A Novel Early Warning Model for Hand, Foot and Mouth Disease Prediction Based on a Graph Convolutional Network / 生物医学与环境科学（英文）

Objectives@#Hand, foot and mouth disease (HFMD) is a widespread infectious disease that causes a significant disease burden on society. To achieve early intervention and to prevent outbreaks of disease, we propose a novel warning model that can accurately predict the incidence of HFMD.@*Methods@#We propose a spatial-temporal graph convolutional network (STGCN) that combines spatial factors for surrounding cities with historical incidence over a certain time period to predict the future occurrence of HFMD in Guangdong and Shandong between 2011 and 2019. The 2011-2018 data served as the training and verification set, while data from 2019 served as the prediction set. Six important parameters were selected and verified in this model and the deviation was displayed by the root mean square error and the mean absolute error.@*Results@#As the first application using a STGCN for disease forecasting, we succeeded in accurately predicting the incidence of HFMD over a 12-week period at the prefecture level, especially for cities of significant concern.@*Conclusions@#This model provides a novel approach for infectious disease prediction and may help health administrative departments implement effective control measures up to 3 months in advance, which may significantly reduce the morbidity associated with HFMD in the future.

A systematic literature review of leptospirosis outbreaks worldwide, 1970-2012 / Revisión sistemática de los brotes de leptospirosis en el mundo, 1970-2012

ABSTRACT Objective. This review describes the geographic and temporal distribution of, detection methods for, and other epidemiological features of published leptospirosis outbreaks, with the aim of informing efforts to standardize outbreak-reporting practices. Methods. We conducted a systematic review of leptospirosis outbreaks reported in the scientific literature and ProMED during 1970-2012. Predefined criteria were used to identify and classify outbreaks and a standard form was used to extract information. Results. During 1970-2012, we identified 318 outbreaks (average: 7 outbreaks/year; range: 1-19). Most outbreaks were reported in the Latin America and the Caribbean region (36%), followed by Southern Asia (13%), and North America (11%). Most outbreaks were located in tropical and subtropical ecoregions (55%). Quality classification showed that there was clear description of laboratory-confirmed cases in 40% of outbreaks. Among those, the average outbreak size was 82 cases overall (range: 2-2 259) but reached 253 cases in tropical/subtropical ecoregions. Common risk factors included outdoor work activities (25%), exposure to floodwaters (23%), and recreational exposure to water (22%). Epidemiologic investigation was conducted in 80% of outbreaks, mainly as case interviews. Case fatality was 5% overall (range: 0%-60%). Conclusions. Outbreak reporting increased over the study period with outbreaks covering tropical and non-tropical regions. Outbreaks varied by size, setting, and risk factors; however, data reviewed often had limited information regarding diagnosis and epidemiology. Guidelines are recommended to develop standardized procedures for diagnostic and epidemiological investigations during an outbreak and for reporting.(AU)

RESUMEN Objetivo. Describir la distribución geográfica y temporal, los métodos de detección y otras características epidemiológicas de los brotes de leptospirosis publicados con el fin de fundamentar los esfuerzos tendientes a estandarizar las prácticas empleadas en la notificación de brotes. Métodos. Se llevó a cabo una revisión sistemática de los brotes de leptospirosis notificados en la bibliografía científica y en ProMED entre 1970 y 2012. Se utilizaron criterios predefinidos para identificar y clasificar los brotes y se empleó un formulario estándar para extraer la información. Resultados. Entre 1970 y 2012 se identificaron 318 brotes (promedio: 7 brotes/año; rango: 1-19), la mayoría de ellos en América Latina y el Caribe (36%), región seguida por Asia meridional (13%) y América del Norte (11%). La mayoría de los brotes se localizaron en ecorregiones tropicales y subtropicales (55%). La clasificación cualitativa reveló que en el 40% de los brotes había una clara descripción de los casos confirmados por laboratorio. Entre ellos, el tamaño promedio del brote fue de 82 casos (rango: 2-2259 casos) pero alcanzó los 253 casos en ecorregiones tropicales o subtropicales. Entre los factores de riesgo frecuentes figuraban las actividades laborales al aire libre (25%), la exposición a agua proveniente de inundaciones (23%) y la exposición a agua con fines recreativos (22%). En el 80% de los brotes se realizaron investigaciones epidemiológicas, principalmente entrevistas de casos. La mortalidad específica de los casos fue del 5% (rango: 0%-60%). Conclusiones. La notificación de brotes aumentó durante el período de estudio, y los brotes abarcaron regiones tropicales y no tropicales. Los brotes fueron diferentes en cuanto a su tamaño, el entorno y los factores de riesgo; sin embargo, los datos examinados con frecuencia incluían una información limitada respecto del diagnóstico y la epidemiología. Se recomiendan directrices para elaborar procedimientos estandarizados para las investigaciones diagnósticas y epidemiológicas durante un brote y para su notificación.(AU)

Niveles de estrés, ansiedad y depresión en la primera fase del brote del COVID-19 en una muestra recogida en el norte de España / Níveis de estresse, ansiedade e depressão na primeira fase do surto de COVID-19 em uma amostra no norte da Espanha / Stress, anxiety, and depression levels in the initial stage of the COVID-19 outbreak in a population sample in the northern Spain

En marzo de 2020, el virus SARS-CoV-2 procedente de China ha llegado a España y desde el 14 de marzo se ha declarado el estado de alarma en todo el Estado español, llevando al confinamiento a toda la población. La presente investigación se contextualiza en la Comunidad Autónoma Vasca (situada al norte de España). Se han analizado los niveles de estrés, ansiedad y depresión a la llegada del virus y se han estudiado los niveles de sintomatología psicológica según edad, cronicidad y confinamiento. Se ha recogido una muestra de 976 personas y la medición de las variables ansiedad, estrés y depresión se ha hecho mediante la escala DASS (Escala de Depresión, Ansiedad y Estrés). Los resultados demuestran que, aunque los niveles de sintomatología han sido bajos en general al principio de la alarma, la población más joven y con enfermedades crónicas ha referido sintomatología más alta que el resto de población. También se ha detectado un mayor nivel de sintomatología a partir del confinamiento, donde las personas tienen prohibido salir de sus casas. Se prevé que la sintomatología aumentará según vaya transcurriendo el confinamiento. Se defienden intervenciones psicológicas de prevención y tratamiento para bajar el impacto psicológico que pueda crear esta pandemia.

Em março de 2020, o vírus SARS-CoV-2, procedente da China, chegou à Espanha e desde 14 de março está declarado estado de emergência em todo o país, forçando toda a população ao confinamento. O presente estudo foi conduzido no País Basco (norte da Espanha). Foram analisados os níveis de estresse, ansiedade e depressão desde a introdução do vírus e os níveis de sintomas psicológicos segundo idade, comorbidades e confinamento. A amostra foi composta de 976 indivíduos e a medição das variáveis ansiedade, estresse e depressão foi realizada a partir do intrumento DASS (Escala de Depressão, Ansiedade e Estresse). Os resultados mostram que, ainda que os níveis de sintomas tenham sido baixos no início do confinamento, os indivíduos mais jovens e com comorbidades referiram mais sintomas que o restante da população. Também se detectou maior nível de sintomas desde o confinamento, quando a população foi proibida de sair de suas casas. Se prevê aumento dos sintomas conforme o confimaneto continuar. Intervenções psicológicas de prevenção e tratamento são necessárias para diminuir o impacto psicológico causado pela pandemia.

The SARS-CoV-2 virus reached Spain in March 2020, and a nationwide state of alert was declared on March 14th, leading to the confinement of the entire population. The current study was conducted in the Basque Autonomous Community in northern Spain. The authors analyzed stress, anxiety, and depression with the arrival of the virus and the levels of symptoms according to age, comorbidity, and confinement. Levels of anxiety, stress, and depression were measured in a sample of 976 adults, using the DASS scale (Depression Anxiety, and Stress Scale). Although levels of symptoms were generally low at the start of the alert, younger individuals with chronic diseases reported more symptoms than the rest of the population. The study also detected higher levels of symptoms after the stay-at-home order was issued. Such symptoms are predicted to increase as the confinement continues. The authors propose psychological interventions for prevention and treatment in order to mitigate the pandemic's psychological impacts.

Dengue outbreaks pattern in southern Guatemala / Patrón de brotes de Dengue en la región sur de Guatemala

This study analyses time series of dengue occurrence in the southern region of Guatemala. Temporal patterns of epidemic outbreaks in the department of Escuintla were investigated using the official reports from 2001 to 2013. In order to identify underlying associations with climate behavior, the epidemiological data were compared with historical reports available for temperature, rainfall and humidity. Preliminary results reveal that waves of dengue outbreaks exhibit a periodic pattern modulated by climatic conditions. A hierarchical cluster analysis allowed to indirectly estimate the degree of association of each climatic variable with dengue occurrences, showing the dominance of rainfall in dengue outbreaks patterns in three different localities. A further prospective analysis was performed to check whether epidemic trends driven by rainfall are hold in the subsequent years. Results presented here give support to predictive models for dengue incidence driven by climate.

Este estudio analiza series de tiempo de incidencia de dengue en la región sur de Guatemala. Los patrones temporales de los brotes epidémicos observados en el departamento de Escuintla se investigaron utilizando los informes oficiales de 2001 a 2013. Con el fin de identificar posibles asociaciones subyacentes con el comportamiento climático, los datos epidemiológicos se compararon con los informes históricos disponibles para temperatura, lluvia y humedad. Los resultados preliminares revelan que las olas de brotes de dengue exhiben un patrón periódico modulado por las condiciones climáticas. Un análisis de conglomerados jerárquicos permitió estimar indirectamente el grado de asociación de cada variable climática con las incidencias del dengue, mostrando el papel dominante de la lluvia en los patrones de brotes de dengue en tres localidades diferentes. Se realizó un análisis prospectivo adicional para verificar si las tendencias epidémicas causadas por las precipitaciones se mantienen en los años subsiguientes. Los resultados presentados aquí dan soporte a los modelos predictivos epidemiológicos con forzamiento estacional.

Levantamento de dados epidemiológicos de surtos de doenças transmitidas por alimentos na cidade de Juiz de Fora, MG, no período de 2007 a 2017 / Data research of foodborne diseases outbreaks from the city of Juiz de Fora, MG, in the period from 2007 to 2017

O perfil epidemiológico das doenças transmitidas por alimentos (DTAs) no Brasil ainda é pouco conhecido, nem todos os estados e/ou municípios dispõem de estatísticas e levantamentos reais sobre as variáveis associadas a essas enfermidades. O objetivo do trabalho foi realizar um levantamento dos dados sobre surtos de origem alimentar ocorridos em Juiz de Fora, MG, no período de 2007 a 2017. Houve 21 notificações de surtos, e em 71,42% desses não se identificou o agente etiológico envolvido. Dos alimentos incriminados, em 66,66% dos casos, estes eram ou continham em sua composição produtos de origem animal. A residência foi o local mais identificado como de início da ocorrência de surtos, representando 28,57% dos casos. Faz-se necessário o desenvolvimento de políticas públicas para a correta notificação das DTAs e, ainda, a conscientização de manipuladores de alimentos quanto aos cuidados na conservação e manipulação dos mesmos, com o objetivo reduzir a ocorrência dessas enfermidades.

Legionelosis ocupacional en mayores de 18 años: revisión sistemática / Occupational legionella in adults over 18 years pf age: a systematic review

Resumen El objetivo es revisar la literatura científica sobre los problemas de salud derivados de la exposición laboral a Legionella spp. Revisión sistemática de la literatura científica recogida en las bases de datos MEDLINE (Pubmed), ISI-Web of Science (Institute for Scientific Information), Cochrane Library Plus, Literatura Latinoamericana de Información en Ciencias de la Salud (LILACS) y SCOPUS, hasta febrero 2015. Los descriptores utilizados fueron: "Legionnaires' Disease" "Legionellosis" "Occupational Exposure" "Occupational Diseases". Se obtuvieron 222 referencias, que tras aplicar los criterios de inclusión y exclusión, se seleccionaron 13 artículos a texto completo. De ellos 9 artículos describen la aparición de neumonía, 4 Fiebre de Pontiac, 1 legionelosis o presunta legionelosis y 3 muerte. El principal agente causal en los profesionales expuestos fue Legionella pneumophila serogrupo 1. La infección por legionela está ligada a las profesiones donde existe nebulización por agua, principalmente en los trabajadores sometidos a largas exposiciones o incluso a la re-exposición. Los brotes se producen de forma estacional, sobre todo en los meses más cálidos.

Abstract The scope of this paper is to review the available scientific literature about the effects on health of occupational exposure to Legionella spp. A systematic review of the scientific literature retrieved from the MEDLINE (via PubMed), ISI-Web of Science (Institute for Scientific Information), Cochrane Library, LILCAS and SCOPUS databases through February 2015 was conducted. The key words used were ««Legionnaires' Disease¼ «Legionellosis¼ «Occupational Exposure¼ «Occupational Diseases¼. Two hundred and twenty-two references were retrieved of which, after applying inclusion/exclusion criteria, 13 complete articles were selected. Of these, 9 describe pneumonia, 4 list Pontiac Fever, 1 reveals legionellosis and 3 result in death. The main causative agent of disease in workers exposed was Legionella pneumophila serogroup 1. Legionella spp infection is closely related to professions where there is nebulization with water, mainly among workers subjected to long exposure or even re-exposure. Outbreaks occurs seasonally, especially in the hottest months.

Dinámica y caracterización epidemiológica del brote de dengue en Argentina año 2016: el caso de la Provincia de Buenos Aires / Dynamics and epidemiological characterization of the dengue outbreak in Argentina 2016: the case of the Province of Buenos Aires

Resumen Introducción: El dengue, de amplia distribución mundial, ha resurgido en Argentina tras más de 70 años de ausencia, con un comportamiento endémico en las provincias norteñas del país; durante el año 2016 se experimentó una diseminación epidémica a la Provincia de Buenos Aires. Objetivos: Caracterizar el brote de fiebre de dengue ocurrido en la Provincia de Buenos Aires, Argentina, durante el período de inicio y expansión del mismo entre enero y mayo del año 2016. Métodos: El Sistema Nacional de Vigilancia de la Salud proveyó los datos semanales, utilizándose, además, ArcGis para la localización espacial. Se empleó test de Knox para establecer relaciones de coordenadas temporo-espaciales y se diseñó la curva epidemiológica calculando el coeficiente de difusión. Resultados: El riesgo relativo y razones de tasas para casos confirmados y la razón infección fue caracterizada por un aumento rápido en su propagación, con conglomerados definidos acompañado de la modificación sostenida entre las razones de tasas de casos infectados provenientes de zonas endémicas y aquellos autóctonos. Hacia la semana 17, el brote cae teniendo los valores más bajos de difusión. Discusión: La información evaluada mediante diferentes sistemas de información y análisis permitió identificar debilidades de los mismos, así como visualizar "zonas calientes" de circulación del virus para determinar acciones tendientes a concentrar los esfuerzos de control de potenciales criaderos de estados inmaduros del mosquito en épocas invernales.

Background: Dengue fever, widely distributed throughout the world, has reemerged in Argentina after more than 70 years of absence, with an endemic behaviour in the northern provinces of the country. During the year 2016 an epidemic spread to the Province of Buenos Aires was experienced. Objective: To characterize the outbreak of dengue fever occurred in the Province of Buenos Aires, Argentina, during the period of beginning and expansion between January and May of the year 2016. Methods: The National Health Surveillance system provided weekly data, also using ArcGis for spatial localization. Knox test was used to establish spatial-temporal coordinates and the epidemiological curve was designed calculating the diffusion coefficient. Results: The relative risk and rates confirmed the epidemiological outbreak characterized by a rapid increase in propagation, with defined conglomerates. Towards week 17 the outbreak falls having the lowest diffusion values. Discussion: The information evaluated through different systems of information and analysis allowed to identify weaknesses of the same ones as well as to visualize "hot spots" of circulation of the virus in order to determine actions aimed at concentrating the efforts of control of potential breeding grounds for immature mosquitoes in winter times.

Yellow fever: profile of cases and factors associated with death in a hospital in the State of Rio de Janeiro, 2017-2018 / Febre amarela: perfil dos casos e fatores associados ao óbito em hospital referência no estado do Rio de Janeiro, 2017-2018

ABSTRACT OBJECTIVE Describe the clinical and epidemiological profile of confirmed cases of yellow fever whose patients were hospitalized in a general hospital for infectious diseases in the State of Rio de Janeiro, Brazil, from March 11, 2017 to June 15, 2018, during a recent outbreak and factors associated with death. METHODS This is a retrospective observational study with analysis of secondary databases of local epidemiological surveillance system, and complementary data collection from epidemiological investigation records and clinical records. Study variables included demographic, epidemiological, clinical, and laboratory data. A descriptive statistical analysis and a bivariate and multivariate analysis by logistic regression were performed to analyze factors associated with death. RESULTS Fifty-two patients diagnosed with yellow fever were hospitalized, 86.5% male patients, median age 49.5 years, 40.4% rural workers. The most frequent signs and symptoms were fever (90.4%), jaundice (86.5%), nausea and/or vomiting (69.2%), changes in renal excretion (53.8%), bleeding (50%), and abdominal pain (48.1%), with comorbidity in 38.5% of all cases. The lethality rate was 40.4%. Factors significantly associated with a higher chance of death in the bivariate analysis were: bleeding, changes in renal excretion, and maximum values of direct bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), urea, and creatinine. In the multivariate analysis by logistic regression, only changes in renal excretion and ALT remained significant predictors of higher chance of death. A threshold effect was also observed for AST. The cutoff points identified as high risk for death were ALT > 4,000 U/L and AST > 6,000 U/L. CONCLUSIONS This study contributed to the knowledge on the profile of confirmed cases of high severity yellow fever. The main factors associated with death were changes in renal excretion and elevated serum transaminases, especially ALT. High lethality emphasizes the need for early diagnosis and treatment, and the importance of increasing vaccination coverage.

RESUMO OBJETIVO Descrever o perfil clínico-epidemiológico dos casos confirmados de febre amarela internados em hospital geral de referência para doenças infecciosas no estado do Rio de Janeiro, Brasil, de 11 de março de 2017 a 15 de junho de 2018, durante recente surto e fatores associados ao óbito. MÉTODOS Estudo observacional retrospectivo, com análise de bases de dados secundários da vigilância epidemiológica local e coleta complementar de dados nas fichas de investigação epidemiológica e prontuários clínicos. As variáveis analisadas incluíram dados demográficos, epidemiológicos, clínicos e laboratoriais. Foi conduzida análise estatística descritiva bivariada e múltipla por regressão logística para estudo de fatores associados ao óbito. RESULTADOS Foram internados 52 casos confirmados, 86,5% deles homens, com mediana de idade de 49,5 anos e 40,4% trabalhadores rurais. Os sinais e sintomas mais frequentes foram: febre (90,4%), icterícia (86,5%), náuseas e/ou vômitos (69,2%), alterações de excreção renal (53,8%), hemorragias (50%) e dor abdominal (48,1%), com comorbidade em 38,5% dos casos. A letalidade foi de 40,4%. Os fatores associados significativamente à maior chance de óbito na análise bivariada foram: hemorragia, alterações de excreção renal e valores máximos de bilirrubina direta, aspartato aminotransferase (AST), alanina aminotransferase (ALT), ureia e creatinina. Na análise múltipla por regressão logística, apenas alterações de excreção renal e ALT permaneceram como preditores significativos de maior chance de óbito. Observou-se ainda efeito limítrofe para AST. Os pontos de corte identificados como de alto risco para óbito foram ALT > 4.000 U/L e AST > 6.000 U/L. CONCLUSÕES O estudo contribuiu para o conhecimento do perfil de casos confirmados de febre amarela com gravidade alta. Os principais fatores associados ao óbito foram a alteração da excreção renal e a elevação sérica de transaminases, sobretudo a ALT. A letalidade elevada reforça a necessidade de diagnóstico e tratamento precoces, e a importância do incremento da cobertura vacinal.

A localized outbreak of Chikungunya virus in Salvador, Bahia, Brazil

A localized Chikungunya virus (CHIKV; East/Central/South African genotype) outbreak (50 cases, 70% laboratory-confirmed; attack rate: 5.3 confirmed cases/100 people) occurred in a Salvador, Brazil neighborhood, between Apr-Jun/2017. Highly clustered cases in space and time, mostly along a single street, highlight an increased risk of CHIKV transmission among pockets of susceptible populations. This finding underscores the need for ongoing local level surveillance for arboviral outbreaks.

Análise dos surtos de origem alimentar notificados no Brasil no período de 2015 a 2017

Perigos químicos, físicos ou microbiológicos podem contaminar os alimentos e causar doenças de origem alimentar. Neste estudo foram analisados os surtos de doenças transmitidas por alimentos notificados no Brasil entre 2015 e 2017. Os resultados indicam que neste período foram notificados 1.758 surtos. O maior número de surtos ocorreu na região sudeste 37,1 %. Os locais de ocorrência dos surtos aconteceram em maior número nas residências (34,3%), restaurantes, padarias e similares (17,1 %) e 16,7% dos locais de ocorrência não foram identificados. Os alimentos mistos foram os mais envolvidos (13,6%), seguidos pela água (8,4%), carnes vermelhas (3,3%), leites e derivados (3,1%) e frutas (1,2%), sendo que em 66% dos surtos, os alimentos responsáveis não foram identificados. Os surtos foram principalmente de origem bacteriana, seguido por vírus e protozoários. No presente estudo, o micro-organismo causador do maior número de surtos foi a Escherichia coli (8%), seguido da Salmonella sp. (4%) e Staphylococcus sp. (3,9%), vale salientar que o agente etiológico não identificado, obteve o maior percentual com 74%, porém tal fato se deve ao atraso ou à inexistência das coletas, tanto clínicas como bromatológicas. Diante da análise dos dados, conclui-se que a maioria dos surtos de origem alimentar notificados no período apresentou resultados inconclusivos em relação aos micro-organismos e alimentos causadores destes, salientando, portanto que os órgãos fiscalizadores devem se preocupar em criar estratégias que possibilitem diminuir essas incidências inconclusas que interferem negativamente na possibilidade da criação de intervenções para minimizar a ocorrências destes tipos de surtos.

Chemical, physical or microbiological hazards can contaminate food and cause food-borne diseases. In this study we analyzed the foodborne disease outbreaks reported in Brazil between 2015 and 2017. The results indicate that in this period 1,758 were reported outbreaks. The largest number of outbreaks occurred in the southeastern region 37.1%. The locations of occurrence of outbreaks occurred in greater numbers in the residences (34.3%), restaurants, bakeries and similar (17.1 %) and 16. 7% of occurrence sites have not been identified. The mixed foods were the most involved (13.6%), followed by water (8.4%), red meat (3.3%), milk and dairy products (3.1%) and fruits (1.2%), and in 66% of the outbreaks, the food responsible have not been identified. The outbreaks were primarily of bacterial origin, followed by viruses and protozoa. In the present study, the microorganism which caused the largest number of outbreaks was Escherichia coli (8%), followed by Salmonella sp. (4%) and Staphylococcus sp. (3.9%), it's worth pointing out that the Etiologic Agent not identified, obtained the highest percentage with 74%, however such fact is due to the delay or the absence of the collections, both clinics as qualitative characteristics. On the analysis of the data, it is concluded that the majority of food-borne outbreaks reported inconclusive results regarding the microorganisms and foods that cause these, stressing, so that regulatory agencies should be bothering to create strategies to decrease these incidents that interfere negatively inconclusive negotiations on the possibility of creating interventions to minimize the occurrences of these types of outbreaks.

A Review of Traditional Vaccine-Preventable Diseases and the Potential Impact on the Otolaryngologist

Abstract Introduction A majority of otolaryngologists have not had direct experience with many vaccine-preventable diseases since the creation of national vaccination programs. Despite the elimination of endemic transmission of some of these diseases in the United States, outbreaks can occur anywhere and still pose a threat to public health around the world. Recent outbreaks and changing trends in exemption rates indicate that it is important for physicians to maintain a working knowledge of how these diseases present and of the recommended treatment guidelines. Objectives This review will evaluate the current state of vaccination rates, vaccine exemption rates and disease incidence in the United States and in the world. It will also examine the clinical presentation and treatment recommendations of these diseases. Data Synthesis United States estimated vaccination rates, vaccine exemption rates and vaccine-preventable disease incidences were obtained from data compiled by the Centers for Disease Control and Prevention. World vaccination rates and disease incidences were obtained from the World Health Organization databases, which compile official figures reported by member states. A PubMed literature review provided information on the current state of vaccination exemptions and outbreaks in the United States. Conclusion Vaccination and vaccine exemption rates continue to put the United States and many areas of the world at risk for outbreaks of vaccine-preventable diseases. Clinical guidelines should be reviewed in the event of a local outbreak.

Estudio y control de brote de tuberculosis en una Escuela Media del Área Programática del Hospital E. Tornú 2017-2018: Informe preliminar / Study and control of tuberculosis outbreak at a middle school of E. Tornú Hospital Programmatic Area 2017-2018: Preliminary report

Este informe refleja la primera etapa del análisis del evento epidemiológico en curso. Describe las acciones realizadas y los resultados preliminares obtenidos en el estudio de brote de tuberculosis ocurrido en una escuela técnica del AP Tornú en el período Febrero-Marzo de 2018: acciones desarrolladas y los resultados preliminares encontrados. Se estudiaron contactos institucionales y familiares de cada uno de los casos. Dentro de los contactos institucionales se incluyeron 5 divisiones, docentes y preceptores, de acuerdo a los listados provistos por la Dirección de la Escuela.(AU)

Characterisation of plasmid-mediated rmtB-1 in Enterobacteriaceae clinical isolates from São Paulo, Brazil

OBJECTIVES The emergence of 16S rRNA methyltranferases (16 RMTAses) has jeopardised the clinical use of aminoglycosides. RmtB is one of the most frequently reported in Gram-negatives worldwide. In this study, we aimed to estimate the frequency of 16S RMTAses encoding genes in Enterobacteriaceae isolated in a three-month period from a tertiary Brazilian hospital. METHODS All Gram-negatives classified as resistant to amikacin, gentamicin, and tobramycin by agar screening were selected for analysis. The presence of 16SRMTases encoding genes was verified by polymerase chain reaction (PCR). Antimicrobial susceptible profile was determined by broth microdilution. The genetic relationship among these isolates was accessed by pulsed field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Selected RmtB-producing isolates were characterised by whole genome sequencing (WGS) analysis. RESULTS Twenty-two of 1,052 (2.1%) Enterobacteriaceae were detected as producers of RmtB-1 [Klebsiella pneumoniae (n = 21) and Proteus mirabilis (n = 1)]. blaKPC-2 was identified among 20 RmtB-1-producing K. pneumoniae isolates that exhibited an identical PFGE and MLST (ST258) patterns. Two K. pneumoniae isolates, the A64216 (not harboring bla KPC-2), A64477 (harboring bla KPC-2) and one P. mirabilis isolate (A64421) were selected for WGS. rmtB-1 and bla KPC-2 genes were carried by distinct plasmids. While a plasmid belonging to the IncFIIk group harbored rmtB-1 in K. pneumoniae, this gene was carried by a non-typable plasmid in P. mirabilis. In the three analysed plasmids, rmtB-1 was inserted on a transposon, downstream a Tn2. CONCLUSION Our findings suggested that the rmtB-1 was harbored by plasmids distinct from those previously reported in Bolivia and China. It suggests that multiple mobilization events might have occurred in South America.

La vigilancia de los eventos sanitarios a través de los medios de comunicación en Perú / The Role of Media-Based Surveillance System for Public Health Events in Peru

RESUMEN Objetivo Caracterizar los eventos y brotes detectados por la vigilancia de eventos sanitarios a través de medios de comunicación entre los años 2013 y 2015. Además, determinar la proporción de eventos o brotes que no fueron captados por los sistemas de vigilancia regulares. Materiales y métodos Se analizaron los datos registrados por la vigilancia de eventos sanitarios a través de medios de comunicación del Centro Nacional de Epidemiologia y Control de Enfermedades (CDC). Esta vigilancia registra diariamente las noticias de los medios de comunicación escritos, radio, televisión e Internet del país, las clasifica por tipo de evento, determina si el evento fue registrado, investigado y confirmado, además, de evaluar si la noticia fue alarmista, informativa o educativa. Resultados Se notificó que el 49,4% de eventos que no habían sido identificados por los sistemas de vigilancia epidemiológica a nivel local, regional o nacional. Además, el 17,4% de las noticias analizadas fueron alarmistas. Conclusión Este tipo de vigilancia es una herramienta con un alto potencial para identificar brotes y/o eventos no identificados por los sistemas de vigilancia regulares, y deben de fortalecerse, además de usar sus resultados para mejorar la toma de decisiones.

ABSTRACT Objectives The objective of this study was to describe events and outbreaks identified by Media-Based Surveillance System for Public Health Events between 2013 and 2015. Further, to determine the percentage of events or outbreaks that were not identifing by regular surveillance systems. Materials and methods We analyzed the data collected from Media-Based Surveillance System for Public Health Events of the National Center for Epidemiology and Disease Control. This surveillance system records news from the written media, radio, television, and Internet in Peru on a daily basis; classifies them according to the type of event; determines whether the event was registered, investigated, and confirmed; and evaluates whether the news was alarmist, informative, or educational. Results Overall, 49.4% of the events reported had not been identified by epidemiological surveillance systems at the local, regional, or national level. In addition, 17.4% of the analyzed news was alarmist. Conclusion This type of surveillance has a high potential to identify outbreaks and/or health events not identified by regular surveillance systems and should thus be strengthened. In addition, the results of this tool may help to improve decision-making.

Informe especial de brote: Brote intrafamiliar de botulismo alimentario / Outbreak special report: Intrafamily outbreak of food botulism

Presentación de dos casos notificados el 24 de diciembre de 2016 a la Gerencia Operativa de Epidemiología de la Ciudad de Buenos Aires por la Dirección de Epidemiología Nacional, sospechosos de botulismo alimentario en integrantes de una familia, e internados en efectores públicos y privados de la Ciudad de Buenos Aires. Se describen el cuadro clínico y el tratamiento recibido, la evolución de los pacientes, la patología de la enfermedad, y acciones de vigilancia epidemiológica: definición de casos sospechosos, de casos notificados, y notificación de la enfermedad. Incluye datos de instituciones de referencia en la Ciudad de Buenos Aires, para atención de esta patología