Emergência de Febre amarela no Brasil 2016 a 2018 : um olhar da Organização Pan-Americana da Saúde (OPAS) a luz do Regulamento Sanitário Internacional

Tese (doutorado)—Universidade de Brasília, Faculdade de Ciências da Saúde, Programa de Pós-Graduação em Saúde Coletiva, 2020.Introdução: A reemergência da Febre Amarela no Brasil, marcada pela epidemia iniciada em 2016 e que se estende até os dias atuais (2020) atingiu números de casos historicamente elevados (2.114 casos) nos anos de 2016 a 2018, concentrados na região extra-amazônica (2.104 casos), mais de quatro vezes a soma de todos os casos dos 20 anos anteriores. A epidemia foi marcada pela persistência da transmissão do vírus em Primatas Não Humanos (PNH) inclusive nos períodos de baixa sazonalidade e atingiu áreas anteriormente consideradas sem risco, como os estados do Rio de Janeiro, Espírito Santo e o leste do estado de São Paulo e sul da Bahia, ampliando a população com necessidade de vacinação antiamarílica em mais de 20.000.000 de habitantes e atualmente a todo o território nacional. Foram ainda reportados casos exportados do Brasil na França, na Holanda, na Argentina e no Chile. Objetivo: Descrever a cooperação da OPAS no enfrentamento da epidemia de Febre Amarela do Brasil dos anos 2016 a 2018. Método: Foi realizada uma revisão narrativa Resultados/Discussão: A cooperação técnica da OPAS se concretizou de diversas formas: múltiplas capacitações, oficinas para troca de experiência e ações diretas nas áreas de vigilância epidemiológica, de epizootias, entomológica e laboratorial, no manejo de pacientes, estruturação da rede de assistência e estratégias de vacinação. Também houve disseminação do conhecimento com apoio a construção de cursos EaD, edição de guias, contratação de pessoal para os laboratórios e atividades de epidemiologia de campo e aquisição de insumos estratégicos que foram desde gelo seco e licenças de software a vacinas. Também figuram entre as atividades de cooperações realizadas pela OPAS no Brasil, durante a epidemia de febre amarela, o apoio aos gestores na tomada de decisão sobre a amplificação da área de recomendação de vacina, o ajuste no esquema vacinal (adoção da dose única) e campanha com doses fracionadas. A OPAS apoiou diversos estudos que utilizaram vigilância genômica em tempo real em conjunto com abordagens epidemiológicas e espaciais, abordando a diversidade genética viral e a dinâmica de transmissão do vírus da Febre Amarela pela geração de genomas completos oriundos de primatas não humanos (NHPs) e casos de 8 infecção humana dos estados de Minas Gerais, São Paulo, Rio de Janeiro, Espírito Santo e Bahia. Esses estudos contribuíram para direcionar as ações de resposta do Brasil e responder às inquietações nacionais e internacionais sobre a dinâmica de transmissão, incluindo o tipo de ciclo de transmissão (silvestre ou urbano), velocidade de deslocamento, origem do vírus, número de introduções do vírus nos estados (única ou reintrodução). Conclusão: A OPAS teve um papel central na condução técnica da emergência de Febre Amarela, contribuindo com o Ministério da Saúde (MS) e com grupos de pesquisa parceiros do MS na resposta nacional e na preparação dos países da região, congregando a expertise de cientistas envolvendo aspectos clínicos, epidemiológicos, virológicos, laboratorial, imunização e políticas públicas.Introduction: Since 2016, Brazil has been in the midst of its largest sylvatic yellow fever epidemic ever, found predominantly outside the Amazon region. Cases originating from Brazil have been reported in France, the Netherlands, Romania, Switzerland, Argentina, and Chile. Methods: This work is an integrative review of Pan American Health Organization cooperation during a sylvatic yellow fever epidemic. Results: The Pan American Health Organization has played a central role in handling the yellow fever emergency, collaborating with the Ministry of Health and various research groups in supporting interventions of different response areas. The Pan American Health Organization's technical cooperation included: training and workshops to exchange experiences, carrying out technical cooperation in patient management and epidemiological, entomological, laboratory, and epizootic surveillance, organizing the assistance network, and acquiring strategic inputs. The Pan American Health Organization’s technical cooperation supported the Ministry of Health’s decision to adopt a single-dose vaccine and use fractional doses to support the vaccination needs of more than 39,000,000 people. Conclusions: Given the ongoing coronavirus disease 2019 pandemic, it is necessary to strengthen measures for the surveillance, prevention, and control of yellow fever with multilateral cooperation between countries

Análise da eficiência dos equipamentos de proteção aos agrotóxicos utilizados em saúde pública

Os Equipamentos de Proteção Individuais (EPI) são utilizados na Saúde Pública para proteger os trabalhadores que utilizam agrotóxicos para controle de vetores de doenças. A exposição dérmica representa o maior risco de contaminação. A permeabilidade é uma característica que torna os EPI inadequados ao uso. Mesmo os EPI confeccionados com materiais impermeáveis, podem ser permeáveis, devido à porosidade dos tecidos e as costuras. Este estudo analisou a permeabilidade dos EPI aos agrotóxicos utilizados no combate ao mosquito Aedes Aegypti. A permeabilidade foi avaliada através do método da pipeta, calculando-se as porcentagens de repelência, de retenção e de penetração dos agrotóxicos nos EPI. Os resultados mostraram que: o tipo de costura influencia na permeabilidade; e que uma menor repelência pode não ser suficiente para avaliar a eficiência de um EPI, pois esta pode ser compensada por uma maior retenção, resultando em uma menor penetração.Los Equipos de Protección Personal (EPP) son utilizados en la salud pública para proteger a los trabajadores que manejan plaguicidas para el control de vectores de enfermedades. La exposición cutánea es el mayor riesgo de contaminación. La permeabilidad de los EPP es una característica que hace su uso inadecuado. Incluso los EPP hechos de materiales impermeables pueden ser permeables debido a la porosidad de la tela y a las costuras. Esta investigación analizó la permeabilidad de los EPP a los plaguicidas utilizados para combatir el mosquito Aedes Aegypti. La permeabilidad se evaluó por el método de la pipeta, computando el porcentaje de repelencia, retención y penetración de los plaguicidas en los EPP. Los resultados mostraron que el tipo de costura influye en la permeabilidad y que una repelencia inferior puede no ser suficiente para evaluar la eficiencia de un EPP, ya que puede ser compensada por una mayor retención, lo que resulta en menos penetración.Les équipements de protection individuelle (EPI) sont utilisés en santé publique pour protéger les travailleurs qui utilisent des pesticides pour lutter contre certaines maladies. L’exposition cutanée représente le plus grand risque de contamination. La perméabilité est une caractéristique des EPI qui les rend impropres à une utilisation. Même les EPI fabriqués à partir de matériaux imperméables sont perméables en raison de la porosité du tissu et des coutures. Cette étude a analysé la perméabilité des EPI contre les pesticides utilisés pour lutter contre les moustiques Aedes aegypti. La perméabilité a été évaluée par la méthode de la pipette, en calculant les pourcentages de répulsion, de rétention et de pénétration des pesticides dans l’EPI. Les résultats ont montré : que le type de couture influence la perméabilité; et qu’une répulsivité inférieure peut ne pas être suffisante pour évaluer l’efficacité de l’EPI, puisque celle-ci peut être compensée par une plus grande rétention, ce qui entraîne moins de pénétration.Personal Protective Equipment (PPE) is used in Public Health to protect the workers who use pesticides for disease control. The dermal exposure is the highest contamination risk. The permeability is a characteristic that makes PPE unsuitable for using. Even those PPE which are made from waterproof materials, can be permeable, due to fabric porosity and the presence of seams. This study analysed the permeability to pesticides on PPE used by health personnel controlling Aedes aegypti mosquito. Permeability was evaluated through the pipette method, by calculating repellency, retention and penetration percentages of pesticides in the PPE. The results showed that the type of seam influences permeability; and a lower repellency may not be sufficient to evaluate the efficiency of PPE, as this can be compensated by a greater retention, resulting in less penetration

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear understanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 In the American tropics, Amazonia stands out as the world's most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple organism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region's vulnerability to environmental change. 15%–18% of the most neglected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lost

Análise da eficiência dos equipamentos de proteção aos agrotóxicos utilizados em saúde pública

Personal Protective Equipment (PPE) is used in Public Health to protect the workers who use pesticides for disease control. The dermal exposure is the highest contamination risk. The permeability is a characteristic that makes PPE unsuitable for using. Even those PPE which are made from waterproof materials, can be permeable, due to fabric porosity and the presence of seams. This study analysed the permeability to pesticides on PPE used by health personnel controlling Aedes aegypti mosquito. Permeability was evaluated through the pipette method, by calculating repellency, retention and penetration percentages of pesticides in the PPE. The results showed that the type of seam influences permeability; and a lower repellency may not be sufficient to evaluate the efficiency of PPE, as this can be compensated by a greater retention, resulting in less penetration

The obscurance of the greatest sylvatic yellow fever epidemic and the cooperation of the Pan American Health Organization during the COVID-19 pandemic

Universidade de Brasília. Programa de Pós-Graduação em Saúde Coletiva. Brasília, DF, Brasil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, Brasil / Universidade Federal de Minas Gerais. Programa de Pós-Graduação em Genética. Belo Horizonte, MG, Brasil.Universidade de Brasília. Programa de Pós-Graduação em Saúde Coletiva. Brasília, DF, Brasil.Introduction: Since 2016, Brazil has been in the midst of its largest sylvatic yellow fever epidemic ever, found predominantly outsidethe Amazon region. Cases originating from Brazil have been reported in France, the Netherlands, Romania, Switzerland, Argentina, and Chile. The epidemic began in the Central-West region of Brazil in 2014, spreading into the Southern region, with significant non-human primate transmission continuing towards Paraguay and Argentina. Methods: This report is an integrative review of Pan American Health Organization cooperation during a sylvatic yellow fever epidemic. Results: The Pan American Health Organization has played a central role in handling the yellow fever emergency, collaborating with the Ministry of Health and various research groups in supporting interventions of different response areas. The Pan American Health Organization's technical cooperation included: training and workshops to exchange experiences, carrying out technical cooperation in patient management and epidemiological, entomological, laboratory, and epizootic surveillance, organizing the assistance network, and acquiring strategic inputs. The Pan American Health Organization’s technical cooperation supported the Ministry of Health’s decision to adopt a single-dose vaccine and use fractional doses to support the vaccination needs of more than 39,000,000 people. The coronavirus disease 2019 pandemic contributed to the failure of reaching the yellow fever vaccination goals and made it difficult to integrate the yellow fever vaccine into recommended areas. Conclusions: Given the ongoing coronavirus disease 2019 pandemic, it is necessary to strengthen measures for the surveillance, prevention, and control of yellow fever with multilateral cooperation between countries

Technology transfer during the COVID-19 pandemic: report on the first face-to-face practical training course in Brazil

Abstract The objective of this report was to describe the first face-to-face course aimed at training public health professionals in performing real-time genomic surveillance during the pandemic period. Experience report on a theoretical-practical course focusing on genomic research and surveillance, including mobile sequencing technologies, bioinformatics, phylogenetics and epidemiological modeling. There were 162 participants in the event and it was the first major face-to-face training course conducted during the COVID-19 epidemic in Brazil. No cases of SARS-CoV-2 infection was detected among the participants at the end of the event, suggesting the safety and effectiveness of all safety measures adopted. The results of this experience suggest that it is possible to conduct professional training safely during pandemics, as long as all safety protocols are followed