High-Risk Areas for Congenital Zika Syndrome in Rio de Janeiro: Spatial Cluster Detection.

Brazil reported 18,282 suspected congenital Zika syndrome (CZS) cases up to 2018 and accounts for 61.4% of the total reported Zika cases in the Americas in the period. To detect high-risk areas for children with CZS in the city of Rio de Janeiro, we used cluster detection and thematic maps. We analyzed data using a Poisson model in Satscan 10.1.3 software. We also analyzed the records of children with CZS from 2015 to 2016 to describe the clinical and epidemiological maternal and child profile, as well as live births in 2016 and the social development index (SDI) by neighborhood. In 2015 and 2016, the incidence rates of CZS were 8.84 and 46.96 per 100,000 live births in the city, respectively. Severe congenital findings such as microcephaly and brain damage, osteoarticular impairment, ocular abnormalities, and hearing loss were observed in 47 children. The spatial distribution of CZS was concentrated in the north and west zones in heterogeneous neighborhoods. The neighborhoods with the highest occurrence of CZS cases were found to have the worst SDIs. Stascan detected three spatial clusters in the north zone, where the SDI is lower. The clusters presented high relative risks for CZS (7.86, 1.46, and 2.08), although they were not statistically significant. Our findings highlight a higher occurrence of CZS in areas with less favorable socioeconomic conditions.

High-risk space-time clusters of mortality in children 5 to 14 years of age in Mato Grosso state, Brazil. / Clusters Espaço-Temporais de Alto Risco da Mortalidade Infantojuvenil em Mato Grosso, Brasil.

The study aimed to detect high-risk areas for deaths of children and adolescents 5 to 14 years of age in the state of Mato Grosso, Brazil, from 2009 to 2020. This was an exploratory ecological study with municipalities as the units of analysis. Considering mortality data from the Mortality Information System (SIM) and demographic data from the Brazilian Institute of Geography and Statistics (IBGE), the study used multivariate statistics to identify space-time clusters of excess mortality risk in this age group. From 5 to 9 years of age, two clusters with high mortality risk were detected; the most likely located in the state's southern mesoregion (RR: 1.6; LRT: 8,53). Among the 5 clusters detected in the 10-14-year age group, the main cluster was in the state's northern mesoregion (RR: 2,26; LRT: 7,84). A reduction in mortality rates was observed in the younger age group and an increase in these rates in the older group. The identification of these clusters, whose analysis merits replication in other parts of Brazil, is the initial stage in the investigation of possible factors associated with morbidity and mortality in this group, still insufficiently explored, and for planning adequate interventions.

O objetivo deste estudo é detectar as áreas de maior risco para óbitos de crianças e adolescentes de 5 a 14 anos no estado de Mato Grosso entre os anos de 2009 e 2020. Estudo ecológico, tipo exploratório, cuja unidade de análise foram os municípios. Considerando dados de mortalidade do SIM e os demográficos do IBGE, o estudo utilizou a estatística multivariada para a identificação dos clusters espaço-temporais de sobrerrisco de mortalidade nesta faixa etária. Dos 5 aos 9 anos, dois clusters de alto risco de mortalidade foram detectados; o mais provável localizado na mesorregião sul (RR: 1,6; LRV: 8,53). Dentre os 5 clusters detectados na faixa etária dos 10 aos 14 anos, o principal foi localizado na mesorregião norte (RR: 2,26; LRV: 7,84). Foi identificada redução das taxas de mortalidade na faixa etária mais jovem e aumento destas taxas na faixa etária mais velha. A identificação destes clusters, cuja análise merece ser replicada a outras partes do território nacional, é a etapa inicial para a investigação de possíveis fatores associados à morbi-mortalidade deste grupo ainda pouco explorado e para o planejamento de intervenções adequadas.

[Space-time heterogeneity of measles, mumps, and rubella vaccination indicators in children from BrazilHeterogeneidad espaciotemporal de los indicadores de inmunización con la vacuna triple viral en la población infantil de Brasil]. / Heterogeneidade espaço-temporal dos indicadores de imunização da vacina tríplice viral em crianças no Brasil.

Objective: To evaluate immunization coverage and dropout rates of the measles, mumps, and rubella vaccine across Brazilian regions. Methods: This ecological study employing a space-time approach used data from the National Immunization Program (PNI) and the Live Births Information System (SINASC). We estimated the annual variation (2014 to 2021) in immunization coverage and dropout rate of the measles, mumps, and rubella vaccine in children aged 12 and 15 months in the 5 570 Brazilian municipalities. Statistical analysis was conducted for the municipalities contained in each Brazilian region using the space-time scan technique, considering the Poisson probabilistic model and the hypothesis that municipalities with lower immunization coverage or high dropout rates would form space-time clusters. Results: From 2014 to 2021, 38.3% and 12.9% of municipalities achieved a coverage ≥ 95.0% in the first and second doses respectively; 53.6% of municipalities had a high dropout rate (20.0% to 49.9%) and 37.2% had a very high dropout rate. The Northeast region had primary clusters for low coverage of the first (2018 to 2021) and second vaccine doses (2020 to 2021) with higher relative risks (RR) compared to other primary clusters. The RR for high dropout rate was elevated in all Brazilian regions (1.57 to 26.23). Conclusions: In some Brazilian regions, the dropout rate has been high since 2014, signaling a risk of measles resurgence. In turn, space-time analysis indicated lower vaccination coverage in 2020, suggesting the influence of the COVID-19 pandemic.

Objetivo: Evaluar la cobertura de vacunación y las tasas de incumplimiento del esquema de vacunación triple viral en las macrorregiones de Brasil. Métodos: En este estudio ecológico, con un enfoque espaciotemporal, se utilizaron datos del Programa Nacional de Inmunización y del Sistema de Información sobre Recién Nacidos Vivos. Se estimó la variación anual de la cobertura de vacunación y la tasa de incumplimiento del esquema de vacunación triple viral en niños de 12 y 15 meses en 5570 municipios brasileños (en el período 2014-2021). El análisis estadístico se realizó en el conjunto de municipios de cada macrorregión brasileña mediante la técnica de barrido espaciotemporal, con un modelo probabilístico de Poisson y con la hipótesis de que los municipios con menor cobertura de vacunación o tasas altas de incumplimiento formarían conglomerados espaciotemporales. Resultados: En el período 2014-2021, el 38,3% y el 12,9% de los municipios alcanzó una cobertura ≥95,0% para la primera y la segunda dosis de la vacuna triple viral, respectivamente; el 53,6% de los municipios tuvo una tasa de incumplimiento alta (del 20,0% al 49,9%) y el 37,2% una tasa extremadamente alta. En la zona del nordeste se observaron los conglomerados primarios de cobertura baja de la primera y la segunda dosis de la vacuna triple viral (administradas en los períodos 2018-2021 y 2020-2021, respectivamente) con un mayor riesgo relativo (RR), en comparación con los demás conglomerados primarios. Se observó un RR alto de tener una tasa elevada de incumplimiento en todas las macrorregiones de Brasil (de entre 1,57 y 26,23). Conclusiones: En algunas macrorregiones, la tasa de incumplimiento había sido elevada desde el 2014, lo cual indica un riesgo de resurgimiento del sarampión. A su vez, en el análisis espaciotemporal se observó una menor cobertura de vacunación en el 2020, lo que denota la influencia de la pandemia de COVID-19.

Heterogeneidade espaço-temporal dos indicadores de imunização da vacina tríplice viral em crianças no Brasil / Space-time heterogeneity of measles, mumps, and rubella vaccination indicators in children from Brazil / Heterogeneidad espaciotemporal de los indicadores de inmunización con la vacuna triple viral en la población infantil de Brasil

[RESUMO]. Objetivo. Avaliar a cobertura vacinal e as taxas de abandono da vacina tríplice viral nas macrorregiões brasileiras. Métodos. Este estudo ecológico, com abordagem espaço-temporal, utilizou dados do Programa Nacional de Imunizações e do Sistema de Informação sobre Nascidos Vivos. Estimou-se a variação anual (2014 a 2021) da cobertura vacinal e da taxa de abandono da vacina tríplice viral em crianças de 12 meses e 15 meses de idade nos 5 570 municípios brasileiros. A análise estatística foi realizada para o conjunto de municípios de cada macrorregião brasileira usando a técnica de varredura espaço-temporal, considerando o modelo probabilístico de Poisson e a hipótese de que os municípios com menores coberturas vacinais ou altas taxa de abandono formariam aglomerados (clusters) espaço-temporais. Resultados. De 2014 a 2021, 38,3% e 12,9% dos municípios alcançaram cobertura da vacina tríplice viral ≥ 95,0% na primeira e segunda doses, respectivamente; 53,6% dos municípios tiveram alta taxa de abandono (20,0% a 49,9%) e 37,2% tiveram altíssima taxa de abandono. O Nordeste apresentou os clusters primários para baixa cobertura da primeira (2018 a 2021) e da segunda doses (2020 a 2021) da vacina tríplice viral com maiores riscos relativos (RR) em relação aos demais clusters primários. O RR para alta taxa de abandono foi elevado em todas as macrorregiões brasileiras (1,57 a 26,23). Conclusões. Em algumas macrorregiões, a taxa de abandono era alta desde 2014, sinalizando risco de res-surgimento do sarampo. Por sua vez, a análise espaço-temporal indicou mais baixas coberturas vacinais em 2020, sugerindo influência da pandemia de covid-19.

[ABSTRACT]. Objective. To evaluate immunization coverage and dropout rates of the measles, mumps, and rubella vaccine across Brazilian regions. Methods. This ecological study employing a space-time approach used data from the National Immunization Program (PNI) and the Live Births Information System (SINASC). We estimated the annual variation (2014 to 2021) in immunization coverage and dropout rate of the measles, mumps, and rubella vaccine in children aged 12 and 15 months in the 5 570 Brazilian municipalities. Statistical analysis was conducted for the municipalities contained in each Brazilian region using the space-time scan technique, considering the Poisson probabilistic model and the hypothesis that municipalities with lower immunization coverage or high dropout rates would form space-time clusters. Results. From 2014 to 2021, 38.3% and 12.9% of municipalities achieved a coverage ≥ 95.0% in the first and second doses respectively; 53.6% of municipalities had a high dropout rate (20.0% to 49.9%) and 37.2% had a very high dropout rate. The Northeast region had primary clusters for low coverage of the first (2018 to 2021) and second vaccine doses (2020 to 2021) with higher relative risks (RR) compared to other primary clusters. The RR for high dropout rate was elevated in all Brazilian regions (1.57 to 26.23). Conclusions. In some Brazilian regions, the dropout rate has been high since 2014, signaling a risk of meas- les resurgence. In turn, space-time analysis indicated lower vaccination coverage in 2020, suggesting the influence of the COVID-19 pandemic.

[RESUMEN]. Objetivo. Evaluar la cobertura de vacunación y las tasas de incumplimiento del esquema de vacunación triple viral en las macrorregiones de Brasil. Métodos. En este estudio ecológico, con un enfoque espaciotemporal, se utilizaron datos del Programa Nacional de Inmunización y del Sistema de Información sobre Recién Nacidos Vivos. Se estimó la variación anual de la cobertura de vacunación y la tasa de incumplimiento del esquema de vacunación triple viral en niños de 12 y 15 meses en 5570 municipios brasileños (en el período 2014-2021). El análisis estadístico se realizó en el conjunto de municipios de cada macrorregión brasileña mediante la técnica de barrido espa- ciotemporal, con un modelo probabilístico de Poisson y con la hipótesis de que los municipios con menor cobertura de vacunación o tasas altas de incumplimiento formarían conglomerados espaciotemporales. Resultados. En el período 2014-2021, el 38,3% y el 12,9% de los municipios alcanzó una cobertura ≥95,0% para la primera y la segunda dosis de la vacuna triple viral, respectivamente; el 53,6% de los municipios tuvo una tasa de incumplimiento alta (del 20,0% al 49,9%) y el 37,2% una tasa extremadamente alta. En la zona del nordeste se observaron los conglomerados primarios de cobertura baja de la primera y la segunda dosis de la vacuna triple viral (administradas en los períodos 2018-2021 y 2020-2021, respectivamente) con un mayor riesgo relativo (RR), en comparación con los demás conglomerados primarios. Se observó un RR alto de tener una tasa elevada de incumplimiento en todas las macrorregiones de Brasil (de entre 1,57 y 26,23). Conclusiones. En algunas macrorregiones, la tasa de incumplimiento había sido elevada desde el 2014, lo cual indica un riesgo de resurgimiento del sarampión. A su vez, en el análisis espaciotemporal se observó una menor cobertura de vacunación en el 2020, lo que denota la influencia de la pandemia de COVID-19.

Temporal trend of the dropout rate and vaccination coverage of the triple viral vaccine in Brazil, 2014-2021.

MAIN RESULTS: Annual vaccination coverage was below 95% in Brazil. The second dose of the vaccine showed stationary and decreasing trends in the country's Federative Units. The dropout rate varied greatly throughout the study period. IMPLICATIONS FOR SERVICES: The results found regarding the trends serve to inform and point to the urgency of planning actions aimed at improving coverage of the triple viral vaccine nationally in Brazil. PERSPECTIVES: Investments in enhanced training of epidemiological surveillance professionals and enhanced computerized systems are necessary, with a view to continuous monitoring, to support actions to promote better and timely vaccine coverage. OBJECTIVE: to analyze the temporal trend of coverage and dropout rate for triple viral vaccine in Brazil, according to the country's Federative Units and Macro-Regions, between 2014 and 2021. METHODS: this was an ecological time series study, using data from the National Immunization Program Information System and the Live Birth Information System; joinpoint regression models were used. RESULTS: in Brazil as a whole annual vaccination coverage was below 95% and ranged from 92.3% (2015) to 54.4% (2021); the second dose of the vaccine showed a decreasing temporal trend in the period (average change over the period = -5.8; 95%CI -10.5;-0.8); the temporal trends were stationary and decreasing in the country's Federative Units; the dropout rate ranged from 22.2% (2014) to 37.4% (2021). CONCLUSION: there was a downward trend in vaccination coverage and an increase in the dropout rate in Brazil as a whole and in the country's Federative Units.

High-risk spatial clusters for Zika, dengue, and chikungunya in Rio de Janeiro, Brazil.

OBJECTIVE: To analyze the spatial distribution and identify high-risk spatial clusters of Zika, dengue, and chikungunya (ZDC), in the city of Rio de Janeiro, Brazil, and their socioeconomic status. METHODS: An ecological study based on data from a seroprevalence survey. Using a rapid diagnostic test to detect the arboviruses, 2,114 individuals were tested in 2018. The spatial distribution was analyzed using kernel estimation. To detect high-risk spatial clusters of arboviruses, we used multivariate scan statistics. The Social Development Index (SDI) was considered in the analysis of socioeconomic status. RESULTS: Among the 2,114 individuals, 1,714 (81.1%) were positive for at least one arbovirus investigated. The kernel estimation showed positive individuals for at least one arbovirus in all regions of the city, with hot spots in the North, coincident with regions with very low or low SDI. The scan statistic detected three significant (p<0.05) high-risk spatial clusters for Zika, dengue, and chikungunya viruses. These clusters correspond to 35.7% (n=613) of all positive individuals of the sample. The most likely cluster was in the North (cluster 1) and overlapped regions with very low and low SDI. Clusters 2 and 3 were in the West and overlapping regions with low and very low SDI, respectively. The highest values of relative risks were in cluster 1 for CHIKV (1.97), in cluster 2 for ZIKV (1.58), and in cluster 3 for CHIKV (1.44). Regarding outcomes in the clusters, the Flavivirus had the highest frequency in clusters 1, 2, and 3 (42.83%, 54.46%, and 52.08%, respectively). CONCLUSION: We found an over-risk for arboviruses in areas with the worst socioeconomic conditions in Rio de Janeiro. Moreover, the highest concentration of people negative for arboviruses occurred in areas considered to have better living conditions.

High-risk spatial clusters for Zika, dengue, and chikungunya in Rio de Janeiro, Brazil

ABSTRACT OBJECTIVE To analyze the spatial distribution and identify high-risk spatial clusters of Zika, dengue, and chikungunya (ZDC), in the city of Rio de Janeiro, Brazil, and their socioeconomic status. METHODS An ecological study based on data from a seroprevalence survey. Using a rapid diagnostic test to detect the arboviruses, 2,114 individuals were tested in 2018. The spatial distribution was analyzed using kernel estimation. To detect high-risk spatial clusters of arboviruses, we used multivariate scan statistics. The Social Development Index (SDI) was considered in the analysis of socioeconomic status. RESULTS Among the 2,114 individuals, 1,714 (81.1%) were positive for at least one arbovirus investigated. The kernel estimation showed positive individuals for at least one arbovirus in all regions of the city, with hot spots in the North, coincident with regions with very low or low SDI. The scan statistic detected three significant (p<0.05) high-risk spatial clusters for Zika, dengue, and chikungunya viruses. These clusters correspond to 35.7% (n=613) of all positive individuals of the sample. The most likely cluster was in the North (cluster 1) and overlapped regions with very low and low SDI. Clusters 2 and 3 were in the West and overlapping regions with low and very low SDI, respectively. The highest values of relative risks were in cluster 1 for CHIKV (1.97), in cluster 2 for ZIKV (1.58), and in cluster 3 for CHIKV (1.44). Regarding outcomes in the clusters, the Flavivirus had the highest frequency in clusters 1, 2, and 3 (42.83%, 54.46%, and 52.08%, respectively). CONCLUSION We found an over-risk for arboviruses in areas with the worst socioeconomic conditions in Rio de Janeiro. Moreover, the highest concentration of people negative for arboviruses occurred in areas considered to have better living conditions.

Temporal trend of the dropout rate and vaccination coverage of the triple viral vaccine in Brazil, 2014-2021 / Tendencia temporal de tasa de abandono y cobertura de vacunación de la vacuna triple viral en Brasil, 2014-2021 / Tendência temporal da taxa de abandono e da cobertura da vacina tríplice viral no Brasil, 2014-2021

Abstract Objective: to analyze the temporal trend of coverage and dropout rate for triple viral vaccine in Brazil, according to the country's Federative Units and Macro-Regions, between 2014 and 2021. Methods: this was an ecological time series study, using data from the National Immunization Program Information System and the Live Birth Information System; joinpoint regression models were used. Results: in Brazil as a whole annual vaccination coverage was below 95% and ranged from 92.3% (2015) to 54.4% (2021); the second dose of the vaccine showed a decreasing temporal trend in the period (average change over the period = -5.8; 95%CI -10.5;-0.8); the temporal trends were stationary and decreasing in the country's Federative Units; the dropout rate ranged from 22.2% (2014) to 37.4% (2021). Conclusion: there was a downward trend in vaccination coverage and an increase in the dropout rate in Brazil as a whole and in the country's Federative Units.

Resumen Objetivo: analizar la tendencia temporal de cobertura y tasa deserción de la vacuna triple viral en Brasil, y según Unidades de la Federación y Regiones, entre 2014 y 2021. Métodos: estudio de serie temporal ecológica, sobre datos de los sistemas del Inmunizaciones y Nacido Vivo; se utilizaron modelos de regresión de punto de inflexión. Resultados: la cobertura anual de vacunación estuvo por debajo del 95% y osciló entre 92,3% (2015) y 54,4% (2021), en Brasil; la segunda dosis mostró una tendencia temporal decreciente en el período (variación promedia en el periodo = -5,8; IC95% -10,5;-0,8); las tendencias temporales fueron estacionarias y decrecientes en las Unidades de la Federación; la tasa deserción de varió del 22,2% (2014) al 37,4% (2021). Conclusión: hubo una tendencia a la baja en las coberturas de vacunación y un aumento en la tasa de deserción en Brasil y en las Unidades de la Federación.

Resumo Objetivo: analisar a tendência temporal da cobertura e da taxa de abandono da vacina tríplice viral no Brasil, nas Unidades da Federação (UFs) e grandes regiões nacionais, entre 2014 e 2021. Métodos: estudo ecológico de série temporal, sobre dados do Sistema de Informações do Programa Nacional de Imunizações e do Sistema de Informações sobre Nascidos Vivos; foram utilizados modelos de regressão por pontos de inflexão. Resultados: as coberturas vacinais anuais, no Brasil como um todo, estiveram abaixo de 95%, variando de 92,3% (2015) a 54,4% (2021); a segunda dose da vacina apresentou tendência temporal decrescente no período (variação média no período = -5,8; IC95% -10,5;-0,8); as tendências temporais foram estacionárias e decrescentes nas UFs; a taxa de abandono variou de 22,2% (2014) a 37,4% (2021). Conclusão: houve tendência de queda da cobertura vacinal e aumento da taxa de abandono, no Brasil como um todo e nas UFs.

Characteristics and temporal trends of mortality rates in children and adolescents in Mato Grosso and Brazil, 2009-2020. / Características e tendência temporal das taxas de mortalidade de crianças e adolescentes em Mato Grosso e no Brasil, 2009 a 2020.

OBJECTIVE: to analyze the characteristics and temporal trend of mortality rates in the population aged 5 to 14 years in Mato Grosso state and in Brazil, from 2009 to 2020. METHODS: this was an ecological time-series study, based on data taken from the Mortality Information System. Descriptive and trend analyses were performed, using the joinpoint regression model and calculating the average annual percentage change (AAPC). RESULTS: in Brazil and in Mato Grosso state, deaths were predominantly male, preventable and due to external causes. A falling trend was identified for Brazil (5-9 years AAPC: -2.9; 95%CI -4.3;-1.6 and 10-14 years AAPC: -2.5; 95%CI -3.3;-1.8), while a stationary trend was found in Mato Grosso (5-9 years AAPC: -2.0; 95%CI -5.6;1.7 and 10-14 years AAPC: -0.1; 95%CI -5.9;6.1). CONCLUSION: the stable trend of mortality at high levels demands urgent interventions to reduce it.

[Identification of risk areas and factors associated with the 2019 measles epidemic in the State of São Paulo, Brazil]. / Identificação de áreas de risco e fatores associados à epidemia de sarampo de 2019 no Estado de São Paulo, Brasil.

This study aimed to analyze the occurrence of clusters and factors associated with the resurgence of measles cases from the largest epidemic of the post-elimination period in the State of São Paulo, Brazil, in 2019. Sociosanitary and care factors were analyzed by zero-inflated Poisson (ZIP) and ZIP models with structured and unstructured spatial effect. The SCAN statistic was used to analyze the occurrence of case clusters. Clusters of high-risk cases were identified in municipalities that make up the intermediate region of São Paulo. In the ZIP model, the following variables were observed as risk factors at the municipal level: household heads under 18 years old (adjusted RR =0 1.39; 95%CrI: 1.27-1.53), inequality in income distribution (adjusted RR = 36.67; 95%CrI: 26.36-51.15), unemployment in people over 18 years old (adjusted RR = 1.10; 95%CrI: 1.08-1.12), and non-existent street lighting (adjusted RR = 1.05; 95%CrI: 1.04-1.05). In the ZIP models with structured and unstructured spatial effect, the following variables were observed as risk factors: household heads under 18 years old (adjusted RR = 1.36; 95%CrI: 1.04-1.90) and inequality in income distribution (adjusted RR = 3.12; 95%CrI: 1.02-9.48). In both models, the coverage of health agents was presented as a protective factor. The findings reinforce the importance of intensifying measles surveillance actions articulated to the Family Health Strategy, especially in areas with greater social vulnerability, to ensure equitable and satisfactory vaccination coverage and reduce the risk of reemergence of the disease.

O objetivo foi analisar a ocorrência de clusters e fatores associados ao ressurgimento de casos de sarampo da maior epidemia do período pós-eliminação, ocorrida no Estado de São Paulo, Brasil, em 2019. Fatores sociossanitários e assistenciais foram analisados por modelos de Poisson inflacionado de zero (ZIP) e ZIP com efeito espacial estruturado e não estruturado. A estatística de varredura SCAN foi usada para analisar a ocorrência de clusters de casos. Foram identificados clusters de casos de alto risco em municípios que compõem a região intermediária de São Paulo. No modelo ZIP, foram observadas como fatores de risco no nível municipal as variáveis chefes de domicílio menores de 18 anos (RR ajustado = 1,39; ICr95%: 1,27-1,53), desigualdade na distribuição de renda (RR ajustado = 36,67; ICr95%: 26,36-51,15), desocupação em maiores de 18 anos (RR ajustado = 1,10; ICr95%: 1,08-1,12) e iluminação pública inexistente (RR ajustado = 1,05; ICr95%: 1,04-1,05). Nos modelos ZIP com efeito espacial estruturado e não estruturado, foram identificados como fatores de risco os indicadores chefes de domicílio menores de 18 anos (RR ajustado = 1,36; ICr95%: 1,04-1,90) e desigualdade na distribuição dos rendimentos do trabalho (RR ajustado = 3,12; ICr95%: 1,02-9,48). Em ambos os modelos, a cobertura de agentes de saúde se apresentou como fator de proteção. Os achados reforçam a importância de intensificar as ações de vigilância de sarampo articuladas à Estratégia Saúde da Família, especialmente em áreas de maior vulnerabilidade social, para garantir coberturas vacinais equânimes e satisfatórias e reduzir o risco de reemergência da doença.

El objetivo de este estudio fue analizar la ocurrencia de clusters y sus factores asociados al resurgimiento de los casos de sarampión teniendo por base la mayor epidemia del período poserradicación que tuvo lugar en el Estado de São Paulo, Brasil, en 2019. Los factores sociosanitarios y asistenciales se analizaron mediante modelos de Poisson zero inflated (ZIP) y ZIP con efecto espacial estructurado y no estructurado. La estadística de exploración SCAN se utilizó para analizar la ocurrencia de clusters de casos. Se identificaron clusters de casos de alto riesgo en municipios que componen la Región Intermedia de São Paulo. En el modelo ZIP se observaron como factores de riesgo a nivel municipal las variables jefes de hogar menores de 18 años (RR ajustado = 1,39; ICr95%: 1,27-1,53), desigualdad en la distribución de renta (RR ajustado = 36,67; ICr95%: 26,36-51,15), desempleo en mayores de 18 años (RR ajustado = 1,10; ICr95%: 1,08-1,12) y alumbrado público inexistente (RR ajustado = 1,05; ICr95%: 1,04-1,05). En los modelos ZIP con efecto espacial estructurado y no estructurado, se identificaron como factores de riesgo los indicadores jefe de hogar menor de 18 años (RR ajustado = 1,36; ICr95%: 1,04-1,90) y la desigualdad en la distribución de los ingresos de trabajo (RR ajustado = 3,12; ICr95%: 1,02- 9,48). En ambos modelos, la cobertura de los agentes de salud fue un factor protector. Los hallazgos evidencian la importancia de intensificar las acciones de vigilancia del sarampión vinculadas a la Estrategia de Salud Familiar, especialmente en las zonas de mayor vulnerabilidad social, para garantizar una cobertura de la vacunación de manera equitativa y satisfactoria, además de reducir el riesgo de reemergencia de la enfermedad.

Characteristics and temporal trends in child and adolescent mortality rates in Mato Grosso and Brazil, 2009 to 2020 / Características y tendencia temporal de la mortalidade infantil y adolescente en Mato Grosso y Brasil, 2009 a 2020 / Características e tendência temporal das taxas de mortalidade de crianças e adolescentes em Mato Grosso e no Brasil, 2009 a 2020

Objective: to analyze the characteristics and temporal trend of mortality rates in the population aged 5 to 14 years in Mato Grosso state and Brazil, from 2009 to 2020. Methods: ecological time-series study, based on data from Mortality Information System. Descriptive and trend analysis were performed, using the regression model by inflection points (JoinPoint regression) and calculating the average change in the period (average annual percentage change ­ AAPC). Results: in Brazil and Mato Grosso, deaths were predominantly male, preventable and due to external causes. A decreasing trend was identified in Brazil (5 a 9 years AAPC: -2,9; 95%CI -4,3;-1,6 and 10 a 14 years AAPC: - 2,5; 95%CI -3,3;-1,8) and stationary in Mato Grosso (5 a 9 years AAPC: -2,0; 95%CI -5,6;1,7 and 10 a 14 years AAPC: -0,1; 95%CI -5,9;6,1). Conclusion: the stationarity of the mortality trend at high levels demands urgent interventions to reduce it.

Objetivo: analizar las características y la tendencia temporal de las tasas de mortalidad en la población de 5 a 14 años en Mato Grosso y Brasil, desde 2009 hasta 2020. Métodos: estudio ecológico de serie temporal, sobre datos del Sistema de Información de Mortalidad. Análisis descriptivo y de tendencia fueran realizadas, utilizando el modelo de regresión por puntos de inflexión (joinpoint) y cálculo de la variación media del periodo (VMP). Resultados: en Brasil y Mato Grosso, las muertes fueron predominantemente masculinas, evitables y por causas externas. Se identificó una tendencia decreciente en Brasil (5 a 9 años VPP: -2,9; IC95% -4,3;-1,6 y 10 a 14 años VMP: -2,5; IC95% -3,3;-1,8) y una tendencia estacionaria en Mato Grosso (5 a 9 años VMP: -2,0; IC95% -5,6;1,7 y 10 a 14 años VMP: -0,1; IC95% -5,9;6,1). Conclusión: la tendencia estacionaria de la mortalidad en niveles altos exige intervenciones urgentes dirigidas a reducirla.

Objetivo: analisar as características e a tendência temporal das taxas de mortalidade na população de 5 a 14 anos em Mato Grosso e no Brasil, no período de 2009 a 2020. Métodos: estudo ecológico de série temporal, sobre dados do Sistema de Informação sobre Mortalidade. As análises foram descritivas e de tendência, utilizando-se o modelo de regressão por pontos de inflexão (joinpoint) com cálculo da variação média no período(VMP). Resultados: no Brasil e em Mato Grosso, os óbitos foram predominantemente masculinos, evitáveis e por causas externas. Foi identificada tendência decrescente no Brasil (5 a 9 anos VMP: -2,9; IC95% -4,3;-1,6 e 10 a 14 anos VMP: -2,5; IC95% -3,3;-1,8) e estacionária em Mato Grosso (5 a 9 anos VMP: -2,0; IC95% -5,6;1,7 e 10 a 14 anos VMP:-0,1; IC95% -5,9;6,1). Conclusão: a tendência estável da mortalidade em patamares elevados demanda intervenções urgentes, visando sua redução.

Space-time clusters of severe acute respiratory syndrome and COVID-19 and hierarchical urban network in the state of Mato Grosso, Brazil, 2020-2021 / Clusters espaço-temporais de síndrome respiratória aguda grave e COVID-19 e rede urbana hierárquica no estado de Mato Grosso, Brasil, 2020-2021 / Agrupaciones espacio-temporales de síndrome respiratorio agudo severo y COVID-19 y red urbana jerárquica en el estado de Mato Grosso, Brasil, 2020-2021

Objective: to analyze the space-time distribution of COVID-19 in the state of Mato Grosso, Brazil. Methods: Weekly case records of Severe Acute Respiratory Syndrome were obtained from the Ministry of Health's Database related to this syndrome, including data from COVID-19. Temporal and spatiotemporal analysis using scanning statistics to identify clusters of severe acute respiratory syndrome cases were performed with the software SaTScan. Results: A total of 27,093 cases was observed, with an incidence of 768.33/100,000 inhabitants. The spatial distribution considering the period of study evidenced the heterogeneity of values in the state. The highest incidence rates were observed in more populous municipalities. Conclusion: We highlight priority areas for interventions, aiming at controlling the transmission of the disease and reducing transmission risks to more remote areas of the state of Mato Grosso.

Objetivo: Analisar distribuição espaço-temporal de COVID-19 no estado de Mato Grosso, Brasil. Métodos: Registros de casos semanais de Síndrome Respiratória Aguda Grave foram obtidos junto ao Banco de Dados dessa síndrome do Ministério da Saúde, incluindo dados de COVID-19. Análises temporal e espaço-temporal utilizando varreduras estatísticas para identificação de clusters de casos de síndrome respiratória aguda grave foram realizadas com o programa SaTScan. Resultados: Foram observados 27.093 casos, com incidência de 768,33/100.000 habitantes. A distribuição espacial considerando o período de estudo evidenciou heterogeneidade de valores no estado. As maiores taxas de incidência foram observadas em municípios mais populosos. Conclusão: Destacam-se áreas prioritárias para intervenções, priorizando controle da transmissão da doença e redução dos riscos de transmissão para áreas mais remotas do estado de Mato Grosso.

Objetivo: Analizar la distribución espacio-temporal de COVID-19 en la provincia estado de Mato Grosso, Brasil. Métodos: Se obtuvieron registros semanales de casos de Síndrome Respiratorio Agudo Severo (SRAG) de la Base de Datos SRAG del Ministerio de Salud, incluyendo datos de COVID-19. Se realizaron análisis temporales y espaciotemporales utilizando exploraciones estadísticas para identificar grupos de casos SRAG con el programa SaTScan. Resultados: se observaron 27.093 casos, con una incidencia de 768,33 / 100.000 habitantes. La distribución espacial considerando el período de estudio mostró heterogeneidad de valores en el estado. Las tasas de incidencia más altas se observaron en los municipios más poblados. Conclusión: Se destacan las áreas prioritarias para las intervenciones, priorizando el control de la transmisión de enfermedades y la reducción de los riesgos de transmisión a áreas más remotas del estado de Mato Grosso.

Características e tendência temporal das taxas de mortalidade de crianças e adolescentes em Mato Grosso e no Brasil, 2009 a 2020 / Características y tendencia temporal de la mortalidad en niños y adolescentes en Mato Grosso y Brasil, 2009 a 2020 / Characteristics and temporal trends of mortality rates in children and adolescents in Mato Grosso and Brazil, 2009-2020

Objetivo: analisar as características e a tendência temporal das taxas de mortalidade na população de 5 a 14 anos em Mato Grosso e no Brasil, no período de 2009 a 2020. Métodos: estudo ecológico de série temporal, sobre dados do Sistema de Informação sobre Mortalidade. As análises foram descritivas e de tendência, utilizando-se o modelo de regressão por pontos de inflexão (joinpoint) com cálculo da variação média no período (VMP). Resultados: no Brasil e em Mato Grosso, os óbitos foram predominantemente masculinos, evitáveis e por causas externas. Foi identificada tendência decrescente no Brasil (5 a 9 anos VMP: -2,9; IC95% -4,3;-1,6 e 10 a 14 anos VMP: -2,5; IC95% -3,3;-1,8) e estacionária em Mato Grosso (5 a 9 anos VMP: -2,0; IC95% -5,6;1,7 e 10 a 14 anos VMP: -0,1; IC95% -5,9;6,1). Conclusão: a tendência estável da mortalidade em patamares elevados demanda intervenções urgentes, visando a sua redução.

Objetivo: analizar las características y la tendencia temporal de las tasas de mortalidad en la población de 5 a 14 años en Mato Grosso y Brasil, desde 2009 hasta 2020. Métodos: estudio ecológico de serie temporal, sobre datos del Sistema de Información de Mortalidad. Se realizaron análisis descriptivos y de tendencia, utilizando el modelo de regresión por puntos de inflexión (joinpoint) y el cálculo de la variación media del periodo (VMP). Resultados: en Brasil y Mato Grosso, las muertes fueron predominantemente masculinas, evitables y por causas externas. Se identificó una tendencia decreciente en Brasil (5 a 9 años VPP: -2,9; IC95% -4,3;-1,6 y 10 a 14 años VMP: -2,5; IC95% -3,3;-1,8) y una tendencia estacionaria en Mato Grosso (5 a 9 años VMP: -2,0; IC95% -5,6;1,7 y 10 a 14 años VMP: -0,1; IC95% -5,9;6,1). Conclusión: la tendencia estacionaria de la mortalidad en niveles altos exige intervenciones urgentes orientadas a reducirla.

Objective: to analyze the characteristics and temporal trend of mortality rates in the population aged 5 to 14 years in Mato Grosso state and in Brazil, from 2009 to 2020. Methods: this was an ecological time-series study, based on data taken from the Mortality Information System. Descriptive and trend analyses were performed, using the joinpoint regression model and calculating the average annual percentage change (AAPC). Results: in Brazil and in Mato Grosso state, deaths were predominantly male, preventable and due to external causes. A falling trend was identified for Brazil (5-9 years AAPC: -2.9; 95%CI -4.3;-1.6 and 10-14 years AAPC: -2.5; 95%CI -3.3;-1.8), while a stationary trend was found in Mato Grosso (5-9 years AAPC: -2.0; 95%CI -5.6;1.7 and 10-14 years AAPC: -0.1; 95%CI -5.9;6.1). Conclusion: the stable trend of mortality at high levels demands urgent interventions to reduce it.

Identificação de áreas de risco e fatores associados à epidemia de sarampo de 2019 no Estado de São Paulo, Brasil / Identification of risk areas and factors associated with the 2019 measles epidemic in the State of São Paulo, Brazil / Identificación de áreas de riesgo y factores asociados a la epidemia de sarampión de 2019 en el Estado de São Paulo, Brasil

O objetivo foi analisar a ocorrência de clusters e fatores associados ao ressurgimento de casos de sarampo da maior epidemia do período pós-eliminação, ocorrida no Estado de São Paulo, Brasil, em 2019. Fatores sociossanitários e assistenciais foram analisados por modelos de Poisson inflacionado de zero (ZIP) e ZIP com efeito espacial estruturado e não estruturado. A estatística de varredura SCAN foi usada para analisar a ocorrência de clusters de casos. Foram identificados clusters de casos de alto risco em municípios que compõem a região intermediária de São Paulo. No modelo ZIP, foram observadas como fatores de risco no nível municipal as variáveis chefes de domicílio menores de 18 anos (RR ajustado = 1,39; ICr95%: 1,27-1,53), desigualdade na distribuição de renda (RR ajustado = 36,67; ICr95%: 26,36-51,15), desocupação em maiores de 18 anos (RR ajustado = 1,10; ICr95%: 1,08-1,12) e iluminação pública inexistente (RR ajustado = 1,05; ICr95%: 1,04-1,05). Nos modelos ZIP com efeito espacial estruturado e não estruturado, foram identificados como fatores de risco os indicadores chefes de domicílio menores de 18 anos (RR ajustado = 1,36; ICr95%: 1,04-1,90) e desigualdade na distribuição dos rendimentos do trabalho (RR ajustado = 3,12; ICr95%: 1,02-9,48). Em ambos os modelos, a cobertura de agentes de saúde se apresentou como fator de proteção. Os achados reforçam a importância de intensificar as ações de vigilância de sarampo articuladas à Estratégia Saúde da Família, especialmente em áreas de maior vulnerabilidade social, para garantir coberturas vacinais equânimes e satisfatórias e reduzir o risco de reemergência da doença.

This study aimed to analyze the occurrence of clusters and factors associated with the resurgence of measles cases from the largest epidemic of the post-elimination period in the State of São Paulo, Brazil, in 2019. Sociosanitary and care factors were analyzed by zero-inflated Poisson (ZIP) and ZIP models with structured and unstructured spatial effect. The SCAN statistic was used to analyze the occurrence of case clusters. Clusters of high-risk cases were identified in municipalities that make up the intermediate region of São Paulo. In the ZIP model, the following variables were observed as risk factors at the municipal level: household heads under 18 years old (adjusted RR =0 1.39; 95%CrI: 1.27-1.53), inequality in income distribution (adjusted RR = 36.67; 95%CrI: 26.36-51.15), unemployment in people over 18 years old (adjusted RR = 1.10; 95%CrI: 1.08-1.12), and non-existent street lighting (adjusted RR = 1.05; 95%CrI: 1.04-1.05). In the ZIP models with structured and unstructured spatial effect, the following variables were observed as risk factors: household heads under 18 years old (adjusted RR = 1.36; 95%CrI: 1.04-1.90) and inequality in income distribution (adjusted RR = 3.12; 95%CrI: 1.02-9.48). In both models, the coverage of health agents was presented as a protective factor. The findings reinforce the importance of intensifying measles surveillance actions articulated to the Family Health Strategy, especially in areas with greater social vulnerability, to ensure equitable and satisfactory vaccination coverage and reduce the risk of reemergence of the disease.

El objetivo de este estudio fue analizar la ocurrencia de clusters y sus factores asociados al resurgimiento de los casos de sarampión teniendo por base la mayor epidemia del período poserradicación que tuvo lugar en el Estado de São Paulo, Brasil, en 2019. Los factores sociosanitarios y asistenciales se analizaron mediante modelos de Poisson zero inflated (ZIP) y ZIP con efecto espacial estructurado y no estructurado. La estadística de exploración SCAN se utilizó para analizar la ocurrencia de clusters de casos. Se identificaron clusters de casos de alto riesgo en municipios que componen la Región Intermedia de São Paulo. En el modelo ZIP se observaron como factores de riesgo a nivel municipal las variables jefes de hogar menores de 18 años (RR ajustado = 1,39; ICr95%: 1,27-1,53), desigualdad en la distribución de renta (RR ajustado = 36,67; ICr95%: 26,36-51,15), desempleo en mayores de 18 años (RR ajustado = 1,10; ICr95%: 1,08-1,12) y alumbrado público inexistente (RR ajustado = 1,05; ICr95%: 1,04-1,05). En los modelos ZIP con efecto espacial estructurado y no estructurado, se identificaron como factores de riesgo los indicadores jefe de hogar menor de 18 años (RR ajustado = 1,36; ICr95%: 1,04-1,90) y la desigualdad en la distribución de los ingresos de trabajo (RR ajustado = 3,12; ICr95%: 1,02- 9,48). En ambos modelos, la cobertura de los agentes de salud fue un factor protector. Los hallazgos evidencian la importancia de intensificar las acciones de vigilancia del sarampión vinculadas a la Estrategia de Salud Familiar, especialmente en las zonas de mayor vulnerabilidad social, para garantizar una cobertura de la vacunación de manera equitativa y satisfactoria, además de reducir el riesgo de reemergencia de la enfermedad.

Congenital Zika syndrome: A systematic review.

BACKGROUND: The signs and symptoms of Zika virus infection are usually mild and self-limited. However, the disease has been linked to neurological complications such as Guillain-Barré syndrome and peripheral nerve involvement, and also to abortion and fetal deaths due to vertical transmission, resulting in various congenital malformations in newborns, including microcephaly. This review aimed to describe the o signs and symptoms that characterize the congenital Zika syndrome. METHODS AND FINDINGS: A systematic review was performed with a protocol and described according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. The search strategy yielded 2,048 studies. After the exclusion of duplicates and application of inclusion criteria, 46 studies were included. The main signs and symptoms associated with the congenital Zika syndrome were microcephaly, parenchymal or cerebellar calcifications, ventriculomegaly, central nervous system hypoplasia or atrophy, arthrogryposis, ocular findings in the posterior and anterior segments, abnormal visual function and low birthweight for gestational age. CONCLUSIONS: Zika virus infection during pregnancy can cause a series of changes in the growth and development of children, while impacting the healthcare system due to the severity of cases. Our findings outline the disease profile in newborns and infants and may contribute to the development and updating of more specific clinical protocols.

Zika, dengue and chikungunya population prevalence in Rio de Janeiro city, Brazil, and the importance of seroprevalence studies to estimate the real number of infected individuals.

In the last 40 years, Latin America countries, including Brazil, have suffered from the emergence and reemergence of arboviruses, first Dengue (DENV) and recently Zika (ZIKV) and Chikungunya (CHIKV). All three arboviruses are currently endemic in Brazil and have caused major outbreaks in recent years. Rio de Janeiro city, host of the last Summer Olympic Games and the Football World Cup, has been specially affected by them. A surveillance system based on symptomatic reports is in place in Rio, but the true number of affected individuals is unknown due to the great number of Zika, Dengue and Chikungunya asymptomatic cases. Seroprevalence studies are more suitable to evaluate the real number of cases in a given population. We performed a populational seroprevalence survey in Rio, with recruitment of a sample of volunteers of all ages and gender from July to October 2018, within randomly selected census tracts and household. A total of 2,120 volunteers were interviewed and tested with rapid immunochromatographic test for ZIKV, DENV and CHIKV. Individuals with positive results for IgG and/or IgM from only one virus were classified accordingly, while those with test results positive for both ZIKV and DENV were classified as flaviviruses. We corrected for sample design and non-response in data analysis, and calculated point estimate prevalence and 95% confidence intervals for each virus. Arbovirus prevalence in the Rio's population (n = 6,688,927) was estimated at 48.6% [95% CI 44.8-52.4] (n = 3,254,121) for flaviviruses and at 18.0% [95% CI 14.8-21.2] (n = 1,204,765) for CHIKV. Approximately 17.0% [95% CI 14.1-20.1] (n = 1,145,674) of Rio´s population had no contact with any of the three arboviruses. The reported cases of Zika, Dengue and Chikungunya by the current surveillance system in place is insufficient to estimate their real numbers, and our data indicate that Zika seroprevalence could be at least five times and Chikungunya 45 times bigger. The high number of individuals having never been infected by any of the three arboviruses, may indicate a proper scenario for future outbreaks.

[Spaces of production of cutaneous leishmaniasis in the state of Rio de Janeiro, Brazil]. / Espaços de produção da leishmaniose tegumentar americana no estado do Rio de Janeiro, Brasil.

The scope of this research was to identify and characterize spatial units of epidemiological relevance in the state of Rio de Janeiro, through the highest concentrations of cutaneous leishmaniasis (CL) from 1980 to 2012, considering the geographical aspects. SUCAM, FUNASA and SINAN databases were consulted. A method of adjustment of spatially referenced data for demarcation of the regions with the highest concentrations of cases called circuits and poles was applied. These were superimposed on the socioenvironmental indicator maps. Of the total cases registered in the period, 87% occurred in the municipalities located in the resulting circuits and poles. The variations in the occurrence of cases in the different circuits and poles were not related to the socioenvironmental indicators. The identification of the circuits and poles can subsidize the state CL program of the prioritization of strategies of prevention and control actions and the optimization of the resources of the program. These regions, which are more stable than the localities, allow surveillance and control operations in locations with many cases and in other locations in the identified risk area, because they have the same characteristics as those already affected.

O objetivo foi identificar e caracterizar unidades espaciais de relevância epidemiológica no estado do Rio de Janeiro, por meio das maiores concentrações de casos de leishmaniose tegumentar (LT) no período de 1980 a 2012, considerando os conceitos da geografia. Utilizou-se bancos de dados da SUCAM, FUNASA e SINAN. Foi aplicado um método de ajustamento de dados espacialmente referenciados para delimitação das regiões com as maiores concentrações de densidades de casos chamadas circuitos e polos. Estes foram sobrepostos aos mapas de indicadores socioambientais. Do total de casos registrados no período, 87% ocorreram nos municípios localizados nos circuitos e polos resultantes. As variações na ocorrência de casos nos diferentes circuitos e polos não tiveram relação com os indicadores socioambientais. A identificação dos circuitos e polos pode subsidiar o programa estadual da LT para a priorização de estratégias de ações de prevenção e controle e a otimização dos recursos do programa. Essas regiões, mais estáveis que as localidades, permitem operações de vigilância e controle nas localidades com muitos casos e nas demais da área de risco identificada, por terem as mesmas características daquelas já afetadas.

Espaços de produção da leishmaniose tegumentar americana no estado do Rio de Janeiro, Brasil / Spaces of production of cutaneous leishmaniasis in the state of Rio de Janeiro, Brazil

Resumo O objetivo foi identificar e caracterizar unidades espaciais de relevância epidemiológica no estado do Rio de Janeiro, por meio das maiores concentrações de casos de leishmaniose tegumentar (LT) no período de 1980 a 2012, considerando os conceitos da geografia. Utilizou-se bancos de dados da SUCAM, FUNASA e SINAN. Foi aplicado um método de ajustamento de dados espacialmente referenciados para delimitação das regiões com as maiores concentrações de densidades de casos chamadas circuitos e polos. Estes foram sobrepostos aos mapas de indicadores socioambientais. Do total de casos registrados no período, 87% ocorreram nos municípios localizados nos circuitos e polos resultantes. As variações na ocorrência de casos nos diferentes circuitos e polos não tiveram relação com os indicadores socioambientais. A identificação dos circuitos e polos pode subsidiar o programa estadual da LT para a priorização de estratégias de ações de prevenção e controle e a otimização dos recursos do programa. Essas regiões, mais estáveis que as localidades, permitem operações de vigilância e controle nas localidades com muitos casos e nas demais da área de risco identificada, por terem as mesmas características daquelas já afetadas.

Abstract The scope of this research was to identify and characterize spatial units of epidemiological relevance in the state of Rio de Janeiro, through the highest concentrations of cutaneous leishmaniasis (CL) from 1980 to 2012, considering the geographical aspects. SUCAM, FUNASA and SINAN databases were consulted. A method of adjustment of spatially referenced data for demarcation of the regions with the highest concentrations of cases called circuits and poles was applied. These were superimposed on the socioenvironmental indicator maps. Of the total cases registered in the period, 87% occurred in the municipalities located in the resulting circuits and poles. The variations in the occurrence of cases in the different circuits and poles were not related to the socioenvironmental indicators. The identification of the circuits and poles can subsidize the state CL program of the prioritization of strategies of prevention and control actions and the optimization of the resources of the program. These regions, which are more stable than the localities, allow surveillance and control operations in locations with many cases and in other locations in the identified risk area, because they have the same characteristics as those already affected.

Effect of income on the cumulative incidence of COVID-19: an ecological study.

OBJECTIVE: to analyze the relationship between per capita income and the cumulative incidence of COVID-19 in the neighborhoods of the city of Rio de Janeiro, RJ, Brazil. METHOD: an ecological study using neighborhoods as units of analysis. The cumulative incidence rate per 100,000 inhabitants and the median of potential confounding variables (sex, race, and age) were calculated. Multiple analysis included quantile regression, estimating the regression coefficients of the variable income for every five percentiles from the 10th to 90th percentiles to verify the relationship between income and incidence. RESULTS: the city's rate was 36.58 new cases per 100,000 inhabitants. In general, the highest rates were observed in the wealthiest regions. Multiple analysis was consistent with this observation since the per capita income affected all percentiles analyzed, with a median regression coefficient of 0.02 (p-value <0.001; R2 32.93). That is, there is an increase of R$ 0.02 in the neighborhood's per capita income for every unit of incidence. CONCLUSION: cumulative incident rates of COVID-19 are influenced by one's neighborhood of residency, suggesting that access to testing is uneven.

Hot spots of leprosy in the endemic area of São Luís, Maranhão State, Northeastern Brazil.

BACKGROUND: Despite the decreasing of leprosy cases in Brazil, its occurrence remains high in certain Brazilian cities. The aim of the study was to analyze the spatial pattern of leprosy in São Luís, capital of Maranhão State, Northeastern Brazil. METHODOLOGY: An ecological study was carried out based on secondary data from leprosy cases and contacts reported in the Notification of Injury Information System in2015, and information on residency domiciles in three districts in the city. RESULTS: A positive correlation was found between the leprosy cases and the average number of residents per household, and households with open sewage, garbage accumulated, with street identification, persons without income, dependents and the poor. A negative correlation between cases and households with a sidewalk, literate people and 60 years old or more were identified. The seropositivity of contacts examined using the ML Flow test was of 23.19%. The disease presents a heterogeneous spatial pattern, with hyperendemic clusters. CONCLUSIONS: The spatialization of both leprosy cases and contacts and the identification of areas presenting the highest concentration of the disease in each district is important and constitutes an important tool to subsidize disease-control actions.