Vigilância epidemiológica: breve histórico e a experiência dos Estados Unidos e do estado de São Paulo / Inteligencia epidemiológica: breve histórico y la experiencia de los Estados Unidos y del estado de São Paulo, en Brasil / Epidemiological surveillance: a brief history and the experiences of the United States and the state of São Paulo

Objetivo: O objetivo desta revisão narrativa foi elencar alguns aspectos históricos da vigilância epidemiológica, modelo tecnológico de intervenção inicialmente desenhado para auxiliar no controle das doenças transmissíveis, no último século. Métodos: Narrativa construída a partir de textos selecionados, para registrar o desenvolvimento da vigilância epidemiológica nos Estados Unidos e no estado de São Paulo, Brasil. Resultados: São apresentadas as origens de algumas das ações componentes do repertório da vigilância epidemiológica, e uma breve história da construção do originalmente nomeado Center for Disease Control, agência dos Estados Unidos exemplar na forma como se faz vigilância em praticamente todo o mundo. Do mesmo modo, são delineados os caminhos que levaram à organização do sistema de vigilância no estado de São Paulo, traçando alguns paralelos com o sistema brasileiro. Conclusão: A narrativa é concluída com uma diferenciação conceitual entre vigilância epidemiológica, monitoramento e vigilância em saúde.

Objetivo: El objetivo de esta revisión narrativa es enumerar algunos aspectos históricos de la vigilancia epidemiológica modelo tecnológico de intervención diseñado para apoyar en el control de las enfermedades transmisibles en el último siglo. Métodos: Narrativa construida a partir de textos seleccionados y la experiencia del autor, para registrar el desarrollo dsen en los Estados Unidos y en el estado de São Paulo, Brasil. Resultados: Se presentan los orígenes de algunas de las acciones que componen el repertorio de la vigilancia epidemiológica, así como una breve historia de la construcción del Center for Disease Control, una agencia de Estados Unidos que es ejemplar por la forma en que realiza la vigilancia en, prácticamente, todo el mundo. Asimismo, se delinean los caminos que llevaron a la organización del sistema de vigilancia en el estado de São Paulo, trazando algunos paralelos con el sistema brasileño. Conclusión: Finalmente, concluye con la diferenciación entre vigilancia epidemiológica, monitoreo y vigilancia en salud.

Objective: The objective of this narrative review was to list some historical aspects of epidemiological surveillance, a technological intervention model initially designed to help control communicable diseases in the last century. Methods: This narrative was built based on texts selected to record the development of epidemiological surveillance in the United States and in the state of São Paulo, Brazil. Results: The origins of some of the actions that constitute epidemiological surveillance activities are presented, as well as a brief history of the establishment of the originally named Center for Disease Control, a United States agency that is held up as an example in relation to the way surveillance has been performed, practically all over the world. Likewise, we outline the paths that led to the establishment of the surveillance system in the state of São Paulo, drawing some parallels with the Brazilian system. Conclusion: The narrative concludes with a conceptual differentiation between epidemiological surveillance, monitoring and health surveillance.

Conceptual Frameworks in Scientific Inquiry and the Centers for Disease Control and Prevention's Approach to Pesticide Toxicity (1948-1968).

This article examines the rise of the Centers for Disease Control and Prevention's (CDC's) small but influential program on the human toxicology of synthetic pesticides after World War II. For nearly 20 years, scientists working in the CDC's Toxicology Section conducted a range of laboratory, field, and clinical studies to assess whether pesticides, such as dichlorodiphenyltrichloroethane (DDT), caused harm to humans. Applying an industrial hygiene approach to study pesticide toxicity, the team used the symptoms of poisoning as their criteria for harm and consistently found that, when used as intended, pesticides were generally safe for humans. In the post-Silent Spring era, these findings were increasingly challenged as the field of toxicology developed and different ways of understanding pesticide toxicity gained greater acceptance. While it is easy to dismiss the CDC's findings as excessively narrow, examining how the team arrived at their conclusions provides an instructive lesson about the powerful ways conceptual frameworks shape scientific inquiry and the unexpected ways data can be reinterpreted in different problem contexts. (Am J Public Health. 2019;109:1548-1556. doi: 10.2105/AJPH.2019.305260).

Progress in Public Health Emergency Preparedness-United States, 2001-2016.

OBJECTIVES: To evaluate the Public Health Emergency Preparedness (PHEP) program's progress toward meeting public health preparedness capability standards in state, local, and territorial health departments. METHODS: All 62 PHEP awardees completed the Centers for Disease Control and Prevention's self-administered PHEP Impact Assessment as part of program review measuring public health preparedness capability before September 11, 2001 (9/11), and in 2014. We collected additional self-reported capability self-assessments from 2016. We analyzed trends in congressional funding for public health preparedness from 2001 to 2016. RESULTS: Before 9/11, most PHEP awardees reported limited preparedness capabilities, but considerable progress was reported by 2016. The number of jurisdictions reporting established capability functions within the countermeasures and mitigation domain had the largest increase, almost 200%, by 2014. However, more than 20% of jurisdictions still reported underdeveloped coordination between the health system and public health agencies in 2016. Challenges and barriers to building PHEP capabilities included lack of trained personnel, plans, and sustained resources. CONCLUSIONS: Considerable progress in public health preparedness capability was observed from before 9/11 to 2016. Support, sustainment, and advancement of public health preparedness capability is critical to ensure a strong public health infrastructure.

The Development of Surveillance Systems.

Surveillance systems in public health practice have increased in number and sophistication with advances in data collection, analysis, and communication. When the Communicable Disease Center (now the Centers for Disease Control and Prevention) was founded some 70 years ago, surveillance referred to the close observation of individuals with suspected smallpox, plague, or cholera. Alexander Langmuir, head of the Epidemiology Branch, redefined surveillance as the epidemiology-based critical factor in infectious disease control. I joined Langmuir as assistant chief in 1955 and was appointed chief of the Surveillance Section in 1961. In this paper, I describe Langmuir's redefinition of surveillance. Langmuir asserted that its proper use in public health meant the systematic reporting of infectious diseases, the analysis and epidemiologic interpretation of data, and both prompt and widespread dissemination of results. I outline the Communicable Disease Center's first surveillance systems for malaria, poliomyelitis, and influenza. I also discuss the role of surveillance in the global smallpox eradication program, emphasizing that the establishment of systematic reporting systems and prompt action based on results were critical factors of the program.

Posicionamiento del Comité Español Interdisciplinario de Prevención Cardiovascular y la Sociedad Española de Cardiología en el tratamiento de las dislipemias: divergencia entre las guías europea y estadounidense / Spanish Interdisciplinary Committee for Cardiovascular Disease Prevention and the Spanish Society of Cardiology Position Statement on Dyslipidemia Management. Differences Between the European and American Guidelines

La publicación en EE. UU. de la guía de 2013 de American College of Cardiology/American Heart Association para el tratamiento del colesterol elevado ha tenido gran impacto por el cambio de paradigma que supone. El Comité Español Interdisciplinario de Prevención Cardiovascular y la Sociedad Española de Cardiología han revisado esa guía, en comparación con la vigente guía europea de prevención cardiovascular y de dislipemias. El aspecto más destacable de la guía estadounidense es el abandono de los objetivos de colesterol unido a lipoproteínas de baja densidad, de modo que proponen el tratamiento con estatinas en cuatro grupos de riesgo aumentado. En pacientes con enfermedad cardiovascular establecida, ambas guías conducen a una estrategia terapéutica similar (estatinas potentes, dosis altas). Sin embargo, en prevención primaria, la aplicación de la guía estadounidense supondría tratar con estatinas a un número de personas excesivo, particularmente de edades avanzadas. Abandonar la estrategia según objetivos de colesterol, fuertemente arraigada en la comunidad científica, podría tener un impacto negativo en la práctica clínica y crear cierta confusión e inseguridad entre los profesionales y quizá menos seguimiento y adherencia de los pacientes. Por todo ello, el presente documento reafirma las recomendaciones de la guía europea. Ambas guías tienen aspectos positivos pero, en general y mientras no se resuelvan las dudas planteadas, la guía europea, además de utilizar tablas basadas en la población autóctona, ofrece mensajes más apropiados para el entorno español y previene del posible riesgo de sobretratamiento con estatinas en prevención primaria (AU)

The publication of the 2013 American College of Cardiology/American Heart Association guidelines on the treatment of high blood cholesterol has had a strong impact due to the paradigm shift in its recommendations. The Spanish Interdisciplinary Committee for Cardiovascular Disease Prevention and the Spanish Society of Cardiology reviewed this guideline and compared it with current European guidelines on cardiovascular prevention and dyslipidemia management. The most striking aspect of the American guideline is the elimination of the low-density lipoprotein cholesterol treat-to-target strategy and the adoption of a risk reduction strategy in 4 major statin benefit groups. In patients with established cardiovascular disease, both guidelines recommend a similar therapeutic strategy (high-dose potent statins). However, in primary prevention, the application of the American guidelines would substantially increase the number of persons, particularly older people, receiving statin therapy. The elimination of the cholesterol treat-to-target strategy, so strongly rooted in the scientific community, could have a negative impact on clinical practice, create a certain amount of confusion and uncertainty among professionals, and decrease follow-up and patient adherence. Thus, this article reaffirms the recommendations of the European guidelines. Although both guidelines have positive aspects, doubt remains regarding the concerns outlined above. In addition to using risk charts based on the native population, the messages of the European guideline are more appropriate to the Spanish setting and avoid the possible risk of overtreatment with statins in primary prevention (AU)

Syphilis and human experimentation from World War II to the present: a historical perspective and reflections on ethics.

Even after the Nuremberg code was published, research on syphilis often continued to fall far short of ethical standards. We review post-World War II research on this disease, focusing on the work carried out in Guatemala and Tuskegee. Over a thousand adults were deliberately inoculated with infectious material for syphilis, chancroid, and gonorrhea between 1946 and 1948 in Guatemala, and thousands of serologies were performed in individuals belonging to indigenous populations or sheltered in orphanages. The Tuskegee syphilis study, conducted by the US Public Health Service, took place between 1932 and 1972 with the aim of following the natural history of the disease when left untreated. The subjects belonged to a rural black population and the study was not halted when effective treatment for syphilis became available in 1945.

History of Injury and Violence as public health problems and emergence of the National Center for Injury Prevention and Control at CDC.

Injuries and violence are among the oldest health problems facing humans. Only within the past 50 years, however, has the problem been addressed with scientific rigor using public health methods. The field of injury control began as early as 1913, but wasn't approached systematically or epidemiologically until the 1940s and 1950s. It accelerated rapidly between 1960 and 1985. Coupled with active federal and state interest in reducing injuries and violence, this period was marked by important medical, scientific, and public health advances. The National Center for Injury Prevention and Control (NCIPC) was an outgrowth of this progress and in 2012 celebrated its 20th anniversary. NCIPC was created in 1992 after a series of government reports identified injury as one of the most important public health problems facing the nation. Congressional action provided the impetus for the creation of NCIPC as the lead federal agency for non-occupational injury and violence prevention. In subsequent years, NCIPC and its partners fostered many advances and built strong capacity. Because of the tragically high burden and cost of injuries and violence in the United States and around the globe, researchers, practitioners, and decision makers will need to redouble prevention efforts in the next 20 years. This article traces the history of injury and violence prevention as a public health priority-- including the evolution and current structure of the CDC's National Center for Injury Prevention and Control.

Afterword.

In 1949, Alexander Langmuir became the first chief epidemiologist at the Communicable Disease Center (CDC) in Atlanta, Georgia. Among his many contributions to the agency and to public health, 2 of the most important--the Epidemic Intelligence Service (EIS) and his particular brand of epidemic-assistance investigation (the Epi-Aid)--are highlighted in this supplement to the American Journal of Epidemiology. What makes these and many other of Langmuir's innovations so remarkable is their continued relevance to the health challenges we face in this new century. CDC (now the Centers for Disease Control and Prevention) is recognized globally for its quality science, not only in epidemiology and laboratory practice but also in the behavioral and social sciences, statistics, and economics. Support to state and local health departments has been instrumental to CDC's success during its first 60 years, and the articles describing Epi-Aids in this supplement capture this partnership elegantly. They also reflect the evolution of CDC from an agency focused almost entirely on communicable diseases to one engaged in a broad array of global public health challenges.

Vaccine-preventable diseases, immunizations, and the Epidemic Intelligence Service.

During 1946-2005, vaccine-preventable diseases were the topic of approximately 20% of all epidemic-assistance investigations by the Centers for Disease Control and Prevention. Both in the United States and abroad, current and former Epidemic Intelligence Service officers have played a critical role in describing the epidemiology of vaccine-preventable diseases, contributing to development of immunization policies, participating in the implementation of immunization programs, and establishing effective means for assessing adverse events following immunization. As newer vaccines are developed and introduced, they will continue to play similar roles and most likely will be involved increasingly in investigations of the factors that affect people's willingness to accept vaccination for themselves or their children.