Evolução da Política Federal de Financiamento do Componente de Vigilância em Saúde no Brasil após a criação Sistema Único de Saúde (SUS)

A Vigilância em Saúde (VS) é um dos componentes do Sistema Único de Saúde (SUS). Este artigo tem o objetivo de descrever as mudanças recentes no financiamento da VS e o seu papel na organização e descentralização das ações de saúde. A Lei 8080/1990 estabeleceu a VS como eixo estruturante do SUS e a criação de um teto financeiro exclusivo para as ações de VS na Norma Operacional Básica do SUS 1/96, composto por critérios equitativos, o que facilitou a descentralização das ações para a esfera municipal, permitindo ao gestor o planejamento e a continuidade das ações. O Pacto pela saúde, em 2006, e a sua regulamentação pela Portaria GM nº 3252/2009 aprofundou a descentralização, a territorialização e a integralidade da atenção. As mudanças de conceituação da VS e a política de financiamento pactuada pelas esferas de governo foram catalisadoras para o processo de institucionalização da Vigilância em Saúde (VS) nos últimos anos no Brasil.Health surveillance (HS) is one of the key components of the Brazilian Unified Health System (SUS). This article describes recent changes in health surveillance funding models and the role these changes have had in the reorganization and decentralization of health actions. Federal law no. 8.080 of 1990 defined health surveillance as a fundamental pillar of the SUS, and an exclusive fund with equitable distribution criteria was created in the Basic Operational Norm of 1996 to pay for health surveillance actions. This step facilitated the decentralization of health care at the municipal level, giving local authorities autonomy to plan and provide services. The Health Pact of 2006 and its regulation under federal decree No. 3252 in 2009 bolstered the processes of decentralization, regionalization and integration of health care. Further changes in the basic concepts of health surveillance around the world and in the funding policies negotiated by different spheres of government in Brazil have been catalysts for the process of HS institutionalization in recent years

PNAD COVID-19 : a powerful new tool for Public Health Surveillance in Brazil

O Ministério da Saúde declarou em 03 de fevereiro de 2020 estado de emergência em saúde pública de importância nacional em decorrência da pandemia pelo novo coronavírus SARS-CoV-2. Com isso, o IBGE adiou a realização do Censo Demográfico de 2020 e passou a formular uma PNAD COVID-19. O inquérito contou com uma amostra total de 349 mil pessoas em cerca de 200 mil domicílios. Do total da população-residente brasileira, o IBGE estimou em maio/2020 que 24,0 milhões (11,4%) tiveram pelo menos um dos sintomas de síndrome gripal (SG). Desse contingente, 20,2 milhões (84,3% do total dos sintomáticos) não procuraram unidade de saúde. As inovações trazidas para a vigilância em saúde e o pioneirismo do IBGE demonstram ser possível, em um país continental e que vem experimentando diversas epidemias locais em momentos diferentes em seu território, que outros países também desenvolvam inquéritos domiciliares semelhantes, com coleta de dados semanal (referida às semanas epidemiológicas) por telefone de forma inovadora e tempestiva. A PNAD COVID-19 trouxe ainda uma nova tecnologia para o Instituto, resgatando o papel de avaliador externo do Sistema Único de Saúde (SUS).On February 3, 2020, the Brazilian Ministry of Health declared a state of emergency in public health of national relevance due to the pandemic caused by the new coronavirus SARS-CoV-2. As a result, IBGE postponed the 2020 Demographic Census and started to formulate a COVID-19 PNAD. The survey included a total sample of 349 thousand people in about 200 thousand households. Of the total Brazilian resident population, the IBGE estimated in May/2020 that 24.0 million (11.4%) had at least one of the flu-like syndrome symptoms. Of this contingent, 20.2 million (84.3% of all symptomatic patients) did not seek health care. The innovations brought to health surveillance and the IBGE’s pioneering spirit show that it is possible, in a continental country that has been experiencing several local epidemics at different times in its territory, that other countries also develop similar household surveys, with weekly data collection (referred to epidemiological weeks) by telephone in an innovative and timely manner. The COVID-19 PNAD also brought new technology to the Institute, reviving its role as an external evaluator of the Unified Health System (SUS)

Cuidados em doenças infecciosas e parasitárias: endêmicas, emergentes e re-emergentes

Este módulo é dividido em nove lições e aborda epidemiologia, manifestações clínicas, diagnóstico, tratamento, medidas de controle e vigilância epidemiológica das seguintes doenças: Influenza, Febre Amarela, Leishmaniose, Malária, Doença de Chagas, Parasitoses, Esquistossomose, Doenças Sexualmente Transmissíveis e Hantavirose.Fundo Nacional de Saúde - FN

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK.

BACKGROUND: A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. METHODS: This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. FINDINGS: Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0-75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4-97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8-80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3-4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. INTERPRETATION: ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials. FUNDING: UK Research and Innovation, National Institutes for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, Bill & Melinda Gates Foundation, Lemann Foundation, Rede D'Or, Brava and Telles Foundation, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and AstraZeneca

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK

Background A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. Methods This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. Findings Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0–75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4–97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8–80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3–4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. Interpretation ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials

Ethical issues in the management of patients with Ebola virus disease

Submitted by Rodrigo Senorans ([email protected]) on 2015-03-30T15:08:53Z No. of bitstreams: 1 Questões éticas no manejo de pacientes.pdf: 60492 bytes, checksum: 388e42d4cf9672541ef31fc42a7db02f (MD5)Approved for entry into archive by Anderson Silva ([email protected]) on 2015-03-30T15:09:55Z (GMT) No. of bitstreams: 1 Questões éticas no manejo de pacientes.pdf: 60492 bytes, checksum: 388e42d4cf9672541ef31fc42a7db02f (MD5)Approved for entry into archive by Anderson Silva ([email protected]) on 2015-03-30T15:10:08Z (GMT) No. of bitstreams: 1 Questões éticas no manejo de pacientes.pdf: 60492 bytes, checksum: 388e42d4cf9672541ef31fc42a7db02f (MD5)Made available in DSpace on 2015-03-30T15:36:48Z (GMT). No. of bitstreams: 1 Questões éticas no manejo de pacientes.pdf: 60492 bytes, checksum: 388e42d4cf9672541ef31fc42a7db02f (MD5) Previous issue date: 2014Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil

Seroepidemiology of SARS-CoV-2 on a partially vaccinated island in Brazil: Determinants of infection and vaccine response

Background: A vaccination campaign targeted adults in response to the pandemic in the City of Rio de Janeiro. Objective: We aimed to evaluate the seroprevalence of SARS-CoV-2 antibodies and identify factors associated with seropositivity on vaccinated and unvaccinated residents. Methods: We performed a seroepidemiologic survey in all residents of Paquetá Island, a neighborhood of Rio de Janeiro city, during the COVID-19 vaccine roll-out. Serological tests were performed from June 16 to June 19, 2021, and adjusted seropositivity rates were estimated by age and epidemiological variables. Logistic regression models were used to estimate adjusted ORs for risk factors to SARS-CoV-2 seropositivity in non-vaccinated individuals, and potential determinants of the magnitude of antibody responses in the seropositive population. Results: We included in the study 3,016 residents of Paquetá (83.5% of the island population). The crude seroprevalence of COVID-19 antibodies in our sample was 53.6% (95% CI = 51.0, 56.3). The risk factors for SARS-CoV-2 seropositivity in non-vaccinated individuals were history of confirmed previous COVID-19 infection (OR = 4.74; 95% CI = 3.3, 7.0), being a household contact of a case (OR = 1.93; 95% CI = 1.5, 2.6) and in-person learning (OR = 2.01; 95% CI = 1.4, 3.0). Potential determinants of the magnitude of antibody responses among the seropositive were hybrid immunity, the type of vaccine received, and time since the last vaccine dose. Being vaccinated with Pfizer or AstraZeneca (Beta = 2.2; 95% CI = 1.8, 2.6) determined higher antibody titers than those observed with CoronaVac (Beta = 1.2; 95% CI = 0.9, 1.5). Conclusions: Our study highlights the impact of vaccination on COVID-19 collective immunity even in a highly affected population, showing the difference in antibody titers achieved with different vaccines and how they wane with time, reinforcing how these factors should be considered when estimating effectiveness of a vaccination program at any given time. We also found that hybrid immunity was superior to both infection-induced and vaccine-induced immunity alone, and online learning protected students from COVID-19 exposure