Óbitos por gripe pandémica A (H1N1) 2009 em Portugal Período de Abril de 2009 a Março de 2010

Procedeu-se à análise dos 124 óbitos notificados em Portugal por gripe pandémica A (H1N1) 2009 no período de Abril de 2009 a Março de 2010. A taxa de mortalidade estimada foi de 1,17/100.000 habitantes. Cerca de 60% dos falecidos eram do sexo masculino, a idade média foi de 47,6 anos e 66,7% apresentavam, pelo menos, um factor de risco para doença grave. As doenças pulmonar e cardíaca crónicas foram os factores de risco mais prevalentes, identificados em 24,7% e 20,7% dos casos, respectivamente. Mais de ¾ dos doentes foram internados em Unidades de Cuidados Intensivos (UCI). A pneumonia viral primária foi a principal causa de morte, diagnosticada em 79,7% dos doentes. Constatou-se haver diferença estatisticamente significativa em relação à distribuição da causa de morte nos grupos dos indivíduos com e sem factores de risco (p=0.048). Estimaram-se em 2 853 os anos potenciais de vida perdidos, o que equivale a 30,8 anos por 100.000 habitantes. Os valores encontrados são comparáveis, na generalidade, com os encontrados noutros países com o mesmo nível de desenvolvimento. Em futuras circunstâncias semelhantes deverá ser equacionada a notificação obrigatória dos casos de maior gravidade

Relatório final sobre a mortalidade na pandemia de gripe (H1N1) de 2009 em Portugal (de abril de 2009 a agosto de 2010)

ABSTRACT - We analyzed the 124 deaths reported in Portugal form flu pandemic. The estimated mortality rate was 1.17/100 000 population. 60% were males, the average age was 47.6 and 66.1% had at least one risk factor. Chronic lung and heart diseases were the most common risk factors. Viral pneumonia was the major cause of death. 11% of the deceased had no treatment with neuraminidase inhibitors and none was vaccinated against the pandemic strain of flu. Compared to average life expectancy, we estimated that 3859 years of potential life were lost. In the future, we should work on improved strategies for risk communication for health professionals and general public.RESUMO - Em Portugal, durante a pandemia de gripe A(H1N1) 2009 foram reportados 124 óbitos. A taxa de mortalidade estimada foi de 1,17/100 000 habitantes. 60% dos falecidos eram do sexo masculino, a média das idades foi de 47,6 anos e em 66,1% havia pelo menos um factor de risco. As doenças crónicas respiratórias e cardíacas foram os factores de risco mais comuns. A pneumonia viral primária foi a principal causa de morte. 11% dos falecidos não receberam terapêutica com antivíricos e nenhum foi vacinado com a vacina pandémica. Em relação à esperança média de vida, os anos potenciais de vida perdidos foram 3859 anos. No futuro em circunstâncias semelhantes, devemos melhorar as estratégias de comunicação do risco para os profissionais de saúde e população em geral.info:eu-repo/semantics/publishedVersio

Study of mortality by Diabetes Mellitus in Portugal

A diabetes mellitus (DM) é considerada um dos problemas de saúde pública de maior importância a nível mundial, pela elevada prevalência, morbilidade e mortalidade (Sousa, 2006), prevendo-se um agravamento na próxima década relacionado com o envelhecimento da população e com as alterações progressivas no estilo de vida (Cruz, 2005). A Organização Mundial de Saúde (WHO) estima que a diabetes possa vir a ser responsável pela primeira regressão na esperança média de vida dos últimos 200 anos. Pretende-se, com o presente estudo, avaliar a evolução temporal e a distribuição geográfica da mortalidade por DM em Portugal

Virus Genome Sequencing as a Key Tool to Understand Cryptic Transmission

Funding: This study is co-funded by Fundação para a Ciência e Tecnologia and Agência de Investigação Clínica e Inovação Biomédica (234_596874175) on behalf of the Research 4 COVID-19 call. This work is also a result of the GenomePT project (POCI-01-0145-FEDER-022184), supported by COMPETE 2020 - Operational Programme for Competitiveness and Internationalisation (POCI), Lisboa Portugal Regional Operational Programme (Lisboa2020), Algarve Portugal Regional Operational Programme (CRESC Algarve2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF), and by Fundação para a Ciência e a Tecnologia (FCT). This work was also supported by Fundos FEDER through the ProgramaOperacionalFactores de Competitividade–COMPETE and by FundosNacionais through the Fundação para a Ciência e a Tecnologia within the scope of the project UID/BIM/00009/2019 (Centre for Toxicogenomics and Human Health -ToxOmics).Dissemination of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in healthcare institutions affects both patients and health-care workers (HCW), as well as the institutional capacity to provide essential health services. Here, we investigated an outbreak of SARS-CoV-2 in a "non-COVID-19" hospital ward unveiled by massive testing, which challenged the reconstruction of transmission chains. The contacts network during the 15-day period before the screening was investigated, and positive SARS-CoV-2 RNA samples were subjected to virus genome sequencing. Of the 245 tested individuals, 48 (21 patients and 27 HCWs) tested positive for SARS-CoV-2. HCWs were mostly asymptomatic, but the mortality among patients reached 57.1% (12/21). Phylogenetic reconstruction revealed that all cases were part of the same transmission chain. By combining contact tracing and genomic data, including analysis of emerging minor variants, we unveiled a scenario of silent SARS-CoV-2 dissemination, mostly driven by the close contact within the HCWs group and between HCWs and patients. This investigation triggered enhanced prevention and control measures, leading to more timely detection and containment of novel outbreaks. This study shows the benefit of combining genomic and epidemiological data for disclosing complex nosocomial outbreaks, and provides valuable data to prevent transmission of COVID-19 in healthcare facilities.publishersversionpublishe

Acute coronary syndromes and other forms of coronary heart disease in the National Health Service 1997-2001

Aims: 1) To study the frequency and distribution of acute coronary syndromes and other forms of ischemic heart disease (IHD) as the cause of hospitalization in the Portuguese National Health Service (NHS); 2) To compare mortality from the various forms of IHD by gender in NHS hospitals in the period 1997-2001. Material and Methods: Annual in-patient data based on Diagnosis Related Groups (DRGs) sent by each NHS hospital to the Informatics and Financial Management Institute (IGIF) using ICD-9-CM codes. After quality control of the data by IGIF, the Statistics Department of the Directorate- General of Health (GDS) studied the distribution of codes 410-414 by age group and gender. Measures of central tendency were studied and the Student’s t test was used to evaluate the significance of differences between men and women in the distribution of IHD in-patients. Results: Acute myocardial infarction (AMI) (410) caused 7618 hospitalizations (5271 male, 2347 female) in 1997. In 2001 the number was 10 047 (6693 male, 3354 female). Other acute and subacute forms of IHD (411) were 4005 (2522 male, 1483 female) and 4100 (2618 male, 1482 female) respectively during 1997 and 2001. Angina pectoris (413) and other forms of chronic ischemic heart disease (414) were 2479 (1543 male, 936 female) and 11 293 (7951 male, 3342 female) during 1997, and 1993 (1212 male, 781 female) and 12 029 (8277 male, 3752 female) during 2001. The age (meanSD) of in-patients coded as 410 was 63.1 ± 12.9/63.9 ± 17.0 years in men and 72.4 ± 11.6/73.1 ± 11.1 years in women over the period 1997-2001. Age differences by gender were statistically significant (p < 0.001). Age for code 411 was similar to AMI in men (62.9 ± 11.1 years and 63.8 ± 11.7 years respectively in 1997 and 2001), but was lower in AMI cases in women (68.4 ± 10.6 years and 69.3 ± 10.7 years respectively in 1997 and 2001). AMI mortality was higher in 1997 (11.6 % male, 22.1% female) than in 2001 (9.9 % male, 19.8% female). Conclusions: Acute coronary events are the cause of approximately half of the hospitalizations for IHD, in both sexes. The frequency of every form of IHD in men is higher than in women, and hospitalization occurs nine years earlier on average. Between 1997 and 2001, hospitalizations for IHD increased by over 10%, mainly for AMI (32 %), although with no significant increase in age. Nevertheless, the prognosis for AMI in in-patients has improved in both sexes.Objectivos: 1) Caracterizar a frequência e distribuição das síndromes coronárias agudas e das outras formas da Doença Isquémica Cardíaca (DIC) como causa de internamento hospitalar (IH); 2) Comparar a letalidade das diferentes formas da DIC nos Hospitais do SNS segundo o sexo, no período de 1997-2001. Material e Métodos: Bases de dados dos Grupos de Diagnóstico Homogéneos (GDH) de 1997-2001. Dados de IH na Rede dos Hospitais do SNS codificados pela CID-9 e enviados para o IGIF. Após controlo de qualidade, as bases foram enviadas para a DGS. Na Divisão de Estatística estudou-se a distribuição das rubricas nosológicas 410-414 segundo o grupo etário, em ambos os sexos. Relativamente à idade, calcularam--se os parâmetros de tendência central e estudou-se o significado da diferença entre o tempo de ocorrência das diversas formas da DIC entre homens e mulheres (teste t de Student). Resultados: O enfarto agudo do miocárdio - EAM (410), em 1997, justificou 7618 IH (5271 H, 2347 M) enquanto, em 2001, o numero foi de 10 047 (6693 H, 3354 M). O número das outras formas agudas e subagudas da DIC (411) foi de 4005 (2522 H, 1483 M) e 4100 (2618 H, 1482 M), respectivamente em 1997 e 2001. Outras formas de angina de peito (413) e de DIC crónica (414) foram a causa de IH, respectivamente, de 2479 (1543 H, 936 M) e de 11 293 (7951 H, 3342 M) casos, em 1997, e de 1993 (1212 H, 781 M) e de 12 029 (8277 H, 3752 M) casos, em 2001. A idade (média ± DP) dos eventos codificados como 410 foi em 1997/2001 de 63,1 ± 12,9/ /63,9 ± 17,0 anos nos H e de 72,4 ± 11,6//73,1 ± 11,1 anos nas M. A diferença da idade por sexo atingiu significado estatístico (p < 0,001). O código 411 encontrou-se no grupo cuja idade foi idêntica à do EAM nos H (62,9 ± 11,1 anos e 63,8 ± 11,7 anos, respectivamente em 1997 e 2001), mas inferior relativamente aos casos de EAM nas M (68,4 ± 10,6 anos e 69,3 ± 10,7 anos, respectivamente em 1997 e 2001). A letalidade do EAM foi mais elevada em 1997 (11,6% H; 22,1 % M) do que em 2001 (9,9% H; 19,8 % M)

The August 2003 heat wave and its effects on the mortality of the Portuguese population

RESUMO - Portugal continental, como outros países europeus, foi afectado por uma onda de calor de grande intensidade no Verão de 2003, com efeitos na mortalidade da população. O excesso de óbitos associados à onda de calor foi estimado pela comparação do número de óbitos observados entre 30 de Julho e 15 de Agosto de 2003 e o número de óbitos esperados se a população tivesse estado exposta às taxas de mortalidade médias do biénio 2000-2001 no respectivo período homólogo. Os óbitos esperados foram calculados com ajustamento para a idade. O número de óbitos observados (O) foi superior ao número esperado (E) em todos os dias do período estudado e o seu excesso global foi estimado em 1953 óbitos (excesso relativo de 43%), dos quais 1317 (61%) ocorreram no sexo feminino e 1742 no grupo de 75 e + anos (89%). A nível distrital, Portalegre teve o maior aumento relativo do número de óbitos (+89%) e Aveiro o menor (+18%). Numa área geográfica contínua do interior do território (Guarda, Castelo Branco, Portalegre e Évora) houve aumentos relativos superiores a 80%. Em termos absolutos, o maior excesso de óbitos ocorreu no distrito de Lisboa (mais cerca de 396) e no do Porto (mais cerca de 183). As causas de morte «golpe de calor» e «desidratação e outros distúrbios metabólicos» tiveram os aumentos relativos mais elevados (razões O/E de, respectivamente, 70 e 8,65). Os maiores aumentos absolutos do número de óbitos ocorreram no grupo das «doenças do aparelho circulatório» (mais 758), nas «doenças do aparelho respiratório» (mais 255) e no conjunto de «todas as neoplasias malignas» (mais 131). No período da onda de calor e no período de comparação, a percentagem dos óbitos que ocorreu nos hospitais (52% e 56%), no domicílio (32 e 33%) e em «outros locais» foi semelhante. A discussão sobre os factores que condicionaram a obtenção dos valores apresentados, relativos ao excesso de óbitos por sexo, grupo etário, distrito, causa e local da morte, permite concluir que os mesmos se afiguram adequados para medir a ordem de grandeza e caracterizar o efeito da onda de calor na mortalidade. O erro aleatório, medido pelos intervalos de confiança, e alguns possíveis erros sistemáticos associados ao período de comparação escolhido não deverão afectar de modo relevante as estimativas.ABSTRACT - Like other European countries, Portugal was affected by a heat wave of high intensity during the summer of 2003. In spite of the alert that was launched and of the interventions, which were carried out, it was recognised that still during the month of August, the heat wave had caused severe effects regarding the mortality of the population. This report presents the statistics of those effects, which were based on the definite mortality data that are now available. The excess of deaths associated with the heat wave were estimated by means of comparing the number of deaths observed between July 30 and August 15 and the number of expected deaths. This, if the population was exposed to the average mortality rates of the 2000-2001 biennium in what concerns the respective homologue period (30.07 to 15.08). Adjustment for age group was used to derive the number of expected deaths, because an alteration of the population structure was present, namely in the 75 year-old and + age groups within that biennium and 2003. Although, estimates have been carried out using other periods of comparison, the authors consider that the biennium of 2000- 2001 produced the most adequate estimation. The number of deaths observed (O) was higher than the expected number (E). Between the days of July 30 and August 15, 3 significant statistical peaks of mortality occurred, which took place on day 2 (418 total deaths), on day 8 (464 total deaths) and on day 13 (439 total deaths). The global excess of deaths associated with the heat wave period was estimated in 1953 deaths (IC95: 1866-2039), out of which 636 (IC95: 530-744) occurred in males and 1317 (IC95: 1202-1435) in females. These figures corresponded to a relative excess of 43% of the expected deaths in both sexes, 27% in males and of 61% in females. The death excesses took place, mainly in the older age groups. In the 75 age group and more, there were about 1742 deaths whilst in the 65-74 age group there were about 161 deaths. One should point out that the significant statistically excess of mortality was not observed in the younger age groups, contrary to what was verified in the heat waves of 1981 and of 1991. The effects of the heat affected all the districts of Mainland, although with different intensities. The district of Portalegre had the highest increase in the number of deaths (+ 89%), whilst the minimum number occurred in Aveiro (+ 18%). Four districts, which had relative increases above 80% (Guarda, Castelo Branco, Portalegre and Évora), constituted a continuous geographical area in the inland of the territory. The districts ranked differently when the absolute increase of the number of deaths was considered. The highest death excesses occurred in the district of Lisbon (about 396 deaths) and in Oporto (about 183 deaths), which are higher populated areas. The districts of Bragança (about 24 deaths) and Vila Real (about 31 deaths) had the lowest death excesses. Some of the death causes were associated with the observed excess of mortality. Namely, the «heat stroke» had the relative highest increase (ratio O/E = 70.0), «dehydration and other metabolic disorders» also had a high relative increase (ratio O/E = 8.65), both causes with ratios much higher than the rest. On the contrary, the highest absolute number of deaths increase was observed in the group of the «diseases of the circulatory system» (758 deaths) and, among these, the «cerebrovascular diseases» (370.2 deaths), the «ischaemic heart diseases» (144.5 deaths) and the «heart failure» (118.0 deaths). The group of the «diseases of the respiratory system» (255 deaths) and the group of «malignant neoplasms» (131.2 deaths) held the following positions. The percentage of the deaths that occurred in the various locations was similar in the heat wave period and in the comparison period (hospitals — 2003: 52.6%; biennium 2000- 2001: 56.0%; at home — 2003: 32.2%; 2000-2001: 32.6%; other locations — 2003: 15.2%; 2000-2001: 11.3%). The number of deaths associated with the heat wave cannot be directly determined, it can only be estimated using the number of expected deaths within the same period of time, if the heat wave had not occurred. In fact, the deaths associated with specific causes, which are directly related with the «exposure to excessive natural heat», represent only a small proportion of the total number of deaths. The figures presented for the total number of deaths, per sex, age group, district and death cause seem to be adequate in order to indicate the greatness of the effect of the heat wave in mortality. It should be pointed out that these estimations have a degree of uncertainties related with randomness, which were meant to be measured by the respective confidence interval. There may be still present some systematic errors associated with the period of comparison that was chosen (2000-2001) and with other circumstances, which, however, should not affect the estimates in a relevant manner

Nosocomial Outbreak of SARS-CoV-2 in a “Non-COVID-19” Hospital Ward: Virus Genome Sequencing as a Key Tool to Understand Cryptic Transmission

(This article belongs to the Collection SARS-CoV-2 and COVID-19)Dissemination of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in healthcare institutions affects both patients and health-care workers (HCW), as well as the institutional capacity to provide essential health services. Here, we investigated an outbreak of SARS-CoV-2 in a "non-COVID-19" hospital ward unveiled by massive testing, which challenged the reconstruction of transmission chains. The contacts network during the 15-day period before the screening was investigated, and positive SARS-CoV-2 RNA samples were subjected to virus genome sequencing. Of the 245 tested individuals, 48 (21 patients and 27 HCWs) tested positive for SARS-CoV-2. HCWs were mostly asymptomatic, but the mortality among patients reached 57.1% (12/21). Phylogenetic reconstruction revealed that all cases were part of the same transmission chain. By combining contact tracing and genomic data, including analysis of emerging minor variants, we unveiled a scenario of silent SARS-CoV-2 dissemination, mostly driven by the close contact within the HCWs group and between HCWs and patients. This investigation triggered enhanced prevention and control measures, leading to more timely detection and containment of novel outbreaks. This study shows the benefit of combining genomic and epidemiological data for disclosing complex nosocomial outbreaks, and provides valuable data to prevent transmission of COVID-19 in healthcare facilities.This study is co-funded by Fundação para a Ciência e Tecnologia and Agência de Investigação Clínica e Inovação Biomédica (234_596874175) on behalf of the Research 4 COVID-19 call. This work is also a result of the GenomePT project (POCI-01-0145-FEDER-022184), supported by COMPETE 2020 - Operational Programme for Competitiveness and Internationalisation (POCI), Lisboa Portugal Regional Operational Programme (Lisboa2020), Algarve Portugal Regional Operational Programme (CRESC Algarve2020), under the PORTUGAL 2020 Partnership Agreement, through the European Regional Development Fund (ERDF), and by Fundação para a Ciência e a Tecnologia (FCT). This work was also supported by Fundos FEDER through the Programa Operacional Factores de Competitividade–COMPETE and by Fundos Nacionais through the Fundação para a Ciência e a Tecnologia within the scope of the project UID/BIM/00009/2019 (Centre for Toxicogenomics and Human Health -ToxOmics).info:eu-repo/semantics/publishedVersio