The effectiveness of COVID-19 vaccines against severe cases and deaths in Brazil from 2021 to 2022: a registry-based study.

Background: Brazil started the COVID-19 mass vaccination in January 2021 with CoronaVac and ChAdOx1, followed by BNT162b2 and Ad26.COV2.S vaccines. By the end of 2021, more than 317 million vaccine doses were administered in the adult population. This study aimed at estimating the effectiveness of the primary series of COVID-19 vaccination and booster shots in protecting against severe cases and deaths in Brazil during the first year of vaccination. Methods: A cohort dataset of over 158 million vaccination and severe cases records linked from official national registries was analyzed via a mixed-effects Poisson model, adjusted for age, state of residence, time after immunization, and calendar time to estimate the absolute vaccine effectiveness of the primary series of vaccination and the relative effectiveness of the booster. The method permitted analysis of effectiveness against hospitalizations and deaths, including in the periods of variant dominance. Findings: Vaccine effectiveness against severe cases and deaths remained over 25% and 50%, respectively, after 19 weeks from primary vaccination of BNT162b2, ChAdOx1, or CoronaVac vaccines. The boosters conferred greater protection than the primary series of vaccination, with heterologous boosters providing marginally greater protection than homologous. The effectiveness against hospitalization during the Omicron dominance in the 60+ years old population started at 61.7% (95% CI, 26.1-86.2) for ChAdOx1, 95.6% (95% CI, 82.4-99.9) for CoronaVac, and 72.3% (95% CI, 51.4-87.4) for the BNT162b2 vaccine. Interpretation: This study provides real-world evidence of the effectiveness of COVID-19 vaccination in Brazil, including during the Omicron wave, demonstrating protection even after waning effectiveness. Comparisons of the effectiveness among different vaccines require caution due to potential bias effects related to age groups, periods in the pandemic, and eventual behavioural changes. Funding: Fundação Oswaldo Cruz (FIOCRUZ), Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Fundação de Amparo a Pesquisa do Estado do Rio de Janeiro (FAPERJ), Pan American Health Organization (PAHO), Departamento de Ciência e Tecnologia da Secretaria de Ciência, Tecnologia, Inovação e Insumos Estratégicos em Saúde do Ministério da Saúde do Brasil (DECIT/SCTIE/MS).

Estimated COVID-19 severe cases and deaths averted in the first year of the vaccination campaign in Brazil: A retrospective observational study.

Background: A nationwide Severe Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) vaccination campaign was initiated in Brazil in January 2021 with CoronaVac (Sinovac Biotech) and ChAdOx1 nCoV-19 (AstraZeneca) followed by BNT162b2 mRNA (Pfizer-BioNTech) and Ad26.COV2.S (Johnson & Johnson-Janssen) vaccines. Here we provide estimates of the number of severe cases and deaths due to coronavirus disease (COVID-19) averted during the first year of the mass vaccination campaign in Brazil. Methods: Data on COVID-19 vaccination and COVID-19-related illness and death were obtained from the Brazilian Ministry of Health and used to estimate the direct effects of the vaccination campaign on the number of severe cases and deaths due to COVID-19 occurring between January 17, 2021 and January 31, 2022. To this end, we compared the daily age-specific rates between the unvaccinated population and the "at least partly vaccinated" population (received at least one dose of a two-dose vaccine), as well as other two vaccination subgroups, "fully vaccinated" (completed the one- or two-dose vaccine schedule), and "boosted-vaccinated" (fully vaccinated and recipients of booster dose) populations. Findings: We estimated that 74% (n = 875,846; 95% confidence interval, CI 843,383-915,709) of total expected cases of severe COVID-19 and 82% (n = 303,129; 95% CI 284,019-321,681) of total expected deaths due to COVID-19 were averted in the first year of the national vaccination campaign. The averted burden was heterogeneous between age groups and higher in the more populous states. However, outcome rate differences between vaccinated and unvaccinated groups were higher in the less populated states. Interpretation: The first year of the COVID-19 vaccination program in Brazil saved the lives of at least 303,129 adults. The results highlight the need for future vaccination campaigns, including those required in the current pandemic, to rapidly achieve high uptake, particularly among the elderly and residents of the least populous regions. Funding: Ministry of Health (Brazil).

Incompletude da variável profissão/ocupação nos bancos de síndrome gripal, síndrome respiratória aguda grave e mortalidade, Brasil, 2020-2021 / Incompleteness of the profession/occupation variable in the flu-like syndrome, severe acute respiratory syndrome and mortality databases, Brazil, 2020-2021

Resumo Objetivo: descrever a incompletude da informação sobre profissão/ocupação nas bases de dados de síndrome respiratória aguda grave (SRAG), síndrome gripal (SG) e no Sistema de Informações sobre Mortalidade (SIM) no Brasil. Métodos: estudo descritivo utilizando os bancos de dados de SRAG, SG e SIM. Calcularam-se percentuais de incompletude na variável profissão/ocupação segundo sexo, macrorregiões e unidades da federação, em 2020-2021. Resultados: o percentual de incompletude foi de 94,7% no banco de SG; 97,7% no de SRAG; e 17,0% no SIM. Em todas as macrorregiões a incompletude foi superior a 91,0% nos bancos de SG e SRAG; e superior a 13,0% no SIM. Todas as unidades da federação apresentaram percentuais de incompletude acima de 90,0% para SG; de 74,0% para SRAG; e de 6,8% para óbitos. Amapá apresentou maior percentual de incompletude na base de dados de SG (98,1%); Rio Grande do Sul (99,4%) na de SRAG; e Alagoas (45,0%) no SIM. Conclusões: observaram-se elevados percentuais de incompletude da variável profissão/ocupação nos sistemas de informação estudados. Recomenda-se uma articulação intersetorial, envolvendo representantes dos governos e dos trabalhadores, para formulação de estratégias que contornem a falta de informação sobre ocupação/profissão nas bases de dados relevantes para a vigilância em saúde.

Abstract Objective: to describe the incomplete filling out of the profession/occupation variable in the flu-like syndrome, severe acute respiratory syndrome and mortality databases in Brazil. Methods: descriptive study with secondary data from flu-like syndrome (FLS), severe acute respiratory syndrome (SARS) and mortality databases (SIM). We calculeted the absolute and relative filling frequencies of the profession/occupation variable according to State, gender, regions, and federative units, for 2020 and 2021. Results: we found a 94.7% incompleteness on the FLS database, 97.7% of missing profession/occupation data on the SARS, and 17.0% on the SIM database. Incompleteness frequency was above 91.0% in all Brazilian regions for FLS and SARS. Incompleteness on the mortality database was over 13.0%. All federative units presented incompleteness above 90.0% for FLS, 74.0% for SARS, and 6.8% for mortality in all genders. Higher levels of missing data were found in the states of Amapá for FLS (98.1%), Rio Grande do Sul for SARS and Alagoas (45.0%) for mortality (99.4%). Conclusions: all databases showed a high incompleteness of the profession/occupation variable. We recommend an articulation between the Ministry of Health, Ministry of Labor and workers' representations to solve this lack of data on occupation/profession in public databases.

Transição da idade de casos, internações e óbitos em internações por Covid-19 no município do Rio de Janeiro / Age transition of cases, admissions, and deaths by COVID-19 in the municipality of Rio de Janeiro / Transición de la edad de casos, admisiones y muertes en admisiones por Covid-19 en el municipio de Río de Janeiro

O presente trabalho objetiva analisar a evolução de casos, internações e óbitos por Covid-19 no município do Rio de Janeiro por faixas etárias entre março de 2020 e abril de 2021. Foram calculadas as frequências absolutas e relativas de casos e óbitos por Covid-19 para faixas etárias decenais das semanas epidemiológicas (SE) 13 de 2020 a 21 de 2021 e intervalos de valores esperados por grupo etário e SE. Os resultados mostram que a maior carga de casos correspondeu às faixas etárias de 20 a 29 e 30 a 39 anos. Internações e óbitos se concentraram nos grupos de 60 a 69, 70 a 79 e 80 anos ou mais, com uma marcante tendência de rejuvenescimento da carga de óbitos a partir da SE 10 de 2021. Conclui-se que há uma transição da idade da pandemia no Rio de Janeiro, possivelmente pelo progresso da vacinação, mostrando, portanto, o sucesso desta medida. Reforçamos a necessidade de aceleração do processo de imunização da população para controle e prevenção da Covid-19.

To describe the evolution of cases, hospitalizations, and deaths from COVID-19 in the city of Rio de Janeiro by age group between March 2020 and April 2021. Methods: the relative frequencies of COVID-19 cases and deaths were calculated for ten-year age groups in the epidemiological week (EW) 13 from 2020 to 21 of 2021 and expected value ranges by age group and EW. Results: the higher burden of cases was concentrated in the 20-29 and 30-39 age groups. Hospitalizations and deaths were concentrated in the age groups 60-69 years, 70-79 years and 80 years or more, with a marked tendency to rejuvenate the burden of deaths from EW 10 of 2021. Conclusions: There is an age transition in the pandemic in Rio de Janeiro, possibly due to the progress of vaccination. This is, therefore, a successful measure. We insist on the need to accelerate the population immunization process for the control and prevention of COVID-19.

Analizar la evolución de casos, hospitalizaciones y muertes por Covid-19 en la ciudad de Río de Janeiro por franjas etarias entre marzo de 2020 y abril de 2021. Métodos: se calcularon las frecuencias absolutas y relativas de casos y defunciones por Covid-19 para grupos de diez años desde la semana epidemiológica (SE) 13 de 2020 hasta la 21 de 2021 e intervalos de valores esperados por grupo etario y SE. Resultados: la mayor carga de casos se concentró en las franjas etarias de 20 a 29 y de 30 a 39 años. Las hospitalizaciones y las muertes se concentraron en los grupos de 60 a 69, 70 a 79 años y 80 o más años, con una marcada tendencia a rejuvenecer la carga de muertes a partir de la SE 10 de 2021. Conclusiones: Hay una transición de la edad de la pandemia en Río de Janeiro, posiblemente debido al avance de la vacunación. Por lo tanto, esta medida es exitosa. Reforzamos la necesidad de acelerar el proceso de inmunización de la poblaciona para el control y la prevención del Covid-19.

Spatial analysis of the origin-destination flow of admissions for severe acute respiratory syndrome caused by COVID-19 in the Metropolitan Region of Rio de Janeiro. / Análise espacial do fluxo origem-destino das internações por síndrome respiratória aguda grave por COVID-19 na região metropolitana do Rio de Janeiro.

This study analyzed the inter-municipality flow of hospital admissions due to severe acute respiratory syndrome by COVID-19 in the metropolitan region of Rio de Janeiro. We identified 12,676 inter-municipality hospitalizations for COVID-19 involving the municipality of Rio de Janeiro. In total, 11,288 (89.0%) admissions were of residents of the Metropolitan Region (RM), 87% residents in other municipalities of the same region and admitted to hospitals from the state capital, and 13% residents of the capital admitted to hospitals from other municipalities in the RM. There was a negative correlation when it comes to the distance between cities and the origin-destination flow (r=0.62, p<0.001). The RM of the capital Rio de Janeiro imports more admissions for SARS by COVID-19 than it exports. This study highlights the importance of care networks intended for more severe cases that mainly require specialized care.

Este estudo analisou o fluxo intermunicipal das internações por síndrome respiratória aguda grave por COVID-19 na região metropolitana do Rio de Janeiro. Foram identificadas 12.676 internações intermunicipais por COVID-19 envolvendo o município do Rio de Janeiro. Dessas, 11.288 (89,0%) eram de residentes na região metropolitana, 87% de residentes em outros municípios da mesma região e internados na capital do estado, e 13% eram residentes da capital internados em outros municípios da região. Há correlação negativa entre a distância dos municípios e o fluxo origem-destino (r=0,62, p<0,001). O município do Rio de Janeiro importa mais internações por síndrome respiratória aguda grave por COVID-19 do que exporta. Este estudo evidenciou a importância das redes de atendimento para casos mais graves, os quais necessitem, principalmente, de atenção especializada.

Space-time analysis of the first year of COVID-19 pandemic in the city of Rio de Janeiro, Brazil.

OBJECTIVE: To describe the space-time evolution of cases and deaths due to COVID-19 in the Rio de Janeiro municipality, Brazil, during the first year of the pandemic. METHODS: An ecological study was carried out. The units of analysis were the neighborhoods of the city of Rio de Janeiro. Incidence and mortality rates, excess risk, Global Moran's Index (Moran's I), local indicator for spatial association, standardized incidence ratio, and standardized mortality ratio were estimated for neighborhoods in the municipality of Rio de Janeiro. RESULTS: Over the first year of the pandemic, registries in the city of Rio de Janeiro included 204,888 cases and 19,017 deaths due to COVID-19. During the first three months of the pandemic, higher incidence rates were verified in the municipality compared with the state of Rio de Janeiro and Brazil, in addition to higher mortality rates compared with the state of Rio de Janeiro and Brazil from May 2020 to February 2021. Bonsucesso was the neighborhood with the highest incidence and mortality rates, and throughout the neighborhoods and months, there is no synchrony between the worst moments of the COVID-19 pandemic. CONCLUSION: The authors emphasize the need for implementing more rigid control and prevention measures, increasing case detection, and accelerating the COVID-19 immunization campaign.

Spatial analysis of the origin-destination flow of admissions for severe acute respiratory syndrome by COVID-19 in the Metropolitan Region of Rio de Janeiro / Análise espacial do fluxo origem-destino das internações de Síndrome Respiratória Aguda Grave por COVID-19 na Região Metropolitana do Rio de Janeiro

This study analyzed the intercity flow of SRAG admissions by COVID-19 in the metropolitan region of Rio de Janeiro. We identified 12,676 inter-municipal hospitalizations for COVID-19 involving the municipality of Rio de Janeiro. Among these admissions, 11,288 (89.0%) were residents of the RM, 87% were residents of other cities in the RM and hospitalized in the MRJ and 13% residents of the MRJ and hospitalized in other municipalities in the RM. There is a negative correlation between the distance between cities and the origin-destination flow (r=0.62, p<0.001). MRJ imports more SRAG admissions by COVID-19 than it exports. This study highlights the importance of care networks for more severe cases that mainly require specialized care.

Este estudo analisou o fluxo intermunicipal das internações de SRAG por COVID-19 na região metropolitana do Rio de Janeiro. Foram identificadas 12.676 internações intermunicipais por COVID-19 envolvendo o município do Rio de Janeiro. Dentre estas internações, 11.288 (89,0%) eram residentes da RM, 87% residentes de outros municípios da RM e internados no MRJ e 13% residentes do MRJ e internados em outros municípios da RM. Há correlação negativa entre a distância entre os municípios e o fluxo origem-destino (r=0,62, p<0,001). O MRJ importa mais internações de SRAG por COVID-19 do que exporta. Este estudo evidencia a importância das redes de atendimento para casos mais graves que necessitem, principalmente, de atenção especializada.

Does deforestation drive visceral leishmaniasis transmission? A causal analysis.

Vector-borne diseases (VBDs) are important contributors to the global disease burden and are a key factor in perpetuating economic inequality. Although environmental changes are often cited as drivers of VBDs, the link between deforestation and VBD occurrence remains unclear. Here, we examined this relationship in detail using the spread of visceral leishmaniasis (VL) in São Paulo state (Brazil) as the case study. We used a two-step approach to estimate the causal effects (overall, direct, and indirect) of deforestation on the occurrence of the VL vector, canine visceral leishmaniasis (CVL), and human visceral leishmaniasis (HVL). We first estimated the parameters via a double Metropolis-Hastings algorithm and then estimated the causal effects through a Gibbs sampler. We observed that the odds of vector, CVL, and HVL occurrence were 2.63-, 2.07-, and 3.18-fold higher, respectively, in deforested compared with forested municipalities. We also identified a significant influence of the presence of vector, CVL, and HVL in one municipality on disease occurrence in previously naive neighbouring municipalities. Lastly, we found that a hypothetical reduction in deforestation prevalence from 50 to 0% across the state would reduce vector, CVL, and HVL occurrence by 11%, 6.67%, and 29.87%, respectively. Our results suggest that implementing an eco-friendly development strategy that considers trade-offs between agriculture, urbanization, and conservation could be an effective mechanism of controlling VL.

Space-time analysis of the first year of COVID-19 pandemic in Rio de Janeiro municipality / Análise espaço-temporal do primeiro ano da pandemia de COVID-19 no município do Rio de Janeiro

Objective: To describe the space-time evolution of cases and deaths due to COVID-19 in the Rio de Janeiro municipality during the first year of the pandemic. Methods: We carried out an ecological study whose units of analysis were the neighborhoods of the municipality of Rio de Janeiro. We calculated Incidence and mortality rates, excess risk, global Moran index (Moran's I), Local indicator of spatial association (LISA), standardized incidence ratio (SIR) and standardized mortality ratio (SMR) for neighborhoods in the municipality of Rio de Janeiro. Results: Over the first year, City of Rio de Janeiro registries included 204,888 cases and 19,017 deaths due to COVID-19. During the first three months of the pandemic, the municipality show higher incidence rates than the State of Rio de Janeiro and Brazil and higher mortality rates than the State of Rio de Janeiro and Brazil from May 2020 to February 2021. Bonsucesso was the neighborhood with the highest incidence and mortality rates, and throughout the communities and months, there is no synchrony between the worst moments of the COVID-19 pandemic. Conclusion: We emphasize the need to implement more rigid control and prevention measures, increase case detection, and accelerate the COVID-19 immunization campaign.

Objetivo: descrever a evolução espaço-temporal de detecção de casos e mortalidade por COVID-19 no município do Rio de Janeiro durante o primeiro ano da pandemia. Métodos: foi realizado um estudo ecológico cujas unidades de análise foram os bairros do município do Rio de Janeiro. Foram calculadas as taxas de incidência e mortalidade, excesso de risco, índice de Moran global (I de Moran), indicador local de associação espacial (LISA), razão de incidência padronizada (SIR) e razão de mortalidade padronizada (SMR) para bairros do município do Rio de Janeiro. Resultados: foram notificados 204.888 casos e 19.017 óbitos por COVID-19, o município apresentou durante os 3 primeiros meses de pandemia taxas de incidência superiores ao Estado do Rio de Janeiro e ao Brasil e taxas de mortalidade superiores ao Estado do Rio de Janeiro e Brasil a partir de maio de 2020 até fevereiro de 2021. Bonsucesso foi o bairro com maiores taxas de incidência e mortalidade, e ao longo dos bairros e dos meses não há sincronia entre os piores momentos da pandemia de COVID-19 Conclusão: ressaltamos a necessidade de implantação de medidas mais rígidas para controle e prevenção, aumento na detecção de casos e a aceleração da campanha de imunização da COVID-19.

Space-time analysis of the first year of COVID-19 pandemic in the city of Rio de Janeiro, Brazil / Análise espaço temporal do primeiro ano da pandemia de COVID-19 no município do Rio de Janeiro

ABSTRACT: Objective: To describe the space-time evolution of cases and deaths due to COVID-19 in the Rio de Janeiro municipality, Brazil, during the first year of the pandemic. Methods: An ecological study was carried out. The units of analysis were the neighborhoods of the city of Rio de Janeiro. Incidence and mortality rates, excess risk, Global Moran's Index (Moran's I), local indicator for spatial association, standardized incidence ratio, and standardized mortality ratio were estimated for neighborhoods in the municipality of Rio de Janeiro. Results: Over the first year of the pandemic, registries in the city of Rio de Janeiro included 204,888 cases and 19,017 deaths due to COVID-19. During the first three months of the pandemic, higher incidence rates were verified in the municipality compared with the state of Rio de Janeiro and Brazil, in addition to higher mortality rates compared with the state of Rio de Janeiro and Brazil from May 2020 to February 2021. Bonsucesso was the neighborhood with the highest incidence and mortality rates, and throughout the neighborhoods and months, there is no synchrony between the worst moments of the COVID-19 pandemic. Conclusion: The authors emphasize the need for implementing more rigid control and prevention measures, increasing case detection, and accelerating the COVID-19 immunization campaign.

RESUMO: Objetivo: Descrever a evolução espaço temporal de detecção de casos e mortalidade por COVID-19 no município do Rio de Janeiro durante o primeiro ano da pandemia. Métodos: Foi realizado um estudo ecológico cujas unidades de análise foram os bairros do município do Rio de Janeiro. Calcularam-se as taxas de incidência e mortalidade, excesso de risco, índice de Moran global (I de Moran), indicador local de associação espacial, razão de incidência padronizada e razão de mortalidade padronizada para bairros do município do Rio de Janeiro. Resultados: Foram notificados 204.888 casos e 19.017 óbitos por COVID-19. O município apresentou durante os três primeiros meses de pandemia taxas de incidência superiores às do estado do Rio de Janeiro e do Brasil e taxas de mortalidade superiores às do estado do Rio de Janeiro e Brasil de maio de 2020 até fevereiro de 2021. Bonsucesso foi o bairro com maiores taxas de incidência e mortalidade, e ao longo dos bairros e dos meses não há sincronia entre os piores momentos da pandemia de COVID-19. Conclusão: Ressaltamos a necessidade de implantação de medidas mais rígidas para controle e prevenção da COVID-19, aumento na detecção de casos e aceleração da campanha de imunização.

Análise espacial do fluxo origem-destino das internações por síndrome respiratória aguda grave por COVID-19 na região metropolitana do Rio de Janeiro / Spatial analysis of the origin-destination flow of admissions for severe acute respiratory syndrome caused by COVID-19 in the Metropolitan Region of Rio de Janeiro

RESUMO: Este estudo analisou o fluxo intermunicipal das internações por síndrome respiratória aguda grave por COVID-19 na região metropolitana do Rio de Janeiro. Foram identificadas 12.676 internações intermunicipais por COVID-19 envolvendo o município do Rio de Janeiro. Dessas, 11.288 (89,0%) eram de residentes na região metropolitana, 87% de residentes em outros municípios da mesma região e internados na capital do estado, e 13% eram residentes da capital internados em outros municípios da região. Há correlação negativa entre a distância dos municípios e o fluxo origem-destino (r=0,62, p<0,001). O município do Rio de Janeiro importa mais internações por síndrome respiratória aguda grave por COVID-19 do que exporta. Este estudo evidenciou a importância das redes de atendimento para casos mais graves, os quais necessitem, principalmente, de atenção especializada.

ABSTRACT: This study analyzed the inter-municipality flow of hospital admissions due to severe acute respiratory syndrome by COVID-19 in the metropolitan region of Rio de Janeiro. We identified 12,676 inter-municipality hospitalizations for COVID-19 involving the municipality of Rio de Janeiro. In total, 11,288 (89.0%) admissions were of residents of the Metropolitan Region (RM), 87% residents in other municipalities of the same region and admitted to hospitals from the state capital, and 13% residents of the capital admitted to hospitals from other municipalities in the RM. There was a negative correlation when it comes to the distance between cities and the origin-destination flow (r=0.62, p<0.001). The RM of the capital Rio de Janeiro imports more admissions for SARS by COVID-19 than it exports. This study highlights the importance of care networks intended for more severe cases that mainly require specialized care.

Excess mortality in Brazil in times of Covid-19. / Excesso de mortalidade no Brasil em tempos de COVID-19.

Given the growing number of deaths due to the COVID-19 pandemic in Brazil, this study presents an initial and exploratory descriptive analysis of the excess mortality observed from March to May 2020 in capitals and other municipalities. The data source was the death registers from the Civil Registry Offices. The data were disaggregated by gender and capitals and other municipalities of the 26 federative units and the Federal District. The standardized mortality ratio for 2020 was calculated with the 2019 mortality coefficients as standards. The results showed 39,146 excess deaths for the period studied and is higher among men. This increase was more significant among the capitals of the North, Northeast, and Southeast regions. In the other municipalities in these regions, the increase was observed in May, indicating a possible inland-bound COVID-19 transmission. The need to improve the detection and registration of cases is highlighted to enable the efficient monitoring of the pandemic.

EXCESS MORTALITY IN BRAZIL IN TIMES OF COVID-19 / EXCESSO DE MORTALIDADE NO BRASIL EM TEMPOS DE COVID-19

Given the growing number of deaths due to the COVID-19 pandemic in Brazil, this study presents an initial and exploratory descriptive analysis of the excess mortality observed from March to May 2020 in capitals and other municipalities. The data source was the death registers from the Civil Registry Offices. The data were disaggregated by gender and capitals and other municipalities of the 26 federative units and the Federal District. The standardized mortality ratio for 2020 was calculated with the 2019 mortality coefficients as standards. The results showed 39,146 excess deaths for the period studied and is higher among men. This increase was more significant among the capitals of the North, Northeast, and Southeast regions. In the other municipalities in these regions, the increase was observed in May, indicating a possible inland-bound COVID-19 transmission. The need to improve the detection and registration of cases is highlighted to enable the efficient monitoring of the pandemic.

Tendo em vista o crescente número de óbitos pela pandemia de COVID-19 no país, o presente trabalho apresenta análise descritiva inicial e exploratória sobre o excesso de mortalidade observado nos meses de março a maio de 2020 nas capitais e demais municípios do país. A fonte de dados utilizada foi o registro de óbitos pelos Cartórios de Registro Civil. Os dados foram desagregados por capitais e demais municípios das 26 unidades federativas e do Distrito Federalsegundo sexo. A razão de mortalidade ajustada para o ano de 2020 foi calculada tendo como padrão os coeficientes de mortalidade do ano de 2019. Os resultados indicaram excesso de 39.146 óbitos para o período estudado, sendo maior entre homens do que mulheres. Esse aumento foi maior entre as capitais das regiões Norte, Nordeste e Sudeste. Nos demais municípios dessas regiões, o incremento foi observado em maio, indicando possível interiorização da transmissão da COVID-19. Evidencia-se a necessidade de aprimorar a detecção e registro de casos para viabilizar omonitoramento eficiente da pandemia.

Excesso de mortalidade no Brasil em tempos de COVID-19 / Excess mortality in Brazil in times of Covid-19

Resumo Tendo em vista o crescente número de óbitos pela pandemia de COVID-19 no país, o presente trabalho apresenta análise descritiva inicial e exploratória sobre o excesso de mortalidade observado nos meses de março a maio de 2020 nas capitais e nos demais municípios do país. A fonte de dados utilizada foi o registro de óbitos pelos Cartórios de Registro Civil. Os dados foram desagregados por capitais e demais municípios das 26 unidades federativas e do Distrito Federal segundo sexo. A razão de mortalidade ajustada para o ano de 2020 foi calculada tendo como padrão os coeficientes de mortalidade do ano de 2019. Os resultados indicaram excesso de 39.146 óbitos para o período estudado, sendo maior entre homens do que nas mulheres. Esse aumento foi maior nas capitais das regiões Norte, Nordeste e Sudeste. Nos demais municípios dessas regiões o incremento foi observado em maio, indicando possível interiorização da transmissão da COVID-19. Evidencia-se a necessidade de se aprimorar a detecção e o registro de casos para viabilizar o monitoramento eficiente da pandemia.

Abstract Given the growing number of deaths due to the COVID-19 pandemic in Brazil, this study presents an initial and exploratory descriptive analysis of the excess mortality observed from March to May 2020 in capitals and other municipalities. The data source was the death registers from the Civil Registry Offices. The data were disaggregated by gender and capitals and other municipalities of the 26 federative units and the Federal District. The standardized mortality ratio for 2020 was calculated with the 2019 mortality coefficients as standards. The results showed 39,146 excess deaths for the period studied and is higher among men. This increase was more significant among the capitals of the North, Northeast, and Southeast regions. In the other municipalities in these regions, the increase was observed in May, indicating a possible inland-bound COVID-19 transmission. The need to improve the detection and registration of cases is highlighted to enable the efficient monitoring of the pandemic.

Como o desmatamento influencia a ocorrência de leishmaniose visceral? Uma abordagem contrafactual / How deforestation influence tha occurrence of Visceral Leishmaniasis? A counterfactual approach

A leishmaniose visceral (LV) é uma doença sistêmica de transmissão vetorial. No Brasil, ela é causada pelo protozoário Leishmania infantum e é transmitida por flebotomíneos do gênero Lutzomyia, tendo os cães como a principal fonte de infecção em áreas urbanas. Historicamente a LV era conhecida como uma doença endêmica rural, porém desde a década de 1980, ela atingiu proporções endêmicas e epidêmicas em grandes cidades brasileiras. Desde então vários fatores são considerados como norteadores da expansão da LV, como variáveis socioeconômicas, climáticas e ambientais. Mais especificamente sobre o efeito do desmatamento e perturbações antrópicas no ambiente, a maioria do que se encontra na literatura tem natureza qualitativa ou utiliza de abordagens reducionistas, sem considerar a complexidade da dinâmica de uma doença infecciosa de transmissão vetorial e de caráter zoonóticos. Na presente dissertação, investigamos o efeito do desmatamento na ocorrência de Lutzomyia longipalpis (Lu. longipalpis), leishmaniose visceral canina (LVC) e leishmaniose visceral humana (LVH), tomando como exemplo o estado de São Paulo. Para isso, utilizamos uma abordagem contrafactual para estimar os efeitos (geral, direto e indireto) do desmatamento na ocorrência do Lu. longipalpis/LVC/LVH. Isso foi feito em dois passos, primeiro estimamos os parâmetros por meio de um algoritmo de Metropolis-Hastings duplo e, por fim, estimamos os efeitos causais através de um amostrador de Gibbs, por meio do pacote autognet no R.Vimos que municípios desmatados apresentam 2.63, 2.07 e 3.18 maiores chances de apresentar o vetor, LVC e LVH, respectivamente quando comparados com os municípios que não apresentaram desmatamento. Foi observada também uma forte influência da presença do vetor, LVC e LVH dos municípios vizinhos na ocorrência dos mesmos em municípios previamente livres dos desfechos (6.67, 4.26 e 4.27). Já sob mudanças hipotéticas de prevalência do desmatamento de 50% para 0% no estado, são esperadas quedas na prevalência do vetor, LVC e LVH de 11%, 6.67% e 29.87% respectivamente. O desmatamento influi na ocorrência do vetor, doença em cães e humanos por duas principais vias, (i) alterando o funcionamento do ecossistema e estrutura da comunidade, permitindo a reprodução e colonização do vetor; e (ii) promovendo uma aproximação entre todos os componentes do ciclo da LV. De tal modo, para correto controle da LV e doenças infecciosas como um todo, é imprescindível um desenvolvimento ecologicamente correto com soluções viáveis para as compensações entre a agricultura, urbanização e conservação. urbanização e conservação.

Visceral leishmaniasis (VL) is a systemic vector-borne disease. In Brazil, it caused by the protozoan Leishmania infantum and is transmitted by sandflies of the genus Lutzomyia, with dogs as the principal source of infection in urban areas. Historically, VL was known as a rural endemic disease, since the 80's it has become endemic and epidemic in large Brazilian cities. Since then, many factors were hypothesised as driving VL expansion, as socioeconomic, climatic and environmental variables. More specifically, concerning deforestation and human-made actions in the environment, most studies tend to be qualitative in nature or use traditional reductionist approaches, ignoring the complexities that are inherent of vector-borne zoonotic infectious diseases. The present study aimed to investigate the effect of deforestation in the occurrence of Lutzomyia longipalpis, canine visceral leishmaniasis (CVL), and human visceral leishmaniasis (HVL), taking as a motivating example the São Paulo state (Brazil). To this end, we chose a counterfactual approach to estimate the effects (overall, direct and indirect) of deforestation in the occurrence of vector/CVL/HVL. We did it in two steps; first, we estimated the parameters through a double Metropolis-Hastings algorithm and, finally, we estimated the causal effects through a Gibbs sampler, using the autognet package in R. We observe that deforested cities show 2.63, 2.07, and 3.18 higher odds of vector/CVL/HVL occurrence, respectively, when compared to non-deforested municipalities. We also see a significant influence of vector, CVL, and HVL presence in the neighbours in its appearance in previous naive cities, 6.67, 4.26, 4,27 respectively. Lastly, under hypothetical changes in deforestation's prevalence from 50% to 0% in the whole state, is expected a decrease in its prevalence of the vector, LVC and LVH of 11%, 6.67% and 29.87% respectively. Deforestation in the occurrence of infectious diseases and, more specifically, VL importance, is two-folded: (i) changing's the ecosystem equilibrium and community structure, allowing its vector to reproduce and colonise; (ii) promoting a close contact through the VL cycle components. In such a way, for correct control of VL and infectious disease as a whole, it is essential an eco-friendly development with viable solutions for trade-offs between agriculture, urbanization and conservation.

Sandflies in an endemic area for Visceral Leishmaniasis in Northeastern Brazil / Flebotomíneos em uma área endêmica para Leishmaniose Visceral no Nordeste do Brasil

Abstract Phlebotomines of the genus Lutzomyia are important vector for species of Leishmania, the etiological agent of leishmaniasis. The aim of this study was to assess the diversity of sandflies in an endemic area for Visceral Leishmaniasis (VL). Sampling was performed in four localities on the coast of the municipality of Goiana, state of Pernambuco, Northeastern Brazil. Specimens were collected monthly on three consecutive nights, from November 2017 to October 2018. CDC light traps were installed at a height of 1.5 m above the ground, in two ecotypes (i.e. tree and animal facility), both in peridomestic areas. A total of 5,205 sandflies were collected, among which the species Lutzomyia longipalpis (99.85%; 5,197/5,205) was the most common, followed by Lutzomyia evandroi (0.13%; 07/5,205) and Lutzomyia whitmani (0.02%; 01/5,205). Specimens of L. longipalpis were collected throughout the study period and most of them were found near to the animal facilities. The findings from this research indicate that vectors for Leishmania infantum are present in the study area throughout the year, along with occurrences of vectors relating to Cutaneous Leishmaniasis (CL). Preventive vector control measures need to be implemented in Goiana to reduce the risk of infection for the human and animal populations.

Resumo Flebotomíneos do gênero Lutzomyia são importantes vetores de espécies de Leishmania, agente etiológico das leishmanioses. O objetivo deste estudo foi avaliar a diversidade de flebotomíneos em área endêmica para Leishmaniose Visceral (LV). As coletas foram realizadas em quatro localidades do litoral do município de Goiana, Pernambuco, Nordeste do Brasil. Os espécimes foram coletados mensalmente em três noites consecutivas de novembro de 2017 a outubro de 2018. Foram instaladas armadilhas luminosas modelo CDC a uma altura de 1,5 m acima do solo em dois ecótopos (ex. árvore e instalações de animais), ambos em áreas peridomiciliares. Um total de 5.205 flebotomíneos foi coletado, sendo Lutzomyia longipalpis (99,85%; 5.197/5.205) a mais comum, seguida por Lutzomyia evandroi (0,13%; 07/5.205) e Lutzomyia whitmani (0,02%; 01/5.205). L. longipalpis foi coletada durante todo o período do estudo. A maioria dos espécimes foi detectada perto das instalações dos animais. Os achados deste estudo indicam a presença de vetores de Leishmania infantum na área avaliada ao longo do ano, bem como a ocorrência de vetores relacionados à Leishmaniose Cutânea (LC). Medidas preventivas de controle vetorial devem ser implementadas em Goiana para reduzir o risco de infecção à população humana e animal.

Sandflies in an endemic area for Visceral Leishmaniasis in Northeastern Brazil.

Phlebotomines of the genus Lutzomyia are important vector for species of Leishmania, the etiological agent of leishmaniasis. The aim of this study was to assess the diversity of sandflies in an endemic area for Visceral Leishmaniasis (VL). Sampling was performed in four localities on the coast of the municipality of Goiana, state of Pernambuco, Northeastern Brazil. Specimens were collected monthly on three consecutive nights, from November 2017 to October 2018. CDC light traps were installed at a height of 1.5 m above the ground, in two ecotypes (i.e. tree and animal facility), both in peridomestic areas. A total of 5,205 sandflies were collected, among which the species Lutzomyia longipalpis (99.85%; 5,197/5,205) was the most common, followed by Lutzomyia evandroi (0.13%; 07/5,205) and Lutzomyia whitmani (0.02%; 01/5,205). Specimens of L. longipalpis were collected throughout the study period and most of them were found near to the animal facilities. The findings from this research indicate that vectors for Leishmania infantum are present in the study area throughout the year, along with occurrences of vectors relating to Cutaneous Leishmaniasis (CL). Preventive vector control measures need to be implemented in Goiana to reduce the risk of infection for the human and animal populations.

Risk factors associated with leptospirosis in swine in state of Pernambuco, Brazil / Fatores de risco associados à leptospirose em suínos no estado de Pernambuco, Brasil

Leptospirosis is a major public health threat, and swine are one of the most important reservoirs and sources of Leptospira infection for man. The aim of this study was to investigate the epidemiological situation of leptospirosis in swine in the state of Pernambuco, Brazil. Blood samples from 265 swine were collected and tested by the microscopic agglutination test (MAT), and an epidemiological form containing questions about animal production characteristics, reproductive management, and sanitary and hygiene aspects of the herd was applied to evaluate infection risk factors. The data were analyzed by means of a logistic regression model. An occurrence of 53.1% (143/265) of swine positives to Leptospira spp. was observed. The most commons serovars were Icterohaemorrhagiae (39.1%), Pomona (25.9%), and Shermani (14.0%). Factors associated with the infection were stagnant water source (p = 0.034, odds ratio - OR = 2.29; confidence interval of 95% - 95%CI 1.06-4.93), farms where the healthy animals are bred with sick ones (OR = 1.69; 95%CI 1.04-2.75), and the properties with flooded areas (OR = 1.65; 95%CI 1.01-2.68). The risk factors found in this study played an important role in the agent dissemination and should be avoided in a way to control the disease in the herds studied.(AU)

A leptospirose é um grande problema de saúde pública, e os suínos são um dos mais importantes reservatórios e fonte de infecção por Leptospira para o homem. O objetivo deste estudo foi investigar a situação epidemiológica da leptospirose em suínos no estado de Pernambuco, Brasil. Amostras de sangue de 265 suínos foram coletadas e testadas pelo teste de microaglutinação (MAT), e foi aplicado um questionário epidemiológico contendo perguntas sobre características da produção, manejo reprodutivo e aspectos sanitários e de higiene do rebanho para avaliar fatores de risco de infecção. Os dados foram analisados por meio de um modelo de regressão logística. Foi observada ocorrência de 53,1% (143/265) de suínos positivos para Leptospira spp. Os sorovares mais comuns foram Icterohaemorrhagiae (39,1%), Pomona (25,9%) e Shermani (14,0%). Os fatores associados à infecção foram fonte de água parada (p = 0,034; odds ratio - OR = 2,29; intervalo de confiança de 95% - IC95% 1,06-4,93), fazendas onde animais saudáveis são criados com os doentes (OR = 1,69; IC95% 1,04-2,75) e áreas inundadas (OR = 1,65; IC95% 1,01-2,68). Os fatores de risco encontrados neste estudo desempenharam papel importante na disseminação do agente e devem ser evitados, de forma a controlar a doença nos rebanhos estudados.(AU)

Seroprevalence and spatial distribution of canine leishmaniasis in an endemic region in Brazil: how has the situation changed after 10 years?

INTRODUCTION: Herein, we assessed the seroprevalence and spatial distribution of Leishmania infantum in dogs in Garanhuns, Northeastern Brazil. METHODS: Sera samples (n = 242) were analyzed using an enzyme-linked immunosorbent assay (ELISA). The spatial distribution of dogs seropositive for anti-Leishmania infantum antibodies was evaluated using kernel density estimation. RESULTS: A total of 2.4% (6/242) of the animals were seropositive for anti-Leishmania infantum antibodies. The kernel map showed their distribution to be heterogeneous over the city, with a hotspot in the northeastern region. CONCLUSIONS: The reported data illustrate the circulation of parasites of the genus Leishmania in a canine population.

Seroprevalence and spatial distribution of canine leishmaniasis in an endemic region in Brazil: how has the situation changed after 10 years?

Abstract INTRODUCTION: Herein, we assessed the seroprevalence and spatial distribution of Leishmania infantum in dogs in Garanhuns, Northeastern Brazil. METHODS: Sera samples (n = 242) were analyzed using an enzyme-linked immunosorbent assay (ELISA). The spatial distribution of dogs seropositive for anti-Leishmania infantum antibodies was evaluated using kernel density estimation. RESULTS: A total of 2.4% (6/242) of the animals were seropositive for anti-Leishmania infantum antibodies. The kernel map showed their distribution to be heterogeneous over the city, with a hotspot in the northeastern region. CONCLUSIONS: The reported data illustrate the circulation of parasites of the genus Leishmania in a canine population.