How the Covid-19 pandemic has drawn attention to the issue of active mobility and co-benefits in Latin American cities.

The Covid-19 pandemic has brought to the fore many issues that will impact public health for years to come -one such impact is on the nexus between transportation and health. Promoting safe, active transport is an activity that has many physical and mental health benefits. During lockdowns, many cities in Latin America imposed infrastructural and legislative changes in order to abide with public health and social mea-sures to reduce virus spread. These ranged from additional bike lanes to reduced speed limits or incentives to purchase bicycles. These cities showed reduced motorized transport, improved air quality and increased active transport, all of which have multiple health and equity benefits. As countries "build back better", promoting active transport offers the most value for investment and improves health and well-being while continuing to offer social distancing. Quantified case studies are needed to have a more comprehensive under-standing of the impact of active transport in various contexts.

Road safety legislation in the Americas / Legislación sobre seguridad vial en las Américas

Legislating five of the main risk factors for road traffic injuries (RTIs), as much as enforcing the law, is essential in forging an integral culture of road safety. Analysis of the level of progression in law enforcement allows for an evaluation of the state of world regions. A secondary analysis of the 2009 Global status report on road safety: time for action survey was undertaken to evaluate legislation on five risk factors (speed management, drinking and driving, motorcycle helmet use, seatbelt use, and use of child restraints) in the Americas. Laws were classified depending on their level of progression: the existence of legislation, whether the legislation is adequate, a level of law enforcement > 6 (on a scale of 0-10), and whether the law is considered comprehensive. A descriptive analysis was performed. The totality of the countries has national or subnational legislation for at least one of the five risk factors. However, 63% have laws on the five risk factors studied, and none of them has comprehensive laws for all five. Seatbelt use appears to be the most extended enforced legislation, while speeding laws appear to be the least enforced. There are positive efforts that should be recognized in the region. However, the region stands in different stages of progression. Law enforcement remains the main issue to be tackled. Laws should be based on evidence about what is already known to be effective.

La legislación sobre cinco de los principales factores de riesgo de sufrir lesiones causadas por el tránsito, así como el cumplimiento de la ley, son esenciales para forjar una cultura integral de seguridad vial. El análisis del nivel de progresión en el cumplimiento de la ley permite evaluar el estado de las regiones del mundo. Se llevó a cabo un análisis secundario de la encuesta Informe sobre la situación mundial de la seguridad vial: es hora de pasar a la acción, de 2009, para evaluar la legislación sobre cinco factores de riesgo (control de la velocidad, conducir bajo la influencia del alcohol, uso del casco al conducir motocicletas, uso de cinturones de seguridad y uso de sistemas de retención para niños) en las Américas. Las leyes se clasificaron según su nivel de progresión: la existencia de legislación, si la legislación es adecuada, un nivel de cumplimiento de la ley > 6 (en una escala de 0-10) y si la ley se considera integral. Se realizó un análisis descriptivo. Todos los países tienen legislación nacional o subnacional al menos con respecto a uno de los cinco factores de riesgo; sin embargo, 63% tienen leyes sobre los cinco factores de riesgo estudiados, y ninguno de ellos tiene leyes integrales para los cinco. La legislación sobre uso de cinturones de seguridad parece ser la de mayor cumplimiento, mientras que las leyes de exceso de velocidad parecen ser las que menos se cumplen. En la región hay esfuerzos positivos que deben reconocerse; sin embargo, existen diferentes etapas de progresión. El cumplimiento de la ley sigue siendo el principal tema por abordar. Las leyes deben basarse en datos de eficacia reconocida.

Economic impact of fatal and nonfatal road traffic injuries in Belize in 2007 / Repercusiones económicas de los traumatismos mortales y no mortales por accidentes de tránsito en Belice en 2007

OBJECTIVE: To estimate the economic cost of road traffic injuries in Belize in 2007. METHODS: A cross-sectional study was conducted using secondary cost data, assuming the health system and social perspectives. Epidemiologic information was obtained from the mortality database, the national hospital discharge database, and administrative records from police and the Ministry of Health. A health provider survey was carried out in order to estimate the postdischarge ambulatory utilization figures. Direct cost was estimated with the World Health Organization WHO-CHOICE (CHOosing Interventions that are Cost Effective) database. Prehospital costs were obtained from the Belize emergency response team. After estimating years of potential life lost using the Belize life expectancy for 2008 and methodology proposed by the Pan American Health Organization, the indirect cost associated with premature death was estimated with the human capital approach. Total estimation of road traffic injuries' economic costs used a decision tree model approach. Multiway sensitivity analysis was used to incorporate uncertainty in the estimations. RESULTS: Sixty-one people died due to road traffic injuries during 2007, 338 were hospitalized, and 565 people were estimated to be slightly injured. A total of 2 501 years of potential life were lost in Belize due to premature death, with a total economic cost of US$11-062-544. This figure represents 0.9 percent of the Belize gross domestic product. Direct cost was estimated at US$163-503, of which 2.4 percent was spent on fatalities, 46.7 percent on the severely injured, and 50.9 percent on the slightly injured. CONCLUSIONS: The economic cost estimations make clear the need to prevent road traffic injuries with a strategic and multisectoral approach that focuses on addressing the main problems identified.

OBJETIVO: Calcular el costo económico de los traumatismos por accidentes de tránsito registrados en Belice durante el año 2007. MÉTODOS. Se realizó un estudio transversal a partir de datos secundarios sobre los costos, tanto desde la perspectiva social como desde la del sistema de salud. La información epidemiológica se obtuvo a partir de la base de datos de mortalidad, la base de datos nacional de egresos hospitalarios y los expedientes administrativos de la policía y el Ministerio de Salud. Se llevó a cabo una encuesta a los prestadores de servicios de salud para calcular las cifras correspondientes a la atención ambulatoria posterior al egreso. Para calcular los costos directos, se utilizó la base de datos del proyecto WHO-CHOICE (elección de intervenciones eficaces en función de los costos) de la Organización Mundial de la Salud. El equipo de respuesta a las urgencias médicas de Belice aportó los datos sobre los costos prehospitalarios. Después de calcular los años de vida potencial perdidos tomando como parámetro la esperanza de vida de Belice correspondiente al año 2008 y empleando el método propuesto por la Organización Panamericana de la Salud, se calculó el costo indirecto asociado a la muerte prematura desde el enfoque del capital humano. Se utilizó un modelo de árbol de decisiones para calcular el costo económico total derivado de los traumatismos causados por el tránsito y se hizo un análisis de sensibilidad multivariado y probabilístico para incorporar los parámetros de incertidumbre en las estimaciones. RESULTADOS: En Belice, durante el año 2007, los traumatismos causados por el tránsito provocaron la muerte de 61 personas, la hospitalización de 338 y, según se calcula, lesiones menores a 565. Se perdieron 2 501 años de vida potencial a causa de las muertes prematuras, lo que se tradujo en un costo económico total de US$11 062 544. Esta cifra representa 0,9 por ciento del producto interno bruto de Belice. Se calculó que el costo directo fue de US$ 163 503, del cual 2,4 por ciento fue ocasionado por las muertes, 46,7 por ciento por la atención de las personas que sufrieron traumatismos graves y 50,9 por ciento por la atención de quienes presentaron lesiones menores. CONCLUSIONES: El costo económico calculado en este estudio pone de manifiesto la necesidad de prevenir los traumatismos causados por el tránsito adoptando un método estratégico y multisectorial que se centre en abordar los principales problemas detectados.

Economic impact of fatal and nonfatal road traffic injuries in Belize in 2007.

OBJECTIVE: To estimate the economic cost of road traffic injuries in Belize in 2007. METHODS: A cross-sectional study was conducted using secondary cost data, assuming the health system and social perspectives. Epidemiologic information was obtained from the mortality database, the national hospital discharge database, and administrative records from police and the Ministry of Health. A health provider survey was carried out in order to estimate the postdischarge ambulatory utilization figures. Direct cost was estimated with the World Health Organization WHO-CHOICE (CHOosing Interventions that are Cost Effective) database. Prehospital costs were obtained from the Belize emergency response team. After estimating years of potential life lost using the Belize life expectancy for 2008 and methodology proposed by the Pan American Health Organization, the indirect cost associated with premature death was estimated with the human capital approach. Total estimation of road traffic injuries' economic costs used a decision tree model approach. Multiway sensitivity analysis was used to incorporate uncertainty in the estimations. RESULTS: Sixty-one people died due to road traffic injuries during 2007, 338 were hospitalized, and 565 people were estimated to be slightly injured. A total of 2,501 years of potential life were lost in Belize due to premature death, with a total economic cost of US$11,062,544. This figure represents 0.9% of the Belize gross domestic product. Direct cost was estimated at US$163,503, of which 2.4% was spent on fatalities, 46.7% on the severely injured, and 50.9% on the slightly injured. CONCLUSIONS: The economic cost estimations make clear the need to prevent road traffic injuries with a strategic and multisectoral approach that focuses on addressing the main problems identified.

Perfil dos atendimentos a acidentes de transporte terrestre por serviços de emergência em São Paulo, 2005 / Perfil de las atenciones a accidentes de transporte terrestre por servicios de emergencia en São Paulo, 2005 / Land transport injuries among emergency department visits in the state of São Paulo, in 2005

OBJETIVO: Analisar as características dos atendimentos decorrentes de lesões relacionadas com transporte terrestre. MÉTODOS: Foram analisados 5.934 atendimentos em quatro unidades de emergências hospitalares do estado de São Paulo, em 2005. O instrumento utilizado foi um questionário baseado em modelos disponibilizados pela Organização Mundial de Saúde. As variáveis analisadas foram: tipo de usuário (ocupante de veículo, pedestre, motociclista e ciclista), sexo e faixa etária e tipo de lesão sofrida. Foi utilizada análise de regressão logística para testar associações entre variáveis. Foram calculadas as odds ratios com os respectivos intervalos de confiança de 95 por cento. RESULTADOS: A maior parte dos atendimentos foram para o sexo masculino (74,2 por cento) e para a faixa de 20 a 29 anos (35,0 por cento). Os usuários vulneráveis do sistema responderam por 72,4 por cento do total de casos (motociclistas 29,8 por cento, pedestres 24,1 por cento e ciclistas 18,5 por cento). As vítimas com idades entre zero e 14 anos que sofreram lesões eram principalmente pedestres e ciclistas; entre 15 e 39 anos predominaram os motociclistas e na faixa acima de 50 anos, pedestres...

OBJECTIVE: To analyze the characteristics of visits resulting from land transport injuries. METHODS: A total of 5,934 visits in four hospital emergency departments (ED) were analyzed, in the state of São Paulo, in 2005. A questionnaire based on the following three models was used to collect data: World Health Organization (WHO), Center for Disease Control and Prevention (CDC), and Pan American Health Organization (PAHO). Variables analyzed were as follows: type of road user (vehicle occupant, pedestrian, motorcyclist, and cyclist), sex, age group, and type of injury suffered. Logistic regression analysis was employed to test associations between variables. Odds ratios with their respective 95 percent confidence intervals were calculated. RESULTS: The majority of victims were males (74.2 percent) in the 20-to-29-year age group (35.0 percent). Vulnerable road users totaled 72.4 percent of all cases (29.8 percent were motorcyclists, 24.1 percent pedestrians, and 18.5 percent cyclists). Victims aged between zero and 14 years who had suffered injuries were mostly pedestrians and cyclists; motorcyclists predominated among those aged between 15 and 39 years; and pedestrians among those aged over 50 years...

OBJETIVO: Analizar las características de las atenciones derivadas de lesiones relacionadas con transporte terrestre. MÉTODOS: Fueron analizadas 5.934 atenciones en cuatro unidades de emergencias hospitalarias del estado de Sao Paulo (Sureste de Brasil), en 2005. El instrumento utilizado fue un cuestionario basado en modelos disponibilizados por la Organización Mundial de la Salud. Las variables analizadas fueron: tipo de usuario (ocupante del vehículo, peatón, motociclista y ciclista), sexo y grupo de edad y tipo de lesión sufrida. Fue utilizado análisis de regresión logística para evaluar asociaciones entre variables. Fueron calculados los odds ratios con los respectivos intervalos de confianza de 95 por ciento. RESULTADOS: La mayor parte de las atenciones fueron para el sexo masculino (74,2 por ciento) y para el grupo de 20 a 29 años (35,0 por ciento). Los usuarios vulnerables del sistema respondieron por 72,4 por ciento del total de casos (motociclistas 29,8 por ciento, peatones 24,1 por ciento y ciclistas 18,5 por ciento). Las víctimas con edades entre cero y 14 años que sufrieron lesiones eran principalmente peatones y ciclistas; entre 15 y 39 años predominaron los motociclistas y en edades por encima de 50 años, peatones...

[Land transport injuries among emergency department visits in the state of São Paulo, in 2005]. / Perfil dos atendimentos a acidentes de transporte terrestre por serviços de emergência em São Paulo, 2005.

OBJECTIVE: To analyze the characteristics of visits resulting from land transport injuries. METHODS: A total of 5,934 visits in four hospital emergency departments (ED) were analyzed, in the state of São Paulo, in 2005. A questionnaire based on the following three models was used to collect data: World Health Organization (WHO), Center for Disease Control and Prevention (CDC), and Pan American Health Organization (PAHO). Variables analyzed were as follows: type of road user (vehicle occupant, pedestrian, motorcyclist, and cyclist), sex, age group, and type of injury suffered. Logistic regression analysis was employed to test associations between variables. Odds ratios with their respective 95% confidence intervals were calculated. RESULTS: The majority of victims were males (74.2%) in the 20-to-29-year age group (35.0%). Vulnerable road users totaled 72.4% of all cases (29.8% were motorcyclists, 24.1% pedestrians, and 18.5% cyclists). Victims aged between zero and 14 years who had suffered injuries were mostly pedestrians and cyclists; motorcyclists predominated among those aged between 15 and 39 years; and pedestrians among those aged over 50 years. About half of the cases suffered minor injuries (strains, dislocations, contusions and cuts), while the other half was comprised by fractures, traumatic brain injuries and internal injuries. Extremities were the most affected body parts, particularly among motorcyclists. The majority of victims were discharged at triage (87.6%). Compared to women, men were 1.5 times more likely to be admitted or transferred, or to die. Pedestrians, vehicle occupants and motorcyclists were, respectively, 2.7, 2.4 and 1.9 times more likely to be admitted or transferred, or to die than cyclists. CONCLUSIONS: Measures aimed to protect vulnerable road users should be among the priorities to reduce land transport-related injuries.

Iniciativas de vigilância e prevenção de acidentes e violências no contexto do Sistema Único de Saúde (SUS) / Initiatives of surveillance and prevention of accidents and violence within the National Unified Health System (SUS)

A violência se incorporou à agenda do setor Saúde recentemente, por volta das duas últimas décadas do século XX, pautada pelo crescimento dos números de óbitos e adoecimentos por causas externas. Segundo a Organização Mundial da Saúde, anualmente, mais de 1,6 milhão de pessoas morrem vítimas de violência individual ou coletiva. Este artigo apresenta o processo de inserção do tema Violência no contexto do Ministério da Saúde (MS) e as iniciativas nas diversas áreas afins ao tema. Relata, ainda, a estruturação da Rede Nacional de Prevenção de Violências e Promoção da Saúde, estimulada pelo MS com o objetivo de subsidiar, técnica e politicamente, projetos locais de promoção da saúde e prevenção de violências; e divulga as principais deliberações da I Oficina Nacional da Rede de Prevenção de Violências, realizada em junho de 2005, visando à articulação dessa Rede...

Agenda de prioridades da vigilância e prevenção de acidentes e violências aprovada no I Seminário Nacional de Doenças e Agravos não Transmissíveis e Promoção da Saúde / Agenda of priorities for the surveillance and prevention of accidents and violence approved by the I National Seminar on Noncommunicable Diseases and Conditions and Health Promotion

As taxas de mortalidade por causas externas – acidentes e violências – apresentam-se altas e crescentes desde a década de 80, disseminando-se, em algumas regiões do Brasil, à semelhança de doenças transmissíveis. O Ministério da Saúde tem se mobilizado para o enfrentamento do problema e, por intermédio da Coordenação-Geral de Doenças e Agravos Não Transmissíveis da Secretaria de Vigilância em Saúde, promoveu, em setembro de 2005, o I Seminário Nacional de Doenças e Agravos Não Transmissíveis e Promoção da Saúde. No evento, aprovou-se a Agenda de Vigilância, Prevenção e Controle dos Acidentes e Violências. O documento define quatro eixos principais de atuação, cujos elementos são detalhados no presente artigo: I – Implantação da Vigilância e do Sistema de Informação de Acidentes e Violências; II – Gestão; III – Intervenção; e IV – Avaliação e apoio à pesquisa...

The burden of injury in Brazil, 2003.

CONTEXT AND OBJECTIVE: Since 1980, injuries have been the second biggest cause of death among the Brazilian population. This study aimed to analyze national data on fatal injuries and nonfatal injury hospitalization in Brazil, for 2003. DESIGN AND SETTING: This was a population-based descriptive study, Brazil, 2003. METHODS: Data from 126,520 fatal injuries and 733,712 nonfatal injuries seen at public hospitals were analyzed. The data were stratified by sex, age, intent and injury mechanism. Raw and age- and sex-specific rates were calculated per 100,000 individuals. RESULTS: The raw injury mortality rate was 71.5/100,000 (122.6/100,000 for male and 22.0/100,000 for female). For fatal injuries, the proportions of unintentional and intentional injuries were equal (44.3% and 46.9%, respectively). Homicides were the leading cause, 40.3% overall (28.8/100,000), followed by transport-related deaths, 26.2% overall (17.0/100,000). For nonfatal injuries, the rate was 414.8/100,000 and unintentional injuries were predominant (88.9%). Overall, the leading cause was unintentional falls, accounting for 42.6% of victims treated in public hospitals (176.8/100,000). Transport-related injuries were second: 15.0% overall; 62.0/100,000. Fractures comprised 46.7% of principal diagnoses at hospitals. The injury types in the fatal and nonfatal datasets varied according to sex and age. The highest rates were found among young males and elderly people. CONCLUSIONS: Injury prevention activities need to be developed. To prevent deaths, homicide has to be addressed. Among hospitalized cases, falls are the most important problem. Traffic-related injuries play an important role in morbidity and mortality.

The burden of injury in Brazil, 2003 / O impacto das causas externas de morbidades no Brasil, 2003

CONTEXT AND OBJECTIVE: Since 1980, injuries have been the second biggest cause of death among the Brazilian population. This study aimed to analyze national data on fatal injuries and nonfatal injury hospitalization in Brazil, for 2003. DESIGN AND SETTING: This was a population-based descriptive study, Brazil, 2003. METHODS: Data from 126,520 fatal injuries and 733,712 nonfatal injuries seen at public hospitals were analyzed. The data were stratified by sex, age, intent and injury mechanism. Raw and age- and sex-specific rates were calculated per 100,000 individuals. RESULTS: The raw injury mortality rate was 71.5/100,000 (122.6/100,000 for male and 22.0/100,000 for female). For fatal injuries, the proportions of unintentional and intentional injuries were equal (44.3 percent and 46.9 percent, respectively). Homicides were the leading cause, 40.3 percent overall (28.8/100,000), followed by transport-related deaths, 26.2 percent overall (17.0/100,000). For nonfatal injuries, the rate was 414.8/100,000 and unintentional injuries were predominant (88.9 percent). Overall, the leading cause was unintentional falls, accounting for 42.6 percent of victims treated in public hospitals (176.8/100,000). Transport-related injuries were second: 15.0 percent overall; 62.0/100,000. Fractures comprised 46.7 percent of principal diagnoses at hospitals. The injury types in the fatal and nonfatal datasets varied according to sex and age. The highest rates were found among young males and elderly people. CONCLUSIONS: Injury prevention activities need to be developed. To prevent deaths, homicide has to be addressed. Among hospitalized cases, falls are the most important problem. Traffic-related injuries play an important role in morbidity and mortality.

CONTEXTO E OBJETIVO: A partir da década de 80, a morbimortalidade por causas externas no Brasil se tornou um desafio para a saúde pública. O objetivo deste estudo é analisar os dados de mortes e internações hospitalares no Sistema Unico de Saúde devido às causas externas no ano de 2003, último ano disponível. TIPO DE ESTUDO E LOCAL: Estudo descritivo com base populacional, realizado no Brasil. MÉTODOS: O universo das 126.520 mortes e 733.712 internações por causas externas foi analisado. Os bancos de dados utilizados foram o Sistema de Informações de Mortalidade (SIM/DATASUS) e o Sistema de Internações Hospitalares (SIH). Os dados foram estratificados por sexo, idade, tipo de causa externa e natureza da lesão. Taxas calculadas por 100.000 habitantes. RESULTADOS: A taxa de mortalidade por causas externas foi 71,5/100.000 (122,6/100.000 para os homens e 22,0/100.000 para as mulheres). Na mortalidade observou-se um equilíbrio entre a proporção de lesões intencionais e não-intencionais (44,3 por cento e 46,9 por cento, respectivamente). Os homicídios representaram 40,3 por cento do total de mortes (28,8/100.000), seguido pelos acidentes de transporte, 26,2 por cento do total (17,0/100.000). A taxa de morbidade foi de 414,8/100.000, as lesões não-intencionais representaram 88,9 por cento. As quedas foram a maioria (42,6 por cento do total; 176,8/100.000), seguidas pelos acidentes de transporte, 15,0 por cento do total, 62,0/100.000. As fraturas foram o diagnóstico mais comum nas internações. CONCLUSÕES: Para prevenir mortes, estratégias para reduzir as agressões devem ser desenvolvidas; para prevenir hospitalizações, medidas para redução das quedas devem ser priorizadas.

[Epidemiology of dengue infection in Ribeirão Preto, SP, Brazil]. / Epidemiologia da infecção pela dengue em Ribeirão Preto, SP, Brasil.

OBJECTIVE: To assess dengue transmission in a correctional facility for juvenile delinquents in Ribeirão Preto, state of São Paulo, Brazil. METHODS: A serological and virology investigation was carried out among inmates and employees of a correctional facility for juvenile delinquents in Ribeirão Preto, Brazil. The study population consisted of 105 inmates and 91 employees representing 89% of the exposed. The collected blood was stored and processed using MAC-ELISA and virus isolation. A questionnaire was applied to each subject at the time of blood collection. RESULTS: Of the total of blood samples collected (n=196), 42 (21.4%) were positive for IgM antibodies and 43 (21.9%) for IgG antibodies; of which, 15 were both IgM and IgG positive and 28 (14.3%) were IgG positive only. Serotype 1 dengue virus was isolated in 5 samples. Out of 42 IgM positive samples, 14 (33.0%) subjects did not have any physical complaints. The incidence rate was 23.8% and 18.6% among inmates and employees, respectively. The first cases in the facility were reported in 1997 and the last ones in March 1997 though results are suggestive of an earlier onset of transmission. CONCLUSIONS: The high incidence rate of dengue infection can be explained by the high population density of the facility, high Aedes aegypti infestation, high numbers of asymptomatic subjects, and a higher transmission of disease in a closed setting.

Epidemiologia da infecçäo pela dengue em Ribeiräo Preto, SP, Brasil / Epidemiology of dengue infection in Ribeiräo Preto, SP, Brazil

OBJETIVO: Avaliar a transmissäo de dengue em uma instituiçäo correcional de adolescentes localizada em Ribeiräo Preto, SP, Brasil. MÉTODOS: Foi realizado um inquérito sorológico e virológico da populaçäo de internos e funcionários de uma instituiçäo correcional de adolescentes infratores localizada em Ribeiräo Preto, SP, Brasil. A populaçäo de estudo consistiu em 105 menores e 91 funcionários que representavam 89por cento do total de pessoas expostas. O sangue coletado da populaçäo estudada foi armazenado e processado para avaliaçäo pelas técnicas de MAC-Elisa e de isolamento viral. Cada participante respondeu a um questionário aplicado na ocasiäo da coleta de sangue. RESULTADOS: Do total de amostras de sangue coletadas (n=196), 42 (21,4por cento) foram positivas para anticorpos da classe IgM, e 43 (21,9por cento), para anticorpo IgG; destes, 15 com IgM e IgG positivas e 28 (14,3por cento) com apenas IgG positiva. Em cinco amostras, foram isolados vírus da dengue, sorotipo 1. Dos 42 casos com IgM positiva, 14 (33,4por cento) näo relataram sintomas característico de dengue. A incidência entre os internos foi de 23,8por cento e, entre funcionários, de 18,6por cento. Os primeiros casos foram notificados em fevereiro de 1997, e os últimos, em março do mesmo ano, embora os resultados mostrem a possibilidade de a transmissäo ter se iniciado bem antes de ser detectada. CONCLUSOES: A alta incidência observada pode ser explicada pela grande densidade populacional na instituiçäo, alta infestaçäo do vetor Aedes aegypti, alta taxa de assintomáticos e transmissäo favorecida pelo fato de a comunidade ser fechada

Dengue control in Ribeiräo Preto, Säo Paulo, Brazil

Após uma epedemia de dengue tipoI no final de 1990, acidade de Ribeiräo Preto (Estado de Säo Paulo, Brasil) assumiu as atividades de combate às larvas do Aedes aegypti. Tais atividades, baseadas em participaçäo popular e manejo ambiental, säo sintetizadas neste trabalho. Utilizaçäo maciça dos meios de comunicaçäo, participaçäo de escolares, contato constante com a populaçäo e integraçäo de diferentes órgäos públicos säo atividades priorizadas pelo programa. Embora a reduçäo de susceptíveis possa ter contribuído para o decréscimo de casos nos anos após a epidemia, o intenso trabalho profilático deve ter exercido papel relevante no controle do dengue na cidade, uma vez que mudanças têm sido observadas em relaçäo ao cuidado com criadouros potenciais. O ressurgimento de casos em anos recentes parece ser devido à maior circulaçäo do vírus no estado e no país. Tal fato aponta para a necessidade de medidas de controle em nível nacional e continental, sem o que torna-se difícil a manutençäo de níveis reduzidos de transmissäo, mesmo em áreas intensamente trabalhadas.