Space-time dynamics of a triple epidemic: dengue, chikungunya and Zika clusters in the city of Rio de Janeiro.

Dengue, an arboviral disease transmitted by Aedes mosquitoes, has been endemic in Brazil for decades. However, vector-control strategies have not led to a significant reduction in the disease burden and have not been sufficient to prevent chikungunya and Zika entry and establishment in the country. In Rio de Janeiro city, the first Zika and chikungunya epidemics were detected between 2015 and 2016, coinciding with a dengue epidemic. Understanding the behaviour of these diseases in a triple epidemic scenario is a necessary step for devising better interventions for prevention and outbreak response. We applied scan statistics analysis to detect spatio-temporal clustering for each disease separately and for all three simultaneously. In general, clusters were not detected in the same locations and time periods, possibly owing to competition between viruses for host resources, depletion of susceptible population, different introduction times and change in behaviour of the human population (e.g. intensified vector-control activities in response to increasing cases of a particular arbovirus). Simultaneous clusters of the three diseases usually included neighbourhoods with high population density and low socioeconomic status, particularly in the North region of the city. The use of space-time cluster detection can guide intensive interventions to high-risk locations in a timely manner, to improve clinical diagnosis and management, and pinpoint vector-control measures

Attention to indigenous patients with tuberculosis of the Mato Grosso do Sul Indigenous Special Sanitary District (DSEI-MS)

Made available in DSpace on 2018-08-06T13:45:54Z (GMT). No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) lais_picinini.pdf: 5414366 bytes, checksum: afb4d843134350529d8b1f5890730d15 (MD5) Previous issue date: 2016Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.Introdução: A tuberculose (TB) é um importante problema de saúde pública no Brasil. A doença atinge principalmente grupos desfavorecidos como os indígenas. O objetivo do estudo foi analisar a atenção à saúde dos indígenas com TB e explorar fatores associados ao relato de reação adversa (RRA) e abandono do tratamento. Métodos: Estudo longitudinal descritivo e analítico, com entrevista e dados do Sistema de Informação de Agravos de Notificação (SINAN) de casos novos de TB em indígenas de 4 pólos-base do Mato Grosso do Sul de 2011-2012. Foi calculada a incidência de TB por aldeia, e descritas características socioeconômicas, clínicas, epidemiológicas, e da atenção à saúde por pólo-base. A análise de componentes principais foi utilizada para criar índices de condição socioeconômica (ICS), e os casos foram classificados em tercis. Indicadores de acompanhamento foram calculados. Resultados: Foram incluídos 166 indígenas com TB, maioria homem, 20-44 anos de idade. A incidência de TB foi de 309,6/100.000 em 2011 e 189,4/100.000 em 2012, sendo maior em Amambai. Segundo o ICS baseado em características do domicílio e posse de bens duráveis, Miranda e Aquidauana possuíam mais casos no 3º tercil (88,9% e 100,0%) e Amambai, mais no 1º tercil (38,6%). Maioria dos casos de Amambai foi diagnosticada por busca ativa (70,2%). O tempo para diagnóstico foi de 5 semanas ou mais em 41,0% dos casos. O resultado da cultura estava disponível para 80,7% dos casos. Casos novos (95,2%), pulmonares (85,5%), esquema terapêutico básico (88,0%), tratamento diretamente observado (99,4%) e atendimento por agente indígena de saúde (83,7%) foram mais comuns. Considerando o relato dos pacientes, a maioria teve acompanhamento excelente em Amambai (66,7%) e Caarapó (87,2%) e regular em Miranda (66,7%) e Aquidauana (75,0%). Houve RRA por 28,3% dos pacientes, sendo cefaleia a principal (14,5%). Menor RRA foi encontrado em Amambai, homens, pessoas sem comorbidades, sem consumo de bebidas alcoólicas, do 1º tercil do ICS e sem história de TB. Quem utilizou o esquema básico, não recebeu explicações sobre o tratamento, e teve falta do medicamento, fez mais RRA. A maioria evoluiu para a cura, com 2 abandonos (casos novos, sem RRA, e que trabalhavam na usina). Conclusão: A TB continua com alta incidência entre indígenas apesar da alta proporção de cura. Melhorias na detecção dos casos e rápido início do tratamento são necessários para combater a propagação da doença.Introduction: Tuberculosis (TB) is a major public health problem in Brazil. The disease mostly affects underprivileged groups such as indigenous. The aim of the study was to analyze the delivery of health care to indigenous TB and to explore factors associated with adverse reaction reporting (ARR) and treatment dropout. Methods: Descriptive and analytical longitudinal study with interviews and data from the Notifiable Diseases Information System (SINAN) of new TB cases among indigenous people from 4 heath bases of Mato Grosso do Sul from 2011-2012. The TB incidence by village was calculated and described socioeconomic, clinical, epidemiological, and health care characteristics were described by health base. The principal components analysis was used to create socioeconomic indexes (SEI), and the cases were classified into tertiles. Monitoring indicators were calculated. Results: 166 indigenous people were included with TB, mostly men, 20-44 years old. The TB incidence was 309.6/100,000 in 2011 and 189.4/100,000 in 2012, being higher in Amambai. According to the SEI based on household characteristics and ownership of durable goods, Miranda and Aquidauana had more cases in the 3rd tertile (88.9% and 100.0%) and Amambai, in the 1st tertile (38.6%). Most cases of Amambai were diagnosed by active search (70.2%). The time for diagnosis was of 5 weeks or more in 41.0% of cases. The culture results were available for 80.7% of cases. New cases (95.2%), pulmonary (85.5%), basic treatment regimen (88.0%), directly observed treatment (99.4%) and care with indigenous health agent (83.7%) were more common. Considering the report of the patients, most had excellent monitoring in Amambai (66.7%) and Caarapó (87.2%) and regular in Miranda (66.7%) and Aquidauana (75.0%). There was ARR by 28.3% of patients, the main being headache (14.5%). Less ARR was found in Amambai and among men, people without comorbidities, people who don’t drink alcohol, the 1st SEI tertile and those with no history of TB. Those who used the basic regimen, received explanations about treatment, and had lack of medicine, made more ARR. Most cases evolved to cure, with 2 dropouts (new cases without ARR, and who worked at the mill). Conclusion: TB continues with high incidence among indigenous people despite the high proportion of cure. Improvements in case detection and rapid onset of treatment are necessary to fight the spread of the disease

Association of past dengue fever epidemics with the risk of Zika microcephaly at the population level in Brazil

Submitted by Fátima Lopes ([email protected]) on 2020-02-07T17:31:30Z No. of bitstreams: 1 AssociationDengueFever.pdf: 2120471 bytes, checksum: 37f2b4f22cdfe2b706ba34952238046e (MD5)Approved for entry into archive by Fátima Lopes ([email protected]) on 2020-02-07T17:38:24Z (GMT) No. of bitstreams: 1 AssociationDengueFever.pdf: 2120471 bytes, checksum: 37f2b4f22cdfe2b706ba34952238046e (MD5)Made available in DSpace on 2020-02-07T17:38:24Z (GMT). No. of bitstreams: 1 AssociationDengueFever.pdf: 2120471 bytes, checksum: 37f2b4f22cdfe2b706ba34952238046e (MD5) Previous issue date: 2020Fundação Oswaldo Cruz. Presidência. Programa de Computação Científica. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Programa de Pós-Graduação em Epidemiologia em Saúde Pública. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Presidência. Programa de Computação Científica. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Doenças Febris Agudas. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Presidência. Programa de Computação Científica. Rio de Janeiro, RJ, Brasil.Despite all the research done on the first Zika virus (ZIKV) epidemics, it was only after the Brazilian epidemic that the Congenital Zika Syndrome was described. This was made possible due to the large number of babies born with microcephaly in the Northeast region (NE) in a narrow time. We hypothesize that the fivefold difference in the rate of microcephalic neonates between the NE and other regions is partially an effect of the population prior immunity against Dengue viruses (DENV), that cross-react with ZIKV. In this ecological study, we analysed the interaction between dengue fever epidemics from 2001 to 2014 and the 2015/2016 microcephaly epidemic in 400 microregions in Brazil using random-effects models under a Bayesian approach. The estimated effect of the time lag between the most recent large dengue epidemic (>400/100,000 inhabitants) and the microcephaly epidemic ranged from protection (up to 6 years prior) to an increased risk (from 7 to 12 years). This sustained window of protection, larger than described in previous longitudinal studies, is possibly an effect of herd immunity and of multiple exposures to DENV that could boost immunity

Fine-scale heterogeneity in population density predicts wave dynamics in dengue epidemics

The spread of dengue and other arboviruses constitutes an expanding global health threat. The extensive heterogeneity in population distribution and potential complexity of movement in megacities of low and middle-income countries challenges predictive modeling, even as its importance to disease spread is clearer than ever. Using surveillance data at fine resolution following the emergence of the DENV4 dengue serotype in Rio de Janeiro, we document a pattern in the size of successive epidemics that is invariant to the scale of spatial aggregation. This pattern emerges from the combined effect of herd immunity and seasonal transmission, and is strongly driven by variation in population density at sub-kilometer scales. It is apparent only when the landscape is stratified by population density and not by spatial proximity as has been common practice. Models that exploit this emergent simplicity should afford improved predictions of the local size of successive epidemic waves

Dengue and microcephaly cases in Brazil used in Carvalho et al

Datasets used in the analysis of the manuscript entitled "Association of past dengue fever epidemics with the risk of Zika microcephaly at population level in Brazil" by Carvalho et al. (submitted). dengueBR2001-2014.csv contains the number of reported dengue cases by month in a selection of Brazilian microregions. microBR2014-2016.csv contains the cumulated number of reported microcephaly cases between 2014 and 2016 in a selection of Brazilian microregions

Spatio-temporal modelling of the first Chikungunya epidemic in an intra-urban setting: The role of socioeconomic status, environment and temperature

none5siThree key elements are the drivers of Aedes-borne disease: mosquito infestation, virus circulating, and susceptible human population. However, information on these aspects is not easily available in low- and middle-income countries. We analysed data on factors that influence one or more of those elements to study the first chikungunya epidemic in Rio de Janeiro city in 2016. Using spatio-temporal models, under the Bayesian framework, we estimated the association of those factors with chikungunya reported cases by neighbourhood and week. To estimate the minimum temperature effect in a non-linear fashion, we used a transfer function considering an instantaneous effect and propagation of a proportion of such effect to future times. The sociodevelopment index and the proportion of green areas (areas with agriculture, swamps and shoals, tree and shrub cover, and woody-grass cover) were included in the model with time-varying coefficients, allowing us to explore how their associations with the number of cases change throughout the epidemic. There were 13627 chikungunya cases in the study period. The sociodevelopment index presented the strongest association, inversely related to the risk of cases. Such association was more pronounced in the first weeks, indicating that socioeconomically vulnerable neighbourhoods were affected first and hardest by the epidemic. The proportion of green areas effect was null for most weeks. The temperature was directly associated with the risk of chikungunya for most neighbourhoods, with different decaying patterns. The temperature effect persisted longer where the epidemic was concentrated. In such locations, interventions should be designed to be continuous and to work in the long term. We observed that the role of the covariates changes over time. Therefore, time-varying coefficients should be widely incorporated when modelling Aedes-borne diseases. Our model contributed to the understanding of the spatio-temporal dynamics of an urban Aedes-borne disease introduction in a tropical metropolitan city.openFreitas, Laís Picinini; Schmidt, Alexandra M.; Cossich, William; Cruz, Oswaldo Gonçalves; Carvalho, Marilia SáFreitas, Laís Picinini; Schmidt, Alexandra M.; Cossich, William; Cruz, Oswaldo Gonçalves; Carvalho, Marilia S

Identifying hidden Zika hotspots in Pernambuco, Brazil: a spatial analysis

Northeast Brazil has the world's highest rate of Zika-related microcephaly. However, Zika case counts cannot accurately describe burden because mandatory reporting was only established when the epidemic was declining in the region.To advance the study of the Zika epidemic, we identified hotspots of Zika in Pernambuco state, Northeast Brazil, using Aedes-borne diseases (dengue, chikungunya and Zika) and microcephaly data. We used Kulldorff's Poisson purely spatial scan statistic to detect low- and high-risk clusters for Aedes-borne diseases (2014–2017) and for microcephaly (2015–2017), separately. Municipalities were classified according to a proposed gradient of Zika burden during the epidemic, based on the combination of cluster status in each analysis and considering the strength of the evidence.We identified 26 Aedes-borne diseases clusters (11 high-risk) and 5 microcephaly clusters (3 high-risk) in Pernambuco. According to the proposed Zika burden gradient, our results indicate that the northeast of Pernambuco and the Sertão region were hit hardest by the Zika epidemic. The first is the most populous area of Pernambuco, while the second has one of the highest rates of social and economic inequality in Brazil.We successfully identified possible hidden Zika hotspots using a simple methodology combining Aedes-borne diseases and microcephaly information.This research was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (https://www.nichd.nih.gov/): grant R01HD091257 awarded to LJM (PI: LJM, co-investigator: MD), and grants P2CH042849 and T32HD007081 awarded to the Population Research Center at the University of Texas at Austin. RL was supported by a Royal Society Dorothy Hodgkin Fellowship(https://royalsociety.org/grants-schemes-awards/grants/dorothy-hodgkin-fellowship/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Peer ReviewedPostprint (author's final draft