Enfermedades emergentes, pobreza y hambre / Emerging diseases, poverty and hunger

La pobreza y el hambre son elementos significativos para la prevalencia de las enfermedades emergentes, además de la ignorancia, la indigencia, las falencias sanitarias y los cambios ambientales debidos al calentamiento global. La desnutrición es consecuencia de la pobreza y ésta es causa de desnutrición. Los niños que viven en condiciones de mayor vulnerabilidad tienen un riesgo alto de morir por diarrea, neumonía y enfermedades emergentes. La mayoría son desnutridos. Su futuro en la adultez guarda relación con la desnutrición en la infancia. En el mundo 820 millones de niños padecen hambre y mueren anualmente 3 millones de menores de 5 años, según datos del Fondo de las Naciones Unidas para la Infancia. En Argentina, según datos del segundo semestre de 2022, un 39,2% de la población es pobre (Instituto Nacional de Estadísticas y Censos). El 15,5% de niños y adolescentes padecen inseguridad alimentaria y 2 millones de niños padecen hambre (Médicos sin Fronteras). La tasa de mortalidad infantil en menores de 5 años tiene una prevalencia del 0,4%. Los cambios climáticos ejercen influencia sobre la salud, produciendo cambios en la epidemiologia de las enfermedades emergentes, mientras que la insuficiente alimentación ocasiona efectos negativos sobre la salud. El calentamiento global aumenta las inundaciones y las sequías, incidiendo en la escasez de alimentos e incrementando las enfermedades emergentes. La situación debe ser revertida mediante el desarrollo sostenido de la educación, el bienestar social y los proyectos sanitarios. (AU)

Poverty and hunger are significant elements for the prevalence of emerging diseases, in addition to ignorance, indigence, sanitary deficiencies and environmental changes due to global warming. Malnutrition is a consequence of poverty and poverty is a cause of malnutrition. Children living in more vulnerable conditions are at greater risk of dying from diarrhea, pneumonia and emerging diseases. Most are malnourished. Their future in adulthood is related to malnutrition in childhood. Worldwide, 820 million children suffer from hunger and 3 million children under 5 die annually (United Nations Children's Fund). In Argentina, according to data from the second half of 2022, 39.2% of the population is poor (Instituto Nacional de Estadísticas y Censos). 15.5% of children and adolescents are food insecure and 2 million children are hungry (Médecins Sans Frontières). The infant mortality rate in children under 5 years of age has a prevalence of 0.4%. Climate change influences health, producing changes in the epidemiology of emerging diseases, while insufficient food has negative effects on health. Global warming increases floods and droughts, leading to food shortages and increasing emerging diseases. The situation must be reversed through sustained development of education, social welfare and health projects. (AU)

Overview of Q fever in Brazil: an underestimated zoonosis

ABSTRACT This review aims to provide current information about Q fever, elucidating the etiological, epidemiological, pathogenic, clinical, diagnostic, therapeutic, and prophylactic aspects of the disease for the medical community. We discuss the main forms of presentation of the agent, its ability to persist in the body, the infinite possibilities of susceptible hosts, the main known forms of transmission, its importance in populations at occupational risk, and the role of arthropods in the natural history of the disease. Focusing on Brazil, we present the cases already described and studies developed since its first report, and how there is still much to unravel. We are aware of the possibilities of the persistence of the agent and the development of severe clinical pictures and the specific treatments currently instituted. We also wish to raise awareness about the future, the new genotypes that are emerging, the need to study the effects of vaccines, and the impact of Q fever on the population. Q fever is a poorly understood disease in Latin America, and recent studies, especially in Brazil, have revealed the importance of developing new studies.

Retos actuales a la enseñanza de la virología para enfrentar enfermedades emergentes / Current challenges to the teaching of virology to face emerging diseases

En los últimos años los microorganismos han generado múltiples evoluciones, provocando enfermedades y problemas agudos de salud pública. Para poder controlar las virosis es necesario conocer su biología y epidemiología, establecer tratamiento y profilaxis adecuada para su control. Para ello, es indispensable comenzar con la formación de los profesionales de la salud, en particular, los estudiantes de medicina, es necesario potenciar el desarrollo de sus habilidades y competencias, no solo dominio del conocimiento científico, si no también pueda promoverlo, transferirlo y aplicarlo con impacto en la salud colectiva y que vaya a la par de los avances tecno-científicos. Es por ello, que surge la inquietud del fórum, discusión acerca del análisis de la enseñanza de la virología para enfrentar enfermedades emergentes en función de perfil del egresado. Se realizó encuesta a los estudiantes de los últimos diez años de la carrera de medicina de UNIANDES, sobre la biología, epidemiologia, respuesta inmunológica y diagnóstico, para mencionadas áreas de conocimiento se obtuvo, tanto en la evaluación objetiva estructurada y evaluación práctica, un nivel altamente satisfactorio. En la pirámide de Miller, se alcanzó nivel tres con conocimiento y desarrollo de habilidades, destrezas y actitudes del egresado satisfactorias. Sin embargo, los profesores de Virología están de acuerdo con innovar en la docencia integrando los contenidos transversalmente a las áreas de conocimiento: enfermedades infecciosas, clínicas, patologías, epidemiología y salud pública, lo que permitirá un aprendizaje integral para realizar abordaje adecuado de caso positivos de las virosis, además de tener capacidades para establecer vigilancia epidemiológica(AU)

In recent years, microorganisms have generated multiple evolutions, causing diseases and acute public health problems. In order to control virosis, it is necessary to know their biology and epidemiology, establish adequate treatment and prophylaxis for their control. For this, it is essential to start with the training of health professionals, in particular, medical students, it is necessary to promote the development of their skills and competencies, not only mastery of scientific knowledge, but also be able to promote it, transfer it and apply it with an impact on collective health and that goes hand in hand with techno-scientific advances. That is why the concern of the forum arises, a discussion about the analysis of the teaching of virology to face emerging diseases based on the profile of the graduate. A survey was conducted to the students of the last ten years of the UNIANDES medical career, on biology, epidemiology, immunological response and diagnosis, for mentioned areas of knowledge it was obtained, both in the objective structured evaluation and practical evaluation, a level highly satisfactory. In the Miller pyramid, level three was reached with satisfactory knowledge and development of abilities, skills and attitudes of the graduate. However, Virology professors agree with innovating in teaching by integrating the content transversally to the areas of knowledge: infectious diseases, clinics, pathologies, epidemiology and public health, which will allow comprehensive learning to carry out an adequate approach to positive cases of virosis, in addition to having the capacity to establish epidemiological surveillance(AU)

5．Confronting COVID-19： Current Issues of SARS-CoV-2 Therapeutic Drug/Vaccine Development / 薬剤疫学

The development of therapeutic agents is important for controlling emerging infectious diseases. However, looking back into our experiences for the last three decades, there were no effective treatments at the beginning of the pandemics. Generally, the first step to develop therapeutic agents for emerging infectious diseases is to search for already existing agents that might have therapeutic effects, and so did with COVID-19. Many candidates have been examined with hopes of success for the past year. Up to now, only two agents, remdesivir and dexamethasone, which were anti-viral and anti-inflammatory agents, respectively, were approved as therapeutic agents. The two drugs are approved based on the results of clinical trials performed overseas and not in Japan. Though many other candidate drugs have been proposed and clinical trials have been carried out in Japan, few studies have reached clear conclusions. The reasons for these ineffective study-progress are not clear, but it appears that high hurdles may exist for doctors to participate in RCTs, probably due to the lack of human resources that can be invested in implementing RCTs. Based on the lessons learned from this pandemic, to proceed RTCs effectively, a new organization with the role of a command tower to manage and support RCTs is eagerly awaited.

Sindemia, infodemia, pandemia de COVID-19: Hacia una pandemiología de enfermedades emergentes / Syndemic, infodemic, pandemic of COVID-19: Towards a pandemiology of emerging diseases

RESUMEN Como base para una teoría de la coocurrencia de procesos epidémicos y pandémicos, en primer lugar, se introduce el concepto de sindemia, creado en la epidemia de VIH/sida para comprender componentes sociales, conductuales y culturales de enfermedades emergentes, tal como la actual pandemia de COVID-19. En segundo lugar, se destaca la noción de infodemia, que tiene gran potencial para comprender los impactos de la pandemia desde planos que generalmente se descuidan en los enfoques epidemiológicos convencionales. En tercer lugar, como complemento e ilustración, se presenta un estudio de caso "microarqueológico" de la infodemia resultante de la pandemia de COVID-19, centrado en la situación concreta de Brasil. Luego, se analizan las correlaciones entre la evidencia científica, los modelos de intervención y las medidas para controlar la pandemia en varios países y su adopción o rechazo en la realidad brasileña, estructurada sobre profundas desigualdades económicas, inequidades sociales e inequidades en salud.

ABSTRACT As the basis for a theory of the co-occurrence of epidemic and pandemic processes, the article begins with a discussion of the concept of syndemic, created during the HIV/AIDS epidemic to understand the social, behavioral, and cultural components of emerging diseases, as is the case of the current COVID-19 pandemic. Secondly, the notion of infodemic is highlighted, which has great potential to better understand the impacts of the pandemic from approaches that are generally neglected in conventional epidemiological research. Third, in order to illustrate these points, a "micro-archaeological" case study of the infodemic resulting from the COVID-19 pandemic is presented, focusing on the specific situation in Brazil. Then, the correlations between scientific evidence, intervention models, and measures to control the pandemic are comparatively analyzed in different countries, as well as their adoption or rejection in the Brazilian context, which is structured by deep economic inequalities, social inequities, and health inequities.

Lagochilascariasis: an emerging parasitic disease

Lagochilascariasis, described for the first time in 1909, is caused by a helminth nematode within the Lagochilascaris genus, and Ascarididae family, which mainly affects the underprivileged, especially among rural populations. Brazil presents more than 75% of the cases worldwide, mostly in the Amazon region, where the illness is considered emergent. The main clinical manifestation in humans is the appearance of subcutaneous purulent lesions normally found around the neck, mastoid and middle ear regions, the originating form is a painless granulomatous reaction that may have a chronic course and lead to death. Considering the paucity of reports on this helminthiasis, a bibliographic study was performed with the intent of consolidating information found systemized as etiology, epidemiology, pathogeny, clinical aspects, diagnostic, treatment, prophylaxis and control, as well as guiding health professionals in the resolution of human lagochilasacariasis cases. The present review reinforces the need for further studies on the subject, with a view to increasing the appropriate management of the disease and learning from it, to improve control, based on adequate knowledge of its natural cycle, as well as health education of the population

Lagochilascariasis: an emerging parasitic disease

Lagochilascariasis, described for the first time in 1909, is caused by a helminth nematode within the Lagochilascaris genus, and Ascarididae family, which mainly affects the underprivileged, especially among rural populations. Brazil presents more than 75% of the cases worldwide, mostly in the Amazon region, where the illness is considered emergent. The main clinical manifestation in humans is the appearance of subcutaneous purulent lesions normally found around the neck, mastoid and middle ear regions, the originating form is a painless granulomatous reaction that may have a chronic course and lead to death. Considering the paucity of reports on this helminthiasis, a bibliographic study was performed with the intent of consolidating information found systemized as etiology, epidemiology, pathogeny, clinical aspects, diagnostic, treatment, prophylaxis and control, as well as guiding health professionals in the resolution of human lagochilasacariasis cases. The present review reinforces the need for further studies on the subject, with a view to increasing the appropriate management of the disease and learning from it, to improve control, based on adequate knowledge of its natural cycle, as well as health education of the population

Senecavirus A (SVA) in finishing swine: diagnosis and viral isolation / Senecavirus A (SVA) em suínos de terminação: diagnóstico e isolamento viral

ABSTRACT: Senecavirus A (SVA) has been a problem in Brazil since the end of 2014. The infections caused by SVA have disrupted the productive chain in Brazil, as it can be confused with foot-and-mouth disease. Although, the virus has remained endemic in the country, an increase in the number of cases of the disease was observed in 2018. The aim of the present study was to conduct the differential diagnosis of foot-and-mouth disease in an outbreak of vesicular disease in finishing swine. Animals (160-170 days old) were kept on a farm with 6000 pigs in Minas Gerais State, Brazil. The morbidity and mortality rates were 20% and 2.2%, respectively. The diagnosis was performed by RT-PCR, using primers that determine the amplification of an internal region of the 3D gene. Furthermore, samples were inoculated into BHK-21 cell culture for viral isolation. In the first passage under cultivation, a cytopathogenic effect compatible with SVA replication (rounding and detachment of the cell monolayer) was observed. The viral identity was confirmed using two additional assays: indirect immunofluorescence assay (IFA) and nucleotide sequencing. Both tests confirmed that the infection was caused by SVA. In summary, we described a method for the diagnosis and viral isolation of SVA, a virus that arrived in Brazil in 2014 and has become endemic in the country.

RESUMO: Senecavírus A (SVA) é um problema no Brasil desde o final de 2014. As infecções causadas pelo SVA têm causado problemas para a cadeia produtiva no Brasil, pois podem ser confundidas com febre aftosa. Embora o vírus permaneça endêmico no país, foi observado um aumento no número de casos em 2018. O objetivo do presente estudo foi realizar o diagnostico diferencial de febre aftosa em um surto de doença vesicular em suínos de terminação. Os animais (160 a 170 dias de idade) eram mantidos em uma granja com 6.000 suínos no estado de Minas Gerais, Brasil. As taxas de morbidade e mortalidade foram de 20% e 2,2%, respectivamente. O diagnostico foi realizado por RT-PCR, utilizando primers que determinam a amplificação de uma região interna do gene 3D. Além disso, as amostras foram inoculadas na cultura de células BHK-21 para isolamento viral. Na primeira passagem em cultivo, foi observado efeito citopatogênico compatível com a replicação do SVA (arredondamento e descolamento da monocamada celular). A identidade viral foi confirmada usando duas técnicas adicionais: ensaio de imunofluorescência indireta (IFA) e sequenciamento de nucleotídeos. Ambos os testes confirmaram que a infecção foi causada por SVA. Em resumo, descrevemos um método para o diagnóstico e isolamento viral do SVA, um vírus que chegou ao Brasil em 2014 e se tornou endêmico no país.

First reporting of Anisakis sp. in the Armed Snook fish (Centropomus armatus) caught and commercialized in Buenaventura, Colombia / Primer reporte de Anisakis sp. en el pez Róbalo (Centropomus armatus) capturado y comercializado en Buenaventura, Colombia

Objective: Nematodes of the Anisakidae family are parasites found in aquatic organisms. The lack of studies on anisakidosis and Anisakis in Colombia has meant this type of parasitosis is not widely known by health personnel and underreporting of the disease is highly likely. The objective of this study was to identify anisakid nematodes in the armed snook fish (Centropomus armatus) obtained by artisanal fishing and sold commercially in the coastal port city of Buenaventura. Material and methods: Morphological identification of these worms was performed using taxonomic keys and supplemented with microscopic study using the histochemical Hematoxylin-Eosin technique. Results: Nematodes of the genus Anisakis were found in 42% and the mean abundance was 2.8 in the C. armatus. Conclusions: The findings confirm the presence of Anisakis sp. in fish for human consumption in Buenaventura, the main fishing port in the Colombian Pacific region. This finding in itself warrants further investigation into the possibility of an emerging disease in Colombia.

Objetivos: Los nematodos de la familia Anisakidae son parásitos de organismos acuáticos. La falta de estudios en anisakidosis y anisakidos en Colombia ha resultado en el desconocimiento de esta infección por parte del personal de salud y un posible subregistro de la enfermedad. El objetivo de este estudio fue identificar nematodos anisakidos en el pez róbalo (Centropomus armatus), obtenido por pesca artesanal y comercializado en la localidad de Buenaventura. Materiales y métodos: La identificación morfológica se realizó usando claves taxonómicas para estos gusanos complementada con estudio microscópico mediante técnica histoquímica de Hematoxilina-Eosina. Resultados: Se encontraron nemátodos del género Anisakis en 42% y una abundancia promedio de 2.8 en el hospedero C. armatus. Conclusiones: Los hallazgos confirman la presencia de Anisakis sp. en peces de consumo humano de Buenaventura, principal puerto pesquero en la región Pacífica colombiana, lo cual abre el camino en la investigación de una posible enfermedad emergente en este país.

Conquistas do SUS no enfrentamento das doenças transmissíveis / The achievements of the SUS in tackling the communicable diseases

Resumo Apresenta-se a evolução da situação epidemiológica de algumas das principais Doenças transmissíveis (DT) no Brasil, assinalando as intervenções proporcionadas pelo SUS e outras políticas sociais. Dados e informações foram levantados do Datasus e Boletins epidemiológicos do Ministério da Saúde e de artigos científicos sobre o tema. A universalização, a descentralização e a ampliação das ações de vigilância, controle e prevenção de DT produziram impacto sobre a morbimortalidade dessas doenças, principalmente das imunopreveníveis. A emergência e reemergência de três arboviroses, para as quais não se dispõe de instrumentos de controle efetivos, interromperam a evolução decrescente no perfil de morbidade das DT no Brasil. Outros programas sociais e econômicos, voltados para a população brasileira mais carente, também contribuíram para a melhoria dos indicadores de saúde analisados. Contudo, a universalização do acesso aos serviços de atenção à saúde, ao lado do aperfeiçoamento do escopo de atuação da vigilância sobre doenças e riscos à saúde, vem desempenhando papel fundamental na melhoria das condições de saúde e qualidade de vida da população, bem como contribuindo para o processo de democratização do país.

Abstract This article presents the development of the epidemiological situation of some of the major communicable diseases (CD) in Brazil, with emphasis on the interventions by the SUS and other social policies. The data and information were collected from Datasus, epidemiological newsletters from the Brazilian Ministry of Health, and scientific articles on the issue. The universalization, decentralization and expansion of the surveillance, control and prevention of CD has produced an impact on the morbidity and mortality of these diseases, mainly those which are vaccine-preventable. The emergence and re-emergence of three arboviruses, for which there are no effective control instruments, interrupted the downward trend in the morbidity profile of CD in Brazil. Other social and economic programs, which are geared to the needier sectors of the Brazilian population, have also contributed to the improvement of the analyzed health indicators. However, the universalization of access to healthcare services, as well as improvements in the scope of the surveillance of diseases and health risks, has played a key role in improving the health and quality of life of the population, as well as contributing to the process of the democratization of Brazil.

Aedes (Stegomyia) aegypti (Diptera: Culicidae) y su importancia en salud humana / Aedes (Stegomyia) aegypti (Diptera: Culicidae) and its importance for human health

El mosquito Aedes aegypti presenta características biológicas que lo convierten en un vector importante en el ciclo de transmisión de diferentes patógenos, en especial arbovirus. Durante la última década, la carga de dengue y otras enfermedades tales como la fiebre del zika o fiebre chikungunya se han incrementado, y nueva información acerca del papel de Ae. aegypti en la transmisión de estas enfermedades ha sido publicada. Este trabajo se enfocó en revisar mediante una estrategia de búsqueda sistemática de la información, el conocimiento actual de la historia evolutiva y otros aspectos biológicos de Ae. aegypti relacionados con la dinámica de transmisión de los principales arbovirus de importancia médica. Factores intrínsecos de Ae. aegypti y extrínsecos han contribuido a la emergencia o reemergencia y expansión mundial de patógenos en el ciclo urbano. El diseño de estrategias costo-efectivas para controlar Ae. aegypti es requerido para interrumpir los ciclos de transmisión de los patógenos y prevenir la aparición de nuevas epidemias(AU)

Due to its biological characteristics, the mosquito Aedes aegypti is an important vector in the transmission cycle of various pathogens, especially of arboviruses. The burden of dengue and other diseases such as Zika virus infection or chikungunya fever has increased in the last decade, and new information has been published about the role of A. aegypti in the transmission of these diseases. Applying a strategy for systematic search of information, the study focused on reviewing current knowledge about the evolutionary history and other biological aspects of A. aegypti associated with the dynamics of transmission of the main arboviruses of medical importance. Intrinsic and extrinsic factors related to A. aegypti have contributed to the emergence or re-emergence and worldwide spread of pathogens in the urban cycle. Cost-effective A. aegypti control strategies should be designed to interrupt the transmission cycles of pathogens and prevent the emergence of new epidemics(AU)

Sharing experiences from a reference laboratory in the public health response for Ebola viral disease, MERS-CoV and H7N9 influenza virus investigations

An efficient public health preparedness and response plan for infectious disease management is important in recent times when emerging and exotic diseases that hitherto were not common have surfaced in countries with potential to spread outside borders. Stewardship from a reference laboratory is important to take the lead for the laboratory network, to proactively set up disease surveillance, provide referral diagnostic services, on-going training and mentorship and to ensure coordination of an effective laboratory response. In Malaysia, the Institute for Medical Research has provided the stewardship for the Ministry of Health's laboratory network that comprises of hospital pathology, public health and university laboratories. In this paper we share our experiences in recent infectious disease outbreak investigations as a reference laboratory within the Ministry of Health infectious disease surveillance network.

Sharing experiences from a reference laboratory in the public health response for Ebola viral disease, MERS-CoV and H7N9 influenza virus investigations

An efficient public health preparedness and response plan for infectious disease management is important in recent times when emerging and exotic diseases that hitherto were not common have surfaced in countries with potential to spread outside borders. Stewardship from a reference laboratory is important to take the lead for the laboratory network, to proactively set up disease surveillance, provide referral diagnostic services, on-going training and mentorship and to ensure coordination of an effective laboratory response. In Malaysia, the Institute for Medical Research has provided the stewardship for the Ministry of Health's laboratory network that comprises of hospital pathology, public health and university laboratories. In this paper we share our experiences in recent infectious disease outbreak investigations as a reference laboratory within the Ministry of Health infectious disease surveillance network.

Dos nuevos registros de vectores potenciales de Fiebre Amarilla selvática y Mayaro para el Ecuador / Two new records of potential Sylvan Yellow Fever and Mayaro species vectors from Ecuador

Se registran por primera vez en el Ecuador dos especies de mosquitos (Diptera: Culicidae), vectores potenciales de los virus de la Fiebre Amarilla y Mayaro. Sabethes amazonicus Gordon and Evans y Haemagogus anastasionis Dyar fueron colectados en fase adulta en una localidad de la provincia de Zamora-Chinchipe, en la cual se han presentado casos de Fiebre Amarilla selvática con anterioridad. Este hallazgo muestra la importancia de profundizar los estudios de linea base de vectores en el país, distribución geográfica y aspectos ecológicos y su posible relación epidemiológica con enfermedades emergentes y re-emergentes.

Two new records of mosquitoes (Diptera: Culicidae) are presented from Ecuador, and both potential vectors of yellow fever virus and Mayaro. Sabethes amazonicus Gordon and Evans and Haemagogus anastasionis Dyar adults were collected in a locality in the province of Zamora-Chinchipe, in which there have been cases of yellow fever previously. This finding shows the importance of further studies of baseline vector in the country, geographical distribution and ecological aspects and possible epidemiological link with emerging and re-emerging diseases.

Integrated Impact of Climate Change and Socioeconomic Development on the Evolution of Camel Farming Systems.

In Sub-Saharan countries, climate change has already been observed for several decades and is characterized by the decrease in mean rainfall with extensive periods of drought followed by short but severe rains. The dromedary camel, adapted to arid lands and low nutritive natural resources, follows the aridification of ecosystems as she/he did so when moving into Africa through the Sinai Peninsula at the beginning of the Christian era. Thus, the on-going desertification in Northern Africa increases the camel distribution area, both geographically and socially, e.g. with regard to its use by people who are not traditionally camel keepers. Elsewhere, camels are used differently, i.e. for their products (milk, agricultural work) rather than for their traditional uses (packing or riding). On the other hand, facing more contrasted crop ecosystems and an unbalanced climate, which seem to contribute to emerging diseases with complex and often unknown aetiologies, caused high unexplained deaths. These global trends would trigger more changes of camel farming systems in Sahelian countries if climate change intensifies continuously in the next decades.

International Health Regulations A Major Paradigm Shift from 1969 to 2005.

The International Health Regulations (IHR 1969), replaced by IHR 2005 had been adopted by the World Health Assembly on 23 May 2005 and came into force on 15 June 2007. IHR 2005 are a legally binding agreement among World Health Organisation (WHO) member states and other states that have agreed to be bound by them. New revision was necessitated by concerns about increasing global health threats and the need to respond with more effective surveillance and control practices. The limitations of IHR 1969, which led to their revision, related to their narrow scope, their dependence on official country notifications, and their lack of a formal internationally coordinated mechanism to contain international disease spread. The IHR 2005, which is firmly based on practical experiences, has broaden the scope of IHR 1969 to cover existing, new and re-emerging diseases, including emergencies caused by non-infectious disease agents.

Síndrome pulmonar e cardiovascular por hantavírus: aspectos clínicos de uma doença emergente no sudeste brasileiro / Pulmonary and cardiovascular syndrome due to hantavirus: clinical aspects of an emerging disease in southeastern Brazil

A síndrome pulmonar e cardiovascular por hantavírus é doença causada pela aspiração de aerossóis dos dejetos de roedores silvestres contaminados por vírus da família Bunyaviridae. Estudamos manifestações clínicas e laboratoriais de 70 casos ocorridos de 1998 a 2007 na região de Ribeirão Preto, SP. A freqüência de sintomas foi dispnéia (87 por cento), febre (81 por cento), tosse (44 por cento), cefaléia (34 por cento), taquicardia (81 por cento), hipotensão arterial (56 por cento), hipóxia (49 por cento), acidose metabólica (57 por cento), linfocitopenia (51 por cento), hematócrito >45 por cento (70 por cento), leucocitose com desvio à esquerda (67 por cento), creatinina (51 por cento) e uréia (42 por cento) séricas elevadas. A letalidade (54,3 por cento) ocorreu principalmente no 4o dia. Insuficiência respiratória, hipotensão arterial e choque ocorreu 24-48 horas; o hematócrito elevado e a plaquetopenia são sinais fortemente sugestivos da doença. A hipótese diagnóstica de pneumonia atípica associada a bom prognóstico (p:0,0136); a infusão hídrica >2.000ml e hipotensão arterial associadas a mau prognóstico (p:0,0286 e p:0,0453).

Pulmonary and cardiovascular syndrome due to hantavirus is a disease caused by inhalation of aerosols from the excreta of wild rodents contaminated by viruses of the Bunyaviridae family. We studied the clinical and laboratory manifestations of 70 cases that occurred in the region of Ribeirão Preto, SP, Brazil, between 1998 and 2007. The frequency of symptoms was as follows: dyspnea (87 percent), fever (81 percent), coughing (44 percent), headache (34 percent), tachycardia (81 percent), low arterial blood pressure (56 percent), metabolic acidosis (57 percent), lymphocytopenia (51 percent), hematocrit > 45 percent (70 percent), leukocytosis with left deviation (67 percent), creatinine (51 percent) and urea (42 percent). Mortality (54.3 percent) occurred mainly on the fourth day. Respiratory insufficiency, low arterial blood pressure and shock occurred after 24 to 48 hours. High hematocrit and decreased platelet levels were signs strongly suggestive of the disease. The diagnostic hypothesis of atypical pneumonia was associated with a good prognosis (p = 0.0136). Fluid infusion greater than 2,000 ml and arterial hypotension were associated with a poor prognosis (p = 0.0286 and p = 0.0453).

Fase aguda da doença de Chagas na Amazônia brasileira: estudo de 233 casos do Pará, Amapá e Maranhão observados entre 1988 e 2005 / Acute phase of Chagas disease in the Brazilian Amazon region: study of 233 cases from Pará, Amapá and Maranhão observed between 1988 and 2005

Foram estudados 233 casos de fase aguda da doença de Chagas, oriundos do Pará, Amapá e Maranhão, observados no período de 1988 a 2005, cento e sessenta deles retrospectivamente de 1988 a 2002 e setenta e três prospectivamente de 2003 a 2005. Entre os casos estudados 78,5 por cento (183/233) faziam parte de surtos provavelmente por transmissão oral, acometendo em média 4 pessoas e 21,5 por cento (50/233) eram casos isolados. Foram considerados casos agudos aqueles que apresentaram exames parasitológicos diretos (a fresco, gota espessa ou Quantitative Buffy Coat - QBC) e/ou IgM anti-Trypanosoma cruzi positivos. Foram feitos ainda xenodiagnósticos em 224 pacientes e hemoculturas em 213. Todos foram avaliados clinica e epidemiologicamente. As manifestações clínicas mais freqüentes foram febre (100 por cento), cefaléia (92,3 por cento), mialgia (84,1 por cento), palidez (67 por cento), dispnéia (58,4 por cento), edema de membros inferiores (57,9 por cento), edema de face (57,5 por cento) dor abdominal (44,2 por cento), miocardite (39,9 por cento) e exantema (27 por cento). O eletrocardiograma mostrou alterações de repolarização ventricular em 38,5 por cento dos casos, baixa voltagem de QRS em 15,4 por cento e desvio de SAQRS em 11,5 por cento, extra-sístoles ventriculares em 5,8 por cento, bradicardia em 5,8 por cento e taquicardia em 5,8 por cento, bloqueio de ramo direito em 4,8 por cento e fibrilação atrial em 4,8 por cento. A alteração mais freqüente vista no ecocardiograma foi o derrame pericárdico em 46,2 por cento dos casos. Treze (5,6 por cento) pacientes evoluíram para o óbito, 10 (76,9 por cento) dos quais por comprometimento cardiovascular, dois por complicações de origem digestiva e um de causa mal definida.

Two hundred and thirty-three cases of the acute phase of Chagas disease, from Pará, Amapá and Maranhão, were observed between 1988 and 2005. One hundred and sixty were studied retrospectively from 1988 to 2002 and seventy-three were prospectively followed up from 2003 to 2005. Among the cases studied, 78.5 percent (183/233) formed part of outbreaks, probably due to oral transmission (affecting a mean of 4 individuals), and 21.5 percent (50/233) were isolated cases. Cases were taken to be acute if they presented positive direct parasitological tests (fresh blood, thick drop or Quantitative Buffy Coat, QBC) and/or positive anti Trypanosoma cruzi IgM. Xenodiagnosis was also performed on 224 patients and blood culturing on 213. All the patients had clinical and epidemiological evaluations. The most frequent clinical manifestations were fever (100 percent), headache (92.3 percent), myalgia (84.1 percent), pallor (67 percent), dyspnea (58.4 percent), swelling of the legs (57.9 percent), facial edema (57.5 percent), abdominal pain (44.3 percent), myocarditis (39.9 percent) and exanthema (27 percent). The electrocardiogram showed abnormalities of ventricular repolarization in 38.5 percent, low QRS voltage in 15.4 percent, left-axis deviation in 11.5 percent, ventricular ectopic beats in 5.8 percent, bradycardia in 5.8 percent, tachycardia in 5.8 percent, right branch block in 4.8 percent and atrial fibrillation in 4.8 percent. The most frequently observed abnormality on the echocardiogram was pericardial effusion, in 46.2 percent of the cases. Thirteen (5.6 percent) patients died: ten (76.9 percent) of them due to cardiovascular involvement, two due to digestive complications and one due to indeterminate causes.

Enfermedades emergentes no infecciosas / Emerging noninfectious diseases

In recent years, emerging diseases were defined as being infectious, acquiring high incidence, often suddenly, or being a threat or an unexpected phenomenon. This study discusses the hallmarks of emerging diseases, describing the existence of noninfectious emerging diseases, and elaborating on the advantages of defining noninfectious diseases as emerging ones. From the discussion of various mental health disorders, nutritional deficiencies, external injuries and violence outcomes, work injuries and occupational health, and diseases due to environmental factors, the conclusion is drawn that a wide variety of noninfectious diseases can be defined as emergent. Noninfectious emerging diseases need to be identified in order to improve their control and management. A new definition of "emergent disease" is proposed, one that emphasizes the pathways of emergence and conceptual traits, rather than descriptive features.

Emergências de saúde pública: conceito, caracterização, preparação e resposta / Public health emergencies: the concept, characterization, preparation and response

Nos últimos anos, tem havido uma maior preocupação internacional com a disseminação ou propagação de agentes etiológicos e doenças, de natureza infecciosa, química e radionuclear. Visando adequar os conceitos e as medidas para evitar ou reduzir o risco dessa disseminação, foi adotado pelos países o novo conceito de emergência de saúde pública de importância internacional, no âmbito do RSI (2005), e implementadas novas estratégias para preparação e resposta a essas emergências. Com base em análise de risco contextualizada sobre eventos de saúde que podem se disseminar internacionalmente, busca-se contar com instrumentos mais oportunos que permitam a identificação e a atuação precoce sobre esses eventos. A adaptação desse conceito, para o propósito da vigilância em saúde e rede de atenção dos serviços de saúde nacional, tem permitido um melhor gerenciamento dos eventos de saúde que constituem risco de disseminação ou propagação de doenças ou agravos dentro do território nacional, além de oferecer uma resposta mais oportuna. A análise sobre esses eventos, realizada no presente trabalho, indica que a ocorrência de desastres ambientais, em número mais reduzido quando comparada com os eventos de natureza infecciosa, coloca em situação de risco a população ou gera danos à saúde em um contingente populacional maior. Por sua vez, os eventos de natureza infecciosa, que em sua maioria ocorrem sob a forma de surtos ou epidemias, acometem um maior número de municípios e apresentam maior letalidade. As medidas adotadas no país para aperfeiçoar o sistema de vigilância em saúde na detecção, preparação e resposta às emergências de saúde pública são descritas neste artigo e são destacados os principais desafios colocados pelos níveis de gestão do sistema.