Excess mortality in Guadeloupe and Martinique, islands of the French West Indies, during the chikungunya epidemic of 2014.

In some chikungunya epidemics, deaths are not completely captured by traditional surveillance systems, which record case and death reports. We evaluated excess deaths associated with the 2014 chikungunya virus (CHIKV) epidemic in Guadeloupe and Martinique, Antilles. Population (784 097 inhabitants) and mortality data, estimated by sex and age, were accessed from the Institut National de la Statistique et des Études Économiques in France. Epidemiological data, cases, hospitalisations and deaths on CHIKV were obtained from the official epidemiological reports of the Cellule de Institut de Veille Sanitaire in France. Excess deaths were calculated as the difference between the expected and observed deaths for all age groups for each month in 2014 and 2015, considering the upper limit of 99% confidence interval. The Pearson correlation coefficient showed a strong correlation between monthly excess deaths and reported cases of chikungunya (R = 0.81, p < 0.005) and with a 1-month lag (R = 0.87, p < 0.001); and a strong correlation was also observed between monthly rates of hospitalisation for CHIKV and excess deaths with a delay of 1 month (R = 0.87, p < 0.0005). The peak of the epidemic occurred in the month with the highest mortality, returning to normal soon after the end of the CHIKV epidemic. There were excess deaths in almost all age groups, and excess mortality rate was higher among the elderly but was similar between male and female individuals. The overall mortality estimated in the current study (639 deaths) was about four times greater than that obtained through death declarations (160 deaths). Although the aetiological diagnosis of all deaths associated with CHIKV infection is not always possible, already well-known statistical tools can contribute to the evaluation of the impact of CHIKV on mortality and morbidity in the different age groups.

[A survey of knowledge and attitudes in a population about dengue transmission--region of Campinas São Paulo, Brazil--1998]. / Inquérito sobre conhecimentos e atitudes da população sobre a transmissão do dengue--região de Campinas São Paulo, Brasil--1998.

A survey with 502 interviews was realized in the region of Campinas (S.P.) to evaluate the community's knowledge and concepts regarding dengue: disease, vector and prevention. This information was then compared with the actual behavior towards prevention and the presence of breeding sites. Three neighborhoods of Santa Barbara D'Oeste (170,000 inhabitants) were chosen because they were located in the first municipality with autochthonous transmission, since 1995. Areas with better social and urban conditions scored higher in terms of knowledge compared with peripheral neighborhoods, even though these regions had priority in the local education program, due to case notification. However, breeding sites were found equally in both regions. A major gap between knowledge and attitude was detected in all regions. The results of the survey can help the organization of education programs to find ways to put this knowledge into practice. This instrument is useful to monitor the impact of dengue control programs.

[Male homicide in the Metropolitan Region of São Paulo between 1979 and 1998: a pictorial approach]. / Homicídios masculinos na Região Metropolitana de São Paulo entre 1979 e 1998: uma abordagem pictórica.

Homicide has become a major social problem in Brazil in the last two decades. In Greater Metropolitan São Paulo, Southeast Brazil, the proportional incidence of male homicides increased from 35 to 121 (x 10-5) from 1979 to 1998. This study presents the trend in this phenomenon using a set of three-dimensional figures. We show both the absolute number and proportional incidence of male deaths by homicide and the natural logarithm of the male/female relative risk of homicide for Greater Metropolitan São Paulo from 1979 to 1998. Seven 3D figures show the homicide trend by age, sex, and year. The figures show the main trends in homicide distribution in the male population during the study period: a clear predominance among adolescents and young adults, a systematic and sharp increase in that same age range, a systematic spread to the lower (below-18) and higher (above-30) age groups, and a non-negligible incidence above the age of 40.

Inquérito sobre conhecimentos e atitudes da população sobre a transmissão do dengue - região de Campinas São Paulo, Brasil - 1998 / A survey of knowledge and attitudes in a population about dengue transmission - region of Campinas São Paulo, Brazil - 1998

A survey with 502 interviews was realized in the region of Campinas (S.P.) to evaluate the community's knowledge and concepts regarding dengue: disease, vector and prevention. This information was then compared with the actual behavior towards prevention and the presence of breeding sites. Three neighborhoods of Santa Barbara D'Oeste (170,000 inhabitants) were chosen because they were located in the first municipality with autochthonous transmission, since 1995. Areas with better social and urban conditions scored higher in terms of knowledge compared with peripheral neighborhoods, even though these regions had priority in the local education program, due to case notification. However, breeding sites were found equally in both regions. A major gap between knowledge and attitude was detected in all regions. The results of the survey can help the organization of education programs to find ways to put this knowledge into practice. This instrument is useful to monitor the impact of dengue control programs.

Trata-se de um inquérito amostral (502 entrevistas) realizado na região de Campinas SP, em Santa Bárbara D'Oeste (170.000 habitantes), por ser o primeiro município a registrar casos de dengue autóctone na região, desde 1995. Avaliou-se o conhecimento da população sobre o dengue, seu vetor e prevenção em 3 bairros da cidade. Estas informações foram comparadas com a presença de criadouros no ambiente domiciliar, em áreas com e sem transmissão. O bairro com melhores condições sociais e urbanas apresentaram conhecimento mais adequado sobre a doença, embora os bairros periféricos tenham sido priorizados em atividades educativas devido à ocorrência de casos. Observou-se criadouros em todas as áreas examinadas, em quantidades semelhantes. Constatou-se a distância entre conhecimento e mudanças de comportamento. Identificou-se as fontes de informações mais referidas e os criadouros predominantes nos domicílios. Os resultados deste inquérito podem servir como subsídios para (re)orientar ações educativas das equipes de controle de vetores, bem como avaliar um instrumento simplificado para acompanhamento do impacto do programa local de controle do dengue.

[Fatality rate in the epidemiology of meningococcal disease: study in the region of Campinas, SP, Brazil, 1993 to 1998]. / Letalidade na epidemiologia da doença meningocócica: estudo na região de Campinas, SP, 1993 a 1998.

OBJECTIVE: To analyze the trends of the meningococcal disease cumulative incidence and case-fatality rate in the region of Campinas, Brazil, an area that encircles five cities and 1.2 million inhabitants, from 1993 to 1998. METHODS: A longitudinal retrospective study of all case records (375) obtained from the regional epidemiological surveillance system was carried out. A logistic regression analysis allowed identifying the risk factors related to fatal outcomes of meningococcal disease. RESULTS: The highest fatality rates (23.8%) were seen in the period of 1996 and 1997, coinciding with the incidence peaks of serogroup B Neisseria and a high percentage of septicemia cases. Also at the same period there was registered a poor etiological investigation of the cases. A seasonal pattern and the predomination of strains B:4:P1.15 and C:2b:P1.3 were observed. In the logistic regression analysis, the risk factors related to fatality were: septicemia with or without meningitis (adjusted odds ratio [OR(aj)] = 13.88 and 95% confidence interval [CI] = 4.68 - 42.13); age over 30 years (OR(aj) = 6.42; CI = 2.32 - 17.80); age under 1 year (OR(aj) = 2.95; CI = 1.55 - 5.63); and serogroup B (OR(aj) = 2.33; CI = 1.14 - 4.79). CONCLUSIONS: Septicemia, age and serogroup were predictive variables related to a fatal outcome. In 1996 and 1997, case-fatality rates were high, indicating the need to further assessment of the quality of the services delivered and their readiness to take preventive action. The lack of etiological identification in many cases precluded more accurate inferences about the epidemiological behavior of Neisseria meningitidis in the region.