Fatores prognósticos associados ao óbito por hantavirose no Brasil, 2007 a 2015 / Prognostic factors associated with death due to hantavirus in Brazil, 2007 to 2015

Objetivo: Analisar fatores associados ao óbito por hantavirose no Brasil. Método: trata-se de um estudo epidemiológico analítico do tipo caso-controle aninhado em uma coorte de casos contidos no Sistema de Informação de Agravos de Notificação. Para a análise bruta univariada, foi realizada regressão logística considerada p<0,20 e, para análise multivariada, foi realizada regressão logística do tipo stepwise-backwards, adotando p<0,05. Resultados: foram identificadas associações significativas com maior letalidade por hantavirose para os seguintes grupos: mulheres (Odds Ratio (OR): 1,43 - IC95% 1,02 a 2,00) para indivíduos com escolaridade não informada (OR: 3,86 ­ IC95% 1,71a 8,66) e ensino fundamental completo (OR: 3,88 - IC95% 1,51 a 9,96). Moradores da zona urbana (OR: 1,56 ­ IC95%. 1,15 a 2,12), indivíduos com choque e/ou hipotensão (OR: 3,37 - IC95% 2,51 a 4,51), sintomas respiratórios, e indivíduos cujo primeiro atendimento foi realizado com até três dias do início de sintoma (OR: 3,76 ­ IC95%: 2,51 a 4,51). Conclusão: algumas características do paciente podem aumentar as chances de óbito principalmente devido à baixa suspeição clínica e a possível demora na adoção do manejo adequado dos casos. A busca precoce de atenção, além da presença choque, hipotensão e/ou sinais respiratórios podem indicar evolução rápida da doença e maior gravidade.

Objetive: to analyze factors associated with death from hantavirus in Brazil. Method: This is an analytical case-control type epidemiological study nested in a cohort of cases contained in the Notifiable Diseases Information System. For the univariate crude analysis, a logistic regression was performed considering p <0.20 and for the multivariate analysis, a stepwise-backwards logistic regression was performed, adopting p <0.05. Results: Significant associations with higher lethality due to hantavirosis were identified for the following groups: women (Odds Ratio (OR): 1.43 - 95% CI 1.02 to 2.00) for individuals with uninformed schooling (OR: 3.86 - IC95% 1.71a 8.66) and complete elementary education (OR: 3.88 - 95% CI 1.51 to 9.96). Urban residents (OR: 1.56 - 95% CI 1.15 to 2.12), individuals with shock and / or hypotension (OR: 3.37 - 95% CI 2.51 to 4.51), respiratory symptoms (OR: 3.76 - 95% CI: 2.51 to 4.51), and individuals whose first care was performed within 3 days from the onset of symptoms. Conclusion: some characteristics of the patient may increase the chances of death mainly due to the low clinical suspicion and possible delay in adopting appropriate management of cases. The early search for attention, in addition to the presence of shock, hypotension and / or respiratory signs may indicate rapid disease progression and greater severity.

Magnitude and distribution of deaths due to hantavirus in Brazil, 2007-2015. / Magnitude e distribuição dos óbitos por hantavirose no Brasil, 2007-2015.

OBJECTIVE: to describe the magnitude and temporal and spatial distribution of hantavirus cases and deaths in Brazil between 2007 and 2015. METHODS: descriptive study with data from the Notifiable Diseases Information System (SINAN). RESULTS: 1,060 cases and 410 deaths were reported in the period; hantavirus lethality was 39.0%, varying according to month (from 28.6% in November to 50.7% in December), sex (37.4% in males and 42.6% in females), age (higher lethality in the elderly and children) and Brazilian regions (46.2% in the North, 32.9% in the South); most of the individuals who died lived in urban areas (58.3%) and were infected in rural area (70.2%). CONCLUSION: high lethality in certain population groups, months of the year and regions of Brazil point to low clinical suspicion of the disease in groups with low exposure, which may compromise proper case management.

Magnitude e distribuição dos óbitos por hantavirose no Brasil, 2007-2015 / Magnitud y distribución de las muertes por hantavirose no Brasil, 2007-2015 / Magnitude and distribution of deaths due to hantavirus in Brazil, 2007-2015

Objetivo: descrever a magnitude e a distribuição temporal e espacial dos casos e óbitos por hantavirose no Brasil, de 2007 a 2015. Métodos: estudo descritivo, com dados do Sistema de Informação de Agravos de Notificação (Sinan). Resultados: foram notificados 1.060 casos e 410 óbitos no período; a letalidade por hantavirose foi de 39,0%, variando segundo mês (de 28,6% em novembro a 50,7% em dezembro), sexo (37,4% no masculino e 42,6% no feminino), idade (maior letalidade em idosos e crianças) e regiões nacionais (46,2% no Norte, 32,9% no Sul); a maioria dos indivíduos que morreram morava em zona urbana (58,3%) e foi infectada na zona rural (70,2%). Conclusão: a alta letalidade em certos grupos populacionais, meses do ano e regiões do Brasil aponta para baixa suspeição clínica da doença em grupos pouco expostos, o que pode comprometer seu manejo adequado.

Objetivo: describir la magnitud y la distribución temporal y espacial de los casos y muertes por hantavirus en Brasil, de 2007 a 2015. Métodos: estudio descriptivo, con datos del Sistema de Información de Agravios de Notificación (Sinan). Resultados: se notificaron 1.060 casos y 410 muertes en este período; la mortalidad por hantavirus fue 39,0%, variando por mes (28,6% en noviembre a 50,7% en diciembre), sexo (37,4% en el masculino y 42,6% en el femenino), edad (mayor letalidad en ancianos y niños) y regiones nacionales (46,2% en el Norte, 32,9% en el Sur); la mayoría de los individuos que murieron vivían en zona urbana (58,3%) y se infectaron en la zona rural (70,2%). Conclusión: la alta letalidad en ciertos grupos poblacionales, meses del año y regiones de Brasil apuntan a baja sospecha clínica de la enfermedad en grupos poco expuestos, lo que puede comprometer su manejo adecuado.

Objective: to describe the magnitude and temporal and spatial distribution of hantavirus cases and deaths in Brazil between 2007 and 2015. Methods: descriptive study with data from the Notifiable Diseases Information System (SINAN). Results: 1,060 cases and 410 deaths were reported in the period; hantavirus lethality was 39.0%, varying according to month (from 28.6% in November to 50.7% in December), sex (37.4% in males and 42.6% in females), age (higher lethality in the elderly and children) and Brazilian regions (46.2% in the North, 32.9% in the South); most of the individuals who died lived in urban areas (58.3%) and were infected in rural area (70.2%). Conclusion: high lethality in certain population groups, months of the year and regions of Brazil point to low clinical suspicion of the disease in groups with low exposure, which may compromise proper case management.

An update on the epidemiological situation of spotted fever in Brazil.

BACKGROUND: Spotted fever is a tick-borne rickettsial disease. In Brazil, its notification to the Ministry of Health is compulsory. Since 2007, cases of spotted fever have been integrated to the Notifiable Diseases Information System, and epidemiological analyzes are part of the routines on surveillance programs. METHODS: This descriptive study updates epidemiological information on cases of spotted fever registered in Brazil between 2007 and 2015. RESULTS: In Brazil, 17,117 suspected cases of the disease were reported and 1,245 were confirmed in 12 states, mainly in São Paulo (550, 44.2 %) and Santa Catarina (276, 22.2 %). No geographic information was registered for 132 cases (10.6 %). Most of the infected people were men (70.9 %), mainly in rural areas (539, 43.3 %), who had contact with ticks (72.7 %). A higher number of suspected cases were registered between 2011 and 2015, but the number of confirmed cases and the incidence were relatively low. Moreover, 411 deaths were registered between 2007 and 2015, mainly in the southeastern region of the country, where the case-fatality rate was 55 %. Lack of proper filling of important fields of notification forms was also observed. CONCLUSIONS: The results showed expansion of suspected cases of spotted fever and high case-fatality rates, which could be related to diagnostic difficulties and lack of prompt treatment. These factors may comprise limitations to the epidemiological surveillance system in Brazil, hence improvement of notification and investigation are crucial to reduce morbidity and mortality due to spotted fever in Brazil.

An update on the epidemiological situation of spotted fever in Brazil

Background Spotted fever is a tick-borne rickettsial disease. In Brazil, its notification to the Ministry of Health is compulsory. Since 2007, cases of spotted fever have been integrated to the Notifiable Diseases Information System, and epidemiological analyzes are part of the routines on surveillance programs. Methods This descriptive study updates epidemiological information on cases of spotted fever registered in Brazil between 2007 and 2015. Results In Brazil, 17,117 suspected cases of the disease were reported and 1,245 were confirmed in 12 states, mainly in São Paulo (550, 44.2 %) and Santa Catarina (276, 22.2 %). No geographic information was registered for 132 cases (10.6 %). Most of the infected people were men (70.9 %), mainly in rural areas (539, 43.3 %), who had contact with ticks (72.7 %). A higher number of suspected cases were registered between 2011 and 2015, but the number of confirmed cases and the incidence were relatively low. Moreover, 411 deaths were registered between 2007 and 2015, mainly in the southeastern region of the country, where the case-fatality rate was 55 %. Lack of proper filling of important fields of notification forms was also observed. Conclusions The results showed expansion of suspected cases of spotted fever and high case-fatality rates, which could be related to diagnostic difficulties and lack of prompt treatment. These factors may comprise limitations to the epidemiological surveillance system in Brazil, hence improvement of notification and investigation are crucial to reduce morbidity and mortality due to spotted fever in Brazil.(AU)

An update on the epidemiological situation of spotted fever in Brazil

Spotted fever is a tick-borne rickettsial disease. In Brazil, its notification to the Ministry of Health is compulsory. Since 2007, cases of spotted fever have been integrated to the Notifiable Diseases Information System, and epidemiological analyzes are part of the routines on surveillance programs. Methods This descriptive study updates epidemiological information on cases of spotted fever registered in Brazil between 2007 and 2015. Results In Brazil, 17,117 suspected cases of the disease were reported and 1,245 were confirmed in 12 states, mainly in São Paulo (550, 44.2 %) and Santa Catarina (276, 22.2 %). No geographic information was registered for 132 cases (10.6 %). Most of the infected people were men (70.9 %), mainly in rural areas (539, 43.3 %), who had contact with ticks (72.7 %). A higher number of suspected cases were registered between 2011 and 2015, but the number of confirmed cases and the incidence were relatively low. Moreover, 411 deaths were registered between 2007 and 2015, mainly in the southeastern region of the country, where the case-fatality rate was 55 %. Lack of proper filling of important fields of notification forms was also observed. Conclusions The results showed expansion of suspected cases of spotted fever and high case-fatality rates, which could be related to diagnostic difficulties and lack of prompt treatment. These factors may comprise limitations to the epidemiological surveillance system in Brazil, hence improvement of notification and investigation are crucial to reduce morbidity and mortality due to spotted fever in Brazil.

Vulnerability of Brazilian municipalities to hantavirus infections based on multi-criteria decision analysis.

BACKGROUND: Hantavirus infection is an emerging zoonosis transmitted by wild rodents. In Brazil, high case-fatality rates among humans infected with hantavirus are of serious concern to public health authorities. Appropriate preventive measures partly depend on reliable knowledge about the geographical distribution of this disease. METHODS: Incidence of hantavirus infections in Brazil (1993-2013) was analyzed. Epidemiological, socioeconomic, and demographic indicators were also used to classify cities' vulnerability to disease by means of multi-criteria decision analysis (MCDA). RESULTS: From 1993 to 2013, 1752 cases of hantavirus were registered in 16 Brazilian states. The highest incidence of hantavirus was observed in the states of Mato Grosso (0.57/100,000) and Santa Catarina (0.13/100,000). Based on MCDA analysis, municipalities in the southern, southeastern, and midwestern regions of Brazil can be classified as highly vulnerable. Most municipalities in northern and northeastern Brazil were classified as having low vulnerability to hantavirus cardiopulmonary syndrome. CONCLUSIONS: Although most human infections by hantavirus registered in Brazil occurred in the southern region of the country, a greater vulnerability to hantavirus was found in the Brazilian Midwest. This result reflects the need to strengthen surveillance where the disease has thus far gone unreported.

Análise do perfil epidemiológico da hantavirose no Brasil no período de 2007 a 2012 / Analysis of the epidemiological profile of hanavirus in Brazil for the period 2007 to 2012

As hantaviroses são zoonoses que causam doenças humanas graves como a síndrome cardiopulmonar por hantavírus (SCPH) registrada no continente americano. No Brasil a SCPH é doença de notificação obrigatória aos serviços de saúde por apresentar elevada letalidade e incipiente conhecimento da sua epidemiologia. O presente estudo descreve o perfil epidemiológico da SCPH no Brasil para o período de 2007 a 2012. Foi realizado um estudo descritivo dos registros do Sistema Nacional de Agravos de Notificação, foram analisadas as fichas de notificação e investigação e os dados foram avaliados quanto a completitude da informação, oportunidade e perfil dos casos registrados. Os resultados são apresentados em números brutos, medidas de proporção e tendência central e as analises foram desenvolvidas pelos softwares Excel 2010, Tabwin 32 e TerraView. No período estudado foram notificados 8.456 casos de SCPH, com confirmação de 9 porcento (756/8.456), preferencialmente pelo critério laboratorial 91,1 porcento (689/756). O coeficiente de letalidade médio para o período foi de 38,2 porcento, as maiores incidências da doença foram nos estados do Mato Grosso, Santa Catarina e Distrito Federal e as maiores letalidades no Amazonas, Mato Grosso e São Paulo. Quanto à sazonalidade foram observados casos em todos os meses do ano; os óbitos foram mais frequentes em homens 72,3 porcento (209/289) e maior letalidade 42,3 porcento (80/189) foi observada em mulheres. Os casos acometeram principalmente pessoas que exerciam atividades relacionadas à agricultura 18,8 porcento (90/478) que se expuseram ao ambiente com roedores 36,9 porcento (279/756)...

Hantaviruses are zoonoses that cause serious human diseases in the Americas such as hantavirus pulmonary syndrome (HPS). In Brazil HPS is a notifiable disease to health services due to its high lethality and incipient knowledge of its epidemiology. The present study describes the epidemiology of HPS in Brazil for the period 2007-2012. We conducted a descriptive study of the records of the National Notifiable Diseases System, analyzed the reporting forms and research, and the data were evaluated for completeness of information, opportunity and profile of registered cases. The results are presented as raw numbers, measures of central tendency and proportion and analyses developed using Excel 2010 software, and 32 Tabwin terraView. In the study period 8,456 cases of HPS were reported, with confirmation of 9 percent (756/8,456), ideally by laboratory testing 91.1 percent (689/756). The average coefficient of lethality for the period was 38.2 percent, whilst the highest incidences of the disease were in the states of Mato Grosso, Santa Catarina and the Federal District and the greatest lethalities were in Amazonas, Mato Grosso and São Paulo. Regarding seasonality, cases were observed in all months of the year. Deaths were more frequent in males 72.3 percent (209/289) and high mortality was observed in women 42.3 percent (80/189). The cases were mainly people who conducted activities related to agriculture 18.8 percent (90/478) who were exposed to the rodent environment, 36.9 percent (279/756)...

Occupational risk of spotted fever: an evaluation of knowledge, attitudes and prevention practices among veterinary medicine students

Spotted fever (SF) is a tick-borne rickettsial disease that in Brazil affects mainly the economically active population. The occupational risk attributed to veterinarians, biologists and animal handlers is due to exposure to disease vectors. This study assessed the knowledge, attitudes and preventivepractices relating to SF in a group of veterinary medicine students. A descriptive analysis was conducted among 173 students at a private higher education institution in the Brazilian Federal District. The participants were asked about their knowledge of SF, their attitudes when they foundticks on their body and practices relating to tick handling, treatment and prevention. The results showed that 84 percent of the respondents had heard about SF. Almost half of the respondents answered that SF is a tick-borne disease. Most respondents knew about prevention methods, and the main method cited was treatment of the animals with acaricides. Regarding attitudes towards SF, it was observed that most respondents removed ticks by hand. None of the respondents were using appropriate protective equipment when exposed to the vector. Although this population was well informed about SF and its preventive measures, this knowledge was not reflected in implementation of prevention practices.

A febre maculosa (FM) é uma riquetsiose transmitida por carrapatos que, no Brasil, acomete principalmente a população economicamente ativa. O risco ocupacional atribuído aos profissionais veterinários, biólogos e tratadores de animais se deve à exposição aos vetores da doença. O presente estudo avalia os conhecimentos sobre a FM, as atitudes e práticas preventivas contra a doença emum grupo de estudantes de medicina veterinária. Uma análise descritiva foi realizada com 173 alunos de uma instituição de ensino superior privado do Distrito Federal. Os participantes foramquestionados sobre seus conhecimentos em relação à FM, suas atitudes ao encontrar carrapatos nocorpo, práticas relacionadas ao manuseio dos carrapatos, bem como o tratamento e a prevençãoda doença. Os resultados mostraram que 84 por cento dos entrevistados já ouviram falar da FM. Quase a metade respondeu que a FM é uma doença transmitida por carrapato. A maioria conhecia os métodos de prevenção e o mais citado foi o tratamento dos animais com carrapaticidas. Quanto às atitudes relacionadas à FM, predominou a declaração de que removiam carrapatos com as mãos. Nenhumdos entrevistados usou equipamento de proteção adequado quando exposto ao vetor. Embora a população esteja bem informada sobre a FM e suas medidas preventivas, tal conhecimento não serefletiu na implementação de práticas de prevenção.

Investigação de ratada associada a florescimento e frutificação de taquaras em São Francisco do Sul, Santa Catarina, Brasil, 2012 / Investigación e ratada asociaa a florecimiento y frutificación de tacuaras een são francisco do sul, santa Catarina, Brasil, 2012 / Research on odennt outbreak associated with flowering and fruiting of bamboos in são francisco do sul, santa Catarina, Brazil, 2122

A reprodução e a morte massiva de plantas de longa vida, como taquaras e bambus, estão associadas historicamente a episódios de ratadas. A superpopulação de roedores, que é favorecida pelo evento reprodutivo desses vegetais, traz consigo grandes prejuízos e riscos de emergências de doenças. Nesta nota, relatamos o episódio de ratada ocorrido no município de São Francisco do Sul, Santa Catarina. Para subsidiar esta comunicação foram feitas observações de campo, entrevistas não estruturadas e coleta de material biológico em novembro de 2012. Foi constatada a reprodução da taquara do gênero Merostachys e a invasão subsequente de domicílios por roedores dos gêneros Oligoryzomys e Akodon, reservatórios de hantavírus, no sul do Brasil.

Reproduction and massive death of long lived plants like bamboo are historically associated with episodes of mouse outbreaks. The over population of rodents that is favored by the reproduction of these vegetables brings big losses and risks of emerging diseases. In this note we report the mouse outbreaks happened in the district of São Francisco do Sul, Santa Catarina, Brazil. In order to supoort this communication we conducted observations, unstructured interview and sand collection of biological material in November 2012. It was found bamboo reproduction of the genus Merostachys and subsequent invasion of houses by rodents of the genus Oligoryzomys and Akodon, which are hantavirus reservoirs, in southern Brazil.

La reproducción y muerte masiva de plantas de larga vida, como tacuaras y bambús, están asociadas históricamente a episodios de ratadas. La superpoblación de roedores, que es favorecida por el evento reproductivo de esos vegetales, trae consigo grandes perjuicios y riesgos de emergencias de enfermedades. En esta nota, relatamos el episodio de ratada ocurrido en el municipio de São Francisco do Sul, Santa Catarina. Para subsidiar esta comunicación fueron hechas observaciones de campo, entrevistas no estructuradas y recogida de material biológico en noviembre de 2012. Fue constatada la reproducción de la tacuara del género Merostachys y la invasión subsecuente de domicilios por roedores de los géneros Oligoryzomys e Akodon, reservorios de hantavirus, en el sur de Brasil.