Avaliação do sistema de vigilância em saúde do trabalhador relacionada aos acidentes de trabalho, antes e após a implantação do software de linkage Sentinela, em Porto Alegre, 2018-2021 / Evaluation of the occupational health surveillance system before and after the implementation of the Sentinela linkage software, in Porto Alegre, 2018-2021 / Evaluación del sistema de vigilancia de la salud del trabajador relacionada con los accidentes de trabajo, antes y después de la implementación del software de enlace Sentinela, en Porto Alegre, 2018-2021

O objetivo deste artigo é avaliar, segundo alguns atributos, o sistema de vigilância dos acidentes de trabalho antes e após a implantação do software Sentinela (2018-2021), com base em uma pesquisa descritiva de dados secundários, e efetuar recomendações. Foram analisadas variáveis da ficha de investigação, de acordo com os atributos qualidade dos dados (completitude e consistência), oportunidade e representatividade. Os resultados mostraram que, após o Sentinela, houve aumento da notificação de acidentes (66,16%), maior completitude das variáveis, com importante alteração na 'atividade econômica' (98,9%) e 'evolução' (96,3%), diminuição dos campos ignorados/em branco, com destaque para o campo 'evolução' (3,7%), e melhora na oportunidade de controle dos acidentes fatais (79 dias). Concluímos que a vigilância dos acidentes de trabalho tem excelente qualidade dos dados, é representativa, mas inoportuna. O Sentinela melhorou o sistema, tornando-o mais sensível na captação dos acidentes e permitindo-lhe ter informações de melhor qualidade. É necessária a avaliação rotineira dos atributos, para aprimoramento constante do sistema, assim como rever as rotinas das equipes de saúde, melhorando a oportunidade de controle por meio de suas ações

This article aims to evaluate the occupational health surveillance system before and after the implementa-tion of the Sentinela software (2018-2021), according to some attributes and based on descriptive research using secondary data, and to make recommendations. Variables of the accident investigation report were analysed, according to the attributes of data quality (completeness and consistency), opportunity and rep-resentativeness. The results have revealed that after Sentinela, there was an increase in the notification of accidents (66.16%), greater completeness of the variables, with an important change in 'economic activity' (98.9%) and 'evolution' (96.3%), a decreased in blank fields/information missing, with emphasis on the 'evolution' field (3.7%), and an improvement in the opportunity to control fatal accidents (79 days). We have concluded that the surveillance of the occupational accidents has excellent data quality, is representative, but inopportune. The Sentinela has improved the system, making it more sensitive in capturing accidents, allowing it to provide better quality of information. An evaluation of the attributes is routinely necessary to constantly improve the system, as well as reviewing the routines of health professionals, improving the opportunity to control by their actions

El objetivo de este artículo es evaluar, según algunos atributos, el sistema de vigilancia de los accidentes de trabajo antes y después de la implementación del software Sentinela (2018-2021), por medio de una investigación descriptiva de datos secundarios, y hacer recomendaciones. Fueron analizadas variables de la ficha de investigación de accidentes, de acuerdo con los atributos de calidad de los datos (completitud y consistencia), oportunidad y representatividad. Los resultados demostraron que, después del Sentinela, ha habido un aumento de la notificación de accidentes (66,16 %), una mayor completitud de las variables, con un cambio importante en 'actividad económica' (98,9 %) y 'evolución' (96,3 %), una disminución de campos ignorados/en blanco, con énfasis en el campo 'evolución' (3,7%), y mejora en la probabilidad de control de los accidentes mortales (79 días). Concluimos que la vigilancia de los accidentes de trabajo tiene excelente calidad de datos, es representativa, pero inoportuna. El Sentinela ha mejorado el sistema, haciéndolo más sensible en la captación de los accidentes y permitiéndole tener informaciones de mejor calidad. La evaluación de los atributos con regularidad es necesaria para el perfeccionamiento constante del sistema, así como la revisión de las rutinas de los equipos de salud, mejorando la oportunidad de control a través de sus acciones

Contaminated water confirmed as source of infection by bioassay in an outbreak of toxoplasmosis in South Brazil.

The protozoan Toxoplasma gondii is a causative agent of toxoplasmosis, an important and widespread zoonotic disease. The transmission of this disease in humans includes ingestion of sporulated oocysts present in contaminated water or food. T. gondii oocysts are widely distributed and toxoplasmosis is considered a major food- and waterborne pathogen worldwide, making drinking water containing sporulated T. gondii oocysts a major source of contamination for people. In the first half of 2018, an unprecedented outbreak of toxoplasmosis was reported in the city of Santa Maria, southern Brazil. The temporal and spatial distribution of the cases strongly suggested a waterborne infection. Thus, the aim of this study was to investigate a possible involvement of treated water as a source of the outbreak. For this, piglets received potentially contaminated water ad libitum for 21 days and the infection was monitored by serology through IFAT and investigation of T. gondii DNA in tissues by PCR amplification of a 529 bp followed by mouse bioassays. All piglets receiving test water ad libitum for 21 days as well as positive controls seroconverted to T. gondii. T. gondii DNA was detected in 62.5% of the piglets that received test water. All mice inoculated with tissues from each positive piglet were PCR-positive. These results strongly indicated the presence of viable oocysts in the test water administered to the animals during the study.

Isolation, genetic and immunohistochemical identification of Toxoplasma gondii from human placenta in a large toxoplasmosis outbreak in southern Brazil, 2018.

The present study aimed to describe a molecular analysis of environmental and pork samples, the isolation, genetic identification and immunohistochemistry (IHC) of Toxoplama gondii from placenta and amniotic fluid from five pregnant women that miscarried during a toxoplasmosis outbreak in 2018, Santa Maria, Rio Grande do Sul. Environmental and pork samples were submitted to polymerase chain reaction (PCR); placenta and amniotic fluid samples to histopathology, IHC, mouse bioassay and PCR. All samples were genotyped by PCR-RFLP with 11 loci. Histopathologic and IHC were compatibles with toxoplasmosis. All pregnants were positive in PCR and bioassay, the genotypes were compared, and all were equal suggesting a same source of infection. Among the environmental and food samples, a sludge sample from a water tank and two porks samples were positive in PCR, and the genotypes were different from the pregnant women isolates. It is concluded that obtain and compare isolates is essential to elucidate outbreak source.

Isolation and molecular characterization of Toxoplasma gondii from placental tissues of pregnant women who received toxoplasmosis treatment during an outbreak in southern Brazil.

Toxoplasma gondii is a protozoan that has great genetic diversity and is prevalent worldwide. In 2018, an outbreak of toxoplasmosis occurred in Santa Maria, Brazil, which was considered the largest outbreak ever described in the world. This paper describes the isolation and molecular characterization of Toxoplasma gondii from the placenta of two pregnant women with acute toxoplasmosis who had live births and were receiving treatment for toxoplasmosis during the outbreak. For this, placental tissue samples from two patients underwent isolation by mice bioassay, conventional PCR and genotyping using PCR-RFLP with twelve markers. Both samples were positive in isolation in mice. The isolate was lethal to mice, suggesting high virulence. In addition, the samples were positive in conventional PCR and isolates submitted to PCR-RFLP genotyping presented an atypical genotype, which had never been described before. This research contributes to the elucidation of this great outbreak in Brazil.

Human metapneumovirus in Southern Brazil.

INTRODUCTION: Infections caused by respiratory viruses are important problems worldwide, especially in children. Human metapneumovirus (hMPV) is a respiratory pathogen and causes severe infections with nonspecific symptoms. This study reports the hMPV occurrence and dissemination in southern Brazil and compares the frequency of occurrence of this virus and the human respiratory syncytial virus (hRSV) in the epidemiological weeks in a three-year period (2009-2011). METHODS: In total, 545 nasopharyngeal (NP) specimens from individuals with Severe Acute Respiratory Syndrome (SARS) who were negative for other seven respiratory viruses were analyzed for the presence of hMPV. Human metapneumovirus was detected by direct immunofluorescence and real-time reverse transcription polymerase chain reaction. RESULTS: hMPV was detected in 109 patients from the main geographic regions of the southernmost state of Brazil, presenting similar overall prevalence in males (46.8%) and females (53.2%). Among children who were less than six years old, hMPV was detected in 99 samples of all age groups, with a higher frequency in infants who were less than one year old (45.7%) compared to all other age groups until six years. hMPV and hRSV infection occurred in almost the same epidemiological weeks (EWs) of each year, with peaks of incidence between EW 31/37 and EW 26/38 for the years 2009 and 2011, respectively. hMPV was further detected in several cases of SARS and it was the only virus detected in three deaths. CONCLUSIONS: These findings indicate that hMPV is in circulation in southern Brazil and highlight the importance of diagnosing hMPV for influenza-like illness in the population.

Human metapneumovirus in Southern Brazil

INTRODUCTION Infections caused by respiratory viruses are important problems worldwide, especially in children. Human metapneumovirus (hMPV) is a respiratory pathogen and causes severe infections with nonspecific symptoms. This study reports the hMPV occurrence and dissemination in southern Brazil and compares the frequency of occurrence of this virus and the human respiratory syncytial virus (hRSV) in the epidemiological weeks in a three-year period (2009-2011). METHODS: In total, 545 nasopharyngeal (NP) specimens from individuals with Severe Acute Respiratory Syndrome (SARS) who were negative for other seven respiratory viruses were analyzed for the presence of hMPV. Human metapneumovirus was detected by direct immunofluorescence and real-time reverse transcription polymerase chain reaction. RESULTS: hMPV was detected in 109 patients from the main geographic regions of the southernmost state of Brazil, presenting similar overall prevalence in males (46.8%) and females (53.2%). Among children who were less than six years old, hMPV was detected in 99 samples of all age groups, with a higher frequency in infants who were less than one year old (45.7%) compared to all other age groups until six years. hMPV and hRSV infection occurred in almost the same epidemiological weeks (EWs) of each year, with peaks of incidence between EW 31/37 and EW 26/38 for the years 2009 and 2011, respectively. hMPV was further detected in several cases of SARS and it was the only virus detected in three deaths. CONCLUSIONS These findings indicate that hMPV is in circulation in southern Brazil and highlight the importance of diagnosing hMPV for influenza-like illness in the population. (AU)

Identification of priority Health Regions in the State of Rio Grande do Sul, Brazil, for Health Surveillance actions. / Identificação das Regiões de Saúde do Rio Grande do Sul, Brasil, prioritárias para ações de Vigilância em Saúde.

This paper aimed to identify the priority Health Regions of Rio Grande do Sul (RS) to implement Health Surveillance strengthening actions. This is a descriptive study with data from time series of 11 (eleven) Health Surveillance indicators of the Ministry of Health's 2016 Guidelines, Objectives, Targets and Indicators Journal agreed by the Bipartite Interagency Committee/RS. The selected indicators are synthesized to produce a Composite Health Surveillance Assessment Indicator (ICAVES) for each of the 30 Health Regions of the state, creating values ranging from zero (worst) to 1 (best), using the Human Development Index (HDI) construction calculation method. The lowest rates of the composite indicator are found in the Health Regions "20-Rota da Produção" and "19-Região do Botucaraí". These two Health Regions are priorities for the strengthening of collective Health Surveillance actions and the management of health risks and diseases, considering horizontal equity as guideline of the Unified Health System.

Resumo O presente artigo identifica as Regiões de Saúde do Rio Grande do Sul (RS) prioritárias com vistas a implementar ações para o fortalecimento da Vigilância em Saúde. Estudo descritivo com dados da série histórica de 11 (onze) indicadores de Vigilância em Saúde do Caderno de Diretrizes, Objetivos, Metas e Indicadores 2016, do Ministério da Saúde pactuados pela Comissão Intergestores Bipartite/RS. Os indicadores selecionados são sintetizados para produzir um Indicador Composto de Avaliação da Vigilância em Saúde (ICAVES) para cada uma das 30 Regiões de Saúde do estado, criando valores que variam de 0 (pior) a 1 (melhor), tendo como método de cálculo o utilizado para a construção do Índice de Desenvolvimento Humano (IDH). Os menores índices do indicador composto estão nas Regiões de Saúde: 20-Rota da Produção e 19-Região do Botucaraí. As Regiões de Saúde 20 e 19 são prioritárias para o fortalecimento das ações de âmbito coletivo da Vigilância em Saúde e o gerenciamento de riscos e agravos à saúde considerando a equidade horizontal como diretriz do Sistema Único de Saúde.

Identificação das Regiões de Saúde do Rio Grande do Sul, Brasil, prioritárias para ações de Vigilância em Saúde / Identification of priority Health Regions in the State of Rio Grande do Sul, Brazil, for Health Surveillance actions

Resumo O presente artigo identifica as Regiões de Saúde do Rio Grande do Sul (RS) prioritárias com vistas a implementar ações para o fortalecimento da Vigilância em Saúde. Estudo descritivo com dados da série histórica de 11 (onze) indicadores de Vigilância em Saúde do Caderno de Diretrizes, Objetivos, Metas e Indicadores 2016, do Ministério da Saúde pactuados pela Comissão Intergestores Bipartite/RS. Os indicadores selecionados são sintetizados para produzir um Indicador Composto de Avaliação da Vigilância em Saúde (ICAVES) para cada uma das 30 Regiões de Saúde do estado, criando valores que variam de 0 (pior) a 1 (melhor), tendo como método de cálculo o utilizado para a construção do Índice de Desenvolvimento Humano (IDH). Os menores índices do indicador composto estão nas Regiões de Saúde: 20-Rota da Produção e 19-Região do Botucaraí. As Regiões de Saúde 20 e 19 são prioritárias para o fortalecimento das ações de âmbito coletivo da Vigilância em Saúde e o gerenciamento de riscos e agravos à saúde considerando a equidade horizontal como diretriz do Sistema Único de Saúde.

Abstract This paper aimed to identify the priority Health Regions of Rio Grande do Sul (RS) to implement Health Surveillance strengthening actions. This is a descriptive study with data from time series of 11 (eleven) Health Surveillance indicators of the Ministry of Health's 2016 Guidelines, Objectives, Targets and Indicators Journal agreed by the Bipartite Interagency Committee/RS. The selected indicators are synthesized to produce a Composite Health Surveillance Assessment Indicator (ICAVES) for each of the 30 Health Regions of the state, creating values ranging from zero (worst) to 1 (best), using the Human Development Index (HDI) construction calculation method. The lowest rates of the composite indicator are found in the Health Regions "20-Rota da Produção" and "19-Região do Botucaraí". These two Health Regions are priorities for the strengthening of collective Health Surveillance actions and the management of health risks and diseases, considering horizontal equity as guideline of the Unified Health System.

Investigação de surto de doença meningocócica do grupo C no município de Cachoeirinha/Rio Grande do Sul, 2015 / Investigation of meningococcal disease outbreak of group c in the municipality of Cachoeirinha/Rio Grande do Sul, 2015

Confirmar a ocorrência do surto, descrever suas características epidemiológicas e desencadear medidas de controle. (AU)

Panorama epidemiológico da varicela no Rio Grande do Sul no período de 2007 a 2016 / Epidemiological panorama of chickenpox in Rio Grande do Sul from 2007 to 2016

Panorama epidemiológico da transmissão da varicela no estado do Rio Grande do Sul no período de 2007 a 2016. (AU)

Surto de parvovírus B19 no município de Crissiumal/17ª CRS/ RS, agosto de 2016 / Parvovirus B19 outbreak in the municipality of Crissiumal/17ª CRS/ RS, august 2016

Em 18/08/2016, uma escola infantil notificou à vigilância do município de Crissiumal a ocorrência de vários casos de crianças com febre e exantema. A partir dessa informação, a equipe da vigilância, junto com médico da rede de atenção à saúde, deslocou-se até a escola para realizar avaliação clínica dos casos e fazer a investigação epidemiológica com vistas a confirmar a ocorrência de surto de doença exantemática, identificar a causa e desencadear medidas de controle. (AU)

Enteroviroses no Rio Grande do Sul: uma vigilância a ser estruturada? / Enteroviroses in Rio Grande do Sul: a surveillance to be structured?

Em agosto de 2016, o European Center of Disease Control (ECDC) publicou um artigo alertando para os casos de enteroviroses (EV) com sintomas neurológicos severos detectados na Europa neste mesmo ano e o aumento de casos do enterovírus D68 e outras enteroviroses em anos recentes. No texto, é sugerido que devem ser discutidas e exploradas a coleta de dados e a vigilância de enterovírus não pólio, especialmente de casos mais severos. É necessário, também, que os clínicos devam ser encorajados a obter fezes e espécimes respiratórias para a detecção e a caracterização de enterovírus de todos os pacientes com meningites, encefalites, doença da mão-pé-boca, mielite ou paralisia flácida aguda. (AU)

Doenças em eliminação no Rio Grande do Sul / Diseases being eliminated in Rio Grande do Sul

Este estudo trata das doenças imunopreveníveis em eliminação nas Américas: sarampo, rubéola e Síndrome da Rubéola Congênita (SRC), poliomielite e tétano neonatal. A proposta de eliminação autóctone dessas doenças, no continente, aconteceu em períodos diferentes, por decisão dos países-membros da Organização Pan-Americana de Saúde (OPAS), órgão da Organização Mundial de Saúde (OMS), em suas conferências anuais. O Brasil, como membro da OPAS/OMS, participou dessa decisão, implantou estratégias e atingiu a eliminação autóctone da poliomielite em 1994; do sarampo, em 2000; da rubéola e SRC em 2008. O tétano neonatal é considerado eliminado no país, uma vez que tem havido menos de 1 caso para cada 100.000 nascidos vivos. O Rio Grande do Sul atingiu a eliminação de todas essas doenças e mantém estratégias para sua manutenção. Para eliminação dessas doenças é recomendado implantar uma vigilância robusta e oportuna, manter altas coberturas vacinais na rotina e em campanhas e dispor de uma rede de laboratórios que permita o dignóstico e identificação de genótipos circulantes no país. Portanto, o objetivo desta publicação é descrever a experiência, os resultados alcançados e as perspectivas da vigilância epidemiológica no estado. (AU)

Investigação de surto de doença exantemática por enterovirus não pólio em município turístico da serra gaúcha / Investigation of an outbreak of non polio enterovirus in a tourist municipality of Rio Grande do Sul

Confirmar a ocorrência de surto, descrever o surto em relação a tempo, lugar e pessoa, identificar o agente etiológico e realizar medidas de prevenção e controle. (AU)

Investigação de surto de doença respiratória em escola privada, Cachoeirinha/RS / Investigation of respiratory disease outbreak in private school, Cachoeirinha/RS

O objetivo deste estudo é confirmar a ocorrência de surto de Síndrome Gripal e descrever o surto em relação a tempo, lugar e pessoa. (AU)

Outbreak of rubella after mass vaccination of children and adult women: challenges for rubella elimination strategies.

OBJECTIVE: To describe rubella outbreaks and control strategies in the Brazilian state of Rio Grande do Sul before rubella elimination. METHODS: We analyzed rubella and congenital rubella syndrome surveillance data for the state of Rio Grande do Sul and calculated age- and gender-specific incidence of confirmed rubella cases in 2007. We obtained data on measles-rubella doses administered during the outbreak from the state immunization program and reviewed the timing of suspect case notification and implementation of control measures. RESULTS: Of 2,842 confirmed rubella cases reported to the state health department in 2007, 2,145 (75.5%) were in males (39.5 cases per 100,000 population) and 697 (24.5%) were in females (12.3 per 100,000 population). Incidence among 15- to 39-year-olds was 1.8 to 5.5 times higher in males than in females. Rubella genotype 2B was detected in nasopharyngeal specimens from 13 patients from multiple chains of transmission. Eight children were born with congenital rubella syndrome (5.9 cases per 100 000 births in 2008). Delayed notification of initial cases hampered early control efforts, resulting in outbreak spread throughout the state. Rubella transmission was interrupted after mass vaccination of adult men and women as part of a national vaccination campaign. CONCLUSIONS: Routine vaccination strategies and mass vaccination of adolescents and adults for accelerated rubella control and elimination should target men and women.

Outbreak of rubella after mass vaccination of children and adult women: challenges for rubella elimination strategies / Brote epidémico de rubéola tras la vacunación masiva de niños y mujeres adultas: un reto para las estrategias de eliminación de la rubéola

OBJECTIVE: To describe rubella outbreaks and control strategies in the Brazilian state of Rio Grande do Sul before rubella elimination. METHODS: We analyzed rubella and congenital rubella syndrome surveillance data for the state of Rio Grande do Sul and calculated age- and gender-specific incidence of confirmed rubella cases in 2007. We obtained data on measles-rubella doses administered during the outbreak from the state immunization program and reviewed the timing of suspect case notification and implementation of control measures. RESULTS: Of 2 842 confirmed rubella cases reported to the state health department in 2007, 2 145 (75.5 percent) were in males (39.5 cases per 100 000 population) and 697 (24.5 percent) were in females (12.3 per 100 000 population). Incidence among 15- to 39-year-olds was 1.8 to 5.5 times higher in males than in females. Rubella genotype 2B was detected in nasopharyngeal specimens from 13 patients from multiple chains of transmission. Eight children were born with congenital rubella syndrome (5.9 cases per 100 000 births in 2008). Delayed notification of initial cases hampered early control efforts, resulting in outbreak spread throughout the state. Rubella transmission was interrupted after mass vaccination of adult men and women as part of a national vaccination campaign. CONCLUSIONS: Routine vaccination strategies and mass vaccination of adolescents and adults for accelerated rubella control and elimination should target men and women.

OBJETIVO: Describir los brotes de rubéola y las estrategias para el control de la enfermedad anteriores a la eliminación de la rubéola en el estado brasileño de Rio Grande do Sul. MÉTODOS: Se analizaron los datos de vigilancia epidemiológica sobre la rubéola y el síndrome de rubéola congénita del estado de Rio Grande do Sul y se calculó la incidencia específica por edad y sexo de los casos confirmados de rubéola en el 2007. A partir del programa de vacunación estatal se obtuvieron datos sobre las dosis de vacunación antisarampionosa y antirrubeólica administradas durante el brote y se analizaron el momento de notificación de los casos sospechosos y la puesta en práctica de medidas de control. RESULTADOS: De los 2842 casos confirmados de rubéola notificados al departamento de salud estatal en el 2007, 2 145 (75,5 por ciento) correspondieron a hombres (39,5 casos por 100000 habitantes) y 697 (24,5 por ciento) a mujeres (12,3 por 100000 habitantes). La incidencia en las personas de 15 a 39 años de edad fue de 1,8 a 5,5 veces mayor en los varones que en las mujeres. En 13 pacientes provenientes de distintas cadenas de transmisión se detectó el genotipo 2B del virus de la rubéola en muestras obtenidas de la nasofaringe. Nacieron 8 niños con síndrome de rubéola congénita (5,9 casos por 100000 nacimientos en el 2008). La demora en la notificación de los casos iniciales obstaculizó la adopción temprana de medidas de control, lo que hizo que el brote se propagara a todo el estado. La transmisión de la rubéola se interrumpió después de la vacunación masiva de varones y mujeres adultos como parte de una campaña nacional de vacunación. CONCLUSIONES: Las estrategias de vacunación sistemática y la vacunación masiva de adolescentes y adultos tendientes a acelerar el control y la eliminación de la rubéola deben dirigirse tanto a varones como a mujeres.

[Nutritional status and social determinants of child height in the Guarita Indigenous Territory, Southern Brazil]. / Estado nutricional e fatores associados à estatura de crianças da Terra Indígena Guarita, Sul do Brasil.

The nutritional status of under-five children and the association between social conditions and child stature were examined using data from the program to control malnutrition and mortality in the Guarita Indigenous Territory, southern Brazil, 2001-2002. Anthropometric indices were calculated in z-scores of the CDC 2000 reference. At entrance into the program, 34.7% of the children presented stunting, 12.9% low weight for age, 4.2% wasting, and 8.7% overweight. Stunting was most prevalent among boys and children older than one year. Multivariate linear regression showed that, on average, children were shorter when the drinking water was collected directly in the environment (p = 0.046), there was no refrigerator for food preservation (p = 0.021), maternal age was less than 16 years at the birth of the oldest child among the under-fives (p = 0.019), and the mother was illiterate (p = 0.083). Sewage facilities only had an effect on the unadjusted model. There was no evidence that the number of under-five children had an effect on stature. Social inclusion policies and health and social provision which takes these factors into account are potentially relevant for improving health and nutrition in this population.