Enabling countries to manage outbreaks: statistical, operational, and contextual analysis of the early warning and response system (EWARS-csd) for dengue outbreaks.

Introduction: Dengue is currently the fastest-spreading mosquito-borne viral illness in the world, with over half of the world's population living in areas at risk of dengue. As dengue continues to spread and become more of a health burden, it is essential to have tools that can predict when and where outbreaks might occur to better prepare vector control operations and communities' responses. One such predictive tool, the Early Warning and Response System for climate-sensitive diseases (EWARS-csd), primarily uses climatic data to alert health systems of outbreaks weeks before they occur. EWARS-csd uses the robust Distribution Lag Non-linear Model in combination with the INLA Bayesian regression framework to predict outbreaks, utilizing historical data. This study seeks to validate the tool's performance in two states of Colombia, evaluating how well the tool performed in 11 municipalities of varying dengue endemicity levels. Methods: The validation study used retrospective data with alarm indicators (mean temperature and rain sum) and an outbreak indicator (weekly hospitalizations) from 11 municipalities spanning two states in Colombia from 2015 to 2020. Calibrations of different variables were performed to find the optimal sensitivity and positive predictive value for each municipality. Results: The study demonstrated that the tool produced overall reliable early outbreak alarms. The median of the most optimal calibration for each municipality was very high: sensitivity (97%), specificity (94%), positive predictive value (75%), and negative predictive value (99%; 95% CI). Discussion: The tool worked well across all population sizes and all endemicity levels but had slightly poorer results in the highly endemic municipality at predicting non-outbreak weeks. Migration and/or socioeconomic status are factors that might impact predictive performance and should be further evaluated. Overall EWARS-csd performed very well, providing evidence that it should continue to be implemented in Colombia and other countries for outbreak prediction.

[Maintaining measles elimination status in Colombia during outbreak control, 2019Manutenção do status de eliminação do sarampo na Colômbia durante o controle de surtos, 2019]. / Mantenimiento del estatus de eliminación del sarampión en Colombia durante el control de brotes, 2019.

Objective: Describe measles outbreaks caused by importation of multiple cases, and the corresponding control interventions. Methods: Descriptive study of measles outbreaks caused by the importation of multiple cases to Colombia in 2018-2019. Case definitions, classification of source of infection, collection of biological specimens, searches for suspected cases, case identification, and contact tracing were employed. Vaccination records were obtained from vaccination cards or from the Colombian information system. Nationality was determined from records found in the public health surveillance system. The incident command system was used, and response teams and action plans were activated to control outbreaks. Results: In March 2018, the first case of measles imported from Venezuela was confirmed. Measles incidence in 2018 was 0.2 cases per 100 000 population, and it was 0.3 per 100 000 in 2019. The case fatality rate in 2019 was 0.4%. A total of 214 cases were confirmed in the Venezuelan population (91% with no vaccination history); and 69 outbreaks with no epidemiological link were studied. The MVi/Hulu Langat.MYS/26.11[D8] lineage was identified. Endemic circulation was prevented through innovative interventions such as infection surveillance and control, immediate notification, prioritization of field visits, and transmission risk level criteria. Conclusions: Colombia controlled measles outbreaks that resulted from imported cases, and it prevented endemic circulation, thereby maintaining certification of measles elimination in the country.

Objetivo: Descrever os surtos de sarampo gerados por múltiplas importações de casos e as intervenções de controle. Métodos: Estudo descritivo de surtos devido a múltiplas importações de casos para a Colômbia entre 2018 e 2019. Foram utilizadas definições de caso, classificação da fonte de infecção, coleta de amostras biológicas, rastreamento de casos suspeitos, identificação e seguimento de contatos. O histórico de vacinação foi obtido do cartão de vacinação ou do sistema de informações da Colômbia. A nacionalidade foi definida de acordo com o registro no sistema de vigilância em saúde pública. O sistema de comando de incidentes foi usado, com equipes de resposta e planos de ação para controlar os surtos. Resultados: O primeiro caso de sarampo importado da Venezuela foi confirmado em março de 2018. Nesse ano, a incidência foi de 0,2 casos por 100 mil habitantes e, em 2019, de 0,3 casos por 100 mil habitantes. A taxa de letalidade em 2019 foi de 0,4%. Um total de 214 casos foi confirmado na população venezuelana (91% sem histórico de vacinação). Foram estudados 69 surtos sem vínculo epidemiológico. Foi identificado o genótipo D8, cepa MVi/Hulu Langat.MYS/26.11. A circulação endêmica foi evitada por meio de intervenções inovadoras, como vigilância e controle de infecções, notificação "superimediata", priorização de visitas de campo e critérios para níveis de risco de transmissão. Conclusões: A Colômbia controlou os surtos de sarampo decorrentes de casos importados e impediu a circulação endêmica a fim de manter a certificação da eliminação do vírus do sarampo no país.

Mantenimiento del estatus de eliminación del sarampión en Colombia durante el control de brotes, 2019 / Maintaining measles elimination status in Colombia during outbreak control, 2019 / Manutenção do status de eliminação do sarampo na Colômbia durante o controle de surtos, 2019

[RESUMEN]. Objetivo. Describir los brotes de sarampión generados por la múltiple importación de casos y las intervenciones de control. Métodos. Estudio descriptivo de brotes por múltiple importación de casos a Colombia entre 2018-2019. Se utilizaron las definiciones de caso, clasificación de fuente de infección, recolección de muestras biológicas, rastreo de casos sospechosos, identificación y seguimiento de contactos. El antecedente vacunal se obtuvo del carné o del sistema de información de Colombia. La nacionalidad se definió de acuerdo con el registro en el sistema de vigilancia en salud pública. Se empleó el sistema de comando de incidente con equipos de respuesta y planes de acción para controlar los brotes. Resultados. En marzo de 2018 se confirmó el primer caso de sarampión importado de Venezuela. La incidencia en 2018 fue 0,2 casos por 100 000 habitantes y en 2019 fue 0,3. La letalidad en 2019 fue de 0,4%. Se confirmaron 214 casos en población venezolana (91% sin antecedente vacunal). Se estudiaron 69 brotes sin vínculo epidemiológico. Se identificó el genotipo D8 linaje MVi/Hulu Langat.MYS/26.11. Se evitó la circulación endémica a través de intervenciones innovadoras tales como, la vigilancia y control de infecciones, notificación super inmediata, priorización de visitas de campo y criterios de niveles de riesgo de transmisión. Conclusiones. Colombia controló los brotes de sarampión que se presentaron por la importación de casos e impido la circulación endémica para conservar la certificación de la eliminación del virus de sarampión en el país.

[ABSTRACT]. Objective. Describe measles outbreaks caused by importation of multiple cases, and the corresponding con- trol interventions. Methods. Descriptive study of measles outbreaks caused by the importation of multiple cases to Colombia in 2018–2019. Case definitions, classification of source of infection, collection of biological specimens, sear- ches for suspected cases, case identification, and contact tracing were employed. Vaccination records were obtained from vaccination cards or from the Colombian information system. Nationality was determined from records found in the public health surveillance system. The incident command system was used, and response teams and action plans were activated to control outbreaks. Results. In March 2018, the first case of measles imported from Venezuela was confirmed. Measles incidence in 2018 was 0.2 cases per 100 000 population, and it was 0.3 per 100 000 in 2019. The case fatality rate in 2019 was 0.4%. A total of 214 cases were confirmed in the Venezuelan population (91% with no vaccination history); and 69 outbreaks with no epidemiological link were studied. The MVi/Hulu Langat.MYS/26.11[D8] lineage was identified. Endemic circulation was prevented through innovative interventions such as infection surveillance and control, immediate notification, prioritization of field visits, and transmission risk level criteria. Conclusions. Colombia controlled measles outbreaks that resulted from imported cases, and it prevented endemic circulation, thereby maintaining certification of measles elimination in the country.

[RESUMO]. Objetivo. Descrever os surtos de sarampo gerados por múltiplas importações de casos e as intervenções de controle. Métodos. Estudo descritivo de surtos devido a múltiplas importações de casos para a Colômbia entre 2018 e 2019. Foram utilizadas definições de caso, classificação da fonte de infecção, coleta de amostras biológicas, rastreamento de casos suspeitos, identificação e seguimento de contatos. O histórico de vacinação foi obtido do cartão de vacinação ou do sistema de informações da Colômbia. A nacionalidade foi definida de acordo com o registro no sistema de vigilância em saúde pública. O sistema de comando de incidentes foi usado, com equipes de resposta e planos de ação para controlar os surtos. Resultados. O primeiro caso de sarampo importado da Venezuela foi confirmado em março de 2018. Nesse ano, a incidência foi de 0,2 casos por 100 mil habitantes e, em 2019, de 0,3 casos por 100 mil habitantes. A taxa de letalidade em 2019 foi de 0,4%. Um total de 214 casos foi confirmado na população venezuelana (91% sem histórico de vacinação). Foram estudados 69 surtos sem vínculo epidemiológico. Foi identificado o genótipo D8, cepa MVi/Hulu Langat.MYS/26.11. A circulação endêmica foi evitada por meio de intervenções inovadoras, como vigilância e controle de infecções, notificação “superimediata”, priorização de visitas de campo e critérios para níveis de risco de transmissão. Conclusões. A Colômbia controlou os surtos de sarampo decorrentes de casos importados e impediu a circulação endêmica a fim de manter a certificação da eliminação do vírus do sarampo no país.

Mantenimiento del estatus de eliminación del sarampión en Colombia durante el control de brotes, 2019 / Maintaining measles elimination status in Colombia during outbreak control, 2019 / Manutenção do status de eliminação do sarampo na Colômbia durante o controle de surtos, 2019

RESUMEN Objetivo. Describir los brotes de sarampión generados por la múltiple importación de casos y las intervenciones de control. Métodos. Estudio descriptivo de brotes por múltiple importación de casos a Colombia entre 2018-2019. Se utilizaron las definiciones de caso, clasificación de fuente de infección, recolección de muestras biológicas, rastreo de casos sospechosos, identificación y seguimiento de contactos. El antecedente vacunal se obtuvo del carné o del sistema de información de Colombia. La nacionalidad se definió de acuerdo con el registro en el sistema de vigilancia en salud pública. Se empleó el sistema de comando de incidente con equipos de respuesta y planes de acción para controlar los brotes. Resultados. En marzo de 2018 se confirmó el primer caso de sarampión importado de Venezuela. La incidencia en 2018 fue 0,2 casos por 100 000 habitantes y en 2019 fue 0,3. La letalidad en 2019 fue de 0,4%. Se confirmaron 214 casos en población venezolana (91% sin antecedente vacunal). Se estudiaron 69 brotes sin vínculo epidemiológico. Se identificó el genotipo D8 linaje MVi/Hulu Langat.MYS/26.11. Se evitó la circulación endémica a través de intervenciones innovadoras tales como, la vigilancia y control de infecciones, notificación super inmediata, priorización de visitas de campo y criterios de niveles de riesgo de transmisión. Conclusiones. Colombia controló los brotes de sarampión que se presentaron por la importación de casos e impido la circulación endémica para conservar la certificación de la eliminación del virus de sarampión en el país.

ABSTRACT Objective. Describe measles outbreaks caused by importation of multiple cases, and the corresponding control interventions. Methods. Descriptive study of measles outbreaks caused by the importation of multiple cases to Colombia in 2018-2019. Case definitions, classification of source of infection, collection of biological specimens, searches for suspected cases, case identification, and contact tracing were employed. Vaccination records were obtained from vaccination cards or from the Colombian information system. Nationality was determined from records found in the public health surveillance system. The incident command system was used, and response teams and action plans were activated to control outbreaks. Results. In March 2018, the first case of measles imported from Venezuela was confirmed. Measles incidence in 2018 was 0.2 cases per 100 000 population, and it was 0.3 per 100 000 in 2019. The case fatality rate in 2019 was 0.4%. A total of 214 cases were confirmed in the Venezuelan population (91% with no vaccination history); and 69 outbreaks with no epidemiological link were studied. The MVi/Hulu Langat.MYS/26.11[D8] lineage was identified. Endemic circulation was prevented through innovative interventions such as infection surveillance and control, immediate notification, prioritization of field visits, and transmission risk level criteria. Conclusions. Colombia controlled measles outbreaks that resulted from imported cases, and it prevented endemic circulation, thereby maintaining certification of measles elimination in the country.

RESUMO Objetivo. Descrever os surtos de sarampo gerados por múltiplas importações de casos e as intervenções de controle. Métodos. Estudo descritivo de surtos devido a múltiplas importações de casos para a Colômbia entre 2018 e 2019. Foram utilizadas definições de caso, classificação da fonte de infecção, coleta de amostras biológicas, rastreamento de casos suspeitos, identificação e seguimento de contatos. O histórico de vacinação foi obtido do cartão de vacinação ou do sistema de informações da Colômbia. A nacionalidade foi definida de acordo com o registro no sistema de vigilância em saúde pública. O sistema de comando de incidentes foi usado, com equipes de resposta e planos de ação para controlar os surtos. Resultados. O primeiro caso de sarampo importado da Venezuela foi confirmado em março de 2018. Nesse ano, a incidência foi de 0,2 casos por 100 mil habitantes e, em 2019, de 0,3 casos por 100 mil habitantes. A taxa de letalidade em 2019 foi de 0,4%. Um total de 214 casos foi confirmado na população venezuelana (91% sem histórico de vacinação). Foram estudados 69 surtos sem vínculo epidemiológico. Foi identificado o genótipo D8, cepa MVi/Hulu Langat.MYS/26.11. A circulação endêmica foi evitada por meio de intervenções inovadoras, como vigilância e controle de infecções, notificação "superimediata", priorização de visitas de campo e critérios para níveis de risco de transmissão. Conclusões. A Colômbia controlou os surtos de sarampo decorrentes de casos importados e impediu a circulação endêmica a fim de manter a certificação da eliminação do vírus do sarampo no país.

Qualitative evaluation of enabling factors and barriers to the success and sustainability of national public health institutes in Cambodia, Colombia, Liberia, Mozambique, Nigeria, Rwanda and Zambia.

OBJECTIVES: The success of National Public Health Institutes (NPHIs) in low-income and middle-income countries (LMICs) is critical to countries' ability to deliver public health services to their populations and effectively respond to public health emergencies. However, empirical data are limited on factors that promote or are barriers to the sustainability of NPHIs. This evaluation explored stakeholders' perceptions about enabling factors and barriers to the success and sustainability of NPHIs in seven countries where the U.S. Centers for Disease Control and Prevention (CDC) has supported NPHI development and strengthening. DESIGN: Qualitative study. SETTING: Cambodia, Colombia, Liberia, Mozambique, Nigeria, Rwanda and Zambia. PARTICIPANTS: NPHI staff, non-NPHI government staff, and non-governmental and international organisation staff. METHODS: We conducted semistructured, in-person interviews at a location chosen by the participants in the seven countries. We analysed data using a directed content analysis approach. RESULTS: We interviewed 43 NPHI staff, 29 non-NPHI government staff and 24 staff from non-governmental and international organisations. Participants identified five enabling factors critical to the success and sustainability of NPHIs: (1) strong leadership, (2) financial autonomy, (3) political commitment and country ownership, (4) strengthening capacity of NPHI staff and (5) forming strategic partnerships. Three themes emerged related to major barriers or threats to the sustainability of NPHIs: (1) reliance on partner funding to maintain key activities, (2) changes in NPHI leadership and (3) staff attrition and turnover. CONCLUSIONS: Our findings contribute to the scant literature on sustainability of NPHIs in LMICs by identifying essential components of sustainability and types of support needed from various stakeholders. Integrating these components into each step of NPHI development and ensuring sufficient support will be critical to strengthening public health systems and safeguarding their continuity. Our findings offer potential approaches for country leadership to direct efforts to strengthen and sustain NPHIs.

Determinación de sodio urinario como marcador bioquímico para estimar la ingesta de sal en trabajadores del Ministerio de Salud Pública y Bienestar Social, Paraguay

RESUMEN En América Latina, 13% de todas las muertes y 5,1% de los años de vida ajustados por discapacidad se deben a la hipertensión. El exceso de sodio en la dieta puede incrementar aproximadamente un 30% el riesgo de hipertensión. El objetivo fue determinar la concentración de sodio en orina de 24 de horas para estimar la ingesta de sal en trabajadores del Ministerio de Salud Pública y Bienestar Social (MSPBS). Estudio transversal, en trabajadores de 25 a 64 años (n = 397) del MSPBS en Asunción-Paraguay en el 2014. La información sociodemográfica y económica, así como los factores de riesgo de enfermedades cardiovasculares, se evaluaron mediante un cuestionario validado y desarrollado por la OMS. Los niveles de sodio y potasio en orina de 24 horas se midieron usando un protocolo estandarizado. La mediana de la ingesta diaria de sal fue de 13,7 g. La mediana de la excreción de sodio en orina de 24 horas fue de 239 mEq, superando el valor de excreción de sodio recomendado en un 20%. Los hombres tuvieron una excreción de sodio en orina de 24 horas más alta que las mujeres tanto en el grupo de 25 a 44 años (251 mEq / 24 horas frente a 218 mEq/ 24 horas) como en el grupo de 45 a 64 años (266 mEq / 24 horas frente a 233 mEq / 24 horas) de los participantes del estudio. En conclusión, la ingesta de sal fue notablemente superior a la recomendada por la OMS (<5g/d).

ABSTRACT In Latin America, 13% of all deaths and 5.1% of disability-adjusted life years are due to hypertension. An excess of sodium in the diet may increase the risk of hypertension by 30%. The objective was to determine the 24-hour urine sodium concentration to estimate salt intake in employees of the Paraguayan Ministry of Public Health and Social Welfare (MSPBS). Cross-sectional study in 25-64 years-old employees (n=397) of the Ministry of Public Health and Social Welfare in Asuncion-Paraguay in 2014. Socio-demographic and -economic information as well as risk factors of cardiovascular diseases were assessed using a questionnaire validated and developed by the WHO. Sodium and potassium levels in the 24-hour urine were measured using a standardized protocol. The median salt intake per day was 13.7 g. The median of 24-hour urine sodium excretion was 239 mEq, exceeding the recommended sodium excretion value by 20%. Men had a higher 24-hour urine sodium excretion than women in both the 25-44 years-old group (251 mEq/24 hours vs. 218 mEq/24 hours) and the 45-64 years-old segment of the study participants (266 mEq/24 hours vs. 233 mEq/24 hours). In conclusion, salt intake was remarkably higher than recommended by WHO (<5g/d).

Neurodevelopmental findings in children 20-30 months of age with postnatal Zika infection at 1-12 months of age, Colombia, September-November 2017.

BACKGROUND: Zika virus (ZIKV) infection during pregnancy can cause infant brain and eye abnormalities and has been associated with adverse neurodevelopmental outcomes in exposed infants. Evidence is limited on ZIKV's effects on children infected postnatally within the first year of life. OBJECTIVE: To determine whether any adverse neurodevelopmental outcomes occurred in early childhood for children infected postnatally with ZIKV during infancy, given the neurotoxicity of ZIKV infection and the rapid brain development that occurs in infancy and early childhood. METHODS: The Colombia Instituto Nacional de Salud (INS) conducted health and developmental screenings between September and November 2017 to evaluate 60 children at ages 20-30 months who had laboratory-confirmed symptomatic postnatal ZIKV infection at ages 1-12 months. We examined the frequency of adverse neurologic, hearing, eye, and developmental outcomes as well as the relationship between age at Zika symptom onset and developmental outcomes. RESULTS: Nine of the 60 (15.0%) children had adverse outcomes on the neurologic, hearing, or eye examination. Six of the 47 (12.8%) children without these adverse findings, and who received a valid developmental screening, had an alert score in the hearing-language domain which signals the need for additional developmental evaluation. CONCLUSION: Neurologic, hearing, eye, and developmental findings suggest reassuring results. Since the full spectrum of neurodevelopmental outcomes in children postnatally infected with ZIKV remains unknown, routine paediatric care is advised to monitor the development of these children to ensure early identification of any adverse neurodevelopmental outcomes.

Performance of the Colombian surveillance system during the COVID-19 pandemic: A rapid evaluation of the first 50 days / [Desempeño del sistema de vigilancia colombiano durante la pandemia de COVID-19: evaluación rápida de los primeros 50 días].

Introduction: The COVID pandemic is a challenge for public health surveillance and an opportunity to assess its strengths and weaknesses to improve the response. Objective: To evaluate the performance of the Colombian public health surveillance system during the first 50 days of the COVID-19 pandemic in the country. Materials and methods: We analyzed the data published between March 6 and April 24, 2020, by the Instituto Nacional de Salud and the World Health Organization (WHO). We evaluated: i) the quality of the data according to the fulfillment of Benford's law, and ii) the timeliness of the information measured as the difference in dates between the data generated by the Instituto Nacional de Salud and WHO's situational reports. We assessed the fulfillment of Benford's law using the p values of the log-likelihood ratio, the chi square or Moreno's exact tests. Results: Until April 24 there were 4,881 cases of COVID-19 in Colombia. During most of the first 50 days of the pandemic, Benford's law was fulfilled except the first days of the epidemic. The difference between Instituto Nacional de Salud and WHO reports largely depends on the different reporting times. Conclusion: In general, the Colombian public health surveillance system fulfilled Benford's law suggesting that there was quality in the data. Future studies comparing the performance of the departments and districts will improve the diagnosis of the Colombian surveillance system.

Introducción. La pandemia de COVID es un desafío para la vigilancia en salud pública y una oportunidad para evaluar sus fortalezas y debilidades en aras de mejorar la respuesta. Objetivo. Evaluar el desempeño del sistema de vigilancia en salud pública colombiano durante los primeros 50 días de la pandemia de COVID-19 en el país. Materiales y métodos. Se analizaron los datos publicados entre el 6 de marzo y el 24 de abril de 2020 por el Instituto Nacional de Salud y la Organización Mundial de Salud (OMS). Se consideraron en la evaluación: i) la calidad de los datos según la ley de Benford y ii) la oportunidad de la información, medida como la diferencia en fechas entre los datos generados en el Instituto Nacional de Salud y los recogidos en el informe situacional de la OMS. La variabilidad en el cumplimiento de la ley de Benford se evaluó con los valores de p en las pruebas de razón del logaritmo de la verosimilitud, ji al cuadrado o exacta de Moreno. Resultados. Hasta el 24 de abril hubo 4.881 casos de COVID-19 en Colombia. En la mayoría de los primeros 50 días se cumplió la ley de Benford, excepto en los primeros días de la epidemia. La diferencia entre los informes del Instituto Nacional de Salud y la OMS ha dependido, en gran medida, de la diferencia en los horarios de cierre de la información. Conclusión. En general, el sistema de vigilancia en salud pública colombiano cumplió con la ley de Benford, lo cual sugiere que hubo calidad en los datos. En futuros estudios que comparen el desempeño de los departamentos y distritos se podrá mejorar el diagnóstico de la vigilancia en salud pública del país.

Benchmarking of public health surveillance of COVID-19 in Colombia: First semester / [Evaluación comparativa de la vigilancia en salud pública de COVID-19 en Colombia: primer semestre].

Introduction: Public health surveillance together with good sanitary decisions is essential for the proper management of the SARS-CoV-2 pandemic. Objective: To compare the performance of Colombian departments based on the quality of the data and to build the national ranking. Materials and methods: We analyzed the accumulated cases published between March 6 and September 1, 2020, by the Instituto Nacional de Salud. To achieve comparability, the analyses considered the day the first case was diagnosed as the first analysis date for each department. The fulfillment of Benford's law was assessed with p-values in the log-likelihood ratio or chi-square tests. The analysis was completed with the lethality observed in each department and then the performance ranking was established. Results: Bogotá and Valle del Cauca had optimal public health surveillance performance all along. The data suggest that Antioquia, Nariño, and Tolima had good containment and adequate public health surveillance after the economic opening beginning on June 1, 2020. Conclusion: We obtained the ranking of the departments regarding the quality of public health surveillance data. The best five departments can be case studies to identify the elements associated with good performance.

Introducción. La vigilancia en salud pública y las decisiones sanitarias recomendadas son fundamentales para el manejo adecuado de la pandemia de SARS-CoV-2. Objetivo. Hacer una evaluación comparativa del desempeño de los departamentos colombianos de este atributo del sistema de vigilancia con base en la calidad de los datos y construir la clasificación nacional según el desempeño. Materiales y métodos. Se analizaron los casos acumulados publicados por el Instituto Nacional de Salud entre el 6 de marzo y el 1° de septiembre de 2020. Para la comparación, los análisis consideraron el día en que se diagnosticó el primer caso como la primera fecha de análisis de cada departamento. El cumplimiento de la ley de Benford se evaluó con los valores de p en las pruebas de razón del logaritmo de la verosimilitud o ji al cuadrado. Se completó el análisis del atributo de calidad del dato con la letalidad observada en cada departamento, y se estableció la clasificación según el desempeño. Resultados. La ciudad de Bogotá y el departamento del Valle del Cauca tuvieron un desempeño óptimo en la vigilancia en salud pública durante todo el periodo observado. Los datos sugieren que los departamentos de Antioquia, Nariño y Tolima tuvieron una buena contención y una adecuada vigilancia en salud pública después de la apertura económica iniciada el 1° de junio de 2020. Conclusión. Se obtuvo una clasificación de los departamentos y de Bogotá según la calidad de los datos de vigilancia en salud pública. Los mejores cinco entes territoriales pueden ser casos de estudio para determinar los elementos asociados con el buen desempeño.

Desempeño del sistema de vigilancia colombiano durante la pandemia de COVID-19: evaluación rápida de los primeros 50 días / Performance of the Colombian surveillance system during the COVID-19 pandemic: A rapid evaluation of the first 50 days

Introducción. La pandemia de COVID es un desafío para la vigilancia en salud pública y una oportunidad para evaluar sus fortalezas y debilidades en aras de mejorar la respuesta. Objetivo. Evaluar el desempeño del sistema de vigilancia en salud pública colombiano durante los primeros 50 días de la pandemia de COVID-19 en el país. Materiales y métodos. Se analizaron los datos publicados entre el 6 de marzo y el 24 de abril de 2020 por el Instituto Nacional de Salud y la Organización Mundial de Salud (OMS). Se consideraron en la evaluación: i) la calidad de los datos según la ley de Benford y ii) la oportunidad de la información, medida como la diferencia en fechas entre los datos generados en el Instituto Nacional de Salud y los recogidos en el informe situacional de la OMS. La variabilidad en el cumplimiento de la ley de Benford se evaluó con los valores de p en las pruebas de razón del logaritmo de la verosimilitud, ji al cuadrado o exacta de Moreno. Resultados. Hasta el 24 de abril hubo 4.881 casos de COVID-19 en Colombia. En la mayoría de los primeros 50 días se cumplió la ley de Benford, excepto en los primeros días de la epidemia. La diferencia entre los informes del Instituto Nacional de Salud y la OMS ha dependido, en gran medida, de la diferencia en los horarios de cierre de la información. Conclusión. En general, el sistema de vigilancia en salud pública colombiano cumplió con la ley de Benford, lo cual sugiere que hubo calidad en los datos. En futuros estudios que comparen el desempeño de los departamentos y distritos se podrá mejorar el diagnóstico de la vigilancia en salud pública del país.

Introduction: The COVID pandemic is a challenge for public health surveillance and an opportunity to assess its strengths and weaknesses to improve the response. Objective: To evaluate the performance of the Colombian public health surveillance system during the first 50 days of the COVID-19 pandemic in the country. Materials and methods: We analyzed the data published between March 6 and April 24, 2020, by the Instituto Nacional de Salud and the World Health Organization (WHO). We evaluated: i) the quality of the data according to the fulfillment of Benford's law, and ii) the timeliness of the information measured as the difference in dates between the data generated by the Instituto Nacional de Salud and WHO's situational reports. We assessed the fulfillment of Benford's law using the p values of the log-likelihood ratio, the chi square or Moreno's exact tests. Results: Until April 24 there were 4,881 cases of COVID-19 in Colombia. During most of the first 50 days of the pandemic, Benford's law was fulfilled except the first days of the epidemic. The difference between Instituto Nacional de Salud and WHO reports largely depends on the different reporting times. Conclusion: In general, the Colombian public health surveillance system fulfilled Benford's law suggesting that there was quality in the data. Future studies comparing the performance of the departments and districts will improve the diagnosis of the Colombian surveillance system.

Evaluación comparativa de la vigilancia en salud pública de COVID-19 en Colombia: primer semestre / Benchmarking of public health surveillance of COVID-19 in Colombia: First semester

Introducción. La vigilancia en salud pública y las decisiones sanitarias recomendadas son fundamentales para el manejo adecuado de la pandemia de SARS-CoV-2. Objetivo. Hacer una evaluación comparativa del desempeño de los departamentos colombianos de este atributo del sistema de vigilancia con base en la calidad de los datos y construir la clasificación nacional según el desempeño. Materiales y métodos. Se analizaron los casos acumulados publicados por el Instituto Nacional de Salud entre el 6 de marzo y el 1° de septiembre de 2020. Para la comparación, los análisis consideraron el día en que se diagnosticó el primer caso como la primera fecha de análisis de cada departamento. El cumplimiento de la ley de Benford se evaluó con los valores de p en las pruebas de razón del logaritmo de la verosimilitud o ji al cuadrado. Se completó el análisis del atributo de calidad del dato con la letalidad observada en cada departamento, y se estableció la clasificación según el desempeño. Resultados. La ciudad de Bogotá y el departamento del Valle del Cauca tuvieron un desempeño óptimo en la vigilancia en salud pública durante todo el periodo observado. Los datos sugieren que los departamentos de Antioquia, Nariño y Tolima tuvieron una buena contención y una adecuada vigilancia en salud pública después de la apertura económica iniciada el 1° de junio de 2020. Conclusión. Se obtuvo una clasificación de los departamentos y de Bogotá según la calidad de los datos de vigilancia en salud pública. Los mejores cinco entes territoriales pueden ser casos de estudio para determinar los elementos asociados con el buen desempeño.

Introduction: Public health surveillance together with good sanitary decisions is essential for the proper management of the SARS-CoV-2 pandemic. Objective: To compare the performance of Colombian departments based on the quality of the data and to build the national ranking. Materials and methods: We analyzed the accumulated cases published between March 6 and September 1, 2020, by the Instituto Nacional de Salud. To achieve comparability, the analyses considered the day the first case was diagnosed as the first analysis date for each department. The fulfillment of Benford's law was assessed with p-values in the log-likelihood ratio or chi-square tests. The analysis was completed with the lethality observed in each department and then the performance ranking was established. Results: Bogotá and Valle del Cauca had optimal public health surveillance performance all along. The data suggest that Antioquia, Nariño, and Tolima had good containment and adequate public health surveillance after the economic opening beginning on June 1, 2020. Conclusion: We obtained the ranking of the departments regarding the quality of public health surveillance data. The best five departments can be case studies to identify the elements associated with good performance.

Spatial distribution of the relative risk of Zika virus disease in Colombia during the 2015-2016 epidemic from a Bayesian approach.

OBJECTIVE: To determine the spatial distribution of the risk of Zika virus disease in each region of Colombia during the 2015-2016 epidemic. METHODS: An ecological study was designed to estimate the risks for each Colombian region using first-order neighbors, covariate effects, and three adjacent periods of time (beginning, development, and end of the epidemic) to analyze the spatial distribution of the disease based on a Bayesian hierarchical model. RESULTS: Spatial distribution of the estimated risks of Zika virus disease showed that it increased in a strip that crosses the central area of the country from west to east. Analysis of the three time periods showed greater risk of the disease in the central and southern zones-Arauca and Santander-where the increase in risk was four times higher during the peak phase compared with the initial phase of the outbreak. CONCLUSION: In the identified high-risk areas, integrated surveillance systems for Zika virus disease and its complications must be strengthened to provide up-to-date and accurate epidemiological information. This information would allow those involved in policy and decision making to identify new outbreaks and risk clusters, enabling more focused and accurate measures to target at-risk populations.

Concordancia y subregistro en la notificación de brotes de enfermedades transmitidas por alimentos en Colombia / Concordance and underreporting in the notification of foodborne disease outbreaks in Colombia

RESUMEN Objetivos Determinar la concordancia y el subregistro entre la notificación de brotes en registros individuales y colectivos de enfermedad transmitida por alimentos, notificados al sistema de vigilancia en salud pública durante 2013. Métodos Análisis retrospectivo a partir de la revisión y depuración de las bases de datos de enfermedades transmitidas por alimentos de registros individuales y colectivos notificados al sistema de vigilancia en salud pública; se determinó la concordancia entre brotes notificados en cada registro por entidad territorial. A través del método captura-recaptura se estableció el subregistro de brotes notificados, estimando la pre-valencia para cada registro. Resultados El 38,4% de los brotes de enfermedades transmitidas por alimentos se notificaron en ambos registros, el 11,3% en colectivo y el 50,3% en individual. Por medio del método de captura y recaptura, se estimaron 1 680 brotes (IC-95%; 1 632 - 1 730), se determinó que en registro individual se detecta el 77,5% y en colectivo el 43,3% de los brotes estimados, para un subregistro del 12,8% de brotes. Discusión Se estableció una baja concordancia entre ambos registros y un alto subregistro en registro colectivo al sistema nacional de vigilancia; lo que dificulta la detección de brotes y oportuna aplicación de medidas de mitigación y control.

ABSTRACT Objective To determine the concordance and underreporting of foodborne illness out-breaks comparing the notification of outbreaks in individual and collective registries, reported to Colombia's the national public health surveillance system in 2013. Methods A retrospective analysis based on the review and depuration of the foodborne illness databases of individual and collective records notified to the public health surveillance system; the concordance between reported outbreaks in each registry by territorial was determined and the sub-registry of notified outbreaks was established through the capture-recapture method, estimating the prevalence for each registry. Results 38.4% of outbreaks were reported in both registries, 11.3% were reported in outbreak registries and 50.3% were identified in individual case registries. Through the capture and recapture method, 1 680 outbreaks (IC 95%; 1 632 - 1 730) were estimated with 77.5% detected via individual case registry and 43.3% from the outbreak registry, resulting in underreporting of 12.8% of foodborne disease outbreaks. Discussion Low concordance between the registries was found which suggested high underreporting of outbreaks to the national surveillance system, this showcases the difficulty of outbreak detection in real-time and impacts timely mitigation and control measures.

Factores asociados a la nefropatía inducida por contraste en pacientes hospitalizados a quienes se les realizó tomografia axial computarizada / Factors associated with contrast-induced nephropathy in hospitalized patients who underwent computed tomography

Resumen Introducción: la nefropatía inducida por medio de contraste es la tercera causa de insuficiencia renal aguda en pacientes hospitalizados. En múltiples estudios se ha observado que un factor importante para su desarrollo es el uso de medio de contraste vía intra-arterial y en las angiografías en general. Nuestro objetivo es identificar los factores asociados a nefropatía inducida por contraste en pacientes hospitalizados, a quienes se les realizó tomografia axial computarizada con medio de contraste yodado en una institución de salud de alta complejidad de Neiva, Colombia, durante el 2016. Materiales y métodos: se desarrolló un estudio de casos y controles no pareado con 108 pacientes, 36 casos y 72 controles hospitalizados llevados a tomografia axial computarizada diagnóstica o terapéutica con medio de contraste radiológico yodado. Resultados: los factores asociados con nefropatía inducida por medio de contraste encontrados en los pacientes hospitalizados llevados a TAC contrastada fueron, el sexo (hombre) (OR=3,22; IC=95 % 1,33 - 7,76; p=0,009), y el servicio de procedencia (hospitalización en sala general) (OR=0,26; IC=95 % 0,07 - 1,00; p=0,051).

Abstract Introduction: Contrast-induced Nephropathy is the third most common cause of acute renal failure in patients. It has been observed in several studies that an important factor is the usage of a contrast given via IV and the angiograms. Our goal is to identify the factors associated to a Contrast-induced Nephropathy in patients who had a computarized axial tomography through an iodine contrast in a health institution of high complexity in Neiva, Colombia during 2016. Material and methods: A cased study and no-matched tests were applied in 108 patients (36 cases and 76 tests), who had a computarized axial dianostic or therapeutic tomography through an iodine radiological contrast. Results: The factors associated to contrast-induced Nephropathy, through a contrast dye, found in patients who had a CAT were the gender (male) (OR=3, 22; CI=95 % 1, 33 - 7,76; p=0,009) and the place where the procedure was made (hospitalization in general wards) (OR=0,26; CI=95 % 0,07 - 1,00; p=0,051).

Evaluación de la estructura del componente regular de los programas departamentales de hábitos y estilos de vida saludable, Colombia, 2014-2015 / Evaluation of the structure of the regular component of the departmental programs of habits and healthy lifestyles, Colombia, 2014-2015 / Avaliação da estrutura do componente regular dos programas de hábitos e estilos de vida departamentais, Colômbia, 2014

Resumen Los programas comunitarios de actividad física son una estrategia prometedora para combatir el sedentarismo. En Colombia existe el Programa Nacional de Hábitos y Estilos de Vida Saludable. Establecer la estructura en su propósito de evaluación general es fundamental para conocer su relevancia y coherencia. El objetivo del estudio fue evaluar la estructura y la variabilidad del componente regular de los programas departamentales de hábitos y estilos de vida saludable, Colombia 2014-2015. La investigación contó con un análisis documental, una valoración de los modelos lógicos y una entrevista semiestructurada. La racionalidad presentó diferencias en lo que se refiere al diagnóstico y se encontró consenso en el establecimiento de objetivos; estos responden a las necesidades y problemas de la población y son tratados a través de estrategias que varían muy poco. Las metas que sugieren los programas, en próximos desarrollos, deberán tener en cuenta las conductas y el contexto de los usuarios.

Abstract Community programs of physical training are a promising strategy to struggle against sedentariness. In Colombia, there is a National Program for Healthy Habits and Lifestyle. To ascentain the program structure from its general evaluation purpose becomes essential to know its relevance and coherence. This study aims to evaluate the structure and variability of the regular component of the Province Programs for Healthy Habits and Lifestyle, Colombia 2014-2015. This research consisted of a documentary analysis, an assessment of logical models, and a semi-structured interview. The logic processing of the data showed differences regarding the diagnosis and a consensus was found regarding the setting out of objectives, which are set in reply to the needs and problems of the population and are addressed through hardly variable strategies. The goals proposed in the programs, for future developments, should take into account the user's behavior and context.

Resumo Os programas comunitários de atividade física são uma estratégia promissória para combater o sedentarismo. Na Colombia existe o Programa Nacional de Hábitos e Estilos de Vida Saudável. Estabelecer a estrutura no seu propósito de avaliação geral é fundamental para conhecer sua relevância e coerência. O objetivo do estudo foi avaliar a estrutura e a variabilidade do componente regular dos programas departamentais de hábitos e estilos de vida saudável, Colômbia 2014-2015. A pesquisa incluiu uma análise documental, uma valoração dos modelos lógicos e uma entrevista semiestruturada. A racionalidade apresentou diferenças no que se refere ao diagnóstico e encontrou consenso no estabelecimento de objetivos; eles respondem às necessidades e problemas da população e são tratados através de estratégias que variam muito pouco. As metas sugeridas pelos programas, em próximos desenvolvimentos, deverão levar em conta os comportamentos e contexto dos usuários.

[Behavioral risk factors and readiness in amateur marathon runners 18-64 years of age in Bogotá, Colombia, 2014]. / Factores de riesgo del comportamiento y preparación de aficionados inscritos a carreras atléticas de fondo de 18 a 64 años en Bogotá, Colombia, 2014.

Participation in amateur street marathons has become increasingly popular and requires prior individual health risk assessment. The objective was to identify risk factors and readiness in registered runners. This was a cross-sectional study in a random sample (n = 510) of registered amateur runners 18-64 years of age, using a digital survey with IPAQ, Par-Q+, and STEPwise, with an expected physical inactivity rate of 35% (±5%). The study explored physical activity, (binge) alcohol consumption, fruit, vegetable, and salt intake, smoking, and readiness. Self-reported rates were: 97.4% recommended level of physical activity, 2.4% optimal fruit and vegetable intake, 3.7% smoking, and 44.1% binge drinking. 19.8% were Par-Q+ positive and 5.7% practiced supervised exercise. The analysis showed differences by age, sex, and socioeconomic status. Recreational runners followed the recommended levels of physical activity but did not score well on other risk factors. Prior evaluation of lifestyle-related risk factors and readiness provides a safer athletic strategy.

Factores de riesgo del comportamiento y preparación de aficionados inscritos a carreras atléticas de fondo de 18 a 64 años en Bogotá, Colombia, 2014 / Behavioral risk factors and readiness in amateur marathon runners 18-64 years of age in Bogotá, Colombia, 2014 / Fatores de risco comportamentais e prontidão em corredores amadores de 18 a 64 anos, inscritos em corridas de fundo em Bogotá, Colômbia, 2014

La participación en carreras atléticas de calle ha aumentado; esto requiere detectar riesgos previos al esfuerzo físico. El objetivo fue identificar factores de riesgo del comportamiento y preparación física de inscritos a una carrera. Estudio transversal en aficionados de 18-64 años. Encuesta digital con módulos de IPAQ, Par-Q+ y STEPwise. Muestreo aleatorio sistemático con n = 510, para una inactividad física esperada de 35% (±5%). Se evaluó nivel de actividad física, consumo de alcohol (peligroso), de fruta, verdura, tabaco y sal, y preparación. El cumplimiento de actividad física fue 97,4%; 2,4% consume un nivel óptimo de fruta o verdura (diferencias por edad, sexo y estrato), 3,7% fuma y 44,1% consumo peligroso de alcohol. El 19,8% reportó Par-Q+ positivo y 5,7% requiere supervisión. Hay diferencias por trabajo y estudio. Los aficionados cumplen el nivel de actividad física; pero no de otros factores. Una estrategia de seguridad en el atletismo de calle es evaluar los factores de riesgo relacionados con el estilo de vida, así como la preparación.

Participation in amateur street marathons has become increasingly popular and requires prior individual health risk assessment. The objective was to identify risk factors and readiness in registered runners. This was a cross-sectional study in a random sample (n = 510) of registered amateur runners 18-64 years of age, using a digital survey with IPAQ, Par-Q+, and STEPwise, with an expected physical inactivity rate of 35% (±5%). The study explored physical activity, (binge) alcohol consumption, fruit, vegetable, and salt intake, smoking, and readiness. Self-reported rates were: 97.4% recommended level of physical activity, 2.4% optimal fruit and vegetable intake, 3.7% smoking, and 44.1% binge drinking. 19.8% were Par-Q+ positive and 5.7% practiced supervised exercise. The analysis showed differences by age, sex, and socioeconomic status. Recreational runners followed the recommended levels of physical activity but did not score well on other risk factors. Prior evaluation of lifestyle-related risk factors and readiness provides a safer athletic strategy.

A participação em corridas de rua tem aumentado; isto requer uma detecção de riscos prévios ao esforço físico. O objetivo foi identificar os fatores de risco de comportamento e de readiness nos inscritos em uma corrida atlética. Estudo transversal em aficionados de 18 a 64 anos. Foi aplicado um questionário digital com módulos do IPAQ, Par-Q+ e STEPwise. Uma amostra aleatória sistemática, n = 510, para uma inatividade física estimada em 35% (± 5%). Avaliou-se o nível de atividade física, o consumo perigoso de álcool, fruta, verdura, tabaco, sal e readiness. A realização de atividade física foi de 97,4%; 2,4% consomem níveis ideais de frutas ou verduras (diferenças de idade, sexo e estrato); 3,7% são fumantes; e 44,1% consomem álcool. Dezenove vírgula oito por cento relataram Par-Q+ positivo e 5,7% requerem exercício supervisionado. Existem diferenças de trabalho e estudo.Os corredores recreacionais atendem aos níveis de atividade física, mas não de outros fatores. Uma estratégia de atletismo seguro é avaliar os fatores de risco relacionados ao estilo de vida e readiness.

Manual de práctica clínica basado en la evidencia: controles posquirúrgicos / Evidence-based clinical practice manual: Postoperative controls

Introduction: Post-anesthetic care reduces the anesthesia-related postoperative complications and mortality, shortens the length of stay at the postoperative care units and improves patient satisfaction. Objective: To establish a set of recommendations for immediate post-anesthetic care of patients that received general/regional anesthesia or profound/moderate sedation at the postoperative care units. Methodology: This is a process of "rapid" clinical practice guidelines adaptation, including systematic search. The illegible guidelines for adaptation were rated using AGREE II. The guideline selected to be adapted as the clinical practice handbook was Practice guidelines for post-anesthetic care of the American Society of Anesthesiologists. The manual was evaluated in terms of implementation ability, up-to-date information, relevancy, ethical considerations and patient safety by the group of anesthesiologists and epidemiologists based on Delphi. Result:The manual kept the recommendations on evaluation and monitoring, pharmacological management of postoperative nausea and vomiting, antagonistic actions for sedatives and analgesics and neuromuscular block agents, emergency management and anesthesia recovery, as well as the criteria for discharge from the unit. Indications about the conditions and requirements of the unit and patient admission were also included. Conclusions: This handbook comprises the basic guidelines for primary management of patients at the postoperative care unit. It may be amended or adapted according to the institutional requirements and for specific patient groups and is not intended to replace the existing protocols at the particular institution and does not define outcomes or prognosis.

Introducción: El cuidado posanestésico disminuye las complicaciones y mortalidad poso-peratorias inmediatas relacionadas con la anestesia, acorta la estancia en las unidades de cuidado posoperatoro y mejora la satisfacción de los pacientes. Objetivo: Establecer un conjunto de recomendaciones para el cuidado posantestésico inmediato de los pacientes que recibieron anestesia general/regional o sedación profunda/moderada en la unidades de cuidado posoperatorio. Metodología: Un proceso de adaptación "rápida" de guías de práctica clínica, que incluyó búsqueda sistemática. Se calificaron las guías elegibles a adaptar, mediante AGREE II. La guía seleccionada para su adaptación como manual de práctica clínica fue Practice guidelines for postanesthetic care dela American Society of Anesthesiologists. El manual fue evaluado por un grupo de anestesiólogos y epidemiólogos mediante Delphi, en términos de implementab-ilidad, actualización, pertinencia, consideraciones ética y seguridad del paciente. Resultado: El manual mantuvo las recomendaciones sobre evaluación y monitorización, manejo farmacológico de náuseas y vómito posoperatorio, antagonismo de los efectos de sedantes, analgésicos y agentes de bloqueo neuromuscular, el manejo de la emergencia y recuperación anestésica, y los criterios para egreso de la unidad. Se incluyeron indicaciones sobre condiciones y requisitos de la unidad y el ingreso del paciente a esta. Conclusiones: Este manual es una guía básica sobre el manejo primario de los pacientes en la unidad de cuidado posoperatorio, puede ser modificado o adaptado según los requerimientos institucionales y para grupos específicos de pacientes; no pretende reemplazar los protocolos existentes en cada institución ni puede definir desenlaces ni pronósticos.