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ABSTRACT Brazil experienced one of the fastest increasing numbers of coronavirus disease (COVID-19) cases worldwide. The Sao Paulo State (SPS) reported a high incidence, particularly in Sao Paulo municipality. This study aimed to identify clusters of incidence and mortality of hospitalized patients with severe acute respiratory syndrome for COVID-19 in the SPS, in 2020-2021, and describe the origin flow pattern of the cases. Cases and mortality risk area clusters were identified through different analyses (spatial clusters, spatio-temporal clusters, and spatial variation in temporal trends) by weighting areas. Ripley's K12-function verified the spatial dependence between the cases and infrastructure. There were 517,935 reported cases, with 152,128 cases resulting in death. Of the 470,441 patients hospitalized and residing in the SPS, 357,526 remained in the original municipality, while 112,915 did not. Cases and death clusters were identified in the Sao Paulo metropolitan region (SPMR) and Baixada Santista region in the first study period, and in the SPMR and the Campinas, Sao Jose do Rio Preto, Barretos, and Sorocaba municipalities during the second period. We highlight the priority areas for control and surveillance actions for COVID-19, which could lead to better outcomes in future outbreaks.
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Long-term care facilities for older adults present a high risk of outbreaks since they concentrate often more frail and vulnerable individuals. OBJECTIVE: To describe the epidemiological characteristics of influenza-like illness outbreaks and cases among older people in long-term care facilities in the state of São Paulo, Brazil. METODS: The analysis was performed through an exploratory and descriptive approach, with records from the outbreak module of the National System of Notifiable Diseases between January 2020 and June 2021. RESULTS: Outbreaks of influenza-like illness in this department represented 24.93% of all notifications. The highest concentration was seen in the state capital and metropolitan area. A total of 1 018 confirmed outbreaks were observed, involving 6 110 cases and 1 240 deaths among older people. Of these cases, 71.67% were confirmed for coronavirus disease 19 (COVID-19), 12.77% for the influenza virus, and 15.56% for other respiratory viruses. The percentages regarding death outcomes were similar, with a 20.29% lethality of influenza-like illness. Within the studied group, the older adults were the most affected. A statistical difference was observed between cases and deaths. CONCLUSIONS: Owing to the current scenario and the known vulnerabilities of these facilities, there is an urgent need for joint and articulated action by various administrative levels in order to minimize the devastating effects of influenza-like illness outbreaks (especially of COVID19) in older adults at long-term care homes. The strengthening of information systems and their interoperability are considered of utmost importance in order to improve the quality of information on outbreaks, which is essential during a pandemic.
Instituições de longa permanência para idosos são locais que apresentam um alto risco de surtos epidêmicos, visto que concentram indivíduos, frequentemente mais frágeis e vulneráveis. OBJETIVO: Descrever as características epidemiológicas de surtos de síndrome gripal entre idosos em instituições de longa permanência no estado de São Paulo. MÉTODOS: A análise foi realizada através de uma abordagem exploratória e descritiva, utilizando-se de registros do Sistema de Informações de Agravos de Notificação, módulo surto, entre janeiro de 2020 e junho de 2021. RESULTADOS: Surtos de síndrome gripal neste departamento representaram 24,93% do total de notificações. A maior concentração de surtos ocorreu na capital e região metropolitana. Foram observados 1018 surtos confirmados, envolvendo 6110 casos e 1240 óbitos em idosos. Entre estes casos, 71,67% foram confirmados para COVID-19, 12,77% para o vírus Influenza e 15,56%, para outros vírus respiratórios. Óbitos apresentaram porcentagens semelhantes, com a letalidade de síndrome gripal sendo de 20,29%. No grupo estudado, idosos mais longevos foram os mais acometidos. Houve diferença estatística entre casos e óbitos. CONCLUSÕES: Devido ao cenário atual e às conhecidas vulnerabilidades destas instituições, há a necessidade urgente de uma ação conjunta e articulada por parte de diversas esferas administrativas para minimizar os efeitos devastadores de surtos de síndrome gripal, especialmente os de COVID-19, em instituições de longa permanência. O fortalecimento de sistemas de informação e sua interoperabilidade são considerados de vital importância para melhorar a qualidade da informação sobre surtos institucionais, a qual é essencial durante uma pandemia.
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Disease Outbreaks , Influenza, Human/epidemiology , Homes for the Aged , Brazil/epidemiology , Disease NotificationABSTRACT
RESUMO: Objetivo: Descrever, de forma retrospectiva, os casos graves de pacientes hospitalizados e os óbitos relacionados à epidemia de COVID-19 no estado de São Paulo, desde a data do primeiro registro, com início de sintomas em 10 de fevereiro de 2020 até registros disponíveis em 20 de maio de 2021. Métodos: Trata-se de um estudo descritivo realizado por meio da base de dados do Sistema de Vigilância Epidemiológica da Gripe. Foram calculadas as taxas de incidência, mortalidade e incidência acumulada no período, estratificadas por faixa etária e agrupadas de acordo com cada Departamento Regional de Saúde. Os casos graves foram geocodificados para a análise de seu espalhamento pelo estado e foi calculado o R efetivo, que estima o potencial de propagação de um vírus em uma população. Resultados: Houve aumento significativo dos casos graves e óbitos registrados no período de um ano, e as taxas de incidência e mortalidade foram heterogêneas no estado. Os períodos mais críticos em relação à incidência de casos graves ocorreram entre maio e julho de 2020 e entre março e abril de 2021. Os Departamentos Regionais de Saúde de São José do Rio Preto, Grande São Paulo e Araçatuba concentraram as maiores taxas de incidência e mortalidade. Os casos graves e óbitos foram mais frequentes nos homens e na população acima de 60 anos, e as principais condições de risco relacionadas aos óbitos foram cardiopatia (59%) e diabetes (42,8%). Conclusões: Espera-se que esses resultados ofereçam embasamento e possam contribuir para uma ação de controle mais eficiente da COVID-19, além de permitir o entendimento histórico de sua evolução no estado.
ABSTRACT: Objectives: To retrospectively describe severe cases of hospitalized patients and deaths related to the COVID-19 epidemic in the state of São Paulo, starting from the date of the first record, with symptoms onset on 02/10/2020 up to 05/20/2021. Methods: This is a descriptive study carried out using the Influenza Epidemiological Surveillance System (Sistema de Vigilância Epidemiológica da Gripe - SIVEP-Gripe) database. The rates of incidence, mortality, and accumulated incidence in the period were calculated, stratified by age group and Regional Health Department (RHD). In addition, severe cases were geocoded to analyze their spread across the state; and the Effective R, which determines the spread potential of a virus within a population, was calculated. Results: There was a significant increase in severe cases and deaths recorded in the period of one year, with incidence and mortality rates being heterogeneous within the state. The most critical periods regarding the incidence of severe cases occurred between May and July 2020 and between March and April 2021. The RHD in São José do Rio Preto, Expanded São Paulo, and Araçatuba concentrated the highest incidence and mortality rates. Severe cases and deaths were more frequent in men and in the population over 60 years, while the main risk conditions related to deaths were heart disease (59%) and diabetes (42,8%). Conclusions: These results not only provide a detailed profile for more efficient control action plan, but will also allow the historical understanding of the COVID-19 evolution within the state of São Paulo.
Subject(s)
Humans , Male , Brazil , Retrospective Studies , Pandemics , SARS-CoV-2 , COVID-19ABSTRACT
A UGRHI-17 da bacia hidrográfica do Médio Paranapanema (São Paulo, Brasil) é reconhecidamente uma área de alta biodiversidade de espécies de Biomphalaria e possui grande vulnerabilidade a acometimentos ambientais e em saúde, no caso da esquistossomose. O objetivo do estudo foi identificar áreas de maior risco para a ocorrência da esquistossomose utilizando dados de transmissão da esquistossomose e de diversidade genética molecular, associando-os às ferramentas geoespaciais, e com isso estabelecer áreas potenciais para a vigilância malacológica e da infecção em coleções de água doce na região do Médio Paranapanema. Os moluscos do gênero de Biomphalaria foram identificados por meio de características morfológicas e moleculares; enquanto os outros grupos taxonômicos (Drepanotrema, Lymnaea, Melanoides, Physa e Pomacea) foram identificados por características conchiológicas ou morfológicas. A análise filogenética das espécies de Biomphalaria foi realizada por meio da análise de sequências dos genes mitocondriais COI, 16S rRNA e COI+16S. As sequências do gene COI referentes ao trecho DNA Barcode foram testadas quanto à similaridade com sequências depositadas no GenBank e analisadas em ABDG, bPTP e GMYC para delimitação de espécies putativas. Na análise espacial foram utilizadas as estatísticas de varredura, Gi e de fluxo. Foram utilizadas as fichas notificação e investigação dos casos de esquistossomose na região de estudo entre 1978-2016. Foi calculado as taxas de incidência e foi avaliado a dependência espacial entre os casos autóctones e importados com a função K12 de Ripley. Foram gerados mapas da distribuição espacial dos caramujos do gênero Biomphalaria; dos casos de esquistossomose ocorridos na região de estudo; e da diversidade genética em haplótipos do gene 16S. Além disso, foi realizada modelagem de nicho para estimar cenários futuros de alteração na distribuição dos caramujos, utilizado o algoritmo de máxima entropia. Foram utilizados os dados de variáveis climáticas e topográficas obtidas no WorldClim, HydroSHEDS e TOPODATA e o modelo climático regional HadGEM2-ES do período de 2041-2060, considerando dois cenários de mudança climática possíveis: RCP2.6 e RCP8.5. Foram identificados aglomerados de alto risco para ocorrência de esquistossomose em Ourinhos, Assis e Ipaussu. Entretanto, ao longo dos anos, os casos passaram a ocorrer em baixa densidade em Ourinhos e deixaram de ocorrer nos demais municípios da região. Dos caramujos coletados, 75.5% eram Biomphalaria, 11.2% Drepanotrema e 13.3% de outros gêneros não planorbídeos. O modelo de máxima entropia mostrou que há probabilidade futura da espécie B. glabrata permanecer nos municípios de Ourinhos e Assis, e uma probabilidade em torno de 50% de a espécie expandir sua colonização a corpos de água doce de outros municípios da região de estudo, isto em função das mudanças climáticas. Os resultados para B. straminea mostram que esta espécie tem maior probabilidade de expansão de colonização no futuro, especialmente nos municípios próximos a Ourinhos. A análise filogenética mostrou árvores com cinco ramos monofiléticos com alto suporte estatístico. A diversidade de haplótipos está distribuída de forma diferente em cada um dos cinco taxa analisados. Conclui-se, em um dos resultados deste trabalho, que atualmente a esquistossomose, como problema de saúde pública no Médio Paranapanema, está restrita a Ourinhos. Tal fato pode estar relacionado à presença de B. glabrata em pontos específicos e à cobertura deficiente do saneamento básico. Desta forma, o estudo contribuiu para eleger áreas prioritárias para o combate aos caramujos e à doença para evitar ou reduzir transmissões futuras nesta região
The UGRHI-17 of the Middle Paranapanema watershed (São Paulo, Brazil) is recognized as an area of high biodiversity of Biomphalaria species and great vulnerability to environmental and health impacts for schistosomiasis. The objective of the study is to identify areas of greatest risk for the occurrence of schistosomiasis using transmission data from schistosomiasis and molecular genetic diversity, associating them with the geospatial tools, and thereby establishing potential areas for malacological surveillance and infection in collections of freshwaters in the region of Middle Paranapanema. Molluscs of the genus Biomphalaria were identified by morphological and molecular characteristics; while the other taxonomical groups (Drepanotrema, Lymnaea, Melanoides, Physa and Pomacea) were identified through conchiological or morphological characteristics. Molecular genetic analysis of the species was done through sequence analysis of the mitochondrial genes COI, rRNA16S and COI+16S. The COI gene sequences related to DNA Barcode portions were tested for similarity to sequences deposited in GenBank and analyzed ABDG, BPTP and GMYC for delimiting putative species. In the spatial analysis we used the scan statistics, Gi and flow maps. Reporting and investigation records of cases schistosomiasis in the study regions between 1978 and 2016 were used. Incidence were calculated and the existence of spatial dependence between autochthonous and imported cases was evaluated using Ripley's K12-function. Maps of the spatial distribution of snails of the genus Biomphalaria; cases of schistosomiasis occurred in the study region; and the genetic diversity in haplotypes of the 16S gene were generated. In addition, the ecological niche modeling to estimate future scenarios of alteration in the distribution of snails, used the maximum entropy algorithm in MaxEnt software. Climate and altitude data obtained from WorldClim, HydroSHEDS and TOPODATA and the regional climate model HadGEM2-ES from the period of 2041-2060 were used, considering two possible scenarios of climate change: Representative Concentration Pathways - RCP2.6 and RCP8.5. High-risk clusters were identified for the occurrence of schistosomiasis in Ourinhos, Assis and Ipaussu. However, over the years, cases occurred in low density in Ourinhos and ceased to occur in other municipalities in the region. Of the snails collected, 75.5% were Biomphalaria, 11.2% Drepanotrema and 13.3% of other non-planorbid genera. The maximum entropy model showed that B. glabrata is a future likely to remain in the municipality of Ourinhos and Assis and a probability around 50% of species to expand their colonization to freshwater bodies of other municipality of the study region, due to the climatic changes. The results for B. straminea showed that this is the species most likely to expand colonization in the future, especially in the municipalities near Ourinhos. The phylogenetic analysis showed trees with five monophyletic branches with high statistical support. The diversity of haplotypes is distributed differently at each of the five taxa analyzed. As one of the results of this work it was concluded that, currently, schistosomiasis as a public health problem in the Middle Paranapanema is restricted to Ourinhos. This may be related to the presence of B. glabrata at specific point and poor coverage of basic sanitation. In this way, the study contributed to the selection of priority areas for combating snails and disease in order to avoid or reduce future transmissions in this region
Subject(s)
Phylogeny , Schistosomiasis/epidemiology , Climate Change , Biomphalaria , Demography , Genetic PhenomenaABSTRACT
Abstract INTRODUCTION: The Middle Paranapanema watershed is known for the transmission of schistosomiasis, and there have been autochthonous cases since 1952. This study aimed to describe this disease in space and time and evaluate its current importance as a public health problem. METHODS: Thematic maps showing the risk areas for transmission of schistosomiasis, using scan statistics, and flow maps were created in the period 1978-2016. Incidence was calculated, and the existence of spatial dependence between autochthonous and imported cases was evaluated using Ripley's K12-function. Species of snails were identified in high-risk clusters. RESULTS: A total of 1,511 autochthonous cases were reported in eight of the 25 municipalities in the study area, of which 92.8% occurred in Ourinhos. A total of 2,189 imported cases were reported (27% in Ourinhos and 20% in Assis), mainly originating in the states of Paraná and Minas Gerais. Clusters of autochthonous and imported cases with higher risk were identified in Ourinhos, Assis and Ipaussu. However, over the years, the cases began to occur in low density in Ourinhos and no longer in other municipalities in the region. The cluster detected in the period 2007-2016 in Ourinhos still has risk for the transmission of schistosomiasis. K12-function analysis indicated positive spatial dependence between autochthonous and imported cases. CONCLUSIONS: The study showed that, currently, schistosomiasis as a public health problem in Middle Paranapanema is restricted to Ourinhos. This fact may be related to the presence of Biomphalaria glabrata at a specific point and low coverage of basic sanitation.
Subject(s)
Humans , Animals , Schistosomiasis mansoni/epidemiology , Schistosoma mansoni , Biomphalaria , Schistosomiasis mansoni/transmission , Brazil/epidemiology , Residence Characteristics , Public Health , Incidence , Rivers , Spatial AnalysisABSTRACT
We analyze the current distribution of snails from genus Biomphalaria in the north and south of the coastal fluvial plain in the state of SaËo Paulo, which is part of a large coastal floodplain. Data from twenty-nine collection sites confirmed that the freshwater body in both regions is colonized by Biomphalaria tenagophila and Biomphalaria straminea, which are natural intermediate hosts of Schistosoma mansoni. The abundance of B. straminea in collection sites where only B. tenagophila had previously been recorded indicates the potential for B. straminea to expand in the region. While quantitative analysis of the number of specimens per species showed that local growth of B. tenagophila populations occurs during periods with little rainfall, there is a greater risk of B. tenagophila populations spreading between different water bodies during rainy periods, when heavy rainfall results in water levels rising in the main rivers and flooding caused by water flowing from the Serra do Mar mountain range to the coastal plain. The temperature increase caused by global climate changes and the consequent increasing frequency of high-water levels and floods can be expected to affect the distribution of these snails on the coastal fluvial plain, leading to the risk of a change in the autochthonous transmission pattern of schistosomiasis in the region