Epidemiology of human leptospirosis in urban and rural areas of Brazil, 2000-2015.

BACKGROUND: Leptospirosis is one of the most widespread zoonosis in the world and Brazil has the highest number of cases in Latin America. Transmission occurs mainly through exposure to water and soil contaminated by the urine of infected animals. The goals of this study are to describe the geographic distribution, demographic characteristics and exposure factors of urban and rural cases of leptospirosis, and identify spatial clusters in urban and rural areas of Brazil. METHODS/RESULTS: A retrospective epidemiological study was carried out using 16 years (2000-2015) of surveillance data from the Brazilian Ministry of Health. Cases were described by age, sex and race, and exposure factors were characterized in urban and rural areas. A spatial autocorrelation analysis was conducted using local Moran's I to identify urban and rural clusters of disease. On average 3,810 leptospirosis cases were reported annually with higher numbers in urban areas. National urban and rural incidence rates were the same (1.9 cases/100,000 population), however, regional differences were observed. Urban incidence rates were higher in the North and Northeast regions, while rural incidence rates were higher in the Southeast and South. The main exposure factor reported in urban and rural areas was exposure to places with signs of rodents, followed by flood in urban areas and agriculture and animal farming in rural areas. Clusters of leptospirosis were identified in densely populated urban areas of the North, Southeast and South regions, while rural clusters were concentrated in of the Southern region with large agriculture and animal farming practices. CONCLUSIONS: This study highlights that leptospirosis is an important public health problem in both urban and rural areas of Brazil. The results provide decision-makers with detailed information about where disease incidence is high and can be used in the development of prevention and control strategies for priority areas and risk groups.

Fatal case of spotted fever in a patient from Northeastern Brazil.

Spotted fevers are diseases caused by bacterial agents belonging to the spotted-fever (SF) group of the genus Rickettsia. The first documented case of SF in Pernambuco State, Northeast Brazil, was reported here. Also, it is the first case described of fatal SF in Northeast region of Brazil. The patient was a resident of Arcoverde municipality and the probable site of infection lies in Sertania municipality, both in Pernambuco State, a semi-arid region of Brazil. The patient had not visited other areas where SF is endemic. The patient showed clinical manifestations and epidemiological exposure compatible with SF, and the infection was confirmed by molecular biology techniques.

An update on the epidemiological situation of spotted fever in Brazil.

BACKGROUND: Spotted fever is a tick-borne rickettsial disease. In Brazil, its notification to the Ministry of Health is compulsory. Since 2007, cases of spotted fever have been integrated to the Notifiable Diseases Information System, and epidemiological analyzes are part of the routines on surveillance programs. METHODS: This descriptive study updates epidemiological information on cases of spotted fever registered in Brazil between 2007 and 2015. RESULTS: In Brazil, 17,117 suspected cases of the disease were reported and 1,245 were confirmed in 12 states, mainly in São Paulo (550, 44.2 %) and Santa Catarina (276, 22.2 %). No geographic information was registered for 132 cases (10.6 %). Most of the infected people were men (70.9 %), mainly in rural areas (539, 43.3 %), who had contact with ticks (72.7 %). A higher number of suspected cases were registered between 2011 and 2015, but the number of confirmed cases and the incidence were relatively low. Moreover, 411 deaths were registered between 2007 and 2015, mainly in the southeastern region of the country, where the case-fatality rate was 55 %. Lack of proper filling of important fields of notification forms was also observed. CONCLUSIONS: The results showed expansion of suspected cases of spotted fever and high case-fatality rates, which could be related to diagnostic difficulties and lack of prompt treatment. These factors may comprise limitations to the epidemiological surveillance system in Brazil, hence improvement of notification and investigation are crucial to reduce morbidity and mortality due to spotted fever in Brazil.

An update on the epidemiological situation of spotted fever in Brazil

Spotted fever is a tick-borne rickettsial disease. In Brazil, its notification to the Ministry of Health is compulsory. Since 2007, cases of spotted fever have been integrated to the Notifiable Diseases Information System, and epidemiological analyzes are part of the routines on surveillance programs. Methods This descriptive study updates epidemiological information on cases of spotted fever registered in Brazil between 2007 and 2015. Results In Brazil, 17,117 suspected cases of the disease were reported and 1,245 were confirmed in 12 states, mainly in São Paulo (550, 44.2 %) and Santa Catarina (276, 22.2 %). No geographic information was registered for 132 cases (10.6 %). Most of the infected people were men (70.9 %), mainly in rural areas (539, 43.3 %), who had contact with ticks (72.7 %). A higher number of suspected cases were registered between 2011 and 2015, but the number of confirmed cases and the incidence were relatively low. Moreover, 411 deaths were registered between 2007 and 2015, mainly in the southeastern region of the country, where the case-fatality rate was 55 %. Lack of proper filling of important fields of notification forms was also observed. Conclusions The results showed expansion of suspected cases of spotted fever and high case-fatality rates, which could be related to diagnostic difficulties and lack of prompt treatment. These factors may comprise limitations to the epidemiological surveillance system in Brazil, hence improvement of notification and investigation are crucial to reduce morbidity and mortality due to spotted fever in Brazil.

An update on the epidemiological situation of spotted fever in Brazil

Background Spotted fever is a tick-borne rickettsial disease. In Brazil, its notification to the Ministry of Health is compulsory. Since 2007, cases of spotted fever have been integrated to the Notifiable Diseases Information System, and epidemiological analyzes are part of the routines on surveillance programs. Methods This descriptive study updates epidemiological information on cases of spotted fever registered in Brazil between 2007 and 2015. Results In Brazil, 17,117 suspected cases of the disease were reported and 1,245 were confirmed in 12 states, mainly in São Paulo (550, 44.2 %) and Santa Catarina (276, 22.2 %). No geographic information was registered for 132 cases (10.6 %). Most of the infected people were men (70.9 %), mainly in rural areas (539, 43.3 %), who had contact with ticks (72.7 %). A higher number of suspected cases were registered between 2011 and 2015, but the number of confirmed cases and the incidence were relatively low. Moreover, 411 deaths were registered between 2007 and 2015, mainly in the southeastern region of the country, where the case-fatality rate was 55 %. Lack of proper filling of important fields of notification forms was also observed. Conclusions The results showed expansion of suspected cases of spotted fever and high case-fatality rates, which could be related to diagnostic difficulties and lack of prompt treatment. These factors may comprise limitations to the epidemiological surveillance system in Brazil, hence improvement of notification and investigation are crucial to reduce morbidity and mortality due to spotted fever in Brazil.(AU)

Vulnerability of Brazilian municipalities to hantavirus infections based on multi-criteria decision analysis.

BACKGROUND: Hantavirus infection is an emerging zoonosis transmitted by wild rodents. In Brazil, high case-fatality rates among humans infected with hantavirus are of serious concern to public health authorities. Appropriate preventive measures partly depend on reliable knowledge about the geographical distribution of this disease. METHODS: Incidence of hantavirus infections in Brazil (1993-2013) was analyzed. Epidemiological, socioeconomic, and demographic indicators were also used to classify cities' vulnerability to disease by means of multi-criteria decision analysis (MCDA). RESULTS: From 1993 to 2013, 1752 cases of hantavirus were registered in 16 Brazilian states. The highest incidence of hantavirus was observed in the states of Mato Grosso (0.57/100,000) and Santa Catarina (0.13/100,000). Based on MCDA analysis, municipalities in the southern, southeastern, and midwestern regions of Brazil can be classified as highly vulnerable. Most municipalities in northern and northeastern Brazil were classified as having low vulnerability to hantavirus cardiopulmonary syndrome. CONCLUSIONS: Although most human infections by hantavirus registered in Brazil occurred in the southern region of the country, a greater vulnerability to hantavirus was found in the Brazilian Midwest. This result reflects the need to strengthen surveillance where the disease has thus far gone unreported.

Análise do perfil epidemiológico da hantavirose no Brasil no período de 2007 a 2012 / Analysis of the epidemiological profile of hanavirus in Brazil for the period 2007 to 2012

As hantaviroses são zoonoses que causam doenças humanas graves como a síndrome cardiopulmonar por hantavírus (SCPH) registrada no continente americano. No Brasil a SCPH é doença de notificação obrigatória aos serviços de saúde por apresentar elevada letalidade e incipiente conhecimento da sua epidemiologia. O presente estudo descreve o perfil epidemiológico da SCPH no Brasil para o período de 2007 a 2012. Foi realizado um estudo descritivo dos registros do Sistema Nacional de Agravos de Notificação, foram analisadas as fichas de notificação e investigação e os dados foram avaliados quanto a completitude da informação, oportunidade e perfil dos casos registrados. Os resultados são apresentados em números brutos, medidas de proporção e tendência central e as analises foram desenvolvidas pelos softwares Excel 2010, Tabwin 32 e TerraView. No período estudado foram notificados 8.456 casos de SCPH, com confirmação de 9 porcento (756/8.456), preferencialmente pelo critério laboratorial 91,1 porcento (689/756). O coeficiente de letalidade médio para o período foi de 38,2 porcento, as maiores incidências da doença foram nos estados do Mato Grosso, Santa Catarina e Distrito Federal e as maiores letalidades no Amazonas, Mato Grosso e São Paulo. Quanto à sazonalidade foram observados casos em todos os meses do ano; os óbitos foram mais frequentes em homens 72,3 porcento (209/289) e maior letalidade 42,3 porcento (80/189) foi observada em mulheres. Os casos acometeram principalmente pessoas que exerciam atividades relacionadas à agricultura 18,8 porcento (90/478) que se expuseram ao ambiente com roedores 36,9 porcento (279/756)...

Hantaviruses are zoonoses that cause serious human diseases in the Americas such as hantavirus pulmonary syndrome (HPS). In Brazil HPS is a notifiable disease to health services due to its high lethality and incipient knowledge of its epidemiology. The present study describes the epidemiology of HPS in Brazil for the period 2007-2012. We conducted a descriptive study of the records of the National Notifiable Diseases System, analyzed the reporting forms and research, and the data were evaluated for completeness of information, opportunity and profile of registered cases. The results are presented as raw numbers, measures of central tendency and proportion and analyses developed using Excel 2010 software, and 32 Tabwin terraView. In the study period 8,456 cases of HPS were reported, with confirmation of 9 percent (756/8,456), ideally by laboratory testing 91.1 percent (689/756). The average coefficient of lethality for the period was 38.2 percent, whilst the highest incidences of the disease were in the states of Mato Grosso, Santa Catarina and the Federal District and the greatest lethalities were in Amazonas, Mato Grosso and São Paulo. Regarding seasonality, cases were observed in all months of the year. Deaths were more frequent in males 72.3 percent (209/289) and high mortality was observed in women 42.3 percent (80/189). The cases were mainly people who conducted activities related to agriculture 18.8 percent (90/478) who were exposed to the rodent environment, 36.9 percent (279/756)...

Investigação de ratada associada a florescimento e frutificação de taquaras em São Francisco do Sul, Santa Catarina, Brasil, 2012 / Investigación e ratada asociaa a florecimiento y frutificación de tacuaras een são francisco do sul, santa Catarina, Brasil, 2012 / Research on odennt outbreak associated with flowering and fruiting of bamboos in são francisco do sul, santa Catarina, Brazil, 2122

A reprodução e a morte massiva de plantas de longa vida, como taquaras e bambus, estão associadas historicamente a episódios de ratadas. A superpopulação de roedores, que é favorecida pelo evento reprodutivo desses vegetais, traz consigo grandes prejuízos e riscos de emergências de doenças. Nesta nota, relatamos o episódio de ratada ocorrido no município de São Francisco do Sul, Santa Catarina. Para subsidiar esta comunicação foram feitas observações de campo, entrevistas não estruturadas e coleta de material biológico em novembro de 2012. Foi constatada a reprodução da taquara do gênero Merostachys e a invasão subsequente de domicílios por roedores dos gêneros Oligoryzomys e Akodon, reservatórios de hantavírus, no sul do Brasil.

Reproduction and massive death of long lived plants like bamboo are historically associated with episodes of mouse outbreaks. The over population of rodents that is favored by the reproduction of these vegetables brings big losses and risks of emerging diseases. In this note we report the mouse outbreaks happened in the district of São Francisco do Sul, Santa Catarina, Brazil. In order to supoort this communication we conducted observations, unstructured interview and sand collection of biological material in November 2012. It was found bamboo reproduction of the genus Merostachys and subsequent invasion of houses by rodents of the genus Oligoryzomys and Akodon, which are hantavirus reservoirs, in southern Brazil.

La reproducción y muerte masiva de plantas de larga vida, como tacuaras y bambús, están asociadas históricamente a episodios de ratadas. La superpoblación de roedores, que es favorecida por el evento reproductivo de esos vegetales, trae consigo grandes perjuicios y riesgos de emergencias de enfermedades. En esta nota, relatamos el episodio de ratada ocurrido en el municipio de São Francisco do Sul, Santa Catarina. Para subsidiar esta comunicación fueron hechas observaciones de campo, entrevistas no estructuradas y recogida de material biológico en noviembre de 2012. Fue constatada la reproducción de la tacuara del género Merostachys y la invasión subsecuente de domicilios por roedores de los géneros Oligoryzomys e Akodon, reservorios de hantavirus, en el sur de Brasil.

Avaliação do Sistema de Vigilância Epidemiológica da Peste no Brasil, 2000-2009 / Evaluation of Epidemiological Surveillance System of the Plague in Brazil, 2000-2009

A peste é uma doença infecciosa primordialmente de roedores, cujo bioagente, a Yersinia pestis é transmitido por picadas de pulgas contaminadas. O homem é infectado acidentalmente quando penetra no ecossistema dos roedores em atividades de caça, agricultura, comércio ou lazer. Além disso, a peste é doença de notificação internacional obrigatória e imediata. Os objetivos do presente estudo foram avaliar o sistema de vigilância epidemiológica da peste (SVEpeste) no Brasil, no período de 2000 a 2009; descrever a sua estrutura; avaliar o sistema em relação aos atributos qualitativos, quantitativos e utilidade; descrever as ações de vigilância epidemiológica desenvolvidas no período de 2000 a 2009; descrever os casos notificados pelo SINAN também no mesmo período; bem como avaliar o SVE-Peste em relação aos atributos qualitativos, quantitativos e utilidade. Metodologia: Para avaliação dos atributos qualitativos e quantitativos, utilizamos as diretrizes para avaliação de sistemas de vigilância propostas pelo CDC. Para a identificação dos determinantes contextuais do sistema de vigilância epidemiológica da peste, foram aplicados dois questionários semiestruturados aos gestores estaduais do PCP. Resultados: O Programa de Controle da Peste (PCP) é um sistema de vigilância passiva e universal, assim todo caso suspeito deve ser notificado no máximo em 24 horas e investigado em 48 horas. A primeira amostra sanguínea para diagnóstico deve ser colhida no máximo até o quinto dia do início dos sintomas. No período avaliado, verificou-se que a notificação foi inoportuna nos dois períodos avaliados (11,0 por cento de 2000 a 2006) e (5,6 por cento de 2007 a 2009).

Para a investigação o sistema foi considerado inoportuno (73,7 por cento no período de 2000 a 2006) e oportuno (91,5 por cento no período de 2007 a 2009). Quanto a coleta da primeira amostra sanguínea para diagnóstico laboratorial o sistema foi considerado inoportuno com (14,0 por cento no período de 2000 a 2006) e (28,0 por cento no período de 2007 a 2009). Em relação ao encerramento do caso no sistema de informação, o sistema de vigilância da peste também foi considerado inoportuno (40,1 por cento no período de 2000 a 2006) e (71,8 por cento no período de 2007 a 2009). Conclusões: Os achados deste estudo sugerem que o SVE-Peste se apresentou simples, aceitável, estável, não flexível, inoportuno, mas com boa qualidade de dados. Entretanto, esta avaliação do sistema de vigilância epidemiológica da peste no Brasil possui caráter inédito, uma vez que não há registros na literatura nacional e internacional de outras publicações que tenham usado essa metodologia para sua avaliação.