Avaliação do sistema de vigilância epidemiológica da leptospirose em Campinas, São Paulo, 2007 a 2014 / Evaluation of the leptospirosis epidemiological surveillance system in Campinas, São Paulo

Resumo Introdução A leptospirose figura na lista de doenças de notificação compulsória no Brasil. Objetivo Avaliar o sistema de vigilância epidemiológica da leptospirose no município de Campinas, São Paulo, no período de 2007-2014. Método Foi realizado um estudo de prevalência dos casos de leptospirose no sistema de vigilância epidemiológica. Foram analisados 2.949 casos notificados, considerando-se os atributos do Updated Guidelines for Evaluating Public Health Surveillance Systems e os parâmetros propostos por Souza et al. (2010) ao Sistema Nacional de Vigilância Epidemiológica. Foram analisados os seguintes atributos: completude, aceitabilidade, sensibilidade, valor preditivo positivo, representatividade e oportunidade. Resultados A completude foi boa (94,1%); a aceitabilidade foi de 68,3%; o valor preditivo positivo foi de 10,7%; a representatividade foi de 98,4%; e a oportunidade ocorreu em 71,4% dos casos. Conclusão É possível concluir que o sistema de vigilância epidemiológica para a leptospirose em Campinas teve uma completude aceitável e bom percentual de suspeição da doença. Foram observados atraso na notificação e na investigação dos casos e precária integração entre os sistemas de informações. A avaliação do sistema de vigilância traz informações importantes para a organização dos serviços de saúde e deve fazer parte da rotina das ações previstas no sistema. Este trabalho pode ser usado como modelo para a avaliação de sistemas de informação de outras doenças de notificação compulsória.

Abstract Background Leptospirosis is included in the list of diseases of compulsory notification in Brazil. Objective To evaluate the leptospirosis epidemiological surveillance system in the municipality of Campinas, state of São Paulo, Brazil, between 2007 and 2014. Method A study on the prevalence of leptospirosis cases was carried out in the epidemiological surveillance system. A total of 2949 reported cases were analyzed considering the attributes of the Updated Guidelines for Evaluating Public Health Surveillance Systems and the parameters proposed by Souza et al. (2010) for the National Epidemiological Surveillance System. The following attributes were assessed: completeness, acceptability, sensitivity, positive predictive value, representativeness, and timeliness. Results The following percentages were found for the respective attributes: completeness (94.1%), acceptability (68.3%), positive predictive value (10.7%), representativeness (98.4%) and timeliness (71.4%). Conclusion The leptospirosis epidemiological surveillance system in Campinas presented acceptable completeness and good positive predictive value of disease suspicion. Delays in the notification and investigation of cases and poor integration between the information systems were observed. The evaluation of the surveillance system provides important information for the organization of health services and should be part of the routine of actions provided for in the system. This study can be used as a model to evaluate information systems of other noticeable diseases.

Gas6 drives Zika virus-induced neurological complications in humans and congenital syndrome in immunocompetent mice.

Zika virus (ZIKV) has the ability to cross placental and brain barriers, causing congenital malformations in neonates and neurological disorders in adults. However, the pathogenic mechanisms of ZIKV-induced neurological complications in adults and congenital malformations are still not fully understood. Gas6 is a soluble TAM receptor ligand able to promote flavivirus internalization and downregulation of immune responses. Here we demonstrate that there is a correlation between ZIKV neurological complications with higher Gas6 levels and the downregulation of genes associated with anti-viral response, as type I IFN due to Socs1 upregulation. Also, Gas6 gamma-carboxylation is essential for ZIKV invasion and replication in monocytes, the main source of this protein, which was inhibited by warfarin. Conversely, Gas6 facilitates ZIKV replication in adult immunocompetent mice and enabled susceptibility to transplacental infection. Our data indicate that ZIKV promotes the upregulation of its ligand Gas6, which contributes to viral infectivity and drives the development of severe adverse outcomes during ZIKV infection.

Leptospirosis in Campinas, São Paulo, Brazil: 2007-2014. / Leptospirose no município de Campinas, São Paulo, Brasil: 2007 a 2014.

OBJECTIVE: to analyze the distribution of leptospirosis according to sociodemographic, epidemiologic, and clinical characteristics, assistance time, rainfall and spatial distribution in Campinas/SP in the period from 2007 to 2014. METHOD: This is an ecological study using information from the confirmed cases. A descriptive analysis was carried out according to the selected variables. The relationship between the cases and rainfall was verified through the Spearman's correlation coefficient. The cases/deaths were georeferenced per areas classified according to socioenvironmental deprivation indexes in Campinas. RESULTS: From the 264 cases, 76.1% occurred in men, 58,4% in the 20 to 49 years old age range. Approximately 55% were hospitalized, with a prevalence of clinical-laboratorial diagnoses of 89.4%, and the lethality was 10.6%. The urban area concentrated 74.2% of the cases, and 48,9% occurred in the household environment. The main risk factor was evidence of the presence of rodents at the site. There was strong correlation between the incidence of cases and rainfall (p < 0.05) in 2010 to 2012. A higher concentration of the cases was observed in the Center-Southwest region. Spatial distribution of cases/deaths showed clusters in regions classified at lower socioeconomic levels. CONCLUSIONS: The patterns of occurrence of leptospirosis in Campinas showed similarity with other Brazilian municipalities. The identification of areas with higher incidence of cases/deaths contributes to the adoption of strategies for intervention and prioritization of resources aiming at the reduction of the risk of infection and at early treatment for those affected.

OBJETIVO: Analisar a distribuição de casos e óbitos humanos por leptospirose, segundo características sociodemográficas, epidemiológicas, clínicas, tempo de atendimento, pluviosidade e distribuição espacial em Campinas, São Paulo, no período de 2007 a 2014. MÉTODO: Estudo ecológico utilizando informações dos casos confirmados de leptospirose. Realizou-se análise descritiva dos casos, segundo variáveis selecionadas. A relação entre casos autóctones e pluviosidade foi verificada pelo coeficiente de correlação de Spearman. Georreferenciaram-se casos/óbitos por áreas classificadas segundo indicadores socioambientais. RESULTADOS: Dos 264 casos, 76,1% eram homens e 58,4% tinham entre 20 e 49 anos. Cerca de 55% foram hospitalizados. Prevaleceu o diagnóstico clínico-laboratorial (89,4%) e a letalidade foi de 10,6%. Na área urbana, ocorreram 74,2% dos casos e, 48,9%, no domicílio. O principal fator de risco foi o local com sinal de roedores. Houve forte correlação entre a incidência de casos e a pluviosidade (p < 0,05) nos anos de 2010 a 2012. Observou-se maior concentração de casos na região centro-sudoeste. A distribuição espacial dos casos/óbitos mostrou aglomerados em regiões classificadas como de menor nível socioeconômico. CONCLUSÃO: Os padrões de ocorrência de leptospirose em Campinas, São Paulo, mostraram similaridade com outras cidades brasileiras. A identificação de áreas com maior incidência de casos/óbitos contribui para a adoção de estratégias específicas de intervenção e priorização de recursos na redução do risco de infecção e tratamento precoce dos acometidos pela doença.

Leptospirose no município de Campinas, São Paulo, Brasil: 2007 a 2014 / Leptospirosis in Campinas, São Paulo, Brazil: 2007-2014

RESUMO: Objetivo: Analisar a distribuição de casos e óbitos humanos por leptospirose, segundo características sociodemográficas, epidemiológicas, clínicas, tempo de atendimento, pluviosidade e distribuição espacial em Campinas, São Paulo, no período de 2007 a 2014. Método: Estudo ecológico utilizando informações dos casos confirmados de leptospirose. Realizou-se análise descritiva dos casos, segundo variáveis selecionadas. A relação entre casos autóctones e pluviosidade foi verificada pelo coeficiente de correlação de Spearman. Georreferenciaram-se casos/óbitos por áreas classificadas segundo indicadores socioambientais. Resultados: Dos 264 casos, 76,1% eram homens e 58,4% tinham entre 20 e 49 anos. Cerca de 55% foram hospitalizados. Prevaleceu o diagnóstico clínico-laboratorial (89,4%) e a letalidade foi de 10,6%. Na área urbana, ocorreram 74,2% dos casos e, 48,9%, no domicílio. O principal fator de risco foi o local com sinal de roedores. Houve forte correlação entre a incidência de casos e a pluviosidade (p < 0,05) nos anos de 2010 a 2012. Observou-se maior concentração de casos na região centro-sudoeste. A distribuição espacial dos casos/óbitos mostrou aglomerados em regiões classificadas como de menor nível socioeconômico. Conclusão: Os padrões de ocorrência de leptospirose em Campinas, São Paulo, mostraram similaridade com outras cidades brasileiras. A identificação de áreas com maior incidência de casos/óbitos contribui para a adoção de estratégias específicas de intervenção e priorização de recursos na redução do risco de infecção e tratamento precoce dos acometidos pela doença.

ABSTRACT: Objective: to analyze the distribution of leptospirosis according to sociodemographic, epidemiologic, and clinical characteristics, assistance time, rainfall and spatial distribution in Campinas/SP in the period from 2007 to 2014. Method: This is an ecological study using information from the confirmed cases. A descriptive analysis was carried out according to the selected variables. The relationship between the cases and rainfall was verified through the Spearman's correlation coefficient. The cases/deaths were georeferenced per areas classified according to socioenvironmental deprivation indexes in Campinas. Results: From the 264 cases, 76.1% occurred in men, 58,4% in the 20 to 49 years old age range. Approximately 55% were hospitalized, with a prevalence of clinical-laboratorial diagnoses of 89.4%, and the lethality was 10.6%. The urban area concentrated 74.2% of the cases, and 48,9% occurred in the household environment. The main risk factor was evidence of the presence of rodents at the site. There was strong correlation between the incidence of cases and rainfall (p < 0.05) in 2010 to 2012. A higher concentration of the cases was observed in the Center-Southwest region. Spatial distribution of cases/deaths showed clusters in regions classified at lower socioeconomic levels. Conclusions: The patterns of occurrence of leptospirosis in Campinas showed similarity with other Brazilian municipalities. The identification of areas with higher incidence of cases/deaths contributes to the adoption of strategies for intervention and prioritization of resources aiming at the reduction of the risk of infection and at early treatment for those affected.

Excess Mortality Related to Chikungunya Epidemics in the Context of Co-circulation of Other Arboviruses in Brazil.

INTRODUCTION: Chikungunya is an emerging arbovirus that reached the Western Hemisphere at the end of 2013. Studies in the Indian Ocean and India suggest that passive surveillance systems cannot recognize many of deaths associated with chikungunya, which can be inferred by an increase in the overall mortality observed during chikungunya epidemics. OBJECTIVE: We assess the mortality associated with chikungunya epidemics in the most affected states in Brazil, from 2015 and 2016. METHODS: We studied the monthly mortality by age group, comparing a period without epidemics to a chikungunya epidemic period, which we defined arbitrarily as consecutive months with incidences of more than 50 cases/100,000 persons. RESULTS: We obtained official data from the National System of Reported Diseases (SINAN) and the Mortality Information System (SIM), both maintained by the Ministry of Health. We identified a significant increase in the all-cause mortality rate during chikungunya epidemics, while there was no similar mortality in the previous years, even during dengue epidemics. We estimated an excess of 4,505 deaths in Pernambuco during the chikungunya epidemics (47.9 per 100,000 persons).The most affected age groups were the elderly and those under 1 year of age, and the same pattern occurred in all the states. DISCUSSION: Further studies at other sites are needed to confirm the association between increased mortality and chikungunya epidemics indifferent age groups. If these findings are confirmed, it will be necessary to revise the guidelines to recognize the actual mortality associated with chikungunya and to improve therapeutic approaches and protective measures in the most vulnerable groups.

Visceral leishmaniasis in an environmentally protected area in southeastern Brazil: Epidemiological and laboratory cross-sectional investigation of phlebotomine fauna, wild hosts and canine cases.

BACKGROUND: Leishmaniasis is a rapidly expanding zoonosis that shows increasing urbanization. Concern exists regarding the role of wildlife in visceral leishmaniasis (VL) transmission, due to frequent natural or anthropogenic environmental changes that facilitate contact between wildlife, humans and their pets. The municipality of Campinas, in southeastern Brazil, initially recorded VL in 2009, when the first autochthonous case was confirmed in a dog living in an upscale residential condominium, located inside an environmentally protected area (EPA). Since then, disease transmission remains restricted to dogs inhabiting two geographically contiguous condominiums within the EPA. METHODOLOGY/PRINCIPAL FINDINGS: We conducted a cross-sectional study of the VL focus to investigate Leishmania spp. infection in domestic dogs, wild mammals and sand flies using molecular tools and recommended serological techniques. Canine seroprevalences of 1.5% and 1.2% were observed in 2013 and 2015, respectively. Six insect species, confirmed or suspected vectors or potential transmitters of Leishmania, were identified. Two specimens of the main L. (L.) infantum vector in Brazil, Lutzomyia longipalpis, were captured in the EPA. Natural infection by L. (L.) infantum was recorded in one Expapillata firmatoi specimen and two Pintomyia monticola. Natural infection by L. (L.) infantum and Leishmania subgenus Viannia was also detected in two white-eared opossums (Didelphis albiventris), a known reservoir of VL. Geographical coordinates of each sampling of infected animals were plotted on a map of the EPA, demonstrating proximity between these animals, human residences, including the dogs positive for VL, and forest areas. CONCLUSIONS/SIGNIFICANCE: The EPA, which is inhabited by humans, has an active VL focus. The risk of establishing and maintaining disease transmission foci in similar scenarios, i.e. wild areas that undergo environmental modifications, is evident. Moreover, different epidemiological profiles of VL must be included to elaborate prevention and control measures that consider the particularities of each transmission area.

The first canine visceral leishmaniasis outbreak in Campinas, State of São Paulo Southeastern Brazil.

INTRODUCTION: Early detection of American visceral leishmaniasis (AVL) outbreak in animals is crucial for controlling this disease in non-endemic areas. METHODS: Epidemiological surveillance (2009-2012) was performed in Campinas, State of São Paulo, Brazil. RESULTS: In 2009, Leishmania chagasi was positively identified in four dogs. Entomological research and three serological studies (2010-2012) were undertaken as monitoring measures; these approaches revealed a moderate prevalence of Leishmania present in 4% of the canine population. Nyssomyia whitmani and Lutzomyia longipalpis were the predominant species identified. CONCLUSIONS: Detection of an AVL outbreak in dogs in an area with an evolving natural landscape containing sand flies is crucial for control programs.