ABSTRACT
OBJECTIVE: To create a protocol for performing minimally invasive autopsies (MIA) in detecting deaths from arboviruses and report preliminary data from its application in Ceará state, Brazil. METHODS: Training was provided to medical pathologists on MIA. RESULTS: A protocol was established for performing MIA, defining criteria for sample collection, storage methods, and diagnoses to be carried out according to the type of biological sample; 43 MIAs were performed in three months. Of these, 21 (48.8%) arrived at the Death Verification Service (SVO) with arboviruses as a diagnostic hypothesis, and seven (16.3%) were confirmed (six chikungunya cases and one dengue case); cases of COVID-19 (n = 9), tuberculosis (n = 5), meningitis (n = 4), cryptococcosis (n = 1), Creutzfeldt-Jakob disease (n = 1), breast cancer (n = 1), and human rabies (n = 1) were also confirmed. CONCLUSION: The protocol implemented enabled identification of a larger number of suspected arbovirus-related deaths, as well as confirmation of other diseases of interest for surveillance. MAIN RESULTS: A protocol was developed to perform minimally invasive autopsies (MIAs) in Death Verification Services (SVO), capable of expanding the system's capacity to identify a greater number of deaths suspected to be due to arboviruses. IMPLICATIONS FOR SERVICES: The experience suggests that in-service trained health professionals are able to perform MIA, and that use of this technique in SVOs has been shown to be capable of increasing the system's sensitivity in detecting deaths of interest to public health. PERSPECTIVES: Trained professionals will be able to collect biological material in hospitals, through MIA, in cases of interest for health surveillance and when family members do not allow a complete conventional autopsy to be performed.
Subject(s)
Arbovirus Infections , Autopsy , Humans , Brazil/epidemiology , Autopsy/methods , Arbovirus Infections/epidemiology , Arbovirus Infections/diagnosis , Arbovirus Infections/pathology , Female , Sensitivity and Specificity , Male , Middle Aged , Adult , Adolescent , Young Adult , Arboviruses/isolation & purification , Aged , Population Surveillance/methods , Epidemiological Monitoring , Cause of Death , Child , Child, PreschoolABSTRACT
Abstract Objective: To create a protocol for performing minimally invasive autopsies (MIA) in detecting deaths from arboviruses and report preliminary data from its application in Ceará state, Brazil. Methods: Training was provided to medical pathologists on MIA. Results: A protocol was established for performing MIA, defining criteria for sample collection, storage methods, and diagnoses to be carried out according to the type of biological sample; 43 MIAs were performed in three months. Of these, 21 (48.8%) arrived at the Death Verification Service (SVO) with arboviruses as a diagnostic hypothesis, and seven (16.3%) were confirmed (six chikungunya cases and one dengue case); cases of COVID-19 (n = 9), tuberculosis (n = 5), meningitis (n = 4), cryptococcosis (n = 1), Creutzfeldt-Jakob disease (n = 1), breast cancer (n = 1), and human rabies (n = 1) were also confirmed. Conclusion: The protocol implemented enabled identification of a larger number of suspected arbovirus-related deaths, as well as confirmation of other diseases of interest for surveillance.
Resumen Objetivo: Estabelecer un protocolo utilizado para la realización de autopsias mínimamente invasivas (AMI) para la detección de muertes por arbovirus y presentar datos preliminares de este protocolo en Ceará, Brasil. Métodos: Se llevó a cabo la capacitación de médicos patólogos en AMI. Resultados: Se estableció un protocolo para la realización de AMI, que define los criterios para la toma de muestras, métodos de almacenamiento y diagnóstico; en tres meses se realizaron 43 AMI; de estas, 21 (48,8%) llegaron al Servicio de Verificación de Óbito (SVO) con una hipótesis diagnóstica de alguna arbovirosis y siete (16,3%) fueron confirmadas (seis casos de chikungunya y uno de dengue); también se confirmaron casos de Covid-19 (n = 9), tuberculosis (n = 5), meningitis (n = 4), criptococosis (n = 1), enfermedad de Creutzfeldt-Jakob (n = 1), neoplasia de mama (n = 1) y rabia humana (n = 1). Conclusión: El protocolo implementado permitió la identificación de un mayor número de muertes sospechosas de arbovirus, además de la confirmación de otras patologías de interés.
Resumo Objetivo: Estabelecer protocolo para realização de autópsias minimamente invasivas (AMIs) na detecção de óbitos por arboviroses e relatar dados preliminares desse protocolo no Ceará, Brasil. Métodos: Médicos patologistas foram treinados em AMI. Resultados: Estabeleceu-se protocolo para AMI, definindo-se critérios para amostras a serem coletadas, suas formas de armazenamento e diagnóstico, segundo o tipo de amostra biológica; em três meses, foram realizadas 43 AMIs, das quais 21 (48,8%) chegaram ao Serviço de Verificação de Óbito (SVO) com hipótese diagnóstica de alguma arbovirose e sete (16,3%) foram confirmados (seis de chikungunya; uma de dengue); também foram confirmados casos de covid-19 (n = 9), tuberculose (n = 5), meningite (n = 4), criptococose (n = 1), doença de Creutzfeldt-Jakob (n = 1), neoplasia de mama (n = 1) e raiva humana (n = 1). Conclusão: O protocolo implantado permitiu a captação de um maior número de óbitos suspeitos de arboviroses, além da confirmação de outras patologias de interesse da vigilância.
ABSTRACT
In Brazil, the SARS-CoV-2 vaccination program has so far prioritized people over 75 years of age. By the end of March 2021, in Ceará State, a total of 313,328 elderly people had received at least one dose of vaccine (45% Oxford-AstraZeneca/Fiocruz and 55% CoronaVac-Sinovac/Butantan), and 159,970 had received two doses (83% CoronaVac-Sinovac/Butantan and 17% Oxford-AstraZeneca/Fiocruz). After a single dose, there was already a significant reduction in COVID 19-related deaths (protection ratio: 19.31 (95% CI: 18.20-20.48), attributable protection ratio: 94.8%); higher protection ratios were observed after the application of two doses of the vaccine (132.67; 95% CI: 109.88-160.18), with an attributable protection ratio of 99.2%. SARS-CoV-2 vaccines are highly effective in reducing the number of COVID-19-related deaths in over 75-year-olds in Brazil, one of the hardest hit countries by the current pandemic.
ABSTRACT
Since its beginning in Wuhan, China, in December 2019, the disease caused by COVID-19 has reached more than 27 million confirmed cases and more than 880 thousand deaths worldwide by early September 2020. Although it is known that some of these deaths may have been influenced by the overload of health systems, the world medical literature lacks data on deaths due to COVID-19 in patients who have not received medical assistance. We conducted a retrospective transversal study to report the clinical and epidemiological profile of the first 200 consecutive cases of home deaths without medical assistance caused by COVID-19 diagnosed by verbal autopsy and real-time PCR in samples of postmortem nasopharyngeal swabs, in the state of Ceara, in Northeastern Brazil. The data show a slightly increased prevalence of cases in males (57%) and an average age of 76.8 years. Previous comorbidities were reported in 85.5% of cases, the most common being cardiovascular disease (45%), neurological disease (30%), and diabetes (29%). The main symptoms reported were dyspnea (79%), fever (75.5%), cough (69%), and fatigue (42.5%). The average time between the onset of illness and death was 7.3 days, being statistically shorter in patients who had previous comorbidities (P = 0.0215). This is the first study to evidence the clinical and epidemiological characteristics of COVID-19 home deaths without medical assistance, which may represent a considerable portion of the pandemic burden, especially in the context of health system overload.
