Ecosystem approaches to controlling of vector-borne diseases : dengue and Chagas disease; editorial

This one-page editorial for a special issue of “Cadernos de Saúde Pública” (Reports in Public Health) introduces some articles that originate from projects supported by the IDRC/Ecohealth programme, focusing on Chagas disease and dengue. Both diseases are characterized by vector transmission, having complex and diverse factors that need to be included in integrated responses. As well, it is suggested that different stakeholders could lead local projects to improve human health conditions

Vigilância em saúde: é necessária uma legislação de emergência?

A Lei n. 8.080/1990 que rege o Sistema Único de Saúde (SUS) inclui no seu texto a Vigilância Epidemiológica/VE, ampliando o seu conceito. Todavia, legalmente este campo da saúde pública permanece subordinado à Lei n. 6.259/1975. Projetos de Lei vêm sendo elaborados para substituir esta última; porém, não estão em consonância com a Lei n. 8.080. Ademais, a promulgação do novo Regulamento Sanitário Internacional (RSI/2005) exige que o país elabore instrumento legal para atender às exigências desse Código Sanitário. Este artigo tem como objetivo apresentar algumas reflexões sobre os Ante-projetos de Lei apresentados e possíveis repercussões no processo de consolidação dos princípios que orientam a Reforma Sanitária Brasileira. Descreve-se a criação e desenvolvimento do Sistema Nacional de Vigilância Epidemiológica no Brasil e destaca-se que a Lei à qual a VE está subordinada, ainda que promulgada em plena Ditadura Militar, não previa sanções aos indivíduos. No entanto, os referidos Anteprojetos contemplam a instituição de infrações e crimes sanitários, fato rechaçado pela comunidade que milita no campo da Saúde Coletiva, por entender que tais dispositivos são autoritários, invasivos à liberdade individual e violam direitos que asseguram a dignidade da pessoa humana. Caso necessário, recomenda-se que uma nova Lei para o SNVS seja consentânea com o Estado Democrático de Direito e com princípios da Reforma Sanitária Brasileira e do SUS. Ressalta-se que medidas restritivas sejam transitórias e cuidadosamente elaboradas, para que, em nome da necessidade do uso de força para controle de riscos à saúde, atos arbitrários não venham a ser cometidos pelas autoridades

Dengue : vinte e cinco anos da reemergência no Brasil

The article revisits the epidemiology of dengue twenty-five years after its re-emergence in Brazil, and discusses some of the principal determinants and implications for its control. It presents the changes occurring in the dengue epidemiological pattern in recent years, such as the sudden age shift in the incidence of dengue hemorrhagic fever, and discusses possible associated factors. The authors conclude that the current situation emphasizes a need for the international scientific community to renew its efforts to generate knowledge in the development of new tools and strategies for dengue prevention.Este artigo revisita a epidemiologia da dengue no Brasil após 25 anos da sua reemergência discutindo os principais determinantes e implicações no seu controle. Destacam-se peculiaridades clínicas e epidemiológicas desta virose neste país, que ocupa uma das primeiras posições no que diz respeito tanto ao número de casos notificados como no risco de ocorrência desta doença no mundo. Apresentam-se as mudanças que vêm ocorrendo no padrão epidemiológico da doença nos últimos anos, a exemplo do súbito deslocamento de faixa etária na incidência da febre hemorrágica da dengue, discutindo-se os possíveis fatores envolvidos. Particulariza-se a epidemia do Rio de Janeiro, em 2008, o reflexo deste episódio na comunidade internacional e o temor de disseminação da doença para a Europa. Os autores consideram que esta conjuntura aponta para a necessidade da comunidade científica mundial renovar esforços para gerar conhecimentos que possibilitem o aperfeiçoamento e avanço no desenvolvimento de novas ferramentas e estratégias de prevenção da dengue

Vigilância em saúde: é necessária uma legislação de emergência?

A Lei n. 8.080/1990 que rege o Sistema Único de Saúde (SUS) inclui no seu texto a Vigilância Epidemiológica/VE, ampliando o seu conceito. Todavia, legalmente este campo da saúde pública permanece subordinado à Lei n. 6.259/1975. Projetos de Lei vêm sendo elaborados para substituir esta última; porém, não estão em consonância com a Lei n. 8.080. Ademais, a promulgação do novo Regulamento Sanitário Internacional (RSI/2005) exige que o país elabore instrumento legal para atender às exigências desse Código Sanitário. Este artigo tem como objetivo apresentar algumas reflexões sobre os Ante-projetos de Lei apresentados e possíveis repercussões no processo de consolidação dos princípios que orientam a Reforma Sanitária Brasileira. Descreve-se a criação e desenvolvimento do Sistema Nacional de Vigilância Epidemiológica no Brasil e destaca-se que a Lei à qual a VE está subordinada, ainda que promulgada em plena Ditadura Militar, não previa sanções aos indivíduos. No entanto, os referidos Anteprojetos contemplam a instituição de infrações e crimes sanitários, fato rechaçado pela comunidade que milita no campo da Saúde Coletiva, por entender que tais dispositivos são autoritários, invasivos à liberdade individual e violam direitos que asseguram a dignidade da pessoa humana. Caso necessário, recomenda-se que uma nova Lei para o SNVS seja consentânea com o Estado Democrático de Direito e com princípios da Reforma Sanitária Brasileira e do SUS. Ressalta-se que medidas restritivas sejam transitórias e cuidadosamente elaboradas, para que, em nome da necessidade do uso de força para controle de riscos à saúde, atos arbitrários não venham a ser cometidos pelas autoridades.The Law 8.080/90 which regulates the Brazilian National Public Health System includes the Epidemiologic Surveillance, expanding the concept. However legally this field of public health remains subject to the Law 6.259/1975. Bills are being drafted to replace the latter, but they are not in accordance to the 8.080 Act. Morever the promulgation of the new International Health Regulations (RSI/2005) requires that the country elaborates legal instrument to meet the demands of the International Code. This article aims to present some reflections on the preliminaries drafts of laws presented and their possible implications in the process of consolidation of principles that guide the Brazilian Sanitary Reform. It describes the creation and development of the National System of Epidemiological Surveillance in Brazil, highlighting the Law to which the Epidemiologic Surveillance is subject. Moreover, this Law has been promulgated during the military dictatorship it did not mention punishments against individuals. However, these preliminaries drafts of projects include the establishment of health violations and crimes which is rejected by the community involved with the field of Public Health, once this community believes that such devices are authoritarians, restraints of the individual freedom and that they violate rights such as the human dignity. If it is necessary, it is recommended that a new Law for the National System of Epidemiological Surveillance should be in accordance to the Rule of Law and democratic principles of the Brazilian Health Reform and the Brazilian National Public Health System. It is emphasized that restrictive measures should be transitor and carefully elaborate to avoid arbitrary acts from authorities, on behalf of the necessity of using force to control risks to health

Dengue in pregnancy and maternal mortality: a cohort analysis using routine data.

Dengue is a mosquito-borne disease with major public health importance due to its growing incidence and geographical spread. There is a lack of knowledge on its contribution to maternal death. We conducted a population-based cohort study to investigate the association between symptomatic dengue during pregnancy and deaths in Brazil from 2007 to 2012. We did this by linking routine records of confirmed dengue cases to records of deaths of women who had a live birth. Using the Firth method, we estimated odds ratios for maternal deaths associated with dengue during pregnancy. Dengue increased the risk of maternal death by 3 times (95%CI,1.5-5.8) and dengue haemorrhagic fever increased the risk of maternal death by 450 times (95%CI,186.9-1088.4) when compared to mortality of pregnant women without dengue. The increase in risk occurred mostly during acute dengue 71.5 (95%CI,32.8-155.8), compared with no dengue cases. This study showed an increased risk of adverse outcomes in pregnant women with dengue. Therefore in areas where dengue is circulating, the health of pregnant women should be not only a public health priority, but health professionals attending pregnant women with dengue should more closely observe these patients to be able to intervene in a timely way and avoid deaths

Evaluation of record linkage of two large administrative databases in a middle income country: stillbirths and notifications of dengue during pregnancy in Brazil.

BACKGROUND: Due to the increasing availability of individual-level information across different electronic datasets, record linkage has become an efficient and important research tool. High quality linkage is essential for producing robust results. The objective of this study was to describe the process of preparing and linking national Brazilian datasets, and to compare the accuracy of different linkage methods for assessing the risk of stillbirth due to dengue in pregnancy. METHODS: We linked mothers and stillbirths in two routinely collected datasets from Brazil for 2009-2010: for dengue in pregnancy, notifications of infectious diseases (SINAN); for stillbirths, mortality (SIM). Since there was no unique identifier, we used probabilistic linkage based on maternal name, age and municipality. We compared two probabilistic approaches, each with two thresholds: 1) a bespoke linkage algorithm; 2) a standard linkage software widely used in Brazil (ReclinkIII), and used manual review to identify further links. Sensitivity and positive predictive value (PPV) were estimated using a subset of gold-standard data created through manual review. We examined the characteristics of false-matches and missed-matches to identify any sources of bias. RESULTS: From records of 678,999 dengue cases and 62,373 stillbirths, the gold-standard linkage identified 191 cases. The bespoke linkage algorithm with a conservative threshold produced 131 links, with sensitivity = 64.4% (68 missed-matches) and PPV = 92.5% (8 false-matches). Manual review of uncertain links identified an additional 37 links, increasing sensitivity to 83.7%. The bespoke algorithm with a relaxed threshold identified 132 true matches (sensitivity = 69.1%), but introduced 61 false-matches (PPV = 68.4%). ReclinkIII produced lower sensitivity and PPV than the bespoke linkage algorithm. Linkage error was not associated with any recorded study variables. CONCLUSION: Despite a lack of unique identifiers for linking mothers and stillbirths, we demonstrate a high standard of linkage of large routine databases from a middle income country. Probabilistic linkage and manual review were essential for accurately identifying cases for a case-control study, but this approach may not be feasible for larger databases or for linkage of more common outcomes

Symptomatic dengue infection during pregnancy and the risk of stillbirth in Brazil, 2006-12: a matched case-control study.

BACKGROUND: Maternal infections during pregnancy can increase the risk of fetal death. Dengue infection is common, but little is known about its role in fetal mortality. We aimed to investigate the association between symptomatic dengue infection during pregnancy and fetal death. METHODS: We did a nested case-control study using obstetrician-collected data from the Brazilian livebirth information system (SINASC), the mortality information system (SIM), and the national reportable disease information system (SINAN). We identified all pregnancies ending in stillbirth and a random sample of livebirths between Jan 1, 2006, and Dec 31, 2012. We did linkage to determine which mothers were diagnosed with dengue infection during pregnancy. By use of stillbirths as cases and a sample of matched livebirths as a control, we calculated matched odds ratios (mORs) using conditional logistic regression adjusted for maternal age and education. FINDINGS: 275 (0·2%) of 162 188 women who had stillbirths and 1507 (0·1%) of 1 586 105 women who had livebirths were diagnosed with dengue infection during pregnancy. Symptomatic dengue infection during pregnancy almost doubled the odds of fetal death (mOR 1·9, 95% CI 1·6-2·2). The increase in risk was similar when analyses were restricted to laboratory-confirmed cases of dengue infection (1·8, 1·4-2·4). Severe dengue infection increased the risk of fetal death by about five times (4·9, 2·3-10·2). INTERPRETATION: Symptomatic dengue infection during pregnancy is associated with an increased risk of fetal death. We recommend further epidemiological and biological studies of the association between dengue and poor birth outcomes to measure the burden of subclinical infections and elucidate pathological mechanisms. FUNDING: Brazilian National Council for Scientific and Technological Development, Horizon 2020

Doença periodontal materna como fator associado ao baixo peso ao nascer

OBJECTIVE: Recent studies have presented evidence that periodontal disease in pregnant women may be a determining factor for low birth weight. The present investigation was carried out to verify whether or not there is an association between maternal periodontal disease and low birth weight. METHODS: This was a case-control study on 302 women, of whom 102 were the mothers of live newborns of low weight (case group) and 200 were the mothers of live newborns of normal birth weight (control group). The existence of an association between periodontal disease and low birth weight was evaluated by means of a multivariate logistic regression model that considered other risk factors for low weight. RESULTS: The two groups were comparable with regard to age, height, pre-gestational weight, smoking, alcohol use, previous diseases, marital status, socioeconomic status, frequency of tooth-brushing and use of dental floss, number of meals per day and visits to the dentist. Periodontal disease was diagnosed in 57.8% of the mothers in the case group and 39.0% in the control group. Logistic regression analysis indicated a positive association between periodontal disease and low birth weight (unadjusted OR=2.15; 95% CI: 1.32-3.48), especially among the mothers with schooling of less than or equal to four years (ORadjusted=3.98; 95% CI: 1.58-10.10). CONCLUSIONS: Periodontal disease is a possible risk factor for low birth weight.OBJETIVO: Estudos recentes têm apresentado evidências de que a doença periodontal em gestantes pode ser um dos determinantes do baixo peso ao nascer. Realizou-se estudo para verificar a existência de associação entre doença periodontal materna e baixo peso ao nascer. MÉTODOS: Estudo do tipo caso-controle com 302 mulheres, sendo 102 mães de nascidos vivos de baixo peso (grupo caso) e 200 mães de nascidos vivos com peso normal (grupo controle). A existência de associação entre doença periodontal e baixo peso ao nascer foi avaliada mediante modelo multivariado de regressão logística, considerando outros fatores de risco para o baixo peso. RESULTADOS: Ambos os grupos de mães eram comparáveis no que se refere a idade, altura, peso pré-gestacional, tabagismo, alcoolismo, doenças prévias, estado civil, situação socioeconômica, número de escovações e uso de fio dental, número de refeições diárias, e visitas ao dentista. A doença periodontal foi diagnosticada em 57,8% das mães do grupo caso e 39,0% do grupo controle. A análise de regressão logística indicou associação positiva entre doença periodontal e baixo peso ao nascer (ORbruto=2,15; IC 95%: 1,32-3,48), especialmente entre as mães com escolaridade menor ou igual a quatro anos (ORajustada=3,98; IC 95%: 1,58-10,10). CONCLUSÕES: A doença periodontal é um possível fator de risco para o baixo peso ao nascer