Municípios de alta vulnerabilidade à ocorrência da febre amarela silvestre no Estado de São Paulo, Brasil

Until 1999 the endemic cases of Sylvatic Yellow Fever were located in the states of northern, midwestern and pre-Amazon regions. Since then, the disease progressively expanded its territory of occurrence, cases being registered beyond the traditional boundaries of endemism. The São Paulo State is considered to be part of this context, since after decades without registration of autochthonous cases of the disease, it reported, in 2000 and 2008-2009, epizootic occurrence in non-human primates and 30 cases in humans. Facts like these, added to the increase in incidences of serious adverse effects resulting from the Yellow Fever vaccination, have highlighted the importance of defining priority municipalities for vaccination against the disease in the state. Two groups of municipalities, some affected and some non-affected by YF, were compared for environmental variables related to the eco-epidemiology of the disease according to literature. The Multiple Correspondence Analysis (MCA) was used to pinpoint the factor able to differentiate the two groups of municipalities and define the levels of risk. The southeast region of the São Paulo State was considered to be the area with a higher number of municipalities classified as high risk and should be considered a priority for the application of prevention measures against Yellow Fever.Até o ano de 1999, no Brasil, casos endêmicos de Febre Amarela Silvestre estavam localizados nos estados das regiões Norte, Centro-Oeste e pré-amazônica. Desde então, a doença vem progressivamente expandindo seu território de ocorrência, sendo registrados casos além das fronteiras tradicionais de endemismo. Neste contexto se insere o estado de São Paulo que, após décadas sem registro de casos autóctones da doença, reportou em 2000 e 2008-2009 epizootias em primatas não humanos e 30 casos humanos. Fatos como este, somados a crescente incidência de eventos adversos graves relacionados à vacinação contra Febre Amarela, demonstram a importância de serem definidos municípios prioritários para a vacinação contra a doença no estado. Assim, dois grupos de municípios, afetados e não-afetados pela Febre Amarela, foram comparados para variáveis ambientais relacionadas com a eco-epidemiologia da doença segundo a literatura. A Análise por Correspondência Múltipla foi utilizada para gerar um fator capaz de diferenciar os dois grupos de municípios e definir os níveis de risco. Após aplicação da metodologia para os municípios atualmente localizados fora da área de recomendação de vacinação contra Febre Amarela, a região sudeste do estado foi considerada prioritária para aplicação de medidas preventivas contra a doenç

Environmental licensing of large-scale enterprises: what are the limits for evaluating direct and indirect impacts on health? a case study in the Wajãpi Indigenous Land, Amapá

sem informaçãoA realização de estudos de impacto ambiental (EIA) prévios à implantação de grandes empreendimentos é obrigatória no Brasil. Porém, os critérios normativos para delimitação de áreas de influência são considerados imprecisos e insuficientes. O presente art133519540sem informaçãosem informaçãosem informaçã

Epizootias de febre amarela em primatas não humanos no estado de São Paulo, Brasil, 2008-2009

Desde 2000, vem sendo observada a expansão da febre amarela (FA) no Sudeste do Brasil, sendo detectados casos em áreas consideradas silenciosas por décadas. Epizootias em primatas não humanos (NHPs) são considerados eventos sentinela para a detecção de casos humanos. É importante relatar eventos epizoóticos que podem ter impacto sobre o estado de conservação de espécies sensíveis. Descrevemos as epizootias, notificadas em NHPs no estado de São Paulo, Brasil, entre setembro de 2008 a agosto de 2009. Noventa e um eventos epizoóticos, envolvendo 147 animais, foram notificados em 36 municípios. As amostras foram obtidas a partir de 65 animais (44,2%). A maioria das epizootias (46,6%) foram registradas entre março e abril, no mesmo período no qual YF em que casos humanos ocorreram no estado. As amostras biológicas foram coletadas de animais encontrados mortos e enviadas ao Instituto Adolfo Lutz, em São Paulo. Duas amostras, coletadas em dois municípios, sem indicação para a vacinação de febre amarela, foram positivos para o vírus. Outros 48 animais foram associados com FA por vínculo clínico-epidemiológico com casos confirmados laboratorialmente. Devido a doença em humanos e NHPs terem ocorrido no mesmo período, a detecção do vírus em NHPs não funcionou como sentinela, mas ajudou no processo de delimitação de novas áreas de risco.Since 2000, the expansion of Sylvatic Yellow Fever (YF) has been observed in the southeast of Brazil, being detected in areas considered silent for decades. Epizootics in non-human primates (NHPs) are considered sentinel events for the detection of human cases. It is important to report epizootic events that could have impact on the conservation status of susceptible species. We describe the epizootics in NHPs, notified in state of São Paulo, Brazil, between September 2008 to August 2009. Ninety-one epizootic events, involving 147 animals, were reported in 36 counties. Samples were obtained from 65 animals (44.2%). Most of the epizootics (46.6%) were reported between March and April, the same period during which human cases of YF occurred in the state. Biological samples were collected from animals found dead and were sent to Instituto Adolfo Lutz, in São Paulo. Two samples, collected in two counties without an indication for YF vaccination, were positive for the virus. Another 48 animals were associated with YF by clinical-epidemiological linkage with laboratory confirmed cases. Because the disease in human and NHPs occurred in the same period, the detection of the virus in NHPs did not work as sentinel, but aided in the delineation of new areas of risk

Occurrence records and metadata for sand flies (Diptera, Psychodidae, Phlebotominae) collected in the lands of indigenous people in the Brazilian Amazon

In order to contribute to knowledge of the epidemiology of American cutaneous leishmaniasis (ACL) among indigenous people living in sylvatic regions, we studied the sand fly fauna collected in areas of disease transmission in the Brazilian Amazon. Our two datasets reported here are comprised of occurrence data for sand flies from the Suruwaha Indigenous Land in the state of Amazonas collected between 2012-1013, and the Wajãpi Indigenous Land in the state of Amapá collected between 2013-2014. Sand flies were collected using unbaited CDC-like light traps at various sites within each study area and were identified to species-level by taxonomists with expertise in Amazonian fauna. A total of 4,646 records are reported: 1,428 from the Suruwaha and 3,218 from the Wajãpi. These records will contribute to a better understanding of ACL transmission dynamics, as well as the distribution of insect vectors, in these areas

Abordagens alternativas para a vigilância da leishmaniose tegumentar em áreas indígenas – estudo de caso entre os Wajãpi do Amapá

This paper aims to present the limitations of the surveillance system for cutaneous leishmaniasis (CL) overseen by the Ministry of Health in Brazil in indigenous areas, based on the accounts of technical experts and collaborators who worked on the surveillance of the disease among the Wajãpi indigenous people between 2012 and 2015. The study compares the standard approaches recommended by the Ministry of Health with alternative approaches in three main areas: case detection and diagnosis, treatment, and epidemiological analysis. In the latter area, methods that relate to risk analysis, entomology and the study of vertebrate hosts were compared. The comparison showed that approaches based on qualitative methods and knowledge about cultural patterns and specificities of the indigenous group increased the acceptability of the health service. Integrative approaches such as participatory community workshops involving community members acting as reporting agents working within the health service proved to be important alternatives for improving the sensitivity and representativeness of the CL monitoring system in indigenous areas. It is expected that the approaches compared in this study can form the basis for improvement in health surveillance systems, particularly for vector-borne diseases in indigenous areas.Este artigo tem por objetivo apresentar limitações do sistema de vigilância da Leishmaniose Tegumentar Americana (LTA) executado no âmbito do Ministério da Saúde em áreas indígenas, a partir do relato de experiência de técnicos e colaboradores que atuaram na vigilância da doença na Terra Indígena Wajãpi entre 2012 e 2015. O estudo compara as abordagens padrão preconizadas pelo Ministério da Saúde com abordagens alternativas entre três componentes principais: captação de casos e diagnóstico, tratamento e análise epidemiológica. Neste último componente, foram comparados métodos que se relacionam a análise de locais prováveis de infecção, entomologia e estudo de hospedeiros vertebrados. A comparação demonstrou que abordagens de cunho qualitativo e o conhecimento sobre padrões e espeficidades culturais do grupo indígena incrementaram a aceitabilidade do serviço de saúde. Abordagens integrativas como oficinas comunitárias, e, participativas que envolviam membros da comunidade como agentes de notificação e ação dentro do serviço, mostraram-se importantes alternativas para aperfeiçoamento da sensibilidade e representatividade do sistema de vigilância da LTA em áreas indígenas. Espera-se que as abordagens comparadas neste estudo possam servir de base para aperfeiçoamento de sistemas de vigilância em saúde, principalmente para doenças transmitidas por vetores em áreas indígenas

Methodology for Definition of Yellow Fever Priority Areas, Based on Environmental Variables and Multiple Correspondence Analyses

<div><p>Yellow fever (YF) is endemic in much of Brazil, where cases of the disease are reported every year. Since 2008, outbreaks of the disease have occurred in regions of the country where no reports had been registered for decades, which has obligated public health authorities to redefine risk areas for the disease. The aim of the present study was to propose a methodology of environmental risk analysis for defining priority municipalities for YF vaccination, using as example, the State of São Paulo, Brazil. The municipalities were divided into two groups (affected and unaffected by YF) and compared based on environmental parameters related to the disease's eco-epidemiology. Bivariate analysis was used to identify statistically significant associations between the variables and virus circulation. Multiple correspondence analysis (MCA) was used to evaluate the relationship among the variables and their contribution to the dynamics of YF in Sao Paulo. The MCA generated a factor that was able to differentiate between affected and unaffected municipalities and was used to determine risk levels. This methodology can be replicated in other regions, standardized, and adapted to each context.</p> </div

Statistically significant variables related to YFV circulation when comparing the two groups.

<p>Variables associated with YFV circulation in the State of Sao Paulo.</p

Weight of each variable for F factor calculation.

<p>Weight of each variable for F factor calculation.</p

YF-affected and unaffected municipalities selected for the present study, São Paulo, Brazil.

<p>YF-affected and unaffected municipalities selected for the present study, São Paulo, Brazil.</p