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1.
Am. j. trop. med. hyg ; 101(3): 705-707, Sept. 2019.
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IIERPROD, Sec. Est. Saúde SP | ID: biblio-1016226

RESUMO

A 43-year-old man was admitted to the intensive care unit and diagnosed with yellow fever. He presented with refractory bleeding, extreme hyperferritinemia, and multiple organ dysfunction syndrome, requiring renal replacement therapy, mechanical ventilation, and treatment with vasoactive drugs. Because the bleeding did not respond to fresh-frozen plasma administration, the patient received therapeutic plasma exchange, which was accompanied by a marked improvement of the clinical and biochemical parameters, including a significant decline in serum ferritin levels


Assuntos
Humanos , Masculino , Adulto , Febre Amarela
3.
Am. j. trop. med. hyg ; 101(1): 180-188, July 2019. ilus, tab
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IIERPROD, Sec. Est. Saúde SP | ID: biblio-1016853

RESUMO

Faced with the reemergence of yellow fever (YF) in the metropolitan region of São Paulo, Brazil, we developed a retrospective study to describe the cases of YF attended at the Institute of Infectology Emilio Ribas from January to March 2018 and analyze the factors associated with death, from the information obtained in the hospital epidemiological investigation. A total of 72 cases of sylvatic YF were confirmed, with 21 deaths (29.2% lethality rate). Cases were concentrated in males (80.6%) and in the age group of 30 to 59 years (56.9%). Two logistic regression models were performed, with continuous variables adjusted for the time between onset of symptoms and hospitalization. The first model indicated age (odds ratiosadjusted [ORadj]: 1.038; CI 95%: 1.008-1.212), aspartate aminotransferase (AST) (ORadj: 1.038; CI 95%: 1.005-1.072), and creatinine (ORadj: 2.343; CI 95%: 1.205-4.553) were independent factors associated with mortality. The second model indicated age (ORadj: 1.136; CI 95%: 1.013-1.275), alanine aminotransferase (ALT) (ORadj: 1.118; CI 95%: 1.018-1.228), and creatinine (ORadj: 2.835; CI 95%: 1.352-5,941). The risk of death in the model with continuous variables was calculated from the increase of 1 year (age), 1 mg/dL (creatinine), and 100 U/L for AST and ALT. Another logistic regression analysis with dichotomous variables indicated AST > 1,841 IU/L (ORadj: 12.92; CI 95%: 1.50-111.37) and creatinine > 1.2 mg/dL (ORadj: 81.47; CI 95%: 11.33-585.71) as independent factors associated with death. These results may contribute to the appropriate clinical management of patients with YF in health-care services and improve the response to outbreaks and public health emergencies


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Febre Amarela/epidemiologia , Brasil/epidemiologia
4.
Lancet infect. dis ; 19(7): 750-758, July 2019. ilus, tab
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IIERPROD, Sec. Est. Saúde SP | ID: biblio-1016885

RESUMO

BACKGROUND: Yellow fever virus infection results in death in around 30% of symptomatic individuals. The aim of this study was to identify predictors of death measured at hospital admission in a cohort of patients admitted to hospital during the 2018 outbreak of yellow fever in the outskirts of São Paulo city, Brazil. METHODS: In this observational cohort study, we enrolled patients with yellow fever virus from two hospitals in São Paolo­the Hospital das Clínicas, University of São Paulo and the Infectious Diseases Institute "Emilio Ribas". Patients older than 18 years admitted to hospital with fever or myalgia, headache, arthralgia, oedema, rash, or conjunctivitis were consecutively screened for inclusion in the present study. Consenting patients were included if they had travelled to geographical areas in which yellow fever virus cases had been previously confirmed. Yellow fever infection was confirmed by real-time PCR in blood collected at admission or tissues at autopsy. We sequenced the complete genomes of yellow fever virus from infected individuals and evaluated demographic, clinical, and laboratory findings at admission and investigated whether any of these measurements correlated with patient outcome (death). FINDINGS: Between Jan 11, 2018, and May 10, 2018, 118 patients with suspected yellow fever were admitted to Hospital das Clínicas, and 113 patients with suspected yellow fever were admitted to Infectious Diseases Institute "Emilio Ribas". 95 patients with suspected yellow fever were included in the study, and 136 patients were excluded. Three (3%) of 95 patients with suspected yellow fever who were included in the study were excluded because they received a different diagnosis, and 16 patients with undetectable yellow fever virus RNA were excluded. Therefore, 76 patients with confirmed yellow fever virus infection, based on detectable yellow fever virus RNA in blood (74 patients) or yellow fever virus confirmed only at the autopsy report (two patients), were included in our analysis. 27 (36%) of 76 patients died during the 60 day period after hospital admission. We generated 14 complete yellow fever virus genomes from the first 15 viral load-detectable samples. The genomes belonged to a single monophyletic clade of the South America I genotype, sub-genotype E. Older age, male sex, higher leukocyte and neutrophil counts, higher alanine aminotransferase, aspartate transaminase (AST), bilirubin, and creatinine, prolonged prothrombin time, and higher yellow fever virus RNA plasma viral load were associated with higher mortality. In a multivariate regression model, older age, elevated neutrophil count, increased AST, and higher viral load remained independently associated with death. All 11 (100%) patients with neutrophil counts of 4000 cells per mL or greater and viral loads of 5·1 log10 copies/mL or greater died (95% CI 72­100), compared with only three (11%) of 27 (95% CI 2­29) among patients with neutrophil counts of less than 4000 cells per mL and viral loads of less than 5·1 log10 copies/mL. INTERPRETATION: We identified clinical and laboratory predictors of mortality at hospital admission that could aid in the care of patients with yellow fever virus. Identification of these prognostic markers in patients could help clinicians prioritise admission to the intensive care unit, as patients often deteriorate rapidly. Moreover, resource allocation could be improved to prioritise key laboratory examinations that might be more useful in determining whether a patient could have a better outcome. Our findings support the important role of the virus in disease pathogenesis, suggesting that an effective antiviral could alter the clinical course for patients with the most severe forms of yellow fever


Assuntos
Humanos , Febre Amarela/mortalidade , Brasil/epidemiologia
6.
Rev Inst Med Trop Sao Paulo ; 61: e35, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31340247

RESUMO

Yellow fever is one of the most important mosquito-borne diseases, which still affects a significant number of people every year, mainly in tropical countries. Mortality can be high, even with intensive treatment due to multiple organ failure, including acute kidney injury (AKI). This disease can also be a burden on the health care system in developing countries, without mentioning the number of lives that could be spared with an early diagnosis and adequate monitoring and treatment. The pathophysiology of yellow fever-induced acute kidney injury (AKI) is still to be completely understood, and the best clinical approach has not yet been determined. This manuscript presents the most recent scientific evidence of kidney involvement in yellow fever, since AKI plays an important role in the mortality rate. Recent outbreaks have occurred in Brazil and further studies are required to provide a better clinical control for patients with yellow fever.


Assuntos
Lesão Renal Aguda/virologia , Febre Amarela/complicações , Brasil , Humanos , Estações do Ano , Febre Amarela/diagnóstico , Febre Amarela/tratamento farmacológico , Febre Amarela/prevenção & controle
7.
Washington, D. C.; OPAS; 2019-07-21.
em Português | PAHO-IRIS | ID: phr-51374

RESUMO

[Introdução]. A história do controle das doenças transmitidas por vetores nas Américas é muito extensa, e as evidências mostram que, no passado, vários programas foram exitosos. O controle da febre amarela e do paludismo em Cuba e no Panamá, sob a direção de William Gorgas (1901-1910); a eliminação de Anopheles gambiae no Brasil (1940); a eliminação de Aedes aegypti entre 1950 e 1960, promovida pela OPAS e dirigida por Fred Soper; a eliminação da transmissão da doença de Chagas por Triatoma infestans no Brasil e no Uruguai; e a recente erradicação da oncocercose de 11 dos 13 focos endêmicos na Colômbia, no Equador, no México e na Guatemala (2013-2016) são exemplos recentes de intervenções que combinaram o uso de inseticidas, da engenharia sanitária e a disponibilidade de vacinas ou medicamentos efetivos, apoiados pela participação comunitária e outros métodos de controle... Hoje em dia, estima-se que cerca de metade da população mundial viva em áreas em risco de dengue. Além disso, mais de 100 países apresentam transmissão e são produzidas entre 300 e 500 milhões de infecções anuais, das quais 96 milhões apresentam manifestações clínicas e 500.000 são casos severos, com aproximadamente 25.000 mortes. A infecção é endêmica nas regiões das Américas, Ásia Sul-Oriental, Pacífico Ocidental, África e Mediterrâneo Oriental, e nos últimos 50 anos a incidência cresceu 30 vezes, sem que haja sinais de reversão dessa tendência. O cenário epidemiológico mostra que o número de casos vem aumentando, que os surtos apresentam maior duração e magnitude e que as áreas afetadas e as populações expostas se encontram em constante expansão. A meta da OMS, para o 2020, de reduzir a mortalidade em 50% e a morbidade em 25% é considerada um desafio diante da carência de bons sistemas de vigilância que quantifiquem corretamente a carga de doença e as deficiências dos programas de controle de vetores nos países endêmicos...


Assuntos
Aedes , Mosquitos Vetores , Controle de Mosquitos , Dengue , Wolbachia , Zika virus , Vírus Chikungunya , Febre Amarela
8.
Transplant Proc ; 51(5): 1625-1628, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31155206

RESUMO

Yellow fever is a noncontagious disease caused by an arbovirus in the Flaviviridae family. It is an endemic disease in the tropical forests of Africa and South America, with the mosquito as a vector. Approximately half of those infected will be asymptomatic, while 15% will develop the severe/malignant form of the disease that includes renal and hepatic failure, bleeding, and neurological impairment as the principal symptoms. The lethality of the severe form reaches up to 70%. The objective of this study was to report on the case of a patient who was transferred to the hepatobiliary unit of our service due to acute liver failure due to yellow fever. He was treated with liver transplantation. The patient progressed satisfactorily, being discharged from the intensive care unit in 10 days and discharged from the hospital within 19 days after transplantation. Despite the encouraging result of our team, this has not been applied to other centers that have also performed this modality of treatment; therefore, the question remains as to whether and when to recommend liver transplantation for treatment of severe yellow fever.


Assuntos
Falência Hepática Aguda/cirurgia , Falência Hepática Aguda/virologia , Transplante de Fígado , Febre Amarela/complicações , África , Humanos , Masculino , Pessoa de Meia-Idade , Vírus da Febre Amarela
9.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde, LIS-bvsms | ID: lis-LISBR1.1-46581

RESUMO

A Febre do Mayaro é uma doença infecciosa febril aguda, cujo quadro clínico geralmente é de curso benigno, semelhante à Dengue e à Chikungunya. A Febre do Mayaro compõe a lista nacional de doenças de notificação compulsória imediata, conforme Portaria de Consolidação nº 4, de 28 de setembro de 2017.


Assuntos
Dengue , Febre de Chikungunya , Infecções por Arbovirus , Togaviridae , Infecções por Alphavirus , Febre Amarela
10.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde, LIS-bvsms | ID: lis-LISBR1.1-46582

RESUMO

Pesquisadores da Universidade Federal do Rio de Janeiro (UFRJ) descobriram que outra arbovirose, com sintomas parecidos com os da febre chikungunya, circulou em Niterói, na região metropolitana do Rio, em 2016. A descoberta dos cientistas acendeu o alerta para a possibilidade de outros casos diagnosticados como chikungunya serem, na verdade, do vírus Mayaro, que também pode ser transmitido pela picada dos mosquitos Aedes aegypti e Aedes albopictus [vetores da dengue, zika e chikungunya], além do Cúlex [pernilongo] e do Haemagogus [transmissor da febre amarela].


Assuntos
Infecções por Arbovirus , Dengue , Febre de Chikungunya , Aedes , Culex , Febre Amarela , Reação em Cadeia da Polimerase
11.
Mem Inst Oswaldo Cruz ; 114: e190076, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31038550

RESUMO

BACKGROUND: In Brazil, the Yellow Fever virus (YFV) is endemic in the Amazon, from where it eventually expands into epidemic waves. Coastal south-eastern (SE) Brazil, which has been a YFV-free region for eight decades, has reported a severe sylvatic outbreak since 2016. The virus spread from the north toward the south of the Rio de Janeiro (RJ) state, causing 307 human cases with 105 deaths during the 2016-2017 and 2017-2018 transmission seasons. It is unclear, however, whether the YFV would persist in the coastal Atlantic Forest of RJ during subsequent transmission seasons. OBJECTIVES: To conduct a real-time surveillance and assess the potential persistence of YFV in the coastal Atlantic Forest of RJ during the 2018-2019 transmission season. METHODS: We combined epizootic surveillance with fast diagnostic and molecular, phylogenetic, and evolutionary analyses. FINDINGS: Using this integrative strategy, we detected the first evidence of YFV re-emergence in the third transmission season (2018-2019) in a dying howler monkey from the central region of the RJ state. The YFV detected in 2019 has the molecular signature associated with the current SE YFV outbreak and exhibited a close phylogenetic relationship with the YFV lineage that circulated in the same Atlantic Forest fragment during the past seasons. This lineage circulated along the coastal side of the Serra do Mar mountain chain, and its evolution seems to be mainly driven by genetic drift. The potential bridge vector Aedes albopictus was found probing on the recently dead howler monkey in the forest edge, very close to urban areas. MAIN CONCLUSIONS: Collectively, our data revealed that YFV transmission persisted at the same Atlantic Forest area for at least three consecutive transmission seasons without the need of new introductions. Our real-time surveillance strategy permitted health authorities to take preventive actions within 48 h after the detection of the sick non-human primate. The local virus persistence and the proximity of the epizootic forest to urban areas reinforces the concern with regards to the risk of re-urbanisation and seasonal re-emergence of YFV, stressing the need for continuous effective surveillance and high vaccination coverage in the SE region, particularly in RJ, an important tourist location.


Assuntos
Aedes/virologia , Febre Amarela/epidemiologia , Febre Amarela/virologia , Vírus da Febre Amarela/genética , Alouatta , Animais , Brasil/epidemiologia , Surtos de Doenças , Humanos , Filogeografia , Estações do Ano , População Urbana , Febre Amarela/transmissão
12.
Mem Inst Oswaldo Cruz ; 114: e180509, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31066755

RESUMO

BACKGROUND: The outbreak of sylvatic Yellow Fever (SYF) in humans during 2016-2017 in Brazil is one of the greatest in the history of the disease. The occurrence of the disease in areas with low vaccination coverage favoured the dissemination of the disease; therefore, it is necessary to identify the areas vulnerability to the YF virus (YFV) to assist in the adoption of preventive measures. OBJECTIVE: To correlate the physical-environmental elements associated with the occurrence of SYF in humans via a multicriteria analysis. METHODS: For the multicriteria analysis, preponderant elements related to SYF occurrences, including soil usage and coverage, temperature, precipitation, altitude, mosquito transmitters, and non-human primate occurrence areas, were considered. The results were validated by assessing the correlation between the incidence of SYF and the vulnerable areas identified in the multicriteria analysis. RESULTS: Two regions with different vulnerability to the occurrence of the disease were identified in the multicriteria analysis, with emphasis on the southern areas of the state of São Paulo northeast areas of Minas Gerais, and the entire states of Rio de Janeiro and Espírito Santo. The map of SYF vulnerability obtained in the multicriteria analysis coincides with the areas in which cases of the disease have been recorded. The regions that presented the greatest suitability were in fact the municipalities with the highest incidence. MAIN CONCLUSIONS: The multicriteria analysis revealed that the elements that were used are suited for and consistent in the prediction of the areas that are vulnerable to SYF. The results obtained indicate the proximity of the areas that are most vulnerable to the disease to densely populated areas where an Aedes aegypti infestation was observed, which confers a high risk of re-urbanisation of YF.


Assuntos
Aedes/virologia , Febre Amarela/transmissão , Animais , Brasil/epidemiologia , Doenças Endêmicas/prevenção & controle , Sistemas de Informação Geográfica , Humanos , Densidade Demográfica , Vigilância da População , Medição de Risco , Urbanização , Febre Amarela/epidemiologia , Febre Amarela/prevenção & controle , Vacina contra Febre Amarela
13.
Mem Inst Oswaldo Cruz ; 114: e190033, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31116245

RESUMO

BACKGROUND: Despite a highly efficacious vaccine, yellow fever (YF) is still a major threat in developing countries and a cause of outbreaks. In 2018, the Brazilian state of São Paulo witnessed a new YF outbreak in areas where the virus has not been detected before. OBJECTIVE: The aim is to describe the clinical and laboratorial characteristics of severe cases of YF, evaluate viral to determine markers associated with fatal outcome. METHODS: Acute severe YF cases (n = 62) were admitted to the Intensive Care Unit of a reference hospital and submitted to routine laboratorial evaluation on admission. YFV-RNA was detected in serum and urine by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and then sequenced. Patients were classified in two groups: survival or death. FINDINGS: In the univariate analysis the following variables were associated with outcome: alanin aminotransferase (ALT), aspartat aminotransferase (AST), AST/ALT ratio, total bilirubin (TB), chronic kidney disease epidemiology collaboration (CKD-EPI), ammonia, lipase, factor V, international normalised ratio (INR), lactate and bicarbonate. Logistic regression model showed two independent variables associated with death: lipase [odds ratio (OR) 1.018, 95% confidence interval (CI) 1.007 to 1.030, p = 0.002], and factor V (OR -0.955, 95% CI 0.929 to 0.982, p = 0.001). The estimated lipase and factor V cut-off values that maximised sensitivity and specificity for death prediction were 147.5 U/L [area under the curve (AUC) = 0.879], and 56.5% (AUC = 0.913). MAIN CONCLUSIONS: YF acute severe cases show a generalised involvement of different organs (liver, spleen, heart, kidneys, intestines and pancreas), and different parameters were related to outcome. Factor V and lipase are independent variables associated with death, reinforcing the importance of hemorrhagic events due to fulminant liver failure and pointing to pancreatitis as a relevant event in the outcome of the disease.


Assuntos
Fator V/análise , Lipase/sangue , Febre Amarela/sangue , Adulto , Biomarcadores/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Índice de Gravidade de Doença , Carga Viral
15.
Artigo em Espanhol | PAHO-IRIS | ID: phr-50939

RESUMO

[RESUMEN]. El aumento en la incidencia y distribución geográfica de las arbovirosis constituye uno de los principales problemas de salud pública en la Región de las Américas. La incidencia del dengue ha experimentado una tendencia creciente en los últimos decenios en la Región, donde se ha pasado de una endemicidad baja a hiperendemicidad. También, la incidencia de la fiebre amarilla se ha intensificado en este período, y ha pasado de una actividad restringida a zonas selváticas a presentar brotes urbanos. El chikunguña comenzó a propagarse de forma pandémica en el 2005 a un ritmo sin precedentes y llegó al continente americano en el 2013. Al año siguiente, la infección por el virus del Zika irrumpió también en la Región con un brote explosivo acompañado de gravísimas anomalías congénitas y trastornos neurológicos, hasta convertirse en una de las mayores crisis de salud en los últimos años. La inadecuada vigilancia de las arbovirosis en la Región y la carencia de pruebas serológicas para diferenciar entre los distintos virus plantean retos considerables. Sigue habiendo pocas evidencias científicas en respaldo de las intervenciones de control de vectores. El manejo clínico sigue siendo la piedra angular del control de estas enfermedades. En la actualidad, solo están autorizadas en la Región de las Américas las vacunas contra la fiebre amarilla y contra el dengue, si bien hay varias vacunas experimentales en fase de investigación en ensayos clínicos. El Grupo Mundial de Expertos en Arbovirus ofrece en este artículo un panorama de los progresos, los retos y las recomendaciones sobre prevención y control de las arbovirosis en los países de la Región de las Américas.


[ABSTRACT]. The increasing geographical spread and disease incidence of arboviral infections are among the greatest public health concerns in the Americas. The region has observed an increasing trend in dengue incidence in the last decades, evolving from low to hyperendemicity. Yellow fever incidence has also intensified in this period, expanding from sylvatic-restricted activity to urban outbreaks. Chikungunya started spreading pandemically in 2005 at an unprecedented pace, reaching the Americas in 2013. The following year, Zika also emerged in the region with an explosive outbreak, carrying devastating congenital abnormalities and neurologic disorders and becoming one of the greatest global health crises in years. The inadequate arbovirus surveillance in the region and the lack of serologic tests to differentiate among viruses poses substantial challenges. The evidence for vector control interventions remains weak. Clinical management remains the mainstay of arboviral disease control. Currently, only yellow fever and dengue vaccines are licensed in the Americas, with several candidate vaccines in clinical trials. The Global Arbovirus Group of Experts provides in this article an overview of progress, challenges, and recommendations on arboviral prevention and control for countries of the Americas.


Assuntos
Infecções por Arbovirus , Aedes , Dengue , Febre Amarela , Vírus Chikungunya , Zika virus , Doenças Transmissíveis , Américas , Infecções por Arbovirus , Febre Amarela , Vírus Chikungunya , Zika virus , Doenças Transmissíveis
16.
Adv. rheumatol ; 59(1): 17, Apr. 2019. ilus, tab
Artigo em Inglês | Sec. Est. Saúde SP, SESSP-IIERPROD, Sec. Est. Saúde SP | ID: biblio-1017123

RESUMO

BACKGROUND: In Brazil, we are facing an alarming epidemic scenario of Yellow fever (YF), which is reaching the most populous areas of the country in unvaccinated people. Vaccination is the only effective tool to prevent YF. In special situations, such as patients with chronic immune-mediated inflammatory diseases (CIMID), undergoing immunosuppressive therapy, as a higher risk of severe adverse events may occur, assessment of the risk-benefit ratio of the yellow fever vaccine (YFV) should be performed on an individual level. Faced with the scarcity of specific orientation on YFV for this special group of patients, the Brazilian Rheumatology Society (BRS) endorsed a project aiming the development of individualized YFV recommendations for patients with CIMID, guided by questions addressed by both medical professionals and patients, followed an internationally validated methodology (GIN-McMaster Guideline Development). Firstly, a systematic review was carried out and an expert panel formed to take part of the decision process, comprising BRS clinical practitioners, as well as individuals from the Brazilian Dermatology Society (BDS), Brazilian Inflammatory Bowel Diseases Study Group (GEDIIB), and specialists on infectious diseases and vaccination (from Tropical Medicine, Infectious Diseases and Immunizations National Societies); in addition, two representatives of patient groups were included as members of the panel. When the quality of the evidence was low or there was a lack of evidence to determine the recommendations, the decisions were based on the expert opinion panel and a Delphi approach was performed. A recommendation was accepted upon achieving >/=80% agreement among the panel, including the patient representatives. As a result, eight recommendations were developed regarding the safety of YFV in patients with CIMID, considering the immunosuppression degree conferred by the treatment used. It was not possible to establish recommendations on the effectiveness of YFV in these patients as there is no consistent evidence to support these recommendations. CONCLUSION: This paper approaches a real need, assessed by clinicians and patient care groups, to address specific questions on the management of YFV in patients with CIMID living or traveling to YF endemic areas, involving specialists from many areas together with patients, and might have global applicability, contributing to and supporting Vaccination practices. We recommended a shared decision-making approach on taking or not the YFV


Assuntos
Febre Amarela , Vacinação/normas
17.
Brasília; CONITEC; abr. 2019. tab.
Não convencional em Português | BRISA/RedTESA | ID: biblio-997075

RESUMO

APRESENTAÇÃO: Algumas propostas de incorporação tecnológica no SUS são avaliadas pela CONITEC de forma simplificada, não sendo submetidas à consulta pública e/ou audiência pública. São propostas de relevante interesse público que tratam de ampliação de uso de tecnologias, nova apresentação de medicamentos ou incorporação de medicamentos com tradicionalidade de uso. Todas essas demandas envolvem tecnologias de baixo custo e baixo impacto orçamentário para o SUS e estão relacionadas à elaboração ou revisão de Protocolos Clínicos e Diretrizes Terapêuticas (PCDT). SOLICITAÇÃO DE INCORPORAÇÃO: Demandante: Secretaria de Atenção à Saúde ­ SAS Demanda: incorporação do Transplante de Fígado para Insuficiência Hepática Hiperaguda relacionada à Febre Amarela. TRANSPLANTE DE FÍGADO: O transplante de fígado é um tipo de tratamento proposto para doenças que afetam o sistema hepatobiliar. Consiste na substituição do fígado doente por um enxerto saudável de um doador falecido, ou parte do fígado de um doador vivo. É o tratamento de escolha para um grupo de pacientes com doenças hepáticas ou biliares, para as quais as demais alternativas terapêuticas foram esgotadas e cujo uso tem potencial curativo ou de importante repercussão na qualidade de vida dos doentes. Esses transplantes estão indicados em casos de doenças hepáticas (como cirrose descompensada, polineuropatia amiloidótica familiar e câncer primário do fígado) ou biliares (como cirrose biliar primária ou secundária e atresia de vias biliares) e ainda em casos de algumas doenças metabólicas capazes de alterar gravemente a função hepatobiliar (como doença de Wilson, hemocromatose e deficiência de alfa-1-antitripsina). TRANSPLANTE DE FÍGADO EM FEBRE AMARELA: A partir do final do ano de 2017, a Coordenação-Geral do Sistema Nacional de Transplantes - CGSNT passou a observar um aumento relevante do número de inscrições em lista de espera por Insuficiência Hepática Hiperaguda - IHH. Simultaneamente, o diagnóstico de Febre Amarela ­ FA passou a ser relacionado a esse súbito crescimento, seguido da confirmação clínica e laboratorial dos casos de IHH diretamente provocados pelo agravamento da infecção pelo vírus da FA, notadamente nos mesmos estados brasileiros considerados regiões de surto epidêmico de Febre Amarela, quais sejam: Minas Gerais, Rio de Janeiro e São Paulo. Todos esses estados registraram casos de FA por meio dos sistemas de vigilância em saúde. CONSIDERAÇÕES FINAIS: De acordo com a Nota Informativa constante no processo 25000.042688/2018-63, a presente proposta de incorporação tem o objetivo de admitir temporariamente a indicação de transplante de fígado para casos de IHHFA dados os benefícios potenciais deste tratamento no restabelecimento da função hepática, a justificar sua realização de forma compassiva neste momento, e as ações para prover o estudo destes casos, com a criação do Grupo Técnico e dos procedimentos de Transplante de Fígado em Febre Amarela e Tratamento de Intercorrência em Transplante de Fígado por FA - Pós-transplante Crítico. Ressalte-se que a repercussão da insuficiência hepática no acometimento sistêmico da Febre Amarela não está bem estabelecida, e será um dos objetos do estudo multicêntrico proposto à tentativa de resposta a esta questão. Estima-se que, excluídas as contraindicações e os casos de êxito letal em lista, sejam realizados cerca de 48 (quarenta e oito) transplantes de fígado em IHHFA por ano, considerando a sazonalidade dos surtos de Febre Amarela (dezembro a maio). Chega-se então a um gasto de R$ 9.030.394,56, que poderia traduzir-se no impacto, já que é uma nova indicação e um novo procedimento. RECOMENDAÇÃO DA CONITEC: Os membros da CONITEC, presentes na 64ª reunião ordinária, realizada nos dias 07 e 08 de março de 2018, deliberaram, por unanimidade, recomendar a incorporação do Transplante de fígado para Insuficiência Hepática Hiperaguda ­ IHH relacionada à Febre Amarela ­ FA. Desse modo, foi assinado o Registro de Deliberação nº 346/2018. DECISÃO: A PORTARIA Nº 23, DE 23 DE ABRIL DE 2019 - Torna pública a decisão de incorporar o transplante de fígado para insuficiência hepática hiperaguda-IHH relacionada à febre amarela - FA, no âmbito do Sistema Único de Saúde - SUS.


Assuntos
Febre Amarela , Transplante de Fígado/instrumentação , Insuficiência Hepática/reabilitação , Avaliação da Tecnologia Biomédica , Avaliação em Saúde , Sistema Único de Saúde , Brasil
18.
Emerg Microbes Infect ; 8(1): 218-231, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30866775

RESUMO

The yellow fever virus (YFV) caused a severe outbreak in Brazil in 2016-2018 that rapidly spread across the Atlantic Forest in its most populated region without viral circulation for almost 80 years. A comprehensive entomological survey combining analysis of distribution, abundance and YFV natural infection in mosquitoes captured before and during the outbreak was conducted in 44 municipalities of five Brazilian states. In total, 17,662 mosquitoes of 89 species were collected. Before evidence of virus circulation, mosquitoes were tested negative but traditional vectors were alarmingly detected in 82% of municipalities, revealing high receptivity to sylvatic transmission. During the outbreak, five species were found positive in 42% of municipalities. Haemagogus janthinomys and Hg. leucocelaenus are considered the primary vectors due to their large distribution combined with high abundance and natural infection rates, concurring together for the rapid spread and severity of this outbreak. Aedes taeniorhynchus was found infected for the first time, but like Sabethes chloropterus and Aedes scapularis, it appears to have a potential local or secondary role because of their low abundance, distribution and infection rates. There was no evidence of YFV transmission by Aedes albopictus and Aedes aegypti, although the former was the most widespread species across affected municipalities, presenting an important overlap between the niches of the sylvatic vectors and the anthropic ones. The definition of receptive areas, expansion of vaccination in the most affected age group and exposed populations and the adoption of universal vaccination to the entire Brazilian population need to be urgently implemented.


Assuntos
Surtos de Doenças , Mosquitos Vetores/classificação , Febre Amarela/epidemiologia , Febre Amarela/transmissão , Animais , Brasil/epidemiologia , Cidades , Feminino , Masculino , Mosquitos Vetores/virologia , Filogeografia , Dinâmica Populacional , Vírus da Febre Amarela
20.
Artigo em Inglês, Espanhol | PAHO-IRIS | ID: phr-50488

RESUMO

In 2019, three countries in the Region of the Americas (Bolivia, Brazil, and Peru) have reported confirmed yellow fever cases occurring between December 2018 and February 2019. In 2018, there were five countries and territories in the Region of the Americas that reported confirmed cases of yellow fever: Bolivia, Brazil, Colombia, French Guiana, and Peru.


En 2019, tres países de la Región (Bolivia, Brasil y Perú) notificaron casos confirmados de fiebre amarilla que ocurrieron entre diciembre de 2018 y febrero de 2019. En tanto que durante 2018 fueron cinco los países y territorios de la región de las Américas que notificaron casos confirmados de fiebre amarilla: Bolivia, Brasil, Colombia, Guayana Francesa y Perú.


Assuntos
Febre Amarela , Febre Amarela
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