Monitoramento da Covid-19 nas favelas cariocas: vigilância de base territorial e produção compartilhada de conhecimento / Monitoring COVID-19 in Rio's favelas: territorial-based surveillance and shared production of knowledge

RESUMO Apresenta-se um ensaio crítico-reflexivo sobre a ocorrência da Covid-19 em espaços periféricos do município do Rio de Janeiro, tendo como metodologia principal a análise documental dos três boletins socioepidemiológicos Covid-19 nas favelas, publicados no âmbito do Observatório Covid-19 da Fiocruz. Os resultados dos referidos boletins foram apresentados e problematizados a partir do referencial teórico da epidemiologia crítica e da determinação social do processo saúde-doença, discutindo a magnitude da doença nas favelas. Ademais, compreendeu-se que este debate visibiliza e fortalece a reflexão sobre os impactos sanitários e sociais da Covid-19 nas áreas de periferia de todo o País. Foram descritos o processo de trabalho para a elaboração dos boletins, os desafios metodológicos enfrentados para monitorar processos epidêmicos em espaços periféricos, e problematizados os principais resultados à luz das desigualdades históricas que ficaram ainda mais evidentes com a atual pandemia.

ABSTRACT This is a critical reflection essay on COVID-19 in suburban areas in Rio de Janeiro through documental analysis of the three socio-epidemiological bulletins COVID-19 in the favelas, published in FIOCRUZ COVID-19 Observatory. The results of these bulletins were presented and discussed grounded on critical epidemiology and the social determination of the health-disease process, discussing the magnitude of the disease in the favelas. Furthermore, we understood that this debate elicits and strengthens the discussion about the health and social impacts of COVID-19 in the Brazilian suburbs. We described the work process to prepare the bulletins and the methodological challenges of monitoring diseases in the suburbs. Lastly, the main results were analyzed and discussed, considering the historical inequalities that became more evident with the current pandemic.

Production of Urban Space and the occurrence of malaria in the Brazilian Amazon: the Porto Velho case.

Due to intense ongoing urbanization in the Amazon, the urban pattern of malaria may be changing, both in its spatial distribution and epidemiological profile. The purpose of this paper is to analyze how the process of production of urban space in Porto Velho, the capital of the state of Rondonia, Brazil has contributed to the occurrence and maintenance of urban malaria. Using data collected from the Malaria Epidemiological Surveillance System (SIVEP-Malaria), we calculated malaria indices for the districts of Porto Velho from 2005 to 2018. We also developed two typologies for classifying urban space based on functional characteristics and features of the landscape. While the former considers characteristics of urban space in Porto Velho, the latter is based on suitability for malaria vectors. We found that the annual parasite index declined in Porto Velho during the study period. However, changes in the index were not uniform across the districts of the city. Periurban areas showed no decline in the index, which we attribute to these areas' high vegetation density and hydrological characteristics.

Production of Urban Space and the occurrence of malaria in the Brazilian Amazon: the Porto Velho case / Produção do Espaço Urbano e ocorrência da malária na Amazônia Brasileira: o caso Porto Velho

Abstract Due to intense ongoing urbanization in the Amazon, the urban pattern of malaria may be changing, both in its spatial distribution and epidemiological profile. The purpose of this paper is to analyze how the process of production of urban space in Porto Velho, the capital of the state of Rondonia, Brazil has contributed to the occurrence and maintenance of urban malaria. Using data collected from the Malaria Epidemiological Surveillance System (SIVEP-Malaria), we calculated malaria indices for the districts of Porto Velho from 2005 to 2018. We also developed two typologies for classifying urban space based on functional characteristics and features of the landscape. While the former considers characteristics of urban space in Porto Velho, the latter is based on suitability for malaria vectors. We found that the annual parasite index declined in Porto Velho during the study period. However, changes in the index were not uniform across the districts of the city. Periurban areas showed no decline in the index, which we attribute to these areas' high vegetation density and hydrological characteristics.

Resumo A Amazônia tem passado por um intenso processo de urbanização em anos recentes, produzindo transformações na organização espacial da região que podem estar refletindo no padrão espaço temporal da malária urbana. O objetivo deste trabalho é compreender como o processo de produção do espaço urbano do município de Porto Velho-RO, tem corroborado para a ocorrência e manutenção da malária urbana. Os dados levantados no Sistema de Vigilância Epidemiológica (SIVEP-Malária) possibilitaram o cálculo do Índice Parasitário Anual (IPA) de malária para os bairros da cidade de Porto Velho dos anos de 2005 a 2018 e a construção de duas tipologias da paisagem do espaço urbano. A primeira considerou o processo de produção do espaço urbano de Porto Velho; a segunda se baseou nas condições de receptividade para o vetor da malária. A ocorrência da malária em Porto Velho vem declinando de forma diferenciada ao longo do território, havendo uma tendência de permanência nas áreas periurbanas com maior densidade de vegetação e hidrografia.

Dengue spatiotemporal dynamics in the Federal District, Brazil: occurrence and permanence of epidemics. / Dinâmica espaço-temporal da dengue no Distrito Federal, Brasil: ocorrência e permanência de epidemias.

The specific characteristics of the Federal District (DF) favor the introduction, reproduction, dissemination, and permanence of dengue vector and viruses. Here, we aimed to analyze the spatiotemporal patterns of dengue epidemics in the Administrative Regions (RAs) of the DF from January 2007 to December 2017. We used Fourier partial series model to obtain a seasonal signature of the time series, which allowed calculating indicators of permanence (number of epidemic years, number of epidemic months per year, the proportion of epidemic months for the period) and time/moment of epidemics (month of epidemic peak). A total of 82 epidemics were recorded in this period. The RAs with the largest number of epidemic years were Varjão (5 epidemics), Gama, Lago Sul, and Sobradinho (4 epidemics). These last three RAs also had the highest proportions of epidemic months of the entire study period (9 epidemic months). The RAs with urban centrality function had an earlier epidemic peak than the others, in February and March. Epidemics showed high permanence values in RAs with different types of occupations, emphasizing the need to consider the social organization of space processes in dengue distribution studies.

Neurological complications associated with emerging viruses in Brazil.

OBJECTIVE: To test the hypotheses that emerging viruses are associated with neurological hospitalizations and that statistical models can be used to predict neurological sequelae from viral infections. METHODS: An ecological study was carried out to observe time trends in the number of hospitalizations with inflammatory polyneuropathy and Guillain-Barré syndrome (GBS) in the state of Rio de Janeiro from 1997 to 2017. Increases in GBS from month to month were assessed using a Farrington test. In addition, a cross-sectional study was conducted analyzing 50 adults hospitalized for inflammatory polyneuropathies from 2015 to 2017. The extent to which Zika virus symptoms explained GBS hospitalizations was evaluated using a calibration test. RESULTS: There were significant increases (Farrington test, P<0.001) in the incidence of GBS following the introduction of influenza A/H1N1 in 2009, dengue virus type 4 in 2013, and Zika virus in 2015. Of 50 patients hospitalized, 14 (28.0%) were diagnosed with arboviruses, 9 (18.0%) with other viruses, and the remainder with other causes of such neuropathies. Statistical models based on cases of emerging viruses accurately predicted neurological sequelae, such as GBS. CONCLUSION: The introduction of novel viruses increases the incidence of inflammatory neuropathies.

Dinâmica espaço-temporal da dengue no Distrito Federal, Brasil: ocorrência e permanência de epidemias / Dengue spatiotemporal dynamics in the Federal District, Brazil: occurrence and permanence of epidemics

Resumo O Distrito Federal (DF) apresenta características particulares que favorecem a introdução, reprodução, disseminação e permanência do vetor e dos vírus da dengue. O objetivo deste trabalho foi analisar os padrões espaço-temporais das epidemias de dengue nas Regiões Administrativas (RAs) do DF no período de janeiro de 2007 a dezembro de 2017. Utilizando o modelo da série parcial de Fourier, obteve-se uma assinatura sazonal da série temporal, o que permitiu calcular indicadores de permanência (número de anos epidêmicos, número de meses epidêmicos por ano, proporção de meses epidêmicos do período) e tempo/momento das epidemias (mês do pico epidêmico). Contabilizou-se um total de 82 epidemias nesse período. As RAs com maior número de anos epidêmicos foram Varjão (5 epidemias), Gama, Lago Sul e Sobradinho (4 epidemias). Essas últimas três RAs também tiveram as maiores proporções de meses epidêmicos de todo o período de estudo (nove). Verificou-se que as RAs com função de centralidade urbana possuem pico epidêmico mais cedo que as demais, nos meses de fevereiro e março. As epidemias apresentaram altos valores de permanência em RAs com diferentes tipos de ocupação, ressaltando-se a necessidade de considerar os processos de organização social do espaço nos estudos da distribuição da dengue.

Abstract The specific characteristics of the Federal District (DF) favor the introduction, reproduction, dissemination, and permanence of dengue vector and viruses. Here, we aimed to analyze the spatiotemporal patterns of dengue epidemics in the Administrative Regions (RAs) of the DF from January 2007 to December 2017. We used Fourier partial series model to obtain a seasonal signature of the time series, which allowed calculating indicators of permanence (number of epidemic years, number of epidemic months per year, the proportion of epidemic months for the period) and time/moment of epidemics (month of epidemic peak). A total of 82 epidemics were recorded in this period. The RAs with the largest number of epidemic years were Varjão (5 epidemics), Gama, Lago Sul, and Sobradinho (4 epidemics). These last three RAs also had the highest proportions of epidemic months of the entire study period (9 epidemic months). The RAs with urban centrality function had an earlier epidemic peak than the others, in February and March. Epidemics showed high permanence values in RAs with different types of occupations, emphasizing the need to consider the social organization of space processes in dengue distribution studies.

Imported malaria in Rio de Janeiro state between 2007 and 2015: an epidemiologic approach.

Imported malaria is a malaria infection diagnosed outside the area where it was acquired and is induced by human migration and mobility. This retrospective study was performed based on secondary data from 2007 to 2015. In total, 736 cases of imported malaria (79.7% of 923 cases) were recorded in Rio de Janeiro state. Of the imported cases, 55.3% came from abroad, while 44.7% came from other regions of Brazil. Most cases of imported malaria in Brazil (85.5%) originated in Amazônia Legal, and Burundi (Africa) accounted for 59% of the cases from abroad. Analyses of the determinants of imported malaria in Rio de Janeiro state must be continued to understand the relationship between the origin and destination of cases.

Tuberculosis and its associated factors in a city in the metropolitan region of Rio de Janeiro. / A tuberculose e seus fatores associados em um município da região metropolitana do Rio de Janeiro.

INTRODUCTION: The occurrence of tuberculosis has been related to the spatial organization and improvement of the living conditions of the population. However, this relationship is not directly related and tuberculosis illness involves processes at different levels of organization. METHOD: An ecological study analyzing the relationship between living conditions and tuberculosis in the city of Niteroi, Brazil. Two indicators, socio-environmental and programmatic, were created by factor analysis and analyzed by regression in the period of 2008 to 2012. Thematic maps were constructed to examine the distribution pattern of the incidence rate and indicators in the city. RESULTS: The results showed a direct and significant association of the two indicators with the incidence rate of tuberculosis. A one-unit higher the programmatic indicator was associated with a 7% higher incidence rate. The socio-environmental indicator was associated with a 27% higher tuberculosis rate. DISCUSSION: The results of the present study were consistent with the direct relationship between tuberculosis and living conditions in the city of Niteroi. CONCLUSION: We can conclude that the dynamics of tuberculosis transmission in Niteroi can be explained by the occurrence of the disease in areas of consolidated social periphery and by the social vulnerability of specific groups.

INTRODUÇÃO: A ocorrência da tuberculose tem sido relacionada à organização espacial e à melhoria das condições de vida da população. Contudo, essa relação não é de forma direta, e o adoecimento por tuberculose envolve processos de diferentes níveis de organização. MÉTODO: Estudo ecológico que analisa a relação entre condições de vida e tuberculose no município de Niterói, Brasil. Foram criados dois indicadores, socioambiental e programático, por meio de análise fatorial e analisados por regressão no período de 2008 a 2012. Foram construídos mapas temáticos com os dados referentes à taxa de incidência e aos indicadores, para verificar o padrão da distribuição da taxa de incidência e desses indicadores no município. RESULTADOS: Os resultados apontaram associação direta e significativa entre os dois indicadores com a taxa de incidência de tuberculose. O aumento em uma unidade no indicador programático esteve associado com um aumento na taxa de incidência em 7%. Já o indicador socioambiental associou-se com uma taxa de tuberculose 27% mais elevada. DISCUSSÃO: Os resultados do presente trabalho foram consistentes ao constatar relação direta entre tuberculose e condições de vida no município de Niterói. CONCLUSÃO: Podemos concluir que a dinâmica da transmissão da tuberculose no município de Niterói pode ser explicada pela ocorrência da doença em áreas de periferia social consolidada e pela vulnerabilidade social de grupos específicos.

A tuberculose e seus fatores associados em um município da região metropolitana do Rio de Janeiro / Tuberculosis and its associated factors in a city in the metropolitan region of Rio de Janeiro

RESUMO: Introdução: A ocorrência da tuberculose tem sido relacionada à organização espacial e à melhoria das condições de vida da população. Contudo, essa relação não é de forma direta, e o adoecimento por tuberculose envolve processos de diferentes níveis de organização. Método: Estudo ecológico que analisa a relação entre condições de vida e tuberculose no município de Niterói, Brasil. Foram criados dois indicadores, socioambiental e programático, por meio de análise fatorial e analisados por regressão no período de 2008 a 2012. Foram construídos mapas temáticos com os dados referentes à taxa de incidência e aos indicadores, para verificar o padrão da distribuição da taxa de incidência e desses indicadores no município. Resultados: Os resultados apontaram associação direta e significativa entre os dois indicadores com a taxa de incidência de tuberculose. O aumento em uma unidade no indicador programático esteve associado com um aumento na taxa de incidência em 7%. Já o indicador socioambiental associou-se com uma taxa de tuberculose 27% mais elevada. Discussão: Os resultados do presente trabalho foram consistentes ao constatar relação direta entre tuberculose e condições de vida no município de Niterói. Conclusão: Podemos concluir que a dinâmica da transmissão da tuberculose no município de Niterói pode ser explicada pela ocorrência da doença em áreas de periferia social consolidada e pela vulnerabilidade social de grupos específicos.

ABSTRACT: Introduction: The occurrence of tuberculosis has been related to the spatial organization and improvement of the living conditions of the population. However, this relationship is not directly related and tuberculosis illness involves processes at different levels of organization. Method: An ecological study analyzing the relationship between living conditions and tuberculosis in the city of Niteroi, Brazil. Two indicators, socio-environmental and programmatic, were created by factor analysis and analyzed by regression in the period of 2008 to 2012. Thematic maps were constructed to examine the distribution pattern of the incidence rate and indicators in the city. Results: The results showed a direct and significant association of the two indicators with the incidence rate of tuberculosis. A one-unit higher the programmatic indicator was associated with a 7% higher incidence rate. The socio-environmental indicator was associated with a 27% higher tuberculosis rate. Discussion: The results of the present study were consistent with the direct relationship between tuberculosis and living conditions in the city of Niteroi. Conclusion: We can conclude that the dynamics of tuberculosis transmission in Niteroi can be explained by the occurrence of the disease in areas of consolidated social periphery and by the social vulnerability of specific groups.

Behavioral, climatic, and environmental risk factors for Zika and Chikungunya virus infections in Rio de Janeiro, Brazil, 2015-16.

The burden of arboviruses in the Americas is high and may result in long-term sequelae with infants disabled by Zika virus infection (ZIKV) and arthritis caused by infection with Chikungunya virus (CHIKV). We aimed to identify environmental drivers of arbovirus epidemics to predict where the next epidemics will occur and prioritize municipalities for vector control and eventual vaccination. We screened sera and urine samples (n = 10,459) from residents of 48 municipalities in the state of Rio de Janeiro for CHIKV, dengue virus (DENV), and ZIKV by molecular PCR diagnostics. Further, we assessed the spatial pattern of arbovirus incidence at the municipal and neighborhood scales and the timing of epidemics and major rainfall events. Lab-confirmed cases included 1,717 infections with ZIKV (43.8%) and 2,170 with CHIKV (55.4%) and only 29 (<1%) with DENV. ZIKV incidence was greater in neighborhoods with little access to municipal water infrastructure (r = -0.47, p = 1.2x10-8). CHIKV incidence was weakly correlated with urbanization (r = 0.2, p = 0.02). Rains began in October 2015 and were followed one month later by the largest wave of ZIKV epidemic. ZIKV cases markedly declined in February 2016, which coincided with the start of a CHIKV outbreak. Rainfall predicted ZIKV and CHIKV with a lead time of 3 weeks each time. The association between rainfall and epidemics reflects vector ecology as the larval stages of Aedes aegypti require pools of water to develop. The temporal dynamics of ZIKV and CHIKV may be explained by the shorter incubation period of the viruses in the mosquito vector; 2 days for CHIKV versus 10 days for ZIKV.

The role of spatial mobility in malaria transmission in the Brazilian Amazon: The case of Porto Velho municipality, Rondônia, Brazil (2010-2012).

BACKGROUND: This study aims to describe the role of mobility in malaria transmission by discussing recent changes in population movements in the Brazilian Amazon and developing a flow map of disease transmission in this region. METHODOLOGY/PRINCIPAL FINDINGS: This study presents a descriptive analysis using an ecological approach on regional and local scales. The study location was the municipality of Porto Velho, which is the capital of Rondônia state, Brazil. Our dataset was obtained from the official health database, the population census and an environmental database. During 2000-2007 and 2007-2010, the Porto Velho municipality had an annual population growth of 1.42% and 5.07%, respectively. This population growth can be attributed to migration, which was driven by the construction of the Madeira River hydroelectric complex. From 2010 to 2012, 63,899 malaria-positive slides were reported for residents of Porto Velho municipality; 92% of the identified samples were autochthonous, and 8% were allochthonous. The flow map of patients' movements between residential areas and areas of suspected infection showed two patterns of malaria transmission: 1) commuting between residential areas and the Jirau hydropower dam reservoir, and 2) movements between urban areas and farms and resorts in rural areas. It was also observed that areas with greater occurrences of malaria were characterized by a low rate of deforestation. CONCLUSIONS: The Porto Velho municipality exhibits high malaria endemicity and plays an important role in disseminating the parasite to other municipalities in the Amazon and even to non-endemic areas of the country. Migration remains an important factor for the occurrence of malaria. However, due to recent changes in human occupation of the Brazilian Amazon, characterized by intense expansion of transportation networks, commuting has also become an important factor in malaria transmission. The magnitude of this change necessitates a new model to explain malaria transmission in the Brazilian Amazon.