of epizootic waves in the sylvatic cycle of the YFV together with the role of human, NHPs and mosquito mobility with respect to viral spread. We conclude that the most feasible hypothesis to explain this rapidity would be related to human behavior combined with ecological changes that promoted a significant increase in mosquito and NHP densities and their contacts with humans. We emphasize the urgent need for an adequate response to this outbreak such as extending immunisation coverage to the whole Brazilian population and developing novel strategies for immunisation of NHPs confined in selected reserve areas and zoos. Finally, we stress the urgent need to improve the quality of response in order to prevent future outbreaks and a catastrophic reurbanisation of the disease in Brazil and other South American countries. Continuous monitoring of YFV receptivity and vulnerability conditions with effective control of the urban vector Aedes aegypti and significant investments in YF vaccine production capacity and research and development for reduction of adverse effects are of the highest priority.

Desafios da prevenção e controle da dengue na fronteira Brasil/Bolívia: representações sociais de gestores e profissionais da saúde / Challenges of the prevention and control of dengue fever in Brazil/Bolivia border: social representations of health managers and professionals

Resumo Este estudo tem por objetivo identificar e analisar as representações sociais dos gestores e profissionais da saúde sobre os desafios da prevenção e controle da dengue em Corumbá, Mato Grosso do Sul, fronteira Brasil/Bolívia. Trata-se de uma pesquisa qualitativa fundamentada na teoria das representações sociais. Para a coleta de dados foram entrevistados cinco gestores e 63 profissionais da saúde atuantes na estratégia Saúde da Família e na Santa Casa de Misericórdia de Corumbá; a análise do conteúdo se fez pela técnica do Discurso do Sujeito Coletivo. Os resultados apontam que o município possui grandes dificuldades de enfrentamento da dengue pelo fato de ficar na fronteira. Na análise dos discursos foram identificadas quatro ideias centrais: insuficiência de recursos financeiros, mobilidade transfronteiriça, reduzida cooperação fronteiriça e cultura dos bolivianos. O estudo reforça a necessidade de cooperação bilateral ou multilateral para melhor atendimento à saúde nos territórios de fronteira.

Abstract This study aims to identify and analyze the social representations of health managers and professionals on challenges of combating dengue fever in Corumba, Mato Grosso do Sul state, Brazil/Bolivia border. It is a qualitative research based on the theory of social representations. For data collection were interviewed five managers and 63 health professionals active in the Family Health Strategy and Santa Casa de Misericordia, whose content analysis was done using the Collective Subject Discourse technique. The results indicate that the municipality has great difficulties to combat dengue fever because it is a border. In the discourse analysis, four main ideas were identified: insufficient financial resources, cross-border mobility, border cooperation reduced and Bolivian culture. The study reinforces the need for bilateral or multilateral cooperation for better health care in border areas.

Avaliação da implantação do Programa de Controle da Dengue em dois municípios fronteiriços do estado de Mato Grosso do Sul, Brasil, 2016 / Evaluación de la implantación del Programa de Control del Dengue en dos municipios fronterizos en el Estado de Mato Grosso do Sul, Brasil, 2016 / National Dengue Control Program implementation evaluation in two border municipalities in Mato Grosso do Sul State, Brazil, 2016

Objetivo: avaliar o grau de implantação do Programa Nacional de Controle da Dengue (PNCD) em dois municípios fronteiriços de Mato Grosso do Sul - Corumbá e Ponta Porã -, Brasil, em 2016. Métodos: avaliação normativa, baseada em indicadores da estrutura e do processo de trabalho; foram aplicados questionários a profissionais envolvidos na prevenção e controle da dengue; os pontos de corte utilizados para determinar o grau de implantação foram 'implantado' (>75% das atividades implantadas), 'parcialmente implantado' (50 a 75%), 'baixo nível de implantação' (25 a 49%) e 'não implantado' (<25%). Resultados: participaram do estudo 383 profissionais da Saúde, 227 de Corumbá e 156 de Ponta Porã; o grau de implantação do PNCD foi de 63,1% e 66,4% para Corumbá e Ponta Porã, respectivamente, classificado como parcialmente implantado nos dois municípios. Conclusão: a implantação do PNCD foi parcial em ambos os municípios; os problemas identificados remetem à necessidade de aprimoramento do programa.

Objetivo: evaluar el grado de implantación del Programa Nacional de Control del Dengue (PNCD) en dos municipios fronterizos de Mato Grosso do Sul - Corumbá y Ponta Porã -, Brasil, en 2016. Métodos: evaluación normativa basada en indicadores de la estructura y del proceso de trabajo; se aplicaron cuestionarios a profesionales involucrados en la prevención y control del dengue; los puntos de corte utilizados para determinar el grado de implantación fueron 'implantado' (>75% de las actividades implantadas), 'parcialmente implantado' (50 a 75%), 'bajo nivel de implantación' (25 a 49%) y 'no implantado' (<25%). Resultados: participaron del estudio 383 profesionales de la Salud, 227 de Corumbá y 156 de Ponta Porã; el grado de implantación del PNCD fue de 63,1% y 66,4% para Corumbá y Ponta Porã, respectivamente, clasificado como parcialmente implantado en ambos municipios. Conclusión: la implantación del PNCD fue parcial en ambos municipios; los problemas identificados remiten a la necesidad de perfeccionamiento del programa.

Objective: to evaluate the degree of implementation of the National Dengue Control Program (PNCD) in two border municipalities in Mato Grosso do Sul State (Corumbá and Ponta Porã), Brazil, 2016. Methods: This was a normative evaluation based on indicators of service structure and work process; questionnaires were answered by health professionals involved in dengue prevention and control; the cut-off points used to determine the degree of implementation were 'implemented' (>75% of the activities implemented), 'partially implemented' (50 to 75%), 'low level of implementation' (25 to 49%), and 'not implemented' (<25%). Results: 383 health professionals participated in this study, 227 of whom were from Corumbá and 156 from Ponta Porã; the degree of PNCD implementation was 63.1% and 66.4% for Corumbá and Ponta Porã, respectively, thus being classified as partially implemented in both municipalities. Conclusion: PNCD implementation was partial in both municipalities; problems observed indicate the need for program enhancement.