Saúde mental e atuação de psicólogos hospitalares brasileiros na pandemia da covid-19 / Health and works of brazilian hospital psychologists in the covid-19 pandemic / Salud mental y actuación de psicólogos en hospitales brasileños en la pandemia del covid-19

Em março de 2020 a situação causada pela covid-19 foi elevada à categoria de pandemia, impactando de inúmeras formas a vida em sociedade. O objetivo deste estudo foi compreender os impactos da pandemia na atuação e saúde mental do psicólogo hospitalar, profissional que atua nos espaços de saúde e tem experienciado mais de perto o sofrimento dos doentes e dos profissionais de saúde frente à covid-19. Trata-se de um estudo exploratório-descritivo com 131 psicólogos que atuam em hospitais. Os profissionais foram convidados a participar através de redes sociais e redes de contatos das pesquisadoras, utilizando-se a técnica Bola de Neve. Foram utilizados dois questionários, disponibilizados na plataforma Google Forms, um abordando os impactos da pandemia sentidos pelos profissionais e outro referente ao sofrimento psíquico. Os dados foram analisados a partir de estatísticas descritivas e inferenciais. Foram observados impactos na atuação de quase a totalidade dos participantes, constatada a necessidade de preparação dos profissionais para o novo cenário, a percepção de pouco apoio institucional e quase metade da população estudada referiu-se a sintomas de sofrimento psíquico considerável desde o início da pandemia. É fundamental dar atenção a sinais e sintomas de sofrimento psíquico, procurando evitar o adoecimento de uma categoria profissional que se encontra na linha de frente do combate aos danos psicológicos da pandemia e cuja própria saúde mental é pouco abordada na literatura.(AU)

In March 2020, the COVID-19 pandemic breakout hugely impacted life in society. This study analyzes how the pandemic impacted hospital psychologists' mental health and performance, professional who more closely experienced the suffering of patients and health professionals in this period. An exploratory and descriptive study was conducted with 131 hospital psychologists. Professionals were invited to participate through the researchers' social and contact networks using the Snowball technique. Data were collected by two questionnaires available on the Google Forms platform, one addressing the impacts felt by professionals and the other regarding psychic suffering, and analyzed by descriptive and inferential statistics. Results showed that almost all participants had their performance affected by the need to prepare for the new scenario, the perceived little institutional support. Almost half of the study sample reported considerable psychological distress symptoms since the beginning of the pandemic. Paying attention to signs and symptoms of psychic suffering is fundamental to avoid compromising a professional category that is on the front line of combating the psychological damage caused by the pandemic and whose own mental health is little addressed by the literature.(AU)

En marzo de 2020, la situación provocada por el COVID-19 se caracterizó como pandemia e impactó el mundo de diversas maneras. El objetivo de este estudio fue comprender los impactos de la pandemia en la salud mental y la actuación del psicólogo en los hospitales, uno de los profesionales que trabaja en espacios sanitarios y que ha experimentado más de cerca el sufrimiento de pacientes y profesionales sanitarios frente al COVID-19. Este es un estudio exploratorio descriptivo, realizado con 131 psicólogos que trabajan en hospitales. Los profesionales recibieron la invitación a participar a través de las redes sociales y redes de contactos de las investigadoras, mediante la técnica snowball. Se utilizaron dos cuestionarios disponibles en la plataforma Google Forms: uno sobre los impactos de la pandemia en los profesionales y el otro sobre el sufrimiento psíquico. Los datos se analizaron a partir de estadísticas descriptivas e inferenciales. Se observaron impactos en el trabajo de casi todos los participantes, la necesidad de preparación de los profesionales para este nuevo escenario, la percepción de poco apoyo institucional, y casi la mitad de la población estudiada reportaron sentir síntomas de considerable angustia psicológica desde el inicio de la pandemia. Es esencial prestar atención a los signos y síntomas del sufrimiento psíquico, buscando evitar la enfermedad de una categoría profesional que está a la vanguardia de la lucha contra el daño psicológico de la pandemia y cuya propia salud mental se aborda poco en la literatura.(AU)

Creating Peru's patient zero: pandemic narratives through traditional and social media / Creando el paciente cero de Perú: narrativas sobre la pandemia a través de los medios de comunicación tradicionales y sociales

Abstract During the covid-19 pandemic, authorities, journalists, and the public used the term patient zero to refer to the first diagnosed patient. However, experts describe the term as imprecise because it equates the first infected patient with the first identified one. Although the term's inaccuracy, patients zero became relevant actors and sources of information during the pandemic. This was the case with the Peruvian patient zero, who had public media participation and opened his Instagram to establish a communication channel with the public. Despite knowing the term's inaccuracy, he felt responsible for the audience and sought to give his testimony. The Peruvian case shows how patients zero respond to the public interest and establish their agency through traditional and social media.

Resumen El coronavirus hizo que autoridades, periodistas y público designaran "paciente cero" al primer diagnosticado, aunque los especialistas calificaran al término como impreciso por equiparar el primer paciente infectado con el primero identificado. A pesar de esa inexactitud, pacientes cero se tornaron actores y fuentes de información relevante durante la pandemia. Fue el caso del paciente cero peruano, que participó en los medios de comunicación y abrió su Instagram para establecer un canal con el público. Conociendo la inexactitud del término, asimismo trató de dar su testimonio para aclarar la audiencia. El caso peruano muestra cómo pacientes cero responden al interés público y establecen sus acciones mediante los medios tradicionales y sociales.

Partner notification and associated factors among people living with human immunodeficiency Virus in Bushenge Hospital, Rwanda

Introduction Partner notification is among strategies adopted by WHO to identify people at risk of HIV infection among sexual partners with people living with HIV to achieve the 90-90-90 target. There is still a gap in Sub-Saharan Africa. Objective To assess the determinants of partner notification among people infected with HIV in Bushenge hospital. Methods An unmatched case control study was conducted, 141 people who successfully notified their sexual partners as controls and 141 who did not as cases were selected to identify the factors associated with partner notification. Data were analyzed with Stata V13. Results Most cases were female 81(58%); 91(64.5%) of cases and 97(68.8.5%) of controls were in couple, 40(28.8%)of cases and 67(48%) of controls had multiple partner. Thirty-five 35(25%) of cases and 51(36%) of controls were newly diagnosed; 73(74%) of cases and 78(86.6%) suppressed the viral load. Notification approach was associated with partner notification, aOR = 9, CI[2.8, 29]. Conclusion Partner notification as one of the strategies to reach the first 90 requires more efficient and effective efforts. Different initiatives are needed especially in partner notification approach.

Challenges of contact tracing during COVID-19 pandemic response in a tertiary hospital in Northwestern Nigeria

Background: Contact tracing is a traditional pillar of infectious disease control, especially for illnesses involving direct transmission from person to person, such as COVID-19. Several challenges have arisen from COVID-19 contact tracing activities, particularly in low-resource settings. These include refusal of positive clients to disclose their close contacts, difficulties in conducting risk assessment for contacts traced, among others. Objectives: To explore the activities and identify challenges of contact tracing during COVID -19 pandemic response in a tertiary hospital in Northwestern Nigeria from May, 2020 to March, 2021. Methodology: Amixed method approach was done with quantitative secondary data analysis of COVID-19 contacts traced, and qualitative assessment through Key Informant Interviews (KII) of Ahmadu Bello University Teaching Hospital staff involved in COVID-19 outbreak response during the period. Results: Atotal of 2,249 clients were tested for COVID-19, of which 925 (41.1%) were healthcare workers. The identified challenges included problems with contact identification, delay in notification of results, refusal to disclose contacts by cases, contacts refusing to allow risk assessment, and health workers being overwhelmed by the task of contact tracing. Conclusion: Challenges identified include refusal of cases to disclose their contacts, overwhelming number of contacts, and delay in notification of results. There is need to institute contact tracing protocols to mandate cases to disclose their contacts, train more manpower to reduce the burden of contact tracing, and improve the notification of results.

Viruela símica en países no endémicos - 20 de mayo de 2022 / Varíola do macaco em países não endêmicos - 20 de maio de 2022 / Monkeypox in non-endemic countries - 20 May 2022

Ante la ocurrencia de casos de viruela símica en algunos países dentro y fuera de la Región de las Américas, la Organización Panamericana de la Salud/ Organización Mundial de la Salud (OPS/OMS) comparte con sus Estados Miembros una serie de consideraciones en relación con la identificación de casos, el aislamiento, identificación y seguimiento de contactos, el manejo clínico y la prevención y el control de infecciones asociadas a la atención en salud. También se brinda orientaciones sobre tratamiento disponible y vacunas.

Diante da ocorrência de casos de varíola do macaco em alguns países dentro e fora da Região das Américas, a Organização Pan-Americana da Saúde/Organização Mundial da Saúde (OPAS/OMS) compartilha com seus Estados-Membros uma série de considerações em relação a identificação de casos, isolamento, identificação e acompanhamento de contatos, manejo clínico, e prevenção e controle de infecção relacionada à atenção a saúde. Também oferece orientações sobre tratamentos disponíveis e vacinas

Given the occurrence of cases of monkeypox in countries within and outside of the Region of the Americas, the Pan American Health Organization / World Health Organization (PAHO/WHO) shares with its Member States a series of considerations in relation to the identification of cases, the isolation, identification and follow-up of contacts, the clinical management, and the prevention and control of healthcare-associated infections. Guidance regarding available treatment and vaccines is also provided

Hanseníase em gêmeos de 3 anos em Mato Grosso, Brasil: a importância da baciloscopia no diagnóstico / Leprosy in 3-year-old twin children in Mato Grosso, Brazil: the importance of bacilloscopy in the diagnosis

Introdução: o diagnóstico clínico da hanseníase em crianças é particularmente difícil. Relato de Caso: crianças gêmeas bivitelinas, com três anos de idade, eram contactantes de pai com hanseníase Virchowiana. Os dois pacientes têm lesões cutâneas bem definidas e irregulares, anteriormente tratadas como micoses e uma cicatriz de BCG. Foram confirmados positivos para Mycobacterium por análise histopatológica da pele. Discussão: especialmente, com menos de cinco anos, os diagnósticos de hanseníase são raros e difíceis porque simulam outras doenças. Esses diagnósticos são alarmes epidemiológicos para áreas endêmicas e mostram a importância dos sintomas em crianças e o rastreamento nos contactantes dos pacientes.

Introduction: the clinical diagnosis of leprosy in children is particularly difficult. Case Report: fraternal twins, three years old, were in contact with a father with Virchowian leprosy. Both patients have well-defined and irregular skin lesions previously treated as mycoses and a BCG scar. They were confirmed positive for Mycobacterium by histopathological analysis of the skin. Discussion:especially, with less than five years, leprosy diagnoses are rare and difficult because they simulate other diseases. These diagnoses are epidemiological alarms for endemic areas and show the importance of symptoms in children and tracking of patients' contacts.

Epidemiological characteristics of local COVID-19 epidemics and control experience in routine prevention and control phase in China / 中华流行病学杂志

The COVID-19 pandemic is still ongoing in the world, the risk of COVID-19 spread from other countries or in the country will exist for a long term in China. In the routine prevention and control phase, a number of local COVID-19 epidemics have occurred in China, most COVID-19 cases were sporadic ones, but a few case clusters or outbreaks were reported. Winter and spring were the seasons with high incidences of the epidemics; border and port cities had higher risk for outbreaks. Active surveillance in key populations was an effective way for the early detection of the epidemics. Through a series of comprehensive prevention and control measures, including mass nucleic acid screening, close contact tracing and isolation, classified management of areas and groups at risk, wider social distancing and strict travel management, the local COVID-19 epidemics have been quickly and effectively controlled. The experiences obtained in the control of the local epidemics would benefit the routine prevention and control of COVID-19 in China. The occurrence of a series of COVID-19 case clusters or outbreaks has revealed the weakness or deficiencies in the COVID-19 prevention and control in China, so this paper suggests some measures for the improvement of the future prevention and control of COVID-19.

Course of disease and related epidemiological parameters of COVID-19: a prospective study based on contact tracing cohort / 中华预防医学杂志

Objective: To analyze the course of disease and epidemiological parameters of COVID-19 and provide evidence for making prevention and control strategies. Methods: To display the distribution of course of disease of the infectors who had close contacts with COVID-19 cases from January 1 to March 15, 2020 in Guangdong Provincial, the models of Lognormal, Weibull and gamma distribution were applied. A descriptive analysis was conducted on the basic characteristics and epidemiological parameters of course of disease. Results: In total, 515 of 11 580 close contacts were infected, with an attack rate about 4.4%, including 449 confirmed cases and 66 asymptomatic cases. Lognormal distribution was fitting best for latent period, incubation period, pre-symptomatic infection period of confirmed cases and infection period of asymptomatic cases; Gamma distribution was fitting best for infectious period and clinical symptom period of confirmed cases; Weibull distribution was fitting best for latent period of asymptomatic cases. The latent period, incubation period, pre-symptomatic infection period, infectious period and clinical symptoms period of confirmed cases were 4.50 (95%CI:3.86-5.13) days, 5.12 (95%CI:4.63-5.62) days, 0.87 (95%CI:0.67-1.07) days, 11.89 (95%CI:9.81-13.98) days and 22.00 (95%CI:21.24-22.77) days, respectively. The latent period and infectious period of asymptomatic cases were 8.88 (95%CI:6.89-10.86) days and 6.18 (95%CI:1.89-10.47) days, respectively. Conclusion: The estimated course of COVID-19 and related epidemiological parameters are similar to the existing data.

Tuberculosis infantil en Chile: ¿de dónde provienen los casos? / Childhood tuberculosis in Chile: where do the cases come from?

La tuberculosis es la principal causa de muerte por un agente infeccioso a nivel mundial y se estima que un 6% de los casos nuevos corresponde a tuberculosis infantil. La presencia de tuberculosis en niños es una señal de la existencia de transmisión del agente en la comunidad. Esta investigación busca describir las características epidemiológicas de la tuberculosis infantil en Chile entre 2011 y 2020. METODOLOGÍA: estudio descriptivo de los casos de tuberculosis infantil registrados en Chile entre los años 2011 y 2020. RESULTADOS: se registraron 544 casos de tuberculosis en menores de 15 años en el período analizado, con una tasa de incidencia anual entre 1,1 y 2,2 casos por 100.000. Se observa un importante aumento de casos en los últimos tres años, especialmente en el grupo de menores de 5 años. 63,2% corresponden a tuberculosis pulmonar, y de ellos 62,3% fueron confirmados por bacteriología. La mayoría de los casos no presenta comorbilidades que impliquen inmunosupresión y la incidencia de meningitis tuberculosa en menores de 5 años es baja. La proporción de contactos es de 29% y la de extranjeros de 17%, ambas variables en aumento en los últimos años. CONCLUSIÓN: La tuberculosis en niños sigue siendo un problema de salud poco frecuente en Chile. Sin embargo, su aumento en los últimos años debe alertar sobre un incremento de la transmisión comunitaria de la enfermedad, por lo que se debe reforzar la detección oportuna de casos contagiantes, la investigación de contactos y el tratamiento preventivo.

Tuberculosis is the leading cause of death from a single infectious agent worldwide and it is estimated that 6% of new cases are children. Childhood tuberculosis reflects ongoing transmission within communities. This study aims to describe the epidemiological characteristics of childhood tuberculosis in Chile between 2011 and 2020. METHODOLOGY: descriptive study of the cases of tuberculosis under 15 years-old registered in Chile from 2011 to 2020. RESULTS: 544 cases were registered in the period analyzed, with an annual incidence rate between 1.1 and 2.2 cases per 100,000. A significant increase in cases is observed in the last three years, especially in the group under 5 years-old. 63.2% correspond to pulmonary tuberculosis, and among them 62.3% are confirmed by bacteriology. Most of the cases do not have comorbidities and the incidence of tuberculous meningitis in children under 5 years is low. Contacts are 29% of the cases and foreigners are 17%, both percentages are increasing in the last years. CONCLUSION: Childhood tuberculosis remains a low frequency health problem in Chile. However, its increase in recent years implies an increase in the community transmission. Active case finding, contact tracing and preventive treatment should be reinforced.

Infección por SARS-CoV-2 en niños: características clínicas y dinámica de la transmisión de SARS-CoV-2 en un centro de salud privado: Uruguay / SARS-CoV-2 infection in children: clinical characteristics and dynamics of SARS-CoV-2 transmission in a private health center: Uruguay

INTRODUCCIÓN: Hasta la fecha, la prevalencia y gravedad de la enfermedad COVID- 19 en niños es menor que en adultos. Existen controversias en relación a la dinámica de la transmisión y al rol que juegan en la diseminación de la enfermedad. OBJETIVO: Describir las características clínicas y la dinámica de transmisión de los pacientes bajo 15 años de edad notificados por sospecha y/o contacto para COVID-19 en el período 13 marzo - 20 noviembre 2020, en un prestador integral privado de salud (Médica Uruguaya Corporación de Asistencia Médica, MUCAM). METODOLOGÍA: Estudio descriptivo, retrospectivo, en el que se describen manifestaciones clínicas, noción epidemiológica, casos secundarios, gravedad y evolución. Se estimó el riesgo y la tasa de ataque secundaria intradomiciliaria. RESULTADOS: Cumplieron los criterios de inclusión 539 pacientes. El diagnóstico se confirmó en 29 (5,3%): 13 (7,0%) de los 351 niños sintomáticos y 16 (4,5%) de los 188 asintomáticos. Tuvieron noción de contacto el 100% de los casos confirmados y 85% de los no confirmados (p < 0.05). El OR para la infección a partir de un contacto intradomiciliario fue 26,5 (9,8- 71,7) y la tasa de ataque secundaria intradomiciliaria 23% ± 4,1. CONCLUSIONES: En esta serie, en los pacientes bajo 15 años de edad predominaron las formas leves y asintomáticas. Uno de cada cinco expuestos intradomiciliarios contrajo la enfermedad siendo esta noción de contacto decisiva para indicar estudios confirmatorios. La mayoría de los niños no continuó la cadena de transmisión.

BACKGROUND: To date, the prevalence and severity of the COVID-19 disease in children is lower than in adults. There are controversies regarding the dynamics of transmission and the role they play in the spread of the disease. AIM: To describe the clinical characteristics and transmission dynamics of patients under 15 years of age reported for suspicion and/or contact for COVID-19 in the period March 13 - November 20, 2020, in a private comprehensive health provider (Médica Uruguaya Medical Assistance Corporation, MUCAM). METHODS: Descriptive, retrospective study, in which clinical manifestations, epidemiological notion, secondary cases, severity and evolution are described. The risk and rate of secondary intradomiciliary attack were estimated. RESULTS: 539 patients met the inclusion criteria. The diagnosis was confirmed in 29 (5.3%): 13 (7.0%) of the 351 symptomatic children and 16 (4.5%) of the 188 asymptomatic. 100% of the confirmed cases and 85% of the unconfirmed cases had the notion of contact (p < 0.05). The OR for infection from an indoor contact was 26.5 (9.8-71.7) and the rate of secondary indoor attack 23% ± 4.1. CONCLUSIONS: In this series, mild and asymptomatic forms predominated in patients under 15 years of age. One in five exposed indoors contracted the disease, this notion of contact being decisive to indicate confirmatory studies. Most of the children did not continue the chain of transmission.

Seguimiento de los contactos de casos de tuberculosis / Follow-up of Contacts of Tuberculosis Cases

Introducción: La tuberculosis constituye la principal causa de muerte en el mundo por enfermedad infecciosa. Objetivo: Verificar el cumplimiento de las acciones de control de foco de los contactos de casos de tuberculosis. Métodos: Estudio descriptivo, transversal. Universo constituido por los 338 contactos identificados de 10 casos de tuberculosis. Los datos procedieron de encuestas epidemiológicas, base de datos de morbilidad y tarjetas de notificación de la unidad municipal de higiene y epidemiologia del municipio Boyeros. Se utilizaron las variables: edad, sexo, nivel educacional y ocupación. Se identificaron los factores de vulnerabilidad en los contactos y se verificó cumplimiento del examen médico, los complementarios, realización y resultado de prueba de tuberculina, quimioprofilaxis y seguimiento. Resultados: Prevaleció el sexo masculino (64,2 por ciento) y los mayores de 65 años (46,7 por ciento). Los grupos vulnerables más frecuentes fueron los contactos en unidades de salud con internamiento prolongado y más de 60 años (87,2 por ciento y 62,1 por ciento, respectivamente). No se detectó el número real de contactos y convivientes ni fue investigado el 100 por ciento. Las pruebas de tuberculina realizadas arrojaron el mayor porciento de no reactores, el 90 por ciento de los contactos recibieron quimiprofilaxis y su seguimiento fue deficiente. Conclusiones: La no detección oportuna de los contactos y convivientes de casos de tuberculosis y los incumplimientos de su estudio constituyeron las principales deficiencias de los controles de foco realizados. El seguimiento de los contactos fue inadecuado, lo que pudiera propiciar la aparición de nuevos casos de tuberculosis en el municipio(AU)

Introduction: Tuberculosis is worldwide the main cause of death due to infectious disease. Objective: To verify compliance with outbreak control actions associated with contacts of tuberculosis cases. Methods: Descriptive and cross-sectional study. The universe was made up of the 338 contacts identified from ten cases of tuberculosis. The data came from epidemiological surveys, morbidity database and notification cards of the municipal hygiene and epidemiology unit of Boyeros Municipality. The following variables were used: age, sex, educational level and occupation. The vulnerability factors in the contacts were identified, as well as compliance with medical examination, complementary tests, performance and result of tuberculin test, chemoprophylaxis and follow-up. Results: The male sex (64.2 percent) and people over 65 years of age (46.7 percent) prevailed. The most frequent vulnerable groups were contacts in health units with prolonged hospitalization and aged over 60 years (87.2 percent and 62.1 percent, respectively). The actual number of contacts and partners was not detected, nor 100 percent of them were investigated. The tuberculin tests carried out showed the highest percentage of non-reactors. 90 percent of the contacts received chemoprophylaxis and their follow-up was poor. Conclusions: There was no timely detection of the contacts and cohabitants of tuberculosis cases and no compliance with their study, which constituted the main deficiencies of the outbreak controls carried out. The follow-up of the contacts was inadequate, which could lead to the appearance of new cases of tuberculosis in the municipality(AU)

Algunas consideraciones sobre la organización del sistema sanitario frente a una pandemia / Considerations regarding organizing healthcare systems for a pandemic

No hay fórmula única para enfrentar una pandemia. La diversidad de liderazgos, objetivos sanitarios, escenarios, culturas, financiamiento, y organizaciones de sistemas de salud existentes obligan a cada país a buscar sus propias estrategias. La pandemia causada por el virus SARS-CoV-2 y la tremenda cantidad de información que se ha generado a su entorno ha motivado la necesidad de evaluar la preparación de los sistemas de salud para enfrentar, responder y sobrevivir a un evento de esta naturaleza. Este artículo aporta consideraciones al respecto.

There is no "one size fits all" solution for healthcare systems when it comes to pandemics. Different and diverse scenarios with regards to financing, healthcare system structure, cultural issues and political orientation force countries to seek the most appropriate strategies for their particular case. The SARS-CoV-2 pandemic and the tremendous amount of information that is has generated pressures the need for healthcare systems to seriously evaluate how prepared they are for facing, responding and emerging from an event of this nature. This article offers considerations on the subject.

Impacto de la primera ola pandémica de COVID-19 en el personal de salud en un hospital privado / Impact of the first pandemic wave of COVID-19 on health-care workers in a private hospital

El personal de salud (PS) está más expuesto que la población general a enfermar por SARS-CoV-2, por lo que debe utilizar elementos de protección personal (EPP) en todas las atenciones. El PS de Clínica Las Condes (CLC) que requirió licencia médica (LM) por COVID-19 durante el periodo de estudio, fue evaluado por Organismo Administrador según Ley 16.744, categorizando cada caso de contacto estrecho (CE) o contagio, en común o laboral. Además, fue contactado en su totalidad por equipo de RRHH y de IAAS, para conocer estado de salud, factores de riesgo y evolución. El objetivo fue caracterizar los casos y CE de PS que tuvieron LM, relacionándolas con diferentes eventos ocurridos en la institución y la comunidad durante el periodo comprendido entre el 12 de febrero y el 31 de julio. Un 21% del PS requirió LM en el periodo y un 12,97% presentó infección confirmada por PCR. En cuanto a la distribución por sexo y edad de casos y CE, esta no difiere de la distribución observada en el total de funcionarios de CLC. Se observa que, en los casos, la mayoría corresponde a categoría intrahospitalaria, en cambio los CE, la mayor parte correspondió a comunitario. En relación con casos confirmados intrahospitalarios, destaca que el primer caso ocurrió 63 días después del primer paciente hospitalizado en CLC con diagnóstico de COVID-19, y cuando ya estaba instalada la epidemia en la Región Metropolitana (RM) de Santiago , lo que refleja la efectividad de las medidas de prevención adoptadas al interior de CLC.

Health care workers (HCW) are at higher risk to get sick from SARS-CoV-2 than general population, so they must use personal protective equipment (PPE) in all care situations. The HCW at Clinica las Condes (CLC) that required a sick leave (SL) during the study period was evaluated by the Administrative Institution according to Law 16.744, which categorized each case of close contact (CC) or confirmed case, as community-acquired (CA) or health care-associated (HCA). In addition, all of them were traced by the HR and Infection Control team, to find out health status, risk factors and evolution. The aims were to characterize the confirmed cases and CC, their association with key events that occurred in the institution and the community between February 12th and July 31th. 21%

Field evaluation of COVID­19 antigen tests versus RNA based detection: Potential lower sensitivity compensated by immediate results, technical simplicity, and low cost

One year into the coronavirus disease 2019 (COVID­19) pandemic, diagnosticstrategies, although central for contact tracing and other preventive measures, arestill limited. To meet the global demand, lower cost and faster antigen tests forsevere acute respiratory syndrome coronavirus 2 (SARS­CoV­2) detection are aconvenient alternative to the gold standard reverse transcription­polymerase chainreaction (RT­PCR) assay. We tested laboratory­based RT­PCR RNA detection andtwo rapid antigen detection (RAD) tests, based on the immunochromatography testfor nucleocapsid protein of SARS­CoV­2 (COVID­19 Ag ECO Test, ECO Diagnóstica,and Panbio COVID­19 Ag Rapid Test Abbott). Paired collection and testing weredone in a small prospective open study in three clinical services in São Paulo,constituted of mostly symptomatic volunteers at collection (97%, 109/112) for amedian of 4 days (interquartile range: 3­6), ranging from 1 to 30. Among the108 paired RT­PCR/RAD tests, results were concordant in 96.4% (101/108). Thetest's performance was comparable, with an overall sensitivity of 87% and aspecificity of 96%. These observations add to other data that suggest that antigentests may provide reasonable sensitivity and specificity and deserve a role toimprove testing strategies, especially in resource­limited settings.

Fatores sociodemográficos e clínicos de casos de hanseníase associados ao desempenho da avaliação de seus contatos no Ceará, 2008-2019 / Factores sociodemográficos y clínicos de los casos de lepra asociados con el desempeño de la evaluación de sus contactos en Ceará, Brasil, 2008-2019 / Socio-demographic and clinical factors of leprosy cases associated with the performance of the evaluation of their contacts in Ceará, Brazil, 2008-2019

Objetivo:Analisar o efeito de características sociodemográficas e clínicas de casos novos (CNs) de hanseníase como determinantes no desempenho da avaliação dos contatos. Métodos: Estudo transversal, com abordagem temporal do indicador de avaliação de 100% os contatos examinados de CNs registrados no Ceará, Brasil, via Sistema de Informação de Agravos de Notificação (Sinan), em 2008-2019. Empregou-se regressão logística para estimar razão de chances-odds ratio (OR) com intervalos de confiança de 95% (IC95%). A tendência temporal baseou-se em regressão joinpoint. Resultados: Foram analisados 23.675 CNs, 65,4% com contatos examinados. Verificou-se maior chance para não avaliação de 100% dos contatos registrados com CN multibacilar (OR=1,19 - IC95% 1,11;1,28) e com exame de contatos como modo de entrada (OR=1,71 - IC95% 1,35;2,18). A tendência temporal do indicador foi de aumento (variação percentual anual: 2,1 - IC95% 1,2;3,0). Conclusão: Dimensões distintas de vulnerabilidade individual e social de CNs de hanseníase influenciam o persistente desempenho insatisfatório da avaliação de contatos.

Objetivo: Analizar la asociación entre características sociodemográficas y clínicas de casos nuevos (CNs) de lepra como determinantes para el desempeño de la evaluación de contactos. Métodos: Estudio transversal con abordaje temporal del indicador de evaluación de 100% de los contactos examinados de cada CN registrado en el Sistema de Información de Enfermedades Notificables del Estado de Ceará, Brasil, 2008-2019. Análisis de regresión logística para estimar la razón de probabilidades (OR) e intervalos de confianza de 95% (IC95%), y tendencia temporal basada por regresión joinpoint. Resultados: Fueron analizados 23.675 CN, 65,4% con contactos examinados. Se verificó mayor probabilidad para la no-evaluación del 100% de los contactos registrados cuando el CN: era multibacilar (OR=1,19 - IC95% 1,11;1,28) y forma de entrada por examen de contactos (OR=1,71 - IC95% 1,35;2,18). Tendencia temporal de aumento de este indicador (cambio porcentual anual: 2,1 (IC95% 1,2;3,0). Conclusión: Diferentes dimensiones de la vulnerabilidad individual y social de los nuevos casos de lepra en Ceará influyen en el desempeño insatisfactorio persistente de la evaluación de sus contactos.

Objective: To analyze the effect of sociodemographic and clinical characteristics of new leprosy cases as determinants in the performance of the evaluation of their contacts Methods: This was a cross-sectional study, with a temporal approach to the evaluation indicator of 100% of contacts examined of each new case (NC) registered in the state of Ceará, Brazil, on the Notifiable Diseases Information System (SINAN), in 2008-2019. Logistic regression was used to estimate odds ratio (OR) with 95% confidence intervals (95%CI). The temporal trends were analyzed using joinpoint regression. Results: 23,675 NCs, 65.4% with contacts examined were analyzed. It was less likely to evaluate 100% of the registered contacts when the new cases were multibacillary (OR=1.19 - 95%CI 1.11;1.28) and with examination of contacts as an entry mode (OR=1.71 - 95%CI 1.35;2.18). There was an increasing temporal trend of the indicator (Annual Percentage Change: 2.1 - 95%CI 1.2;3.0). Conclusion: Distinct dimensions of individual and social vulnerability among new leprosy cases influenced the persistent unsatisfactory performance of the evaluation of contacts.

Modelling the impact of contact tracing of symptomatic individuals on the COVID-19 epidemic

OBJECTIVES: With the declining numbers of coronavirus disease 2019 (COVID-19) cases in the state of São Paulo, Brazil, social distancing measures have gradually been lifted. However, the risk of a surge in the number of cases cannot be overlooked. Even with the adoption of nonpharmaceutical interventions, such as restrictions on mass gatherings, wearing of masks, and complete or partial closure of schools, other public health measures may help control the epidemic. We aimed to evaluate the impact of the contact tracing of symptomatic individuals on the COVID-19 epidemic regardless of the use of diagnostic testing. METHODS: We developed a mathematical model that includes isolation of symptomatic individuals and tracing of contacts to assess the effects of the contact tracing of symptomatic individuals on the COVID-19 epidemic in the state of São Paulo. RESULTS: For a selection efficacy (proportion of isolated contacts who are infected) of 80%, cases and deaths may be reduced by 80% after 60 days when 5000 symptomatic individuals are isolated per day, each of them together with 10 contacts. On the other hand, for a selection efficacy of 20%, the number of cases and deaths may be reduced by approximately 40% and 50%, respectively, compared with the scenario in which no contact-tracing strategy is implemented. CONCLUSION: Contact tracing of symptomatic individuals may potentially be an alternative strategy when the number of diagnostic tests available is not sufficient for massive testing.

Utility of early diagnosis, contact tracing and stakeholder engagement in outbreak response in three COVID-19 outbreak settings in Ghana

Objective: To describe how early case detection, testing and contact tracing measures were deployed by stakeholders in response to the COVID-19 outbreak in Ghana ­ using three outbreak scenarios. Design: A descriptive assessment of three case studies of COVID-19 outbreaks within three settings that occurred in Ghana from March 13 till the end of June 2020. Setting: A construction camp, a factory and a training institution in Ghana. Participants: Staff of a construction camp, a factory, workers and students of a training institution. Interventions: We described and compared the three COVID-19 outbreak scenarios in Ghana, highlighting identification and diagnosis of cases, testing, contact tracing and stakeholder engagement for each scenario. We also outlined the challenges and lessons learnt in the management of these scenarios. Main outcome measures: Approach used for diagnosis, testing, contact tracing and stakeholder engagement. Results: Index cases of the training institution and construction camp were screened the same day of reporting symptoms, whiles the factory index case required a second visit before the screening. All index cases were tested with RTPCR. The training institution followed and tested all contacts, and an enhanced contact tracing approach was conducted for staff of the other two sites. Multi-sectorial engagement and collaboration with stakeholders enabled effective handling of the outbreak response in all sites. Conclusion: Comparing all three settings, early diagnosis and prompt actions taken through multi-sectorial collaborations played a major role in controlling the outbreak. Engaging stakeholders in the COVID-19 response is an effective way to mitigate the challenges in responding to the pandemic.

Industry and workplace characteristics associated with the downloading of a COVID-19 contact tracing app in Japan: a nation-wide cross-sectional study

BACKGROUND@#To combat coronavirus disease 2019 (COVID-19), many countries have used contact tracing apps, including Japan's voluntary-use contact-confirming application (COCOA). The current study aimed to identify industry and workplace characteristics associated with the downloading of this COVID-19 contact tracing app.@*METHODS@#This cross-sectional study of full-time workers used an online survey. Multiple logistic regression analysis was used to evaluate the associations of industry and workplace characteristics with contact tracing app use.@*RESULTS@#Of the 27,036 participants, 25.1% had downloaded the COCOA. Workers in the public service (adjusted odds ratio [aOR] = 1.29, 95% confidence interval [CI] 1.14-1.45) and information technology (aOR = 1.38, 95% CI 1.20-1.58) industries were more likely to use the app than were those in the manufacturing industry. In contrast, app usage was less common among workers in the retail and wholesale (aOR = 0.87, 95% CI 0.76-0.99) and food/beverage (aOR = 0.81, 95% CI 0.70-0.94) industries, but further adjustment for company size attenuated these associations. Workers at larger companies were more likely to use the app. Compared with permanent employees, the odds of using the app were higher for managers and civil servants but lower for those who were self-employed.@*CONCLUSIONS@#Downloading of COCOA among Japanese workers was insufficient; thus, the mitigating effect of COCOA on the COVID-19 pandemic is considered to be limited. One possible reason for the under-implementation of the contact tracing app in the retail and wholesale and food/beverage industries is small company size, as suggested by the fully adjusted model results. An awareness campaign should be conducted to promote the widespread use of the contact tracing app in these industries.

La salud pública en la primera ola: una agenda para la cooperación ante Covid-19 / Public health in the first wave: a research agenda for cooperation under Covid-19

Resumen El Covid-19 representa uno de los retos más grandes en la historia reciente de la salud pública. Es fundamental que se fortalezcan los lazos de cooperación científica bajo un objetivo común: proteger la salud de la población. En este artículo se presentan ideas que necesitan un desarrollo urgente y colaborativo. Se discute la estimación de la magnitud de la epidemia mediante un panel nacional de seroprevalencia y nuevas estrategias para mejorar el monitoreo en tiempo real de la epidemia. También se analizan las externalidades negativas asociadas con la respuesta a la pandemia. Finalmente, se presenta un marco general para el desarrollo de ideas para salir del confinamiento, resaltando la importancia de implementar acciones estructurales, sostenibles y equitativas. Se hace un llamado a la solidaridad y la cooperación, donde nuestros esfuerzos y creatividad se dediquen a la resolución de los problemas que enfrentan México y el mundo.

Abstract Covid-19 represents one of the largest challenges in the recent history of public health. It is fundamental that we strengthen scientific cooperation under a common goal: to protect the health of the population. In this article, we present ideas that need urgent and collaborative efforts. We discuss the estimation of the magnitude of the epidemic through a nationwide seroprevalence panel, as well as new strategies to monitor the epidemic in real time. We also analyze the negative externalities associated to the pandemic. Finally, we present a general framework to develop ideas to come out of the lockdown, highlighting the importance of implementing sustainable and equitable structural interventions. We call for solidarity and cooperation, focusing our efforts and creativity in the resolution of the problems that currently affect Mexico and the world.