COVID-19 in long-term care facilities in Brazil: serological survey in a post-outbreak setting

This cross-sectional seroepidemiological survey presents the seroprevalence of SARS-CoV-2 in a population living in 15 Long-Term Care Facilities (LTCFs), after two intra-institutional outbreaks of COVID-19 in the city of Botucatu, Sao Paulo State, Brazil. Residents were invited to participate in the serological survey performed in June and July 2020. Sociodemographic and clinical characterization of the participants as well as the LTCF profile were recorded. Blood samples were collected, processed and serum samples were tested using the rapid One Step COVID-19 immunochromatography test to detect IgM and IgG anti-SARS-CoV-2. Among 209 residents, the median of age was 81 years old, 135 (64.6%) were female and 171 (81.8%) self-referred as being white. An overall seroprevalence of 11.5% (95% CI: 7.5% – 16.6%) was found. The highest seroprevalences of 100% and 76.9% were observed in LTCFs that had experienced COVID-19 outbreaks. Most residents with positive immunochromatography tests (70.8%) referred previous contact with a confirmed COVID-19 case. Although there was a relatively low seroprevalence of COVID-19 in the total number of elderly people, this population is highly vulnerable and LTCFs are environments at higher risk for COVID-19 dissemination. A well-established test for COVID-19 policies, the adequate characterization of the level of interaction between residents and the healthcare provider team and the level of complexity of care are crucial to monitor and control the transmission of SARS-CoV-2 in these institutions

Panorama da infecção pelo SARS-COV-2 no Centro de Progressão Penitenciária do Butantan

OBJECTIVE: To estimate the prevalence of exposure to the SARS-CoV-2 virus among individuals living in restricted freedom. METHODS: A seroprevalence survey was carried out with the population of the female penitentiary of the Centro de Progressão Penitenciária (CPP) in Butantan (municipality of São Paulo), between June 24 and August 20, 2020. During this period, according to the Secretariat of Penitentiary Administration (SAP), the positivity of rapid tests among inmates ranged from 65% to 78%. The evaluation method used in the study was the “One Step COVID-19” rapid test (chromatography), from the company Wondfo, also using the RT-PCR method in symptomatic participants to confirm the viral condition. The study population consisted of 879 female inmates and 170 employees of the institution. RESULTS: The prevalence of total antibodies (IgG/IgM) against the SARS-CoV-2 virus in the total population of 1049 study participants was 6.1%; among the population of 879 inmates, a prevalence of 5.8% was observed, and among the institution’s employees, 7.5%. CONCLUSIONS: The prevalence of covid-19 at the Butantan CPP was low, which is due to the implementation of simple prevention measures at the institution, such as the use of masks (with appropriate changes), emphasis on hygiene, hand washing and social distancing, in addition to other strategies, such as suspending inmates’ visits from relatives and friends and cutting back on elective medical appointments and outside work.OBJETIVO: Estimar a prevalência da exposição ao vírus SARS-CoV-2 entre indivíduos vivendo em restrição de liberdade. MÉTODOS: Foi realizado inquérito de soroprevalência com a população da penitenciária feminina do Centro de Progressão Penitenciária (CPP) do Butantan (município de São Paulo), entre 24 de junho e 20 de agosto de 2020. Nesse período, segundo a Secretaria de Administração Penitenciária (SAP), a positividade dos testes rápidos entre detentos variou de 65 a 78%. O método de avaliação utilizado no estudo foi o teste rápido “One Step COVID-19” (cromatografia), da empresa Wondfo, empregando-se também o método RT-PCR em participantes sintomáticos para confirmação do quadro viral. A população do estudo foi constituída por 879 reeducandas e 170 funcionários da instituição. RESULTADOS: A prevalência de anticorpos totais (IgG/IgM) contra o vírus SARS-CoV-2 na população total de 1.049 participantes do estudo foi de 6,1%; entre a população de 879 reeducandas foi observada prevalência de 5,8% e entre os servidores da instituição, 7,5%. CONCLUSÃO: Houve baixa prevalência de covid-19 no CPP do Butantan, o que se deve à implementação de medidas de prevenção simples na instituição, como o uso de máscaras (com trocas adequadas), ênfase na higiene, lavagem das mãos e distanciamento social, além de outras estratégias, como suspensão de visitas de familiares e amigos das reeducandas, cortes de consultas médicas eletivas e do trabalho externo

Praticas em vigilancia epidemiologica : maneiras de ver e de fazer

Orientador: Eliete Maria SilvaDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias MedicasResumo: Em 1992, o Brasil adotou como meta a eliminação do sarampo até o ano 2000 e em 1994, outros países da região das Américas também estabeleceram essa meta. Considerando esse fato e, a partir da contextualização histórica sobre a estruturação e operacionalização do Sistema de Vigilância Epidemiológica brasileiro, esse estudo procurou caracterizar aspectos da prática de vigilância epidemiológica do sarampo e da rubéola desenvolvida no município de Campinas-SP. Em maio de 2003 foi implantado nesse município, com duração de 13 meses, o Sistema de Vigilância Sindrômica de Febre e Exantema (VigiFEx). Esse Sistema utilizou a abordagem sindrômica para detecção de casos de doenças febris exantemáticas e para sua implementação contou com uma estrutura própria além daquela existente na vigilância epidemiológica descentralizada do município. Para essa análise foram utilizados os dados do Sistema de Informação de Agravos de Notificação, o SINAN, referentes aos períodos de janeiro de 1999 a maio de 2004, e do sistema de informação paralelo utilizado no VigiFEx, o VigiFExEPI, referente ao período de junho de 2003 a maio de 2004. A análise foi baseada na epidemiologia descritiva dos casos notificados, na análise da qualidade dos dados dos sistemas de informação, na análise da adequação à definição de caso suspeito de sarampo e rubéola e na avaliação dos indicadores de qualidade da vigilância para esses agravos. A epidemiologia descritiva indica que a distribuição temporal dos casos notificados não corresponde totalmente ao padrão epidemiológico de sazonalidade esperado. A análise da qualidade dos dados aponta para falta e inconsistência de dados principalmente aqueles referentes a antecedentes epidemiológicos, dados clínicos, medidas de controle e conclusão do caso, em todos os anos. Quando comparados os registros comuns entre as bases de dados, observamos melhor qualidade dos dados na base VigiFExEPI, que nem sempre foram incorporados no SINAN. Em todos os anos, verificamos o baixo percentual de casos notificados que atendiam a definição de caso suspeito para sarampo e para rubéola, sendo que a maioria deles referia apenas presença de febre e exantema. Os indicadores da vigilância do sarampo e da rubéola demonstram que as oportunidades de investigação e de coleta e a adequação do encerramento são aqueles que mais se aproximam da meta estabelecida. Os demais indicam baixa oportunidade de encerramento, de envio de amostras e recebimento de resultados e baixa homogeneidade da cobertura vacinal entre os anos. Esta análise aponta para necessidade de investir em estratégias que visam ao maior comprometimento dos profissionais da saúde com as práticas em vigilância epidemiológica do sarampo e da rubéola. Além disso, também sugere uma revisão do gerenciamento dos sistemas de informação em saúde, para assegurar uma avaliação confiável e de qualidade do sistema de vigilância dessas doençasAbstract: In 1992 Brazil adopted the goal of measles elimination by 2000 and, in 1994, countries in the American region established this goal too. Considering this goal, as well as the historical evaluation of the Brazilian Epidemiological Surveillance System framework, this study proposes to characterize some aspects of the measles and rubella epidemiological surveillance practices in the city of Campinas during the period of 1999 - 2004. In May 2003, Syndromic Surveillance for Febrile Rash Illness (¿VigiFEx¿) was implemented. This system considered rash and fever as the syndromic signs to detect all febrile rash illness cases occuring in Campinas during thirteen months. In addition to the city¿s descentralized surveillance system and its personnel, it also had the support of a specific working group for its functioning. For this analysis, data from the National standardized surveillance information system for notifiable diseases, ¿SINAN¿, for the period of January 1999 to May 2004, were considered. Also, data from the ¿VigiFEx¿ surveillance system database, the ¿VigiFExEPI¿, from the period between June 2003 and May 2004 were included in the analysis. Descriptive epidemiology of all reported cases in this period was conducted, as well as analyses of the quality of the databases in use, an assessment of the clinical case definition used for measles and rubella notification and an evaluation of the measles and rubella surveillance indicators. Temporal distribution of reported cases did not demonstrate seasonal distribution as we would expect. The analyses of databases showed low completeness and consistence of data in SINAN database, speciallly regarding the following variables: previous epidemiological history, clinical data, implemented control activities and final case classification. When comparing cases notified to both databases, SINAN and VigiFExEPI, in the period in which both were in place, VigiFExEPI data were more complete than SINAN data. In the period analyzed, there was a low percentage of reported cases complying with the measles and rubella National case definition, with the majority of them presenting with rash and fever. Evaluation of measles and rubella surveillance indicators demonstrated that timely investigation and sample collection, and adequate case classification were those that achieved the established goal. The other indicators demonstrated low timeliness and heterogeneous vaccination coverage. This study indicates that there is a need for improvement of surveillance practices, strengthening efforts to engage health care professionals into better surveillance practices. Furthermore, it demonstrates the importance of periodical review and analysis of the surveillance system information in order to ensure a trustful surveillance evaluationMestradoEnfermagem e TrabalhoMestre em Enfermage

Vigilancia epidemiologica do sarampo e da rub\ue9ola no Munic\uedpio de Campinas (SP), Brasil: confiabilidade dos dados

Objective. To evaluate and validate the information concerning measles and rubella from the Brazilian National Disease Notification System (BNDNS) (Sistema Nacional de Informa\ue7\ue3o de Agravos de Notifica\ue7\ue3o, or SINAN) for Campinas, a large city in the state of S\ue3o Paulo, Brazil, using as a reference the data from a control system, the Syndromic Surveillance System for Fever and Exanthem (SSSFE) (Sistema de Vigil\ue2ncia Sindr\uf4mica de Febre e Exantema, or VigiFEx), which operated from May 2003 through June 2004. Method. In our study we compared: (1) annual data from BNDNS for the years 1999 through 2003 and (2) data from BNDNS and data from SSSFE for the period of June 2003 through May 2004. We analyzed the rate of completion for key fields (record number, date of notification, and city of notification) as well as for name of disease, date of first symptoms, name of patient, birth date and age, sex, city of residence, date of investigation, immunization history, presence of exanthem, date at start of exanthem, presence of fever, suspected cases among pregnant women, signs and symptoms, date of collection of first sample, results with the sample, virus isolation, final classification, criteria for confirmation/exclusion of cases, diagnosis of excluded patients, development of the case, and date of closure. The level of agreement between the recorded cases in the two data banks was also analyzed. Results. From June 2003 through May 2004, 211 suspected cases of measles or rubella were identified in SSSFE and 275 in BNDNS. All the records had complete information concerning the three key fields. The rate of completion was also 100% for patient name, disease, and city of residence. The completion rate was higher than 95% for date of investigation, measles vaccine, measles and rubella vaccine, and rubella vaccine. A lower completion rate was found for other vaccination variables (number of doses and date of last dose) and for exanthem, fever, and date of start of exanthem. The two information systems were not completely consistent, particularly in terms of variables related to epidemiologic background, clinical data, and case closure. The quality of the SSSFE data was higher. Conclusions. Epidemiologic surveillance, immunization, and laboratory information systems need to undergo routine evaluation to ensure that the data are reliable and can support the planning of public health efforts

Patterns of influenza B circulation in Brazil and its relevance to seasonal vaccine composition

Data on the burden of disease and circulation patterns of influenza B lineages for Brazil are limited. This review aims to describe the pattern of influenza B occurrence in Brazil to have a better understanding of its epidemiology and its relevance when considering seasonal influenza vaccine composition.A review of the data including analysis of international and local surveillance data as well as information from online search of databases using Medical Subject Headings terms in conjunction with screening of abstracts from scientific events was performed.Based on international epidemiologic surveillance data, moderate levels of influenza B disease (19%; 2006–2014) were observed. Of these nine years, it was possible to compare data from three years (2007, 2008 and 2013) which have information on the circulating influenza B lineage. Co-circulation of influenza B lineages was observed in all these three influenza seasons, of which, during one season, a high degree of mismatch between the vaccine lineage and the predominant circulating lineage (91.4% [2013]) was observed. Local surveillance data reveal a distinct and dynamic distribution of respiratory viruses over the years. Data from published literature and abstracts show that influenza B is a significant cause of disease with an unpredictable circulation pattern and showing trends indicating reemergence of the B/Victoria lineage. The abstracts report notable levels of co-circulation of both influenza B lineages (2000–2013). Mismatch between the Southern hemisphere vaccine and the most prevalent circulating viruses in Brazil were observed in five influenza seasons.The evidence on co-circulation of two influenza B lineages and mismatched seasons in Brazil indicates the benefit of quadrivalent influenza vaccines in conferring broader seasonal influenza protection. Additionally, improving influenza surveillance platforms in Brazil is important for monitoring disease trends and the impact of introducing seasonal influenza vaccination. Keywords: Influenza B, Co-circulation, Mismatch, Influenza vaccine

Burden of herpes zoster among Brazilian adults – a hospital-based study

OBJECTIVE: To describe the clinical features of herpes zoster in adult patients treated at a large tertiary care hospital in Brazil over a 5-year period. METHODS: The medical records of suspected herpes zoster cases (based on ICD-10 codes) were identified for full review. Convenience sampling was used to select the medical records from a tertiary hospital in São Paulo. We collected data about co-existing medical conditions, medication use, herpes zoster-related clinical features and outcomes, and healthcare resource utilization. RESULTS: A total of 249 individuals whose first episode of herpes zoster occurred between 2010 and 2014 were included. The mean patient age was 55 years (range 18–96), and the majority were women (63.05%) and aged &ge; 50 years (63.86%). Medical comorbidities were reported in 92.77%, including diabetes (19.68%) and HIV infection (7.63%). Current/recent use of immunosuppressive agents was reported in 31.73%. A total of 65.86% of the patients were hospitalized: 102 patients (40.96%) were admitted for herpes zoster management, while 62 (24.90%) were already receiving inpatient care. The mean hospital length of stay was 16.60 days. One-third (34.14%) were managed as outpatients. Postherpetic neuralgia was reported as a complication in 18.07%. CONCLUSIONS: This retrospective descriptive study found a high frequency of herpes zoster episodes in older adults with comorbidities who sought medical care at a tertiary hospital. These results also underscore the importance of understanding the epidemiology of this disease and developing control strategies for these at-risk populations in Brazil.</p

Pertussis epidemiological pattern and disease burden in Brazil: an analysis of national public health surveillance data

Objective: We described pertussis epidemiological trends in Brazil between 2010 and 2015. We also assessed tetanus, diphtheria and acellular pertussis (Tdap) vaccine coverage among pregnant women from 2014, the year of the introduction of Tdap maternal immunization recommendation in Brazil, to 2016. Methods: Epidemiological data for incidence, prevalence, hospitalization, mortality, and maternal vaccination coverage were calculated based on the Brazilian public surveillance databases. Results: The epidemiological data analysis results showed that the pertussis average incidence rate (IR) was 2.19/100,000 inhabitants for all ages, with a peak in 2014 (4.03/100,000 inhabitants) and highest incidence in <1-year-old children (IR = 175.20/100,000). 97.6% of pertussis deaths (405/415) were in <1-year-old children. Maternal immunization coverage was 9.2% in 2014, 40.4% in 2015, and 33.8% in 2016. Conclusions: Pertussis incidence and pertussis-related deaths increased in Brazil from 2010 to 2014 and decreased in 2015. In the two years, 2015 and 2016 that followed the NIP recommendation, Tdap vaccination coverage of pregnant women was low and varying from region to region. More efforts and national plans would help increase awareness and maternal immunization coverage