Dengue no Brasil: situação epidemiológica e contribuições para uma agenda de pesquisa

The epidemiological situation of dengue in Brazil is presented, showing the introduction and spread of vector and the different virus serotypes in Brazil. At the present time the Aedes aegypti, the vector, and 3 out of 4 existing virus serotypes (DENV-1, DENV-2 and DENV-3) are spread by virtually the entire national territory. The epidemiological picture has been characterized by recurrent epidemics, especially in large urban centers. A new characteristic in this scenario is the growth in the proportion of severe cases, particularly cases of dengue hemorrhagic fever. Existing control actions have been costly and ineffectives. In order to meet the gaps in existing knowledge, some elements for a research agenda are presented. Finally, we must recognize that problems such as dengue have their roots in the explosive form urban populations in countries such as Brazil has grown and in the conditions and lifestyles under which these people live.A situação epidemiológica da dengue no Brasil é apresentada, mostrando-se a introdução e a dispersão do vetor e dos diferentes sorotipos do vírus no Brasil. No presente momento, o Aedes aegypti, o vetor, encontra-se disseminado por praticamente todo o território nacional, bem como três dos quatro sorotipos existentes do vírus (DENV-1, DENV-2 e DENV-3). O quadro epidemiológico tem se caracterizado como epidemias recorrentes, mais visível nos grandes centro urbanos. Um elemento novo no cenário é o crescimento da proporção de casos graves, especialmente casos da febre hemorrágica da dengue. As ações de controle existentes, além de custosas, têm se mostrado inefetivas. Com vistas a preencher as insuficiências existentes no conhecimento, alguns elementos para uma agenda de pesquisa são apresentados. Finalmente, não devemos deixar de reconhecer que problemas como dengue têm suas raízes na forma explosiva como as populações urbanas em países como o Brasil têm crescido, nas condições em que essas populações vivem e nos estilos de vida que adquirem

Vigilância epidemiológica e a pandemia da Covid-19 no Brasil. Elementos para entender a resposta brasileira e a explosão de casos e mortes

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Access to Financial Information for Tax Purposes and Proportionality – Balancing Public Interest with the Protection of Privacy

The purpose of the article is to analyse how to balance public interests with the protection of privacy in the tax field. It has not been an easy task especially in the context of access to financial information.In this area, the compromise to achieve transparency needs to pay regard to the principle of proportionality, as reinforced by recent case law of the ECJ, and align with specific legislation such as the EU General Data Protection Regulation and recently enacted EU Digital Services Act.It is extremely important to investigate the possible consequences of acting against fundamental rights that are attributed to European citizens (and not only), such as the right to privacy and the protection of personal data. The paper aims to provide relevant and further insight to paths that lead to a fair way to handle such relevant information.Every citizen, every academically inclined and dedicated individual, every public official, every judicial agent, must question whether the public interest can ever, or at least, recurrently, surpass a fundamental right to privacy, specially, in a sensible area as the financial information of an individual. Such actions can often lead, if mistakes are made along the way, to dangerous outcomes, such as public humiliation, and can even harm the person’s professional and personal life.Methodology. In the course of the paper, an analysis is made of public decisions taken in cases across the European continent. Additionally, some considerations are made about the recent legislation that is produced by competent authorities, particularly the European Institutions.Results of the research. The authors offer a personal insight regarding the information that has been gathered, confirming some significant concerns. What is of crucial importance, as stated in the title of this article, is a well established balance between the public interest and the protection of privacy, with explained and defined possible paths to follow

Hipersensibilidade tardia a antígeno de Trypanosoma cruzi. III - sensibilidade do teste cutâneo com antígeno T12E no diagnóstico de doença de Chagas em pacientes hospitalizados

Foi feita avaliação de três métodos imunológicos para diagnóstico de doença de Chagas, em 120pacientes hospitalizados. O teste cutâneo e a imuofluorescência foram positivos em 10% dos casos. A hemaglutinação foi positiva em 14,1% dos pacientes. A co-positividade do teste cutâneo com a hemaglutinação e dessa com a imunofluorescência foi de 7,5%. Apenas 5% dos pacientes estudados tinham os três exames concordantes positivos. Todavia, 19,1% dos pacientes tinham pelo menos um dos três exames positivos. Neste estudo a especificidade do teste cutâneo foi semelhante a da imunofluorescência. A sensibilidade desses testes, entretanto, foi menor que a da hemaglutinação indireta. Estes dados mostram que o teste cutâneo com o antígeno T12E faz o diagnóstico da doença de Chagas por uma simples reação de hipersensibilidade cutânea tardia de fácil execução.In this study we evaluated three immunologic methods for confirmation of clinical diagnosis of Chagas' disease, in 120 in-patients. The skin testing with the T12E antigen and the immunofluorescence were positive in 10% of cases. The hemagglutination was positive in 14.1% of these patients. The co-positivity of results of skin-testing with hemagglutination and of this latter with immunofluorescence reached 7.5% of cases. However, only 5% of co-positivity was achieved with results of skin testing, immunofluorescence and hemagglutination. Furthermore, 19.1% of the in¬patients showed at least one out of these exams to be positive. The specificity of the skin testing paralleled that of the immunofluorescence. The sensitivity of these exames, however, was lower than that obtained by the indirect hemagglutination. These data show that the skin testing with T12E antigen allows the diagnosis of Chagas' disease by a simple and handy method

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

Dynamics of the 2006/2007 dengue outbreak in Brazil

We analyzed dengue incidence in the period between October 2006-July 2007 of 146 cities around the country were Larval Index Rapid Assay (LIRA) surveillance was carried out in October 2006. Of these, we chosen 61 cities that had 500 or more cases reported during this period. We calculated the incidence coefficient, the force of infection (») and the basic reproduction number (R0) of dengue in those 61 cities and correlated those variables with the LIRA. We concluded that » and R0 are more associated with the number of cases than LIRA. In addition, the average R0 for the 2006/2007 dengue season was almost as high as that calculated for the 2001/2002 season, the worst in Brazilian history.CNPqFAPESPFMUSP - H

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