Acute hemorrhagic conjunctivitis epidemic in São Paulo State, Brazil, 2011.

Acute hemorrhagic conjunctivitis (AHC) infection is highly contagious and can lead to explosive epidemics. In early February 2011, the Center for Epidemiologic Surveillance of the State of São Paulo Health Secretariat (SES-SP) in Brazil received reports of conjunctivitis outbreaks from rural areas of the state that subsequently spread statewide. This report describes that AHC epidemic and its etiologic agent. Data from the Ministry of Health Information System for Notifiable Diseases (SinanNet) and the SES-SP epidemiologic surveillance system for conjunctivitis, developed to detect outbreaks, confirm the etiologic agent, and carry out control measures, were analyzed. Eye (conjunctival swab) samples were taken from patients with clinical presentation of viral conjunctivitis to perform viral laboratory diagnosis. A total of 1 067 981 conjunctivitis cases were reported to the surveillance system for 2011; there was an increase in the number of cases in epidemiologic weeks 6-26 (summer season) versus previous years. Most cases occurred in the metropolitan region of Greater São Paulo. Of 93 collected samples, 57 tested positive for coxsackievirus-A24 (CV-A24), based on virus isolation in tissue-culture cell lines, reverse transcription polymerase chain reaction (RT-PCR), and enterovirus sequencing of RT-PCR. The data analysis showed that the fast-spreading etiologic agent of the AHC epidemic that occurred in the summer of 2011 was CV-A24. The AHC epidemic was due to an enterovirus that occurred sporadically, spread rapidly and with great magnitude, and had substantial socioeconomic impact due to the high level of absenteeism at work and school.

Acute hemorrhagic conjunctivitis epidemic in São Paulo State, Brazil, 2011 / Epidemia de conjuntivitis hemorrágica aguda en el estado de São Paulo, Brasil, 2011

Acute hemorrhagic conjunctivitis (AHC) infection is highly contagious and can lead to explosive epidemics. In early February 2011, the Center for Epidemiologic Surveillance of the State of São Paulo Health Secretariat (SES-SP) in Brazil received reports of conjunctivitis outbreaks from rural areas of the state that subsequently spread statewide. This report describes that AHC epidemic and its etiologic agent. Data from the Ministry of Health Information System for Notifiable Diseases (SinanNet) and the SES-SP epidemiologic surveillance system for conjunctivitis, developed to detect outbreaks, confirm the etiologic agent, and carry out control measures, were analyzed. Eye (conjunctival swab) samples were taken from patients with clinical presentation of viral conjunctivitis to perform viral laboratory diagnosis. A total of 1 067 981 conjunctivitis cases were reported to the surveillance system for 2011; there was an increase in the number of cases in epidemiologic weeks 6–26 (summer season) versus previous years. Most cases occurred in the metropolitan region of Greater São Paulo. Of 93 collected samples, 57 tested positive for coxsackievirus-A24 (CV-A24), based on virus isolation in tissue-culture cell lines, reverse transcription polymerase chain reaction (RT-PCR), and enterovirus sequencing of RT-PCR. The data analysis showed that the fast-spreading etiologic agent of the AHC epidemic that occurred in the summer of 2011 was CV-A24. The AHC epidemic was due to an enterovirus that occurred sporadically, spread rapidly and with great magnitude, and had substantial socioeconomic impact due to the high level of absenteeism at work and school.

La conjuntivitis hemorrágica aguda es sumamente contagiosa y puede provocar epidemias fulminantes. A principios de febrero del 2011, el Centro para la Vigilancia Epidemiológica de la Secretaría Estatal de Salud de São Paulo (SES-SP), en el Brasil, recibió informes de brotes de conjuntivitis en zonas rurales del estado que posteriormente se difundieron por todo el territorio estatal. En este informe se describe esa epidemia de conjuntivitis hemorrágica aguda y su agente causal. Se analizaron datos del Sistema de Información para las Enfermedades de Notificación Obligatoria del Ministerio de Salud (SinanNet) y del sistema de vigilancia epidemiológica de la SES-SP para la conjuntivitis, que fue creado para detectar brotes, confirmar el agente causal y adoptar medidas de control. Se obtuvieron hisopados conjuntivales de pacientes con un cuadro clínico de conjuntivitis vírica para hacer el diagnóstico vírico en el laboratorio. En el 2011 se notificaron al sistema de vigilancia 1 067 981 casos de conjuntivitis; el número de casos observados de la semana epidemiológica 6 a la 26 (estación del verano) fue mayor que en años anteriores. La mayoría de los casos se produjeron en la zona metropolitana del gran São Paulo. De las 93 muestras obtenidas, 57 resultaron positivas para el virus Coxsackie tipo A24 (vC-A24), según los resultados del aislamiento vírico en líneas celulares obtenidas por histocultivo, la reacción en cadena de la polimerasa con retrotranscriptasa y la secuenciación enterovírica del producto de esta. El análisis de los datos reveló que el agente causal, de rápida propagación, de la epidemia de conjuntivitis hemorrágica aguda que tuvo lugar en el verano del 2011 fue el vC-A24. La epidemia se debió a un enterovirus que apareció de forma esporádica, tuvo una diseminación rápida y de gran magnitud y repercutió de manera importante en la esfera socioeconómica debido al gran ausentismo laboral y escolar que ocasionó.

Prevalence of trachoma in a population of the upper Rio Negro basin and risk factors for active disease.

PURPOSE: To determine the prevalence of trachoma in Sao Gabriel da Cachoeira (SGC), the only urban community of the upper Rio Negro Basin of the Amazon state in Brazil, near the Colombian border, and to investigate the risk factors associated with the active forms of the disease. METHODS: A total of 1702 people (440 children up to 9 years and 1069 adults aged 15 years and above) were examined. The sample was selected from a probabilistic household sampling procedure based on census data and a previous study of trachoma prevalence in Sao Gabriel da Cachoeira. A two-stage probabilistic household cluster sample was drawn. Household units were randomly selected within each cluster. A variety of socioeconomic and hygiene variables were studied in order to determine the risk factors for active trachoma in a household. RESULTS: The total prevalence of trachoma was 8.9%. Prevalence of active trachoma (TF and/or TI) in children aged 1-9 years was 11.1% and trachomatous trichiasis in adults aged 15 years and above was 0.19%. Trachomatous scarring reached a peak of 22.4% for subjects between 50 to 60 years of age. Corneal opacity occurred in subjects aged 50 years and older with a prevalence of 2.0%. No sex effect was found on the overall prevalence of trachoma in SGC. Risk factors associated with active trachoma were mainly related to poor socioeconomic indicators. CONCLUSIONS: Despite the ubiquitous presence of water, the analysis of the risk factors associated with the active forms of the disease supports the idea that a low personal standard of hygiene and not water availability per se, is the key factor associated with trachoma.

Epidemiological surveillance of the ocular impairments in Hansen's disease

An evaluation of data on ocular disabilities of leprosy registered cases in 1989, in São Paulo State, pointed that it was needed to change the criteria of diagnosis to improve sensibility at the time of detection. Since 1990, the Leprosy Program together with the Ophthalmology Service of São Paulo State, intensified training in detection, prevention and treatment of the ocular disabilities. A group of experts designed a new standardization of procedures and criteria for grading of the ocular disabilities in accordance with the WHO guidelines. The Leprosy notification forms were analyzed for the years 1989, 1993 and 1996 with the objective to evaluate the changes of criteria. In 1989, 3210 leprosy cases were notified, the frequency of ocular disabilities in those cases was 72 (2.2%). During 1993, of the 2927 leprosy cases notified, the frequency of ocular disabilities was 130 (5.3%). In 1996, 2915 cases were notified and the frequency of ocular disabilities was 164 (6.9%). The MB cases showed a greater proportion of ocular disabilities than the PB (p < 0.05). The changes in the forms for the diagnosis of the ocular disabilities, detected at the time of the notification, and the training of personnel, contributed to the increase of the number of cases with ocular disabilities, mainly in grade 1 (corneal hypostesia) and grade 2 (lagophthalmos, trichiasis, corneal opacification). This increase does not indicate worsening of the endemic disease neither later diagnosis, just operational improvement

Vigilancia epidemiologica das incapacidades oculares em hanseniase / Epidemiological surveillance of the ocular impairments in Hansen's disease

Após avaliação dos dados de incapacidades oculares disponíveis nas fichas epidemiológicas de hanseníase do ano de 1989, no Estado de São Paulo, constatou-se a necessidade de mudanças de critérios do grau de incapacidade ocular, para aumentar a sensibilidade. Desde 1990, o Programa de Controle da Hanseníase em conjunto com o Serviço de Oftalmologia Sanitária da Secretaria de Estado da Saúde de São Paulo intensificou os treinamentos na detecção, prevenção e tratamento das incapacidades oculares. Um grupo de técnicos foi designado para modificar a padronização dos procedimentos e os critérios para a classificação do grau de incapacidade, de acordo com as orientações da Organização Mundial da Saúde. Com o objetivo de avaliar as modificações da padronização dos critérios foram analisadas as fichas de notificação epidemiológica dos anos de 1989, 1993 e 1996. No ano de 1989, foram detectados 3210 casos de hanseníase, dos quais 72 (2,2%) apresentaram incapacidades oculares. Em 1993, 2927 casos de hanseníase foram notificados, sendo que 130 (5,3%) tinham incapacidades oculares. Em 1996, dos 2915 casos detectados, 164 (6,9%) apresentaram algum grau de incapacidade ocular Os casos multibacilares mostraram uma proporção maior de incapacidades oculares do que os paucibacilares (p < 0,05). As modificações adotadas para o diagnóstico das alterações oculares e os treinamentos realizados contribuíram para um aumento significativo da notificação do número de casos com alterações oculares, principalmente grau I (hipoestesia corneana) e grau II (lagoftalmo, triquíase e opacidade corneana). Este aumento não indica piora da endemia ou mesmo diagnóstico mais tardio, e sim melhora operacional

Vigilância epidemiológica do tracoma em instituiçäo de ensino na cidade de Säo Paulo, SP / Epidemiological surveillance of trachoma in a school in an urban area in Southeastern Brazil

Verifica as condiçöes de vigilância epidemiológica do tracoma desencadeadas a partir da detecçäo de um caso de tracoma inflamatório na APAE-SP. Foram submetidas a exame ocular 1.009 pessoas entre alunos, funcionários e comunicantes intradomiciliares. Os controles de tratamento foram realizados em uma instituiçäo, por vezes, em intervalos de 45 dias. A prevalência total foi de 5,9 por cento, sendo 5,1 por cento de tracoma folicular (TF), 0,3 por cento de tracoma folicular intenso (TF/TI) e 0,5 por cento de tracoma cicatricial (TS). No primeiro controle 45,5 por cento dos cados apresentou alta clínica e 40,0 por cento manteve tratamento. No último controle, 20,0 por cento apresentou alta curado sem cicatrizes. A taxa de faltosos alcançou 38,2 por cento. A distribuiçäo espacial dos casos secundários mostrou ampla dispersäo na Grande Säo Paulo, indicando que o tracoma deve estar disseminado por toda a regiäo. As açöes de controle do tracoma näo apresentaram resultados satisfatórios, provavelmente devido ao prolongado tempo de tratamento e acompanhamento. Estratégias de intervençäo clínica devem ser desenvolvidas para melhor controle da doença

Vigilância epidemiológica do tracoma no Estado de Säo Paulo / Epidemiological surveillance of trachoma in the State of Säo Paulo

O tracoma era considerado "erradicado" no Estado de Säo Paulo desde a década de 70. Entretanto, a partir e 1982, novos casos começaram a ser diagnosticados no município de Bebedouro, regiäo noroeste do estado. Uma série de medidas foram adotadas no sentido de controle da doença, dentre elas destacam-se o estabelecimento de açöes de vigilância epidemiológica e notificaçäo compulsória dos casos de tracoma verificados no município. No período de janeiro de 1984 a dezembro de 1985 foram notificados pelo Serviço de Oftalmologia do Centro de Saúde I de Bebedouro 749 casos de tracoma residentes no município. No presente estudo os autores analisam as informaçöes obtidas através das 749 Fichas Epidemiológicas de tracoma referentes aos casos do período. Os dados säo analisados dentro dos padröes da metodologia epidemiológica, e discutidos em relaçäo as informaçöes fornecidas pela literatura especializada. Esta avaliaçäo forneceu informaçöes valiosas a respeito da ocorrência do tracoma em Bebedouro, além de possibilitar um diagnóstico das açöes de Vigilância Epidemiológica do tracoma. Apresentam-se série de sugestöes visando a ampliaçäo dos conhecimentos em relaçäo a epidemiologia do tracoma no Estado e a melhoria das açöes de controle da doença