Acurácia da definição de caso suspeito de rubéola: implicações para vigilância

OBJECTIVE: To assess the performance of the rubella suspect case definition among patients with rash diseases seen at primary care units. METHODS: From January 1994 to December 2002, patients with acute rash, with or without fever, were seen at two large primary health care units and at a public general hospital in the municipality of Niterói, metropolitan area of Rio de Janeiro, Brazil. Data from clinical and serologic assessment were used to estimate the positive predictive values of the definition of rubella suspect case from the Brazilian Ministry of Health and other combination of signs/symptoms taking serologic status as the reference. Serum samples were tested for anti-rubella virus IgM using commercially available enzyme immunoassays. Positive predictive values and respective 95% confidence intervals were calculated. RESULTS: A total of 1,186 patients with an illness characterized by variable combinations of rash with fever, arthropathy and lymphadenopathy were studied. Patients with rash, regardless of other signs and symptoms, had 8.8% likelihood of being IgM-positive for rubella. The Brazilian suspect case definition (fever and lymphadenopathy in addition to rash) had low predictive value (13.5%). This case definition would correctly identify 42.3% of the IgM-positive cases, and misclassify 26.1% of the IgM-negative cases. CONCLUSIONS: These results support the recommendation to investigate and collect clinical specimens for laboratory diagnosis of all cases of rash, for surveillance purposes. Although this strategy may increase costs, the benefits of interrupting the circulation of rubella virus and preventing the occurrence of congenital rubella syndrome should pay off.OBJETIVO: Avaliar a acurácia da definição de caso suspeito de rubéola entre pacientes com doenças exantemáticas atendidos em unidades de saúde pública. MÉTODOS: A população de estudo foi constituída de pacientes com doença exantemática, com ou sem febre, atendidos em serviços de saúde pública, de janeiro de 1994 a dezembro de 2002 no município de Niterói, RJ. Dados clínicos e sorológicos foram utilizados para estimar os valores preditivos positivos da definição de caso suspeito de rubéola do Ministério da Saúde do Brasil e outras combinações de sinais e sintomas, considerando o resultado da sorologia como referência. A detecção de IgM específica para rubéola em amostras sangüíneas foi realizada por ensaio imunoenzimático. Foram calculados os valores preditivos positivos e respectivos intervalos de confiança de 95%. RESULTADOS: Foram estudados 1.186 pacientes com uma doença caracterizada por uma variada combinação de rash com ou sem febre, artropatia e linfoadenopatia. Pacientes com exantema, independentemente da presença de outros sinais e sintomas, apresentaram uma probabilidade de 8,8% de serem IgM positivos para rubéola. A definição de caso suspeito de rubéola utilizada no Brasil apresentou baixo valor preditivo positivo (13,5%). Esta definição de caso identificou corretamente 42,3% dos casos IgM positivos, e classificou de forma incorreta 26,1% dos IgM negativos. CONCLUSÕES: Os resultados indicam que as doenças exantemáticas devem ser investigadas em conjunto para fins de vigilância epidemiológica e coleta de espécimens clínicos para o diagnóstico laboratorial. Esta estratégia aumenta os custos, mas gera benefícios na interrupção da circulação do vírus e na prevenção da síndrome da rubéola congênita

Aspectos demográficos, socioeconômicos e epidemiológicos da COVID-19 na Região da Sub-Bacia do Canal do Cunha, Rio de Janeiro

The objective of this study was to analyze the COVID-19 incidence of and mortality in a population from a territorial area with a predominance of neighborhoods with slum areas (subnormal settlements), and its relationship with contextual variables. We analyzed 36 neighborhoods of the Canal do Cunha Sub-basin that presented 30,008 deaths by COVID-19 until February 5, 2021. Cumulative incidence, cumulative mortality, and cumulative lethality rates were considered as dependent variables. Contextual variables included patient neighborhood; proportion of ASN by neighborhoods, percentage of black and brown people, age group; income ratio, and sanitation indices. The variables were analyzed descriptively, bivariately by Spearman correlation, and Moran's spatial statistics were performed. The Complexo do Alemão, Mangueira, and Maré neighborhoods had the highest proportions of cases and deaths from COVI-19. The percentage of infection in the 20 to 29, 30 to 39, and 40 to 49 age groups were 13.6%, 21.5%, and 20.1%, respectively. In the 70 to 79 age group was 7.3% of the total COVID-19 cases, and 26.7% deaths and 34.2% lethality rate. When added the records of black and brown people with those without records for color/race there was significant positive moderate correlation between the cumulative incidence rate and mortality rate (rho = 0.383; p=0.048 and rho= 0.3176; p= 0.0106). The global and local Moran's spatial statistical evaluation allowed to verify intermediate and medium priority areas that need to strengthen the surveillance and control system of COVID-19. The epidemiological situation of an area with a high percentage of slum areas showed that mortality by COVID-19 in black and brown people is related to demographic aspects and that there is low notification of cases and deaths attributed to COVID-19 in residents of areas with slums.Objetivo desse estudo foi analisar a incidência e mortalidade por COVID-19 em população de área territorial com predominância de bairros com áreas de favelas (aglomerados subnormais), e sua relação com variáveis contextuais. Foram analisados 36 bairros da Sub-bacia do Canal do Cunha que apresentaram 30.008 óbitos por COVID-19 até o dia 05 de fevereiro de 2021. Considerou-se como variáveis dependentes as taxas de incidência acumulada, mortalidade acumulada e letalidade acumulada. Entre as variáveis contextuais, foram incluídas bairro do paciente; proporção de ASN por bairros, percentual de pretos e pardos, faixa etária; razão de renda, e índices de saneamento. As variáveis foram analisadas de forma descritiva, bivariada pela correlação de Spearman e utilizado a estatística espacial de Moran. Os bairros Complexo do Alemão, Mangueira e Maré foram que apresentaram as maiores proporções de casos e óbitos por COVI-19. O percentual de infecção nas faixas de 20 a 29 anos, 30 a 39 anos e 40 a 49 anos foram de 13,6%, 21.5% e 20,1%, respectivamente. Na faixa etária entre 70 e 79 anos foi 7,3% do total de casos de COVID-19, e 26,7%  de óbitos e 34,2% taxa de letalidade. Quando somado os registros de pessoas pretas e parda com os sem registro para cor/raça houve correlação moderada positiva significativa entre a taxa de incidência acumulada e a taxa de mortalidade  (rho = 0,383; p=0,048 e rho= 0,3176; p=0,0106). A avaliação estatística espacial global e local de Moran permitiu verificar áreas de prioridade intermediárias e médias que necessitam reforçar o sistema de vigilância e controle da COVID-19. A situação epidemiológica de área com grande percentual de áreas favelas mostrou que a mortalidade por COVID-19 em pessoas pretas e pardas está relacionada a aspectos demográficos e que ocorre baixa notificação de casos e de óbitos atribuídas ao COVID-19 em moradores de áreas com favelas

Recurrent dissemination of SARS-CoV-2 through the Uruguayan–Brazilian border

Uruguay is one of the few countries in the Americas that successfully contained the coronavirus disease 19 (COVID-19) epidemic during the first half of 2020. Nevertheless, the intensive human mobility across the dry border with Brazil is a major challenge for public health authorities. We aimed to investigate the origin of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strains detected in Uruguayan localities bordering Brazil as well as to measure the viral flux across this ∼1,100 km uninterrupted dry frontier. Using complete SARS-CoV-2 genomes from the Uruguayan–Brazilian bordering region and phylogeographic analyses, we inferred the virus dissemination frequency between Brazil and Uruguay and characterized local outbreak dynamics during the first months (May–July) of the pandemic. Phylogenetic analyses revealed multiple introductions of SARS-CoV-2 Brazilian lineages B.1.1.28 and B.1.1.33 into Uruguayan localities at the bordering region. The most probable sources of viral strains introduced to Uruguay were the Southeast Brazilian region and the state of Rio Grande do Sul. Some of the viral strains introduced in Uruguayan border localities between early May and mid-July were able to locally spread and originated the first outbreaks detected outside the metropolitan region. The viral lineages responsible for Uruguayan urban outbreaks were defined by a set of between four and 11 mutations (synonymous and non-synonymous) with respect to the ancestral B.1.1.28 and B.1.1.33 viruses that arose in Brazil, supporting the notion of a rapid genetic differentiation between SARS-CoV-2 subpopulations spreading in South America. Although Uruguayan borders have remained essentially closed to non-Uruguayan citizens, the inevitable flow of people across the dry border with Brazil allowed the repeated entry of the virus into Uruguay and the subsequent emergence of local outbreaks in Uruguayan border localities. Implementation of coordinated bi-national surveillance systems is crucial to achieve an efficient control of the SARS-CoV-2 spread across this kind of highly permeable borderland regions around the world

Global disparities in SARS-CoV-2 genomic surveillance

Genomic sequencing is essential to track the evolution and spread of SARS-CoV-2, optimize molecular tests, treatments, vaccines, and guide public health responses. To investigate the global SARS-CoV-2 genomic surveillance, we used sequences shared via GISAID to estimate the impact of sequencing intensity and turnaround times on variant detection in 189 countries. In the first two years of the pandemic, 78% of high-income countries sequenced >0.5% of their COVID-19 cases, while 42% of low- and middle-income countries reached that mark. Around 25% of the genomes from high income countries were submitted within 21 days, a pattern observed in 5% of the genomes from low- and middle-income countries. We found that sequencing around 0.5% of the cases, with a turnaround time <21 days, could provide a benchmark for SARS-CoV-2 genomic surveillance. Socioeconomic inequalities undermine the global pandemic preparedness, and efforts must be made to support low- and middle-income countries improve their local sequencing capacity

Global disparities in SARS-CoV-2 genomic surveillance

Genomic sequencing is essential to track the evolution and spread of SARS-CoV-2, optimize molecular tests, treatments, vaccines, and guide public health responses. To investigate the global SARS-CoV-2 genomic surveillance, we used sequences shared via GISAID to estimate the impact of sequencing intensity and turnaround times on variant detection in 189 countries. In the first two years of the pandemic, 78% of high-income countries sequenced >0.5% of their COVID-19 cases, while 42% of low- and middle-income countries reached that mark. Around 25% of the genomes from high income countries were submitted within 21 days, a pattern observed in 5% of the genomes from low- and middle-income countries. We found that sequencing around 0.5% of the cases, with a turnaround time <21 days, could provide a benchmark for SARS-CoV-2 genomic surveillance. Socioeconomic inequalities undermine the global pandemic preparedness, and efforts must be made to support low- and middle-income countries improve their local sequencing capacity