Avaliação do Sistema de Informações Hospitalares como instrumento para vigilância da malária na Amazônia Legal. Brasil, 1998-2005

Backgound and Objectives: The Hospital Information System of the Brazilian National Health System (SIH/SUS) is a system geared to the management of hospital environments. The objective of this study was to evaluate the SIH/SUS how a tool for the malaria surveillance in Amazonia Legal. Methods: Were reviewed the records of hospital admissions caused by malaria of the SIH/SUS in the Amazonia Legal through January 1st, 1999 to December 31th, 2005. The evaluation was based on Updated Guidelines for Evaluating Public Health Surveillance Systems from Centers for Disease Control and Prevention. Results: Hospital admissions caused by malaria represent 0.98% (118,775) of total admissions followed the International Classification of Disease, by place of residence during the period in the Amazonia Legal, 41% (48,674) was recorded as unspecified malaria. Were recorded 150 deaths, and 100% for unspecified malaria. The curve of the rate of hospitalization is downward, 0.96% in 1998, 0.60% in 2000 and 0.46% in 2005.The costs to the Brazilian National Health System of the hospital admissions caused by unspecified malaria was R$7,595,701.36. Conclusion: The overall results of the evaluations of attributes and the response that the system provides for effective surveillance of the disease, make the system useful. It should establish a routine operation of this system as a source of information in the surveillance health services. KEYWORDS: Malaria, Surveillance. Hospitalization. Evaluation. Information System.Justificativa e Objetivos: O Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS) é um sistema voltado para o gerenciamento de ambientes hospitalares. O objetivo deste trabalho foi avaliar o SIH/SUS como instrumento para vigilância da malária na Amazônia Legal. Método: Realizou-se a análise dos registros de internações por malária no SIH/SUS, na Amazônia Legal, no período de 01 de janeiro de 1999 a 31 de dezembro de 2005. A avaliação foi baseada no Updated Guidelines for Evaluating Public Health Surveillance Systems do Centers for Disease Control and Prevention. Resultados: As internações por malária representavam 0,98internações por malária NE custaram R$ 7.595.701,36 ao SUS. Conclusão: O conjunto dos resultados das avaliações dos atributos e a resposta que o sistema fornece para a efetiva vigilância do agravo tornam o sistema útil. Deve-se estabelecer uma rotina de exploração deste sistema como fonte de informação nos serviços de vigilância

Microcephaly in Pernambuco State, Brazil: epidemiological characteristics and evaluation of the diagnostic accuracy of cutoff points for reporting suspected cases.

The increase in the number of reported cases of microcephaly in Pernambuco State, and Northeast Brazil, characterized an epidemic that led the Brazilian Ministry of Health to declare a national public health emergency. The Brazilian Ministry of Health initially defined suspected cases as newborns with gestational age (GA) ≥ 37 weeks and head circumference (HC) ≤ 33cm, but in December 2015 this cutoff was lowered to 32cm. The current study aimed to estimate the accuracy, sensitivity, and specificity of different cutoff points for HC, using ROC curves, with the Fenton and Intergrowth (2014) curves as the gold standard. The study described cases reported in Pernambuco from August 8 to November 28, 2015, according to sex and GA categories. The Fenton and Intergrowth methods provide HC growth curves according to GA and sex, and microcephaly is defined as a newborn with HC below the 3rd percentile in these distributions. Of the 684 reported cases, 599 were term or post-term neonates. For these, the analyses with ROC curves show that according to the Fenton criterion the cutoff point with the largest area under the ROC curve, with sensitivity greater than specificity, is 32cm for both sexes. Using the Intergrowth method and following the same criteria, the cutoff points are 32cm and 31.5cm for males and females, respectively. The cutoff point identified by the Fenton method (32cm) coincided with the Brazilian Ministry of Health recommendation. Adopting Intergrowth as the standard, the choice would be 32cm for males and 31.5cm for females. The study identified the need to conduct critical and on-going analyses to evaluate cutoff points, including other characteristics for microcephaly case definition

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Survival analysis in non-congenital neurological disorders related to dengue, chikungunya and Zika virus infections in Northeast Brazil

The Northeast of Brazil has experienced a triple epidemic, with the simultaneous circulation of dengue virus (DENV), chikungunya virus (CHIKV) and Zika virus (ZIKV), which may have contributed to the observed increase across this region of atypical forms of disease and deaths. In view of this fact, non-congenital neurological disorders related to arboviruses were compared with other etiologies, mortality and survival rates of patients admitted to referral neurology hospitals in Pernambuco State, Northeast Brazil, from 2015 to 2018. Blood and cerebrospinal fluid samples were collected and tested using molecular and serological assays. The arbovirus-exposed groups were compared with respect to epidemiological, clinical and neurologic characteristics by using the Pearson’s chi-square test. For the survival analysis, the Kaplan-Meier and Hazard Ratio (HR) tests were used, with a 95% confidence interval (CI). Encephalitis and encephalomyelitis were more frequent in arboviruses, while myelitis predominated in the neurological disorders of other etiologies. Guillain-Barré Syndrome (GBS) was similarly distributed amongst the groups. Exposure to one of the arboviruses caused a six-fold increase in the risk of death (HR: 6.37; CI: 2.91 - 13.9). Amongst the arbovirus-exposed groups, infection (DENV/CHIKV) increased nine times the risk of death (HR: 9.07; CI: 3.67 - 22.4). The survival curve indicates that have been exposed to some arbovirus decreased the likelihood of survival compared to those with other etiologies (Log-Rank: p&lt;0.001). Within this scenario, neurologic manifestations of DENV, CHIKV and ZIKV have the potential to increase mortality and decrease survival, and concomitant infection (DENV/CHIKV) is an aggravating factor in reducing the likelihood of survival when compared to monoinfections

Saúde na Copa: The World's First Application of Participatory Surveillance for a Mass Gathering at FIFA World Cup 2014, Brazil

Submitted by Adagilson Silva ([email protected]) on 2017-06-20T18:16:13Z No. of bitstreams: 1 28473308 2017 lea-sau.oa.pdf: 1256223 bytes, checksum: a83019593d027d1f58e1c4c6fc1844d1 (MD5)Approved for entry into archive by Adagilson Silva ([email protected]) on 2017-06-20T18:16:33Z (GMT) No. of bitstreams: 1 28473308 2017 lea-sau.oa.pdf: 1256223 bytes, checksum: a83019593d027d1f58e1c4c6fc1844d1 (MD5)Made available in DSpace on 2017-06-20T18:16:33Z (GMT). No. of bitstreams: 1 28473308 2017 lea-sau.oa.pdf: 1256223 bytes, checksum: a83019593d027d1f58e1c4c6fc1844d1 (MD5) Previous issue date: 2017-05-04Epitrack. Recife, PE, Brazil / SingularityU Recife Chapter. Recife, PE, Brazil / Fundação Oswaldo Cruz. Instituto Aggeu Magalhães. Departamento de Saúde Coletiva. Recife, PE, Brasil.Pernambuco Health Departament. Recife, PE, Brazil.Skoll Global Threats Fund. Pandemics Team. San Francisco, CA, United States.Fundação Oswaldo Cruz. Instituto Aggeu Magalhães. Departamento de Saúde Coletiva. Recife, PE, Brasil.Fundação Oswaldo Cruz. Instituto Aggeu Magalhães. Departamento de Saúde Coletiva. Recife, PE, Brasil.Skoll Global Threats Fund. Pandemics Team. San Francisco, CA, United States.Brazil's Ministry of Health. General Coordination of Public Health Emergencies Response. Brasilia, Brazil.Epitrack. Recife, PE, Brazil / Federal Rural University of Pernambuco. Informatics Departament. Recife, PE, Brazil.BACKGROUND: The 2005 International Health Regulations (IHRs) established parameters for event assessments and notifications that may constitute public health emergencies of international concern. These requirements and parameters opened up space for the use of nonofficial mechanisms (such as websites, blogs, and social networks) and technological improvements of communication that can streamline the detection, monitoring, and response to health problems, and thus reduce damage caused by these problems. Specifically, the revised IHR created space for participatory surveillance to function, in addition to the traditional surveillance mechanisms of detection, monitoring, and response. Participatory surveillance is based on crowdsourcing methods that collect information from society and then return the collective knowledge gained from that information back to society. The spread of digital social networks and wiki-style knowledge platforms has created a very favorable environment for this model of production and social control of information. OBJECTIVE: The aim of this study was to describe the use of a participatory surveillance app, Healthy Cup, for the early detection of acute disease outbreaks during the Fédération Internationale de Football Association (FIFA) World Cup 2014. Our focus was on three specific syndromes (respiratory, diarrheal, and rash) related to six diseases that were considered important in a mass gathering context (influenza, measles, rubella, cholera, acute diarrhea, and dengue fever). METHODS: From May 12 to July 13, 2014, users from anywhere in the world were able to download the Healthy Cup app and record their health condition, reporting whether they were good, very good, ill, or very ill. For users that reported being ill or very ill, a screen with a list of 10 symptoms was displayed. Participatory surveillance allows for the real-time identification of aggregates of symptoms that indicate possible cases of infectious diseases. RESULTS: From May 12 through July 13, 2014, there were 9434 downloads of the Healthy Cup app and 7155 (75.84%) registered users. Among the registered users, 4706 (4706/7155, 65.77%) were active users who posted a total of 47,879 times during the study period. The maximum number of users that signed up in one day occurred on May 30, 2014, the day that the app was officially launched by the Minister of Health during a press conference. During this event, the Minister of Health announced the special government program Health in the World Cup on national television media. On that date, 3633 logins were recorded, which accounted for more than half of all sign-ups across the entire duration of the study (50.78%, 3633/7155). CONCLUSIONS: Participatory surveillance through community engagement is an innovative way to conduct epidemiological surveillance. Compared to traditional epidemiological surveillance, advantages include lower costs of data acquisition, timeliness of information collected and shared, platform scalability, and capacity for integration between the population being served and public health services

Surto de síndrome de Guillain-Barré possivelmente relacionado à infecção prévia pelo vírus Zika, Região Metropolitana do Recife, Pernambuco, Brasil, 2015

Resumo Objetivo: investigar a ocorrência da síndrome de Guillain-Barré (SGB) na Região Metropolitana do Recife, Brasil, 2015. Métodos: estudo descritivo com dados do Sistema de Informações Hospitalares, Sistema Nacional de Gestão da Assistência Farmacêutica e entrevistas; os casos de SGB foram classificados segundo os critérios de Brighton, e a infecção prévia, segundo critérios laboratoriais e clínicos. Resultados: em 2015, houve três vezes mais internações por SGB que em 2014; investigaram-se 44 casos confirmados ou prováveis de SGB, dos quais 18 apresentaram sintomas de infecção por Zika até 35 dias antes da ocorrência da SGB, principalmente exantema; houve um caso confirmado laboratorialmente para Zika e um óbito. Conclusão: os achados reforçam possível relação da SGB com infecção por Zika, por ausência de aumento da ocorrência da SGB em anos epidêmicos de dengue, ausência de registro de transmissão de chikungunya, presença de manifestações clínicas compatíveis com infecção por Zika e uma confirmação laboratorial

New variant of Creutzfeldt-Jakob (vCJD) disease and other human prion diseases under epidemiological surveillance in Brazil

Abstract To increase the timeliness of detection of human cases of the new variant of Creutzfeldt-Jakob disease (vCJD) and to reduce the risk of transmission, the Brazilian Ministry of Health has established and standardized rules and control measures. These include the definition of criteria for suspect cases, reporting, monitoring, and control measures for illness prevention and transmission. Guidelines to be used by the team of health care staff were published and distributed to health workers. A detailed proposal for a simplified system of surveillance for prion diseases was developed and mandatory reporting introduced. Additional effort is necessary to increase vCJD case detection, thus making it necessary to establish a partnership with health care services for best identification of suspected cases and dissemination of information to all involved in the service dealing with vCJD investigation

Surto de doença transmitida por alimento em evento de massa de populações indígenas em Cuiabá, Mato Grosso, Brasil, no ano de 2013

Resumo OBJETIVO: relatar a experiência da investigação do surto de doença diarreica aguda (DDA) ocorrido nos XII Jogos dos Povos Indígenas, no município de Cuiabá, estado de Mato Grosso, Brasil, em 2013. MÉTODOS: foram coletados dados das fichas de atendimento dos casos de DDA, definidos como 'indivíduo participante dos Jogos, referindo episódio de diarreia e/ou vômito' no Posto Médico Avançado; foram calculadas a taxa de ataque de DDA, frequências relativas e medidas de tendência central das variáveis sociodemográficas e clínicas, das inspeções sanitárias e dos resultados de amostras bromatológicas. RESULTADOS: houve 384 (37%) casos que atenderam a definição de DDA; os picos epidêmicos do surto corresponderam ao quarto e sétimo dias do evento, e a taxa de ataque da doença foi de 33,5%; a inspeção sanitária mostrou indícios de contaminação alimentar por Staphyloccocus coagulase-negativa, Bacillus cereus e coliformes termotolerantes. CONCLUSÃO: houve surto de DDA causado por contaminação alimentar