Thinking about development of multi-channel surveillance and multi-dimensional early warning system of emerging respiratory communicable diseases / 中华流行病学杂志

The world has paid a heavy price for the pandemic of the emerging respiratory communicable disease, so more concern about communicable disease surveillance and early warning has been aroused. This paper briefly reviews the establishment of the surveillance and early warning system of respiratory communicable diseases in China, discusses its future development and introduces the novel surveillance methods and early warning models for the purpose of establishment of a multi-channel surveillance and multi-dimensional early warning system of communicable diseases in the future and the improvement of the prevention and control of emerging respiratory communicable diseases in China.

Espalhamento da febre amarela no contexto da crise migratória na América Latina: um estudo de modelagem matemática de múltiplos cenários / Spread of yellow fever in the context of the Latin American migration crisis: a mathematical modelling study of multiple scenarios

INTRODUÇÃO: As doenças infecciosas desconhecem fronteiras e, com a crise climática, a disseminação de doenças sensíveis ao clima tende a aumentar em frequência, intensidade e expansão geográfica. Isso preocupa as organizações humanitárias pois as crises humanitárias são alteradas e entrelaçadas pelos padrões climáticos, cujas interações podem ser imprevisíveis. Com a pandemia da Covid19 agravou-se a estigmatização dos migrantes como meros vetores de doenças, negligenciando as circunstâncias determinantes para propagação de doenças perante a migração. MÉTODOS: A tese é composta por três manuscritos nos quais são aplicados modelos epidêmicos compartimentais: (i) modelo SEIRV-SEI para humanos e vetores aplicado à migração unidirecional de uma comunidade endêmica para uma comunidade hospedeira livre de doença; (ii) SEIRV-SEI para humanos e vetores aplicado a três diferentes populações acopladas - caravanas, comunidade endêmica e comunidade livre de doença, avaliando os efeitos da vacinação em comunidades endêmicas e em caravanas; (iii) o modelo SEIR-SEI para humanos, macacos e vetores onde o tempo gasto para atravessar a floresta é uma medida de exposição. RESULTADOS: O primeiro artigo mostra que o tipo de vetor e a cobertura vacinal nas comunidades hospedeiras são mais relevantes para a ocorrência de surtos do que as taxas de migração. O segundo estudo demonstra que quando as comunidades endêmicas são fonte de migração, a imunidade do rebanho é determinante, mas a vacinação de caravanas é de longe a intervenção mais significativa para proteger comunidades do risco de introdução da FA. Por fim, os resultados mostram que poderia haver mais de 23 mil casos humanos se ocorrer um surto de FA no Gap de Darién, e 19.000 deles deixariam a floresta ainda infectados. O número de mortes está fortemente relacionado ao tempo para atravessar a floresta. CONCLUSÃO: A prevenção de surtos de doenças infecciosas sensíveis ao clima no contexto da migração deve ser um esforço conjunto de interesse comum. Estabelecer corredores de migração oficiais e seguros onde seja possível vacinar os migrantes pode contribuir significativamente para o controle de doenças. Os migrantes são infinitamente mais vulneráveis a infecções, enquanto os responsáveis pela disseminação de doenças infecciosas sensíveis ao clima são a falta de vacinação consistente e as mudanças climáticas. Somente um esforço coletivo deliberado e consistente de vacinação pode garantir a migração segura como direito humano e para adaptação climática.

INTRODUCTION: Infectious diseases do not recognize borders, and with the climate crisis, the spread of climate-sensitive diseases is expected to increase in frequency, intensity, and geographic expansion. This poses a serious concern for humanitarian organizations as weather patterns can alter and intertwine humanitarian crises, leading to unpredictable interactions. Furthermore, with the ongoing Covid19 pandemic, migrants have been stigmatized as mere carriers of diseases, ignoring the underlying circumstances that lead to the spread of diseases during migration. METHODS: The thesis consists of three manuscripts that use compartmental epidemic models. The first manuscript uses a SEIRV-SEI model to study one-way migration from an endemic community to a disease-free host community. The second manuscript uses a SEIRV-SEI model to study three coupled human populations: caravans, resident endemic communities, and a disease-free community to assess the effects of vaccination in endemic communities and caravans. The third manuscript uses a SEIR-SEI model to study humans, monkeys, and vectors, where the time taken to cross the Darién forest is a measure of exposure to the Yellow Fever virus. RESULTS: The first manuscript shows that the type of vector and vaccination coverage in host communities are more relevant for the occurrence of outbreaks than migration rates. The second manuscript demonstrates that vaccinating caravans is the most significant intervention to protect disease-free communities from the risk of Yellow Fever introduction. The third manuscript shows that over 23,000 human cases may occur if an outbreak occurs in the Darién Gap, with 19,000 leaving the forest still infected. The number of deaths is strongly related to the time taken to cross the forest. CONCLUSION: Preventing outbreaks of climate-sensitive infectious diseases during migration must be a collective effort. Establishing official and safe migration corridors where migrants can be vaccinated can significantly contribute to controlling diseases such as Yellow Fever. Migrants are particularly vulnerable to infections, and the spread of climate-sensitive infectious diseases is linked to the lack of consistent vaccination in a changing climate. Only a collective and consistent vaccination effort can guarantee safe migration as a human right and serve as a climate adaptation measure.

Associação entre síndrome congênita e infecção pelo vírus Zika na gestação: estudo de coorte no estado de São Paulo, 2015 a 2018 / Association between congenital syndrome and zika virus infection during pregnancy: a cohort study in the state of São Paulo, 2015 to 2018

Introdução: Entre as doenças emergentes do século XXI, a infecção pelo Zika vírus (ZIKV) foi umas das maiores preocupações e desafios para a saúde pública em todo o mundo, em razão da sua magnitude, dada sua rápida disseminação global e seu grave impacto, decorrente da epidemia de microcefalia e demais alterações fetais associadas a ela. Objetivos: Descrever a transmissão do ZIKV no estado de São Paulo, segundo pessoa, tempo e lugar, identificar, descrever e quantificar o espectro de anormalidades e / ou resultados da gestação, incluindo microcefalia, nos fetos e recém-nascidos e analisar a associação entre essas complicações e a infecção pelo ZIKV, bem como outros fatores de risco. Método: Estudo de coorte retrospectiva cuja população foi composta por gestantes sintomáticas com suspeita de exposição ao ZIKV. Foram utilizados os dados do Sistema de Vigilância às Emergências em Saúde Pública (CeVeSP) e do Sistema de Informação sobre Nascidos Vivos do Centro de Informações Estratégicas em Vigilância em Saúde da Secretaria da Saúde do Estado de São Paulo (SINASC/CIVS/SES). Foram consideradas gestantes expostas aquelas com resultado positivo para ZIKV no RT-PCR e não expostas aquelas com resultado negativo. Foram incluídas todas as gestantes sintomáticas notificadas, no período de 2015 a 2018 no CeVeSP. Utilizamos o modelo teórico hierárquico com a finalidade de analisar e interpretar os resultados à luz do conhecimento existente e lidar com o grande número de variáveis conceitualmente relacionadas. Na análise múltipla foi utilizada a análise de regressão de Poisson robusta, calculando o RR como medida de associação e seu intervalo de confiança (IC 95%). A modificação do efeito da exposição ao ZIKV pelo trimestre de gestação foi avaliada nas escalas aditiva (RERI) e multiplicativa (razão de RR) e seus respectivos intervalos de confiança (IC 95%), estimando o excesso de risco atribuível e relativo, respectivamente. O nível de significância de todos os testes foi de 5%. Resultados: Das 2.299 gestantes notificadas, 29% foram confirmadas com a infecção pelo ZIKV, sendo quase metade solteiras (45%), a maioria de raça/cor da pele branca (74%), com ensino médio completo (54%), e concentradas no nordeste do estado. A proporção de recém-nascidos com anomalias do sistema nervoso central foi de aproximadamente 4%. As gestantes com maior escolaridade apresentaram risco menor de ter uma criança com microcefalia e/ou alteração do SNC. Já as gestantes que tiveram gravidez dupla e o parto foi antes de 37 semanas (pré-termo) ou após 42 semanas (pós-termo) tiveram risco maior de alterações fetais. O risco de uma gestante que teve infecção pelo ZIKV ter um feto com alguma alteração foi de 3,9 (IC 95% 1,835 - 8,411) quando comparado a uma gestante negativa. O trimestre de gestação teve efeito modificador positivo na escala aditiva (RERI: 18,86 - IC 95% 3,52 - 34,19), ou seja, a infecção pelo ZIKV no primeiro trimestre de gestação aumenta o risco da ocorrência de alterações congênitas. Conclusão: Os resultados encontrados neste estudo caracterizam a transmissão do ZIKV em um estado da região sudeste do país e corroboram as evidências de associação entre a infecção pelo ZIKV e ocorrência de microcefalia e/ou alteração do SNC. Assim pode subsidiar o direcionamento de ações da Saúde Pública para regiões e locais com maior risco de transmissão da infecção e, consequentemente, contribuir para a prevenção de recrudescimento da doença e malformações resultantes da transmissão vertical do vírus.

Introduction: Among the diseases of the 21st century, Zika virus (ZIKV) infection was one of the epidemics of concern and challenges for public health around the world, due to its magnitude, given its rapid global spread and its serious impact on microcephaly and other changes fetuses associated with it. Aims: To describe the transmission of ZIKV in the state of São Paulo, according to person, time and place, to identify, describe and quantify the spectrum of abnormalities and/or pregnancy outcomes, including microcephaly, in fetuses and newborns, and to assess the association between these complications and ZIKV infection, as well as other risk factors. Method: Retrospective cohort study whose population consisted of symptomatic pregnant women with suspected exposure to ZIKV. Data from the Public Health Emergency Surveillance System (CeVeSP) and the Information System on Live Births of the Center for Strategic Information on Health Surveillance of the São Paulo State Health Department (SINASC/CIVS/SES) were used. Exposed pregnant women were those with a positive result for ZIKV in the RT-PCR and those with a negative result as non-exposed. All symptomatic pregnant women reported in the period from 2015 to 2018 in CeVeSP were included. We used the hierarchical theoretical model in order to analyze and interpret the results in the light of existing knowledge and deal with the large number of conceptually related variables. In the multiple analysis, a robust Poisson regression analysis was used, calculating the RR as a measure of association and its confidence interval (95% CI). The modification of the effect of exposure to ZIKV by the trimester of pregnancy was evaluated in the additive (RERI) and multiplicative (RR ratio) scales and their respective confidence intervals (95% CI), estimating the attributable and relative excess risk, respectively. The significance level of all tests was 5%. Results: Of the 2,299 pregnant women reported, 29% were confirmed to have ZIKV infection, with almost half being single (45%), the majority of white race/skin color (74%), with complete high school (54%), and concentrated in the northeast of the state. The proportion of newborns with central nervous system abnormalities was approximately 4%. Pregnant women with higher education had a lower risk of having a child with microcephaly and/or CNS alterations. Pregnant women who had a double pregnancy and delivery was before 37 weeks (preterm) or after 42 weeks (postterm) had a higher risk of fetal changes. The risk of a pregnant woman who had ZIKV infection to have a fetus with any alteration was 3.9 (95% CI 1.835 - 8.411) when compared to a negative pregnant woman. The trimester of pregnancy had a positive modifying effect on the additive scale (RERI: 18.86 - 95% CI 3.52 - 34.19), that is, ZIKV infection in the first trimester of pregnancy increases the risk of congenital alterations. Conclusion: This study characterizes the transmission of the ZIKV in a state in the southeastern region of the country and corroborate the evidence of an association between ZIKV infection and the occurrence of microcephaly and/or CNS alteration. Thus, it can support the direction of Public Health actions to regions and places with greater risk of transmission of the infection and, consequently, contribute to the prevention of resurgence of the disease and malformations resulting from the vertical transmission of the virus.

Global epidemiology of Equine Influenza viruses: "A possible emerging zoonotic threat in future" an extensive systematic review with evidence / Epidemiologia global dos vírus da Gripe Equina: "Uma possível ameaça zoonótica emergente no futuro" uma extensa revisão sistemática com evidências

There are different opinions around the World regarding the zoonotic capability of H3N8 equine influenza viruses. In this report, we have tried to summarize the findings of different research and review articles from Chinese, English, and Mongolian Scientific Literature reporting the evidence for equine influenza virus infections in human beings. Different search engines i.e. CNKI, PubMed, ProQuest, Chongqing Database, Mongol Med, and Web of Knowledge yielded 926 articles, of which 32 articles met the inclusion criteria for this review. Analyzing the epidemiological and Phylogenetic data from these articles, we found a considerable experimental and observational evidence of H3N8 equine influenza viruses infecting human being in different parts of the World in the past. Recently published articles from Pakistan and China have highlighted the emerging threat and capability of equine influenza viruses for an epidemic in human beings in future. In this review article we have summarized the salient scientific reports published on the epidemiology of equine influenza viruses and their zoonotic aspect. Additionally, several recent developments in the start of 21st century, including the transmission and establishment of equine influenza viruses in different animal species i.e. camels and dogs, and presumed encephalopathy associated to influenza viruses in horses, have documented the unpredictable nature of equine influenza viruses. In sum up, several reports has highlighted the unpredictable nature of H3N8 EIVs highlighting the need of continuous surveillance for H3N8 in equines and humans in contact with them for novel and threatening mutations.

Existem diferentes opiniões em todo o mundo a respeito da capacidade zoonótica dos vírus da influenza equina H3N8. Neste relatório, tentamos resumir os resultados de diferentes pesquisas e artigos de revisão da literatura científica chinesa, inglesa e mongol relatando as evidências de infecções pelo vírus da influenza equina em seres humanos. Diferentes mecanismos de busca, como CNKI, PubMed, ProQuest, Chongqing Database, Mongol Med e Web of Knowledge geraram 926 artigos, dos quais 32 atenderam aos critérios de inclusão para esta revisão. Analisando os dados epidemiológicos e filogenéticos desses artigos, encontramos uma considerável evidência experimental e observacional de vírus da influenza equina H3N8 infectando seres humanos em diferentes partes do mundo no passado. Artigos publicados recentemente no Paquistão e na China destacaram a ameaça emergente e a capacidade dos vírus da influenza equina para uma epidemia em seres humanos no futuro. Neste artigo de revisão, resumimos os relatórios científicos relevantes publicados sobre a epidemiologia dos vírus da influenza equina e seu aspecto zoonótico. Além disso, vários desenvolvimentos recentes no início do século 21, incluindo a transmissão e estabelecimento de vírus da influenza equina em diferentes espécies animais, ou seja, camelos e cães, e presumida encefalopatia associada aos vírus da influenza em cavalos, documentaram a natureza imprevisível dos vírus da influenza equina. Em suma, vários relatórios destacaram a natureza imprevisível de H3N8 EIVs destacando a necessidade de vigilância contínua para H3N8 em equinos e humanos em contato com eles para novas mutações ameaçadoras.

Viruela símica: zoonosis emergente con impacto global / Monkeypox: emerging zoonosis with unprecedentedglobal impact

El virus de la viruela símica es un orthopoxvirus de características zoonóticas endémico en las regiones de África Central y África Occidental, donde causa brotes desde 1970. En las últimas décadas se registró un aumento exponencial de casos, probablemente asociado a la disminución en la inmunidad conferida por la vacuna antivariólica, discontinuada luego de la erradicación de la viruela. En los últimos años se registraron casos esporádicos fuera del continente africano, siempre relacionados epidemiológicamente a la permanencia en áreas endémicas o contacto con animales infectados. Desde el 13 de mayo de 2022 se encuentra en curso el mayor brote de viruela símica registrado fuera de las áreas endémicas de África, con casos en los cinco continentes. La extensión, el impacto y la duración del brote permanecen aún inciertos.

Monkeypox virus is an orthopoxvirus with zoonotic characteristics endemic in Central and West Africa regions, where it has caused outbreaks since 1970. An exponential increase in cases has been registered in the last decades, probably associated with a decrease in the immunity conferred by the smallpox vaccine, discontinued after smallpox eradication. In recent years, sporadic cases have been reported outside the African continent, always epidemiologically related to permanence in endemic areas or contact with infected animals. Since May 13, 2022, the largest monkeypox outbreak ever reported outside Africa endemic areas, with cases on the five continents, is unfolding. The extent, impact and duration of this outbreak still remain uncertain

As doenças infecciosas emergentes à luz da modernização reflexiva: um estudo da gênese do vírus e da doença zika / Emerging infectious diseases in the light of reflexive modernization: a study on the genesis of the zika virus and disease

Desde, pelo menos, as últimas quatro décadas, o cenário nosológico com o qual se defronta o campo da Saúde Pública, se mostra cada vez mais complexo e incerto diante da emergência, reemergência e recrudescência de doenças infecciosas. Isso é parte das mudanças sociais contemporâneas que se experiencia e estão sendo conformadas na interface entre natureza e sociedade. Compreende-se que o desenvolvimento tecnocientífico tem se mostrado ambivalente para lidar com essas doenças pois, se de um lado, a sociedade demanda e produz mais ciência e tecnologia (C&T) em saúde, de outro, um crescente número de situações de saúde não respondem às incorporações tecno-científicas ou mesmo foram criadas, reflexivamente, por essas práticas. Tomou-se como recorte empírico desta pesquisa o vírus e a doença zika, consideradas expressão das doenças infecciosas emergentes. O objetivo geral foi compreender a constituição sociobiológica destas doenças à luz da teoria da modernização reflexiva. Como abordagem teórico-metodológico elaborou-se uma articulação entre a teoria da modernização reflexiva e um enfoque construtivista dos fatos científicos. Compuseram os materiais de pesquisa um conjunto de artigos selecionados sobre o vírus e a doença zika e um conjunto de textos sobre o contexto sociopolítico de instauração de pesquisas médico-científicas na África Oriental, onde se identificou pela primeira vez o vírus da zika. A partir disso elaborou-se a história da gênese sóciocientífica do vírus zika e da doença por ele causada para mostrar as interações entre humanos e não humanos envolvidas nas circunstâncias de expansão da modernidade industrial capitalista e das atividades científicas, nos primórdios e no meado do século XX, para o continente africano. Além disso, identificou-se que os métodos e técnicas científicos produziram condições para o surgimento de novas situações de doença. Compreende-se que essa análise lança um olhar sobre as doenças infecciosas emergentes no âmbito dos paradoxos e ambiguidades constitutivos da sociedade tecnocientífica contemporânea.

Since at least the last four decades, the nosological scenary faced by the Public Health field has shown off to be increasingly complex and uncertain before the emergence, reemergence and recrudescence of the infectious diseases. These are part of the contemporary social changes that are being experienced and shaped at the interface between nature and society. It is understood that techno-scientific development has been ambivalent in dealing with these diseases. On one hand, society demands and produces more science and technology in health and, on the other hand, an increasing number of health situations have shown to be unresponsive to the technical incorporations or even have been reflexively created by these practices. In this research, zika virus and disease were taken as an empirical clipping, considering them, an expression of emerging infectious diseases. In light of the reflexive modernization theory, the general objective was to understand the sociobiological constitution of emerging and reemerging infectious diseases. As a theoretical-methodology approach, we elaborated an articulation between the social construction analysis of scientific facts and the theory of reflexive modernization. The research materials consisted on a set of selected articles on the zika virus and disease and a set of texts on the socio-political context of medical-scientific research in East Africa, where the zika virus was identified for the first time. From this, we formulated on the socio-scientific history of the genesis of the zika virus and the disease caused by it. This work highlights the interactions between humans and non-humans that proceeded in the circumstances of expansion of capitalist industrial western modernization and scientific activities, in the early and mid- century, to the African continent. In addition, it was identified that scientific methods and techniques produced conditions for the emergence of new, artificial-natural situations. It is understood that this analysis takes a look at emerging infectious diseases in the context of the paradoxes and ambiguities that constitute contemporary technoscientific society.

Strategy and measures in response to highly uncertain emerging infectious disease / 中华流行病学杂志

The incidence and spread of emerging infectious diseases are highly uncertain. This paper summarizes the uncertainty and complexity of emerging infectious disease, and suggests that for the response to the varied emerging infectious diseases in the future, it is still necessary for human to take the strategy of constantly strengthening the prevention and control capability and improving various preparedness protocols. For the better response to emerging infectious diseases and protection of people's health and life, the following measures can be taken, paying more attention to the layout of the infectious disease surveillance network, establishing and maintaining the laboratory surveillance network of infectious diseases, establishing and improving a "wartime-peacetime" transition mechanism or system of medical treatment and response, developing and improving the prevention and control plan for emerging infectious diseases, strengthening the training and rehearsal of emerging infectious disease treatment and response, establishing and improving the system for the grading, classification and stockpile of medical supplies for public health emergency response and establishing and maintaining the system of early warning of emerging infectious diseases and technical platform regulations.

Progress in prevention and control of Nipah virus disease / 中华流行病学杂志

Nipah virus disease (NVD) is a newly emerged zoonosis with a case fatality rate of 40%-75%. NVD is a severe threat to human health and the development of livestock farming. NVD has become one of the emerging infectious diseases with great concern globally during more than 20 years. Nipah virus (NiV) is a pathogen for NVD, the natural host of which is Fruit bats of the Pteropodidae family. The clinical spectrum of NiV infection is broad, including asymptomatic infection, acute respiratory infection, fatal encephalitis, and even death. Since NiV was first identified in Malaysia in 1999, it has been prevalent mainly in Southeast Asia and South Asia. NiV is primarily transmitted to humans through bat-pig-human, contaminated food. Currently, there are no specific therapeutic drugs and vaccines for NVD. Although there are no cases of NVD reported in China, which has close personnel and trade exchanges with major NVD-endemic countries, and NiV antibody has also been detected in relevant bats. There is a potential risk of importing NVD and domestic outbreaks in the future in this country. This paper provides a systematic review of the research progress in the prevention and control of NVD etiology, epidemiology, clinical manifestations and laboratory diagnosis to help relevant staff to understand NVD more comprehensively and systematically.

Caracterización de pacientes extranjeros confirmados con la COVID-19 en Santiago de Cuba / Characterization of foreign patients confirmed with the COVID - 19 in Santiago de Cuba

Introducción: La COVID - 19 es una enfermedad emergente, que ha afectado a todo el mundo de forma pandémica, con elevados costos sanitarios, económicos y sociales. Objetivo: Caracterizar a los pacientes extranjeros confirmados con la COVID - 19 en Santiago de Cuba, según variables clinicoepidemiológicas seleccionadas. Métodos: Se realizó un estudio observacional, descriptivo y transversal de 42 pacientes extranjeros, quienes visitaron la provincia de Santiago de Cuba y resultaron positivos a la COVID - 19, los cuales fueron remitidos a los centros de salud destinados para su atención desde marzo hasta diciembre del 2020. Se analizaron variables, tales como edad, sexo, municipio de residencia, país de procedencia, meses de mayor número de extranjeros que visitaron la provincia y evolución clínica. Resultados: El grupo etario de mayor frecuencia fue el de 30 - 44 años (14 pacientes para 33,3 %), seguido de los afectados de 45 - 59 (11 para 26,2 %). El municipio de Santiago de Cuba resultó el de mayor riesgo de incidencia (27 para 64,3 %). La manifestación clínica más común fue el malestar general y el país de procedencia que prevaleció, Estados Unidos (47,6 %). Todos los pacientes fueron importados. Conclusiones: Los integrantes de la casuística tuvieron una evolución favorable, lo cual permitió accionar, desde la atención primaria de salud, a fin de prevenir la enfermedad y realizar el control de foco como principal herramienta para cortar la cadena de transmisión.

Introduction: The COVID-19 is an emergent disease that has affected everybody in a pandemic way, with high sanitary, economic and social costs. Objective: To characterize foreign patients confirmed with the COVID-19 in Santiago de Cuba, according to selected clinical epidemiological variables. Methods: An observational, descriptive and cross-sectional study of 42 foreign patients who visited Santiago de Cuba province and tested positive to the COVID-19, who were referred to the health centers dedicated for their care was carried out from March to December, 2020. Some variables were analyzed, such as age, sex, residence municipality, origin country, months of more number of foreigners that visited the province and clinical course. Results: The age group of more frequency was that of 30 - 44 years (14 patients for 33.3 %), followed by those affected of 45 - 59 years (11 for 26.2 %). The municipality of Santiago de Cuba had the higher risk of incidence (27 for 64.3 %). The most common clinical sign was the diffuse discomfort and the origin country that prevailed, United States (47.6 %). All the patients were imported. Conclusions: The members of the case material had a favorable clinical course, that allowed to work, from the primary health care, in order to prevent the disease and to carry out the source of infection control as main tool to stop the transmission chain.

El desafío de las enfermedades (re)emergentes, los límites de la respuesta biomédica y el nuevo paradigma de salud global / The challenge of (re)emerging diseases, the limits of the biomedical response and the new paradigm of global health

Resumen Las "enfermedades infecciosas emergentes y reemergentes" constituyen una creciente amenaza para la hegemonía de la biomedicina, al suscitar no pocos interrogantes sobre la idoneidad de su discurso y prácticas para afrontar el desafío global que representan. Se analiza el proceso de construcción de esta nueva categoría nosológica, y se examinan ejemplos destacados del impacto de las enfermedades (re)emergentes en la salud pública, la seguridad alimentaria y el desarrollo humano a escala global. Se refiere a prácticas irresponsables de sectores de la industria farmacéutica y agropecuaria, determinantes en su desencadenamiento y diseminación; y a algunos fallos cruciales de enfoque y manejo de los tiempos en las políticas de salud global en relación al VIH/sida con desastrosas consecuencias para el África subsahariana.

Abstract "Emerging and reemerging infectious diseases" pose a growing threat to the hegemony of biomedicine, raising questions about whether its discourse and practices can handle the global challenge they represent. The construction of this new nosological category is analyzed in this article, which examines some notable examples of the impact of (re)emerging diseases on public health, food security and human development on a global scale. It discusses irresponsible practices by sectors of the pharmaceutical and agricultural industries which led to the emergence and spread of these diseases; and points to some crucial failures of approach and time management in global health policies on HIV/AIDS, with disastrous consequences for sub-Saharan Africa.

Historia y futuro de las pandemias / History and future of pandemics

Este artículo presenta una historia general de las epidemias históricas y de las nuevas enfermedades emergentes, señalando sus factores desencadenantes. Se afirma que las epidemias son inevitables, y que su riesgo aumenta en proporción al tamaño, la complejidad y el poder tecnológico de nuestras sociedades. La historia enseña que las epidemias han sido casi siempre desencadenadas por cambios en el ambiente ocasionados por las propias actividades humanas. Las enfermedades infecciosas son manifestación de una interacción ecológica entre la especie humana y otra especie de microorganismos. Y las epidemias son resultado del cambio en algún factor ambiental capaz de influir en esa interacción. Las catástrofes epidémicas son inevitables: en primer lugar, porque no podemos evitar formar parte de cadenas tróficas en las que comemos y somos comidos por los microbios; en segundo lugar, porque las infecciones son mecanismos evolutivos y factores reguladores del equilibrio ecológico, que regulan sobre todo el tamaño de las poblaciones; y, en tercer lugar, porque las intervenciones técnicas humanas, al modificar los equilibrios previos, crean equilibrios nuevos que son más vulnerables. De este modo las sociedades humanas son más vulnerables cuanto más complejas. Y los éxitos humanos en la modificación de condiciones ambientales conservan, o más bien aumentan, el riesgo de catástrofes epidémicas. Todas las necesarias medidas de vigilancia y control epidemiológico imaginables pueden disminuir los daños que producen las epidemias, pero nunca podrán evitarlas.

This article presents a general history of historical epidemics, and new emerging diseases, pointing out their triggers. It is claimed that epidemics are inevitable, and that their risk increases in proportion to the size, complexity, and technological power of our societies. History teaches that epidemics have almost always been triggered by changes in the environment caused by human activities themselves. Infectious diseases are manifestations of an ecological interaction between the human species and another species of microorganisms. And epidemics are the result of a change in some environmental factor capable of influencing that interaction. Epidemic catastrophes are inevitable: firstly, because we cannot help but be part of trophic chains in which we eat and are eaten by microbes; secondly, because infections are evolutionary mechanisms and regulatory factors of ecological balance, which regulate especially the size of populations; and thirdly, because human technical interventions, in changing previous balances, create new balances that are more vulnerable. In this way human societies are more vulnerable the more complex. And human successes in modifying environmental conditions retain, or rather increase, the risk of epidemic catastrophes. All necessary epidemiological surveillance and control measures imaginable can lessen the damage caused by epidemics, but they can never prevent them.

Personnel Protective Equipment: Forgotten Protocol, Invigorated by COVID-19

Abstract Objective: To make the readers cognizant about the use of Personnel Protective Equipment (PPEs) and infection control practices which should always form a part of basic patient management and not arise with every emerging disease. Material and Methods: Authors personal clinical experiences and existing literature were summed up to infer relevant information related specifically to dentistry. A comprehensive review was done for the last 15 years in an attempt to explain the current state of understanding on the topic. Results: The authors have tried to compile the most probable reasons as to why PPEs have been a forgotten protocol, which can be enumerated as follows: decreased awareness, financial issues, boredom and lethargy, time constraints, unavailability, carelessness, and burnout due to long procedure and patient feeling discomfort/offended. Conclusion: COVID-19 being highly infectious, a dental clinic is a potential and genuine point of source for many new infections, and no confabulation is less to underline the importance of using PPEs during this pandemic or even otherwise.

Abscesos hepaticos en tiempos de pandemia (covid19) / Hepatic abscesses in time of pandemic (COVID 19)

Introducción. Los abscesos hepáticos son infecciones focales supurativas. La Klebsiella pneumoniae es el agente etiológico más frecuente. Afecta principalmente a hombres de edad media, diabéticos, con afecciones hepáticas o en contexto de inmunodepresión. Se clasifican en abscesos colangíticos, pioflebíticos, hematógenos, por continuidad, traumáticos y criptogénicos, según mecanismo de producción. Se manifiestan con dolor abdominal en hipocondrio derecho, sd. febril y sd. colestásico en presencia de obstrucción de vía biliar. La ecografía, TAC y la Resonancia magnética de abdomen son los métodos de elección para determinar topografía y morfología de las colecciones. El tratamiento consiste en el drenaje oportuno de la colección por vía percutánea o quirúrgica, asociado al tratamiento antibiótico. Objetivos: 1. Análisis epidemiológico de abscesos hepáticos durante la Pandemia por Covid 19 en una Institución privada de Tucumán. 2. Estudiar la fisiopatología y agentes patógenos responsables de los mismos. 3. Comparar estadísticas con era similar no Covid 19. Material y métodos. Estudio descriptivo retrospectivo. Se incluyeron seis pacientes con diagnóstico de Absceso Hepático, cinco de ellos del período de la era Covid 19 y uno de la era no Covid 19. Las variables analizadas fueron: cantidad de pacientes ingresados al Servicio, pacientes con absceso hepático, sexo, edad, comorbilidades, métodos de diagnóstico imagenológico utilizados, localización anatómica del absceso, número de lesiones, microbiología de la muestra quirúrgica y en sangre, tratamiento implementado, días desde el diagnóstico hasta la resolución, STROC y recidiva. Resultados: En el análisis epidemiológico se evidenció un notable descenso de la actividad quirúrgica en el periodo del 2020, respecto al mismo período del año previo, a predominio del mes de abril con un porcentaje de descenso del 52%, coincidiendo este período con el inicio de la cuarentena en la provincia. En nuestra serie resultaron todos masculinos, hipertensos y 3 de ellos diabéticos. Todos estudiados por ecografía y 3 complementaron con TAC con contraste EV. Fueron tratados en un promedio de 48hs desde el diagnóstico. Cultivos positivos, Klebsiella Pn (3), St aureus (1), E. Coli (1), Bacilo gram ­ (1). Hemocultivos: 3 negativos, 2 positivos para Klebsiella Pn y 1 para St. Aureus. 3 pacientes fueron sometidos a drenaje percutáneo, 2 a laparoscópico y uno convencional. Se registraron 2 STROC IIIA y 1 IIIB. Un paciente obitó, el resto recibió alta sanatorial. Se registraron 2 recidivas. Conclusiones: Nuestros pacientes, en su totalidad masculinos y diabéticos, desarrollaron abscesos hepáticos piógenos; el agente patógeno más frecuente fue la Klebsiella Pneumoniae. Los abscesos criptogénicos fueron los más prevalentes. En las recidivas documentadas, se determinó misma ubicación topográfica y agente etiológico del primer episodio, lo que nos lleva a preguntarnos sobre la eficacia del tratamiento implementado en cada caso.

Introduction: liver abscess is a common infection. Klebsiella pneumoniae was de most frecuently etiologic agent. The patients were middle-aged men with diabetes, another liver afection or immunodepression context. According to the production mechanism, they are classified in colangitics, pyophlebics, haematogenes, by continuity, traumatic and cryptogrnics. Patients usually present with right upper quadrant, fever, colestasic síndrome when bile-way obstruction exist. Imaging techniques such as ultrasonography, computed tomography scanning and magnetic resonance are useful tools to demostrtate a space occupying lesión and morfology of liver abscess. Treatment consist in timely drainage by percutaneous or surgical route, plus antibiotic treatment. Objetives: 1. Epidemiological análisis of liver abscesses during the pandemic Covid 19 in a private center in Tucumán. 2. Study physiology and pathogenic agents. 3. Campare statistics whit previusly period. Materials and methods: retrospective descriptive study. Six live abscess diagnosis patient were included, five of them included in stage Covid 19 and only one belong stage no Covid 19. Variables analysed: number of patients belong to the Service, number of patients whit liver abscess diagnosis, sex, age, comorbilities, imaging methods, location and number of abscess, microbiology of surgical sample and blood, treatment, days from diagnosis to resolution, STROC and recidivation. Results: epidemiological análisis showed a decrease in surgeries in the period 2020, compared to the same period of the previous year, a predominance in April with a percentage decrease of 52%, coinciding with the start of quarantine in the province. All patients were male, hypertensive and 3 of them with diabetes. Al lof them studied by ultrasound and tomography with contrast. They were treated at 48hours of diagnosis. Microbiology of surgical sample positive: Klebsiella Pn (3), St aureus (1), E. Coli (1), Bacillos gram ­ (1). Microbiology of blood: 3 negative, 2 positive to Klebsiella Pn and 1 to St. Aureus. 3 patients were drainage by percutaneous , 2 by laparoscopic and 1 by surgical conventional. They registered 2 STROC IIIA y 1 IIIB. 1 patiente dead, the rest were external from hospital. Conclusions: our patients developed liver abscess, they were male, diabetics and the most frecuently agent was the Klebsiella pneumoniae. Criptogenics abscess were the most prevalent. The same topographic location in the liver and the etiologic agent was determined in recurrence. That´s why we wonder about the effectiveness of the treatment implemented.

Fauna flebotomínica e soroprevalência para leishmaniose visceral canina em área urbana na região Centro-Oeste do Brasil / [Phlebotomine fauna and seroprevalence for canine visceral leishmaniasis in urban area from Central-West region of Brazil]

A leishmaniose visceral americana (LVA) é uma zoonose de transmissão vetorial na qual o cão tem papel importante na epidemiologia da doença. No Brasil, a elevada prevalência da infecção em cães está diretamente correlacionada com o aumento no risco de ocorrência de casos de LVA. O objetivo deste estudo foi investigar a fauna flebotomínica e verificar a soroprevalência da leishmaniose visceral canina (LVC) na localidade Pedra 90, no município de Cuiabá. Para o levantamento entomológico, armadilhas CDC foram utilizadas de agosto de 2014 a julho de 2015. Na avaliação sorológica dos cães, o teste imunocromatográfico DPP LVC foi utilizado para a triagem das amostras, enquanto o ensaio imunoenzimático (EIE) para o diagnóstico da LVC (Bio-Manguinhos) foi empregado como teste confirmatório. O trabalho vem acrescentar à fauna flebotomínica do município de Cuiabá as espécies Lu. andersoni, Lu. braziliensis, Lu. bourrouli e Lu. scaffi, não registradas em publicações anteriores. Além disso, entre as espécies de flebotomíneos com importância médica, Lu. cruzi, Lu. flaviscutellata e Lu. whitmani foram capturadas. No inquérito canino, a prevalência de LVC observada na localidade Pedra 90 foi de 1,14%, indicando que a região pode ser considerada como área de transmissão.(AU)

American visceral leishmaniasis (AVL) is a vector-borne zoonosis in which the dog has an important role in the epidemiology of the disease. In Brazil, a high prevalence of canine infection is directly correlated with an increased risk of occurrence of AVL. The aim of this study was to investigate the phlebotomine fauna and seroprevalence of canine visceral leishmaniasis in Pedra 90 region of Cuiabá municipality. For the entomological survey, CDC traps were used from August 2014 to July 2015. In the serological evaluation of dogs, the immunochromatographic test DPP LVC was employed for screening the samples while enzyme-linked immunosorbent assay (Bio-Manguinhos) was used as a confirmatory assay. The previously unreported phlebotomine species Lu. andersoni, Lu. braziliensis, Lu. bourrouli, and Lu. scaffi were added to the phlebotomine fauna of Cuiabá. In addition, the medically important phlebotomine species Lu. cruzi, Lu. flaviscutellata, and Lu. whitmani were identified. The canine survey revealed the prevalence of 1.14% for canine visceral leishmaniasis in the Pedra 90 region, the region being considered a transmission area.(AU)

Imagem Cardiovascular e Procedimentos Intervencionistas em Pacientes com Infecção pelo Novo Coronavírus / Cardiovascular Imaging and Interventional Procedures in Patients with Novel Coronavirus Infection

Resumo A pandemia da doença causada pelo novo coronavírus (COVID-19) trouxe grandes desafios para o sistema de saúde devido ao aumento exponencial do número de pacientes acometidos. A racionalização de recursos e a indicação correta e criteriosa de exames de imagem e procedimentos intervencionistas tornaram-se necessárias, priorizando a segurança do paciente, do ambiente e dos profissionais da saúde. Esta revisão visa auxiliar e orientar os profissionais envolvidos na realização desses exames e procedimentos a fazê-los de forma eficaz e segura.

Abstract The coronavirus disease 2019 (COVID-19) pandemic is a huge challenge to the health system because of the exponential increase in the number of individuals affected. The rational use of resources and correct and judicious indication for imaging exams and interventional procedures are necessary, prioritizing patient, healthcare personnel, and environmental safety. This review was aimed at guiding health professionals in safely and effectively performing imaging exams and interventional procedures.

Guía para la planificación, coordinación e implementación de las acciones de detección, aislamiento y seguimiento clínico de las personas afectadas por COVID-19 en mercados de abasto, así como de la vigilancia centinela / Guide for the planning, coordination and implementation of detection, isolation and clinical follow-up actions for people affected by COVID-19 in food markets, as well as sentinel surveillance

El documento contiene los procedimientos para detección, aislamiento y seguimiento de casos de COVID-19 en los mercados de abasto