An Epidemiological Assessment of SARS-CoV-2 in the Sewage System of a Higher Education Institution.

Background: The World Health Organization declared the end of the COVID-19 pandemic in May 2023, three years after the adoption of global emergency measures. Monitoring of SARS-CoV-2 in sewage underscores its importance due to its effectiveness and cost-effectiveness, highlighting the need to prioritize research on water resources and sanitation. Objectives: The aim of this study was to conduct an epidemiological assessment of SARS-CoV-2 in the sewage system of a higher education institution located in Vitória Espírito Santo State, Maruípe campus. Methods: Over a period of 66 days, from February 6 to April 12, 2023, 15 samples were collected. Each sample consisted of 1 L, collected in 1 hour, with 250 mL collected every 15 minutes. The samples were characterized by assessing their appearance, and pH was measured using a Horiba U-50 multiparameter probe. The extracted RNA was subjected to RT-qPCR using the Allplex™ 2019-nCovAssay Seegene kit. Results: The samples exhibited a cloudy appearance with impurities, and the pH ranged from 6.35 to 8.17. Among the evaluated samples, SARS-CoV-2 RNA was detected in two, and, by comparing this with the epidemiological bulletin issued by the State Health Department, an increase in cases in the state was observed during the collection period of these samples. Conclusions: Sewage monitoring proved to be an important tool in this post-pandemic period, serving as an alert and prevention mechanism for the population in relation to new outbreaks. Furthermore, it represents a low-cost mapping strategy and extensive testing of a population, aligning with the studies presented at the beginning of the pandemic. We recommend specific adjustments considering distinct populations.

Assessment of Brazil's vesicular syndrome surveillance system: Profile of notifications and performance of the official veterinary service.

Foot-and-mouth disease (FMD) is an ailment that causes serious damage to the productive chain, and its control through vaccination is of utmost importance for its eradication. Brazil initiated the National Foot-and-Mouth Disease Surveillance Program (PNEFA) with the aim of making the country FMD-free by 2026. As part of the program, notifications of vesicular lesions became mandatory for the Official Veterinary Service (OVS), which is responsible for verifying them. Due to its size, border areas with countries that do not have FMD-free status pose a risk to Brazil and require greater attention. This study described the profile of notifications of suspected outbreaks of vesicular syndrome in Brazil and analyzed the performance of the surveillance system. The results showed 7134 registered notifications of suspected vesicular syndrome outbreaks from 2018 to 2022, with 2022 having the highest number (n = 2343 or 32.85 %). The species that generated the most notifications were swine (90.99 %), cattle and buffaloes (7.54 %), goats and sheep (1.44 %), and others (0.03 %). The sources of notification were "Veterinary medicine professionals" (61.82 %), "Owners or employees" (13.66 %), "Third parties" (8.90 %), "OVS" (7.20 %), and "others" (2.66 %). 41.69 % of notifications originated from non-border municipalities, and 58.32 % from border areas. Only the state of Paraná account for 51.73 % of the total notifications. This state also accounted for 66.70 % of the 32.47 % of notifications with a final diagnosis of "absence of clinically compatible signs or susceptible animals", indicating a certain lack of knowledge in the area, leading to unnecessary notifications and system overload. The performance of the OVS was evaluated based on the service response time from notification registration trough Logistic and Negative binomial regressions. A total of 27.83 % of notifications did not meet the Brazilian legally specified time, and the zone related to the state of Parana needs improvements in performance. The presence and peaks of Senecavirus A cases may have influenced an increased number of swine notifications and led to a decrease in OVS response time. The results demonstrate better performance of surveillance in border areas. Given the vast territory of Brazil, it is not expected that 100 % of responses occur within the legal timeframe, however, the performance of the surveillance system proved to be adequate, with 86 % complied to the legislation. The performance indicators could be used as a monitoring tool, along with indicators to demonstrate system overload. Continued education actions are crucial for strengthening PNEFA.

Neisseria gonorrhoeae ST-1901 in Rio de Janeiro from 2006 to 2022: Phylogeny and antimicrobial resistance evolution of a well-succeeded pathogen.

Neisseria gonorrhoeae is a global threat to public health due to the accumulation of antimicrobial resistance mechanisms. ST-1901 is an internationally important sequence type (ST) because of its high incidence and the usual occurrence of chromosomally determined resistance. In this study, we describe the evolution of the ST-1901 and its single locus variants in Rio de Janeiro from 2006 to 2022. We analyzed 82 N. gonorrhoeae isolates according to antimicrobial susceptibility profile, resistance mechanisms, molecular typing, and phylogenetics. Six different single locus variants were detected. Phylogenetic analysis identified five clades, which share similar characteristics. Resistance rates for penicillin and tetracycline decreased due to the lower occurrence of resistance plasmids, but intermediary resistance to penicillin rose. Resistance to ciprofloxacin remained high throughout all clades and the years of the study. Regarding resistance to azithromycin, alterations in mtrR promoter and gene, and 23S rRNA encoding gene rrl were detected, with a notable rise in the incidence of C2611T mutations in more recent years occurring in four of five clades. In contrast, ß-lactam resistance associated penA 34 mosaic was found only in one persisting clade (Clade D), and unique G45D and A39T mutations in mtrR gene and its promoter (Nm-Like) were found only in Clade B. Taken together, these data suggest that ST-1901, a persistently circulating lineage of N. gonorrhoeae in Rio de Janeiro, has undergone changes over the years and may evolve to develop resistance to the current recommended dual therapy adopted in Brazil, namely, ceftriaxone and azithromycin.

Rabies virus circulation in a highly diverse bat assemblage from a high-risk area for zoonoses outbreaks in the Brazilian Amazon.

Bats are the second most diverse order of mammals and play a central role in ecosystem dynamics. They are also important reservoirs of potentially zoonotic microorganisms, of which rabies virus is the most lethal among the bat-transmitted zoonotic pathogens. Importantly, recent outbreaks of human rabies have been reported from the Brazilian Amazon. Here we present a survey of bat species and rabies virus (RABV) circulation in a bat assemblage in the Marajó region, northern Brazil. Using data from mist-net captures and bioacoustic sampling, 56 bat species were recorded along the Jacundá River basin over a 10-day expedition in November 2022. For the investigation of RABV, we used the direct fluorescent antibody test (DFAT) and the rapid fluorescent focus inhibition test (RFFIT). In total, 159 bat individuals from 22 species were investigated for RABV. Five adults of the common vampire bat, Desmodus rotundus, showed RABV-specific antibodies in serum samples. Additionally, we report on local residents with injuries caused by D. rotundus bites and the occurrence of colonies of non-hematophagous bats from different species roosting inside human residences. This scenario raises concerns about the risks of new cases of human rabies and other zoonotic diseases associated with bats in the region and highlights the need for epidemiological surveillance and mitigation measures to prevent outbreaks of emerging infectious diseases.

Data quality in Brazilian population-based cancer registries for gastrointestinal cancers.

BACKGROUND: Population-based cancer registries (PBCRs) are the primary source of information for cancer surveillance and monitoring. Currently, there are 30 active PBCRs in Brazil. The objective of this study was to analyze the data quality of five gastrointestinal cancers (esophagus, stomach, colorectal, liver, and pancreas) according to the criteria of comparability, validity, completeness, and timeliness in Brazilian cancer registries. METHODS: This study included data from Brazilian PBCRs with more than ten years of historical data starting in the year 2000, regardless of the type of defined geographical coverage (state, metropolitan region, or capital), totaling 16 registries. Brazilian PBCRs were evaluated based on four international data quality criteria: comparability, validity (accuracy), completeness, and timeliness. All cancer cases were analyzed, except for nonmelanoma skin cancer cases (C44) and five gastrointestinal tumors (esophageal cancer, stomach cancer, colorectal cancer, liver cancer, and pancreatic cancer) per cancer registry and sex, according to the available period. RESULTS: The 16 Brazilian PBCRs represent 17% of the population (36 million inhabitants in 2021) according to data from 2000 to 2018. There was a variation in the incidence in the historical series ranging from 12 to 19 years. The proportion of morphologically verified (MV%) cases varied from 74.3% (Manaus) to 94.8% (Aracaju), and the proportion of incidentally reported death certificate only (DCO%) cases varied from 3.0% (São Paulo) to 23.9% (Espírito Santo). High-lethality malignant neoplasms, such as liver and pancreas, had DCO percentages greater than 30% in most cancer registries. The sixteen registries have more than a 48-month delay in data release compared to the 2022 calendar year. CONCLUSION: The studied Brazilian cancer registries met international comparability criteria; however, half of the registries showed indices below the expected levels for validity and completeness criteria for high-lethality tumors such as liver and pancreas tumors, in addition to a long delay in data availability and disclosure. Significant efforts are necessary to ensure the operational and stability of the PBCR in Brazil, which continues to be a tool for monitoring cancer incidence and assessing national cancer control policies.

Investigation of Rabies virus in wild mammals of the atlantic forest in Rio de Janeiro, Brazil.

With the successful control of rabies transmitted by dogs in Brazil, wild animals have played a relevant epidemiological role in the transmission of rabies virus (RABV). Bats, non-human primates and wild canines are the main wild animals that transmit RABV in the country. It is worth highlighting the possibility of synanthropic action of these species, when they become adapted to urban areas, causing infections in domestic animals and eventually in humans. This work aimed to evaluate the circulation of RABV in the Pedra Branca Forest, an Atlantic Forest area, located in the state of Rio de Janeiro, Southeast Brazil. Saliva and blood samples were obtained from 60 individuals of eight species of bats, captured with mist nets, and 13 individuals of callitrichid primates, captured with tomahawk traps. Saliva samples were subjected to Reverse Transcription Polymerase Chain Reaction (RT-PCR), targeting the RABV N gene, with all samples being negative. Blood samples of all animals were submitted to the Rapid Fluorescent Focus Inhibition Test (RFFIT) to detect neutralizing antibodies (Ab) for RABV. Six bat samples (8%) were seropositive for RABV with antibody titers greater than or equal to 0.1 IU/mL. The detection of Ab but not viral RNA indicates exposure rather than current RABV transmission in the analyzed populations. The results presented here reinforce the importance of serological studies in wildlife to access RABV circulation in a region.

Zoonotic sporotrichosis in humans and domestic cats: Profile of notifications and spatio-temporal distribution in Southeastern Brazil between 2017 and 2023.

The research addresses zoonotic sporotrichosis in Brazil, particularly caused by Sporothrix brasiliensis, highlighting its epidemiological severity. Transmission occurs through contact with sick animals, especially felines, and diagnosis in humans is challenging due to the low fungal load in the lesions. The study analyzed data from Information System for Notifiable Diseases (SINAN) and Zoonosis Surveillance Unit (UVZ) from January 2017 to March 2023, carried out in Contagem, Minas Gerais. Geospatial tools and statistical analysis revealed a significant increase in cases, peaking in 2021 for felines and 2022 for humans. The geospatial analysis highlighted areas of higher incidence, suggesting a correlation between human and feline populations. The research contributes to the understanding of sporotrichosis in Contagem, emphasizing the importance of integrated approaches for surveillance and control strategies, aiming to mitigate impacts on the local community.

Epidemiological indicators and predictors of lethality associated with fungal infections in a NICU: a historical series

Abstract Objectives: Fungal infections (FI) pose a public health concern and significantly increase mortality rates, especially within Neonatal Intensive Care Units (NICU). Thus, this study aimed to investigate epidemiological indicators, risk factors, and lethality predictors associated with FI in a NICU. Methods: This study included 1,510 neonates admitted to the NICU of a reference hospital in Brazil between 2015 and 2022. Demographic data, such as sex, birth weight, gestational age, and use of invasive devices were analyzed. Results: Thirty neonates developed invasive FI, totaling 33 episodes and an incidence of 1.2 per 1,000 patient days. Candida albicans was the most frequent species (52.9 %), the bloodstream was the most affected site (78.9 %), and 72.7 % of infections occurred between 2015 and 2018. The lethality rate associated with FI was 33.3 %, and 90 % of deaths occurred within 30 days of diagnosis of infection. Weight < 750 g, prolonged hospital stay, use of parenteral nutrition, and broad-spectrum antimicrobials were independent risk factors for infection occurrence, especially glycopeptides and 4th generation cephalosporins, having a considerable role in the increase in fungal infections. Weight < 750 g was considered a significant predictor of lethality, and C. albicans had the highest lethality rate (40 %). Conclusion: These findings highlight the elevated lethality rate associated with these infections, reinforcing the importance of developing strategies to control FI within NICU.

Nowcasting methods to improve the performance of respiratory sentinel surveillance: lessons from the COVID-19 pandemic.

Respiratory diseases, including influenza and coronaviruses, pose recurrent global threats. This study delves into the respiratory surveillance systems, focusing on the effectiveness of SARI sentinel surveillance for total and severe cases incidence estimation. Leveraging data from the COVID-19 pandemic in Chile, we examined 2020-2023 data (a 159-week period) comparing census surveillance results of confirmed cases and hospitalizations, with sentinel surveillance. Our analyses revealed a consistent underestimation of total cases and an overestimation of severe cases of sentinel surveillance. To address these limitations, we introduce a nowcasting model, improving the precision and accuracy of incidence estimates. Furthermore, the integration of genomic surveillance data significantly enhances model predictions. While our findings are primarily focused on COVID-19, they have implications for respiratory virus surveillance and early detection of respiratory epidemics. The nowcasting model offers real-time insights into an outbreak for public health decision-making, using the same surveillance data that is routinely collected. This approach enhances preparedness for emerging respiratory diseases by the development of practical solutions with applications in public health.

Livestock and environmental characterization of Colombian municipalities: study of vesicular stomatitis.

Amid the surge in data volume generated across various fields of knowledge, there is an increasing necessity for advanced analytical methodologies to effectively process and utilize this information. Particularly in the field of animal health, this approach is pivotal for enhancing disease understanding, surveillance, and management. The main objective of the study was to conduct a comprehensive livestock and environmental characterization of Colombian municipalities and examine their relationship with the distribution of vesicular stomatitis (VS). Utilizing satellite imagery to delineate climatic and land use profiles, along with data from the Colombian Agricultural Institute (ICA) concerning animal populations and their movements, the research employed Principal Component Analysis (PCA) to explore the correlation between environmental and livestock-related variables. Additionally, municipalities were grouped through a Hierarchical Clustering process. The assessment of risk associated with VS was carried out using a Generalized Linear Model. This process resulted in the formation of four distinct clusters: three primarily characterized by climatic attributes and one predominantly defined by livestock characteristics. Cluster 1, identified as "Andino" due to its climatic and environmental features, exhibited the highest odds ratio for VS occurrence. The adopted methodology not only provides a deeper understanding of the local population and its context, but also offers valuable insights for enhancing disease surveillance and control programs.

Epidemiological Evaluation of Events Allegedly Attributable to COVID-19 Vaccination: A Cross-Sectional Study in the Brazilian Amazon.

The emergence of SARS-CoV-2, leading to the widespread outbreak of COVID-19, has unveiled a spectrum of symptoms and severe health complications, challenging healthcare systems and impacting millions of lives worldwide. To analyze events allegedly attributable to vaccination or immunization (ESAVI) against SARS-CoV-2 (COVID-19) in the municipality of Santarém, in the interior of the state of Pará, an epidemiological, descriptive study was conducted using data from e-SUS Notifica in Santarém/PA from January 2021 to January 2022. The analyzed data for ESAVI cases included the administered immunobiologicals (Coronavac, Covishield, and Comirnaty), the type of event, case progression, time in days between immunobiological administration, and symptom onset, causality, and classification of ESAVI according to the vaccine package inserts. The incidence rate of ESAVI due to the COVID-19 vaccine was 17 per 100,000 doses administered in the municipality. According to the ESAVI classification, 14.0% were classified as Serious ESAVI (ESAVIG) (IR: 8.12 per 100,000 doses administered), with 100% of these events resulting in full recovery without sequelae, and 82.4% of reported cases were classified as Non-Serious ESAVI (ESAVING) (IR: 47.78), of which 3.60% were immunization errors (IR: 2.08 IE per 100,000 doses). This study fosters discussion on the importance of accurate recording of ESAVI related to COVID-19 vaccines, demonstrating their safety for the population.

Seroprevalence of dengue IgG and associated risk factors in symptomatic and asymptomatic adults in Posadas (Misiones, Argentina), 2017-2019.

BACKGROUND: Dengue represents a major public health problem in the Americas in general, and in Posadas (Misiones, Argentina) in particular. This study aimed to assess the seroprevalence of dengue virus infection, analyze associated factors, and determine the proportion of asymptomatic cases. METHODS: This prospective cross-sectional study took place from November 2017 to April 2019 in the High Complexity Laboratory of Misiones, at the School Hospital Dr. Ramón Madariaga in Posadas. A random sample of 301 adults (≥ 15 years) was selected from the electoral registry and stratified by geographical area of residence. Sociodemographic, clinical, and laboratory data were collected by means of a survey and serology. Results were analyzed using multivariable logistic regression. RESULTS: The median age of the sample was 33 years; 66% were women, and 46.5% had completed at least secondary school. Anti-dengue IgG antibodies were present in 40.2% of the sample (95% confidence interval [CI] 34.5-45.9%), including 90% of those who reported dengue and 20.5% who did not (odds ratio [OR] 33.25, 95% CI 15.46-71.51, p < 0.001). In the multivariable analysis, adjusted for age, group, gender, and vaccination against yellow fever, seropositivity was associated with having relatives with dengue (adjusted OR 3.96, 95% CI 2.18-7.23; p < 0.001). CONCLUSION: Seroprevalence for dengue in Posadas was higher than estimates based on the notification records, and there was a high proportion of asymptomatic cases. Educational level and having a family member who had suffered from dengue were associated with positive serology.

[SWOT analysis: strengthening tuberculosis prevention and control in post COVID-19 pandemic, Hospital Muñiz, Buenos Aires]. / Análisis FODA: fortalecimiento de la prevención y el control de la tuberculosis en post pandemia de COVID-19, Hospital Muñiz, Buenos Aires.

INTRODUCTION: The Hospital Muñiz's "Strengthening Epidemiological Surveillance in Tuberculosis (VET) Project" is focused on improving operational outcomes, specifically by enhancing early TB diagnosis. Our primary aim is to promptly identify individuals with tuberculosis (TB) who seek care at our institution following the COVID-19 pandemic. METHODS: A SWOT analysis (Strengths, Weaknesses, Opportunities, and Threats) was carried out. It is an essential tool in strategic planning, which provides information for the implementation of actions and corrective measures in the generation of new improvement projects. The internal situation of the institution was evaluated to determine SWOT after the COVID-19 pandemic, in order to strengthen VET, through field epidemiological surveillance. RESULTS: There are trained personnel, the possibility of early diagnosis and its opportune control generated from the Febrile Emergency Unit. The on-call service has an adequate control of the TB population that enables coordination and joint work with other programs (HIV), response capacity of the institution to outbreaks, epidemics and pandemics. DISCUSSION: The application of this project will incorporate a strengthening activity in epidemiological surveillance, where the Muñiz Hospital, through a comprehensive approach and the identification of new cases, responds to the needs of the local population with TB. This will provide valid and reliable information for the prevention and control of TB in the institution after the COVID-19 pandemic.

Introducción: El proyecto de fortalecimiento en Vigilancia Epidemiológica en Tuberculosis (VET) del Hospital Muñiz, Buenos Aires (Argentina), busca mejorar los resultados operacionales relacionados en mayor medida al diagnóstico precoz de la enfermedad, estableciendo como objetivo la identificación oportuna de personas enfermas de tuberculosis (TB) que consultan posterior a la pandemia por COVID-19. Métodos: Se realizó un análisis FODA (Fortalezas, Oportunidades, Debilidades, Amenazas): una herramienta esencial en la planeación estratégica, que proporciona información necesaria para la implementación de acciones y medidas correctivas, generación de nuevos proyectos de mejora, donde se evaluó la situación interna de la institución para determinar las FODA presentadas después de la pandemia COVID-19, a fin de desarrollar un fortalecimiento en VET, mediante vigilancia epidemiológica de campo. Resultados: Se cuenta con personal capacitado, posibilidad de diagnóstico precoz y control oportuno, generado desde la Unidad Febril de Urgencias. El servicio de guardia presenta adecuado control de la población con TB, que posibilita la coordinación y trabajo en conjunto con otros programas ministeriales. Existe capacidad de respuesta de la institución ante los brotes, epidemias y pandemias. Discusión: La aplicación de este proyecto incorporará una actividad de fortalecimiento en vigilancia epidemiológica, donde el Hospital Muñiz, mediante el abordaje integral y la identificación de casos nuevos de respuesta a las necesidades de la población con TB. Se proporcionará así información válida y confiable para la prevención y control de la TB en la institución después de la pandemia por COVID-19.

[Monkeypox: characteristics in female population, Buenos Aires, Argentina]. / Viruela símica: características en población femenina, Buenos Aires, Argentina.

Monkeypox is a zoonotic viral disease caused by a virus of the genus Orthopoxvirus. As of January 1, 2022, it has been reported in 110 WHO Member States. It presents with fever, fatigue, painful lymphadenopathy, and rash. It lasts between 2 and 4 weeks. It is usually self-limited, but severe cases have been described in immunocompromised people. This study describes cases of monkeypox in women, diagnosed between June 2022 and February 2023, and it reports epidemiology, clinical aspects, and complications after infection. A retrospective observational study was carried out in the Febrile Emergency Unit (UFU), reviewing positive cases (RT-PCR) for monkeypox and the population with female biological sex was selected. They were questioned about gynecological complications, menstrual pattern, dyspareunia and pelvic pain. 340 consultations for monkeypox were made, 214 (63%) were positive, 211 cases (99%) male and 3 cases (1%) female. Among these cases is a trans woman, who was not included. The average age is 31 years, immunocompetent, with a negative serology report for HIV, syphilis, hepatitis B and C. Both cases had sexual intercourse without a barrier method. The most frequent symptoms are asthenia and skin lesions, especially in the upper and lower limbs, perianal and genital region. As a risk factor they presented unprotected sexual contact. Within the differential diagnoses, other sexually transmitted infections (STIs) should be considered. There were no gynecological complications reported during follow-up.

La viruela símica es una enfermedad viral zoonótica debida a un virus del género Orthopoxvirus. Desde el 1 de enero de 2022, se ha notificado en 110 Estados Miembros de la OMS. Se presenta con fiebre, astenia, linfoadenopatías dolorosas y exantema. Dura entre 2 y 4 semanas. Suele ser autolimitada y se han descrito casos graves en personas inmunocomprometidas. El presente trabajo describe casos de viruela símica en mujeres, diagnosticados entre junio del 2022 y febrero del 2023 Se realizó un estudio observacional retrospectivo en la Unidad Febril de Urgencias (UFU), revisando casos positivos (RT-PCR) para viruela símica y se seleccionó la población con sexo biológico femenino. Se consultó sobre complicaciones ginecológicas, patrón menstrual, dispareunia y dolor pélvico. Se realizaron 340 consultas por viruela símica, 214 (63%) fueron positivos, 211 casos (99%) de sexo masculino y 3 casos (1%) femeninos. Dentro de estos casos se encuentra una mujer trans, la cual no se incluyó. La edad promedio es de 31 años, inmunocompetentes, con reporte de serologías negativas para HIV, sífilis, hepatitis B y C. Ambos casos mantuvieron relaciones sexuales sin método de barrera. Los síntomas más frecuentes fueron astenia y lesiones en piel, sobre todo en miembros superiores e inferiores, región perianal y genital. Como factor de riesgo presentaron contacto sexual sin protección. Dentro de los diagnósticos diferenciales, debe tenerse en cuenta otras infecciones de transmisión sexual (ITS). En seguimiento epidemiológico no refirieron complicaciones ginecológicas.

Epidemiological indicators and predictors of lethality associated with fungal infections in a NICU: a historical series.

OBJECTIVES: Fungal infections (FI) pose a public health concern and significantly increase mortality rates, especially within Neonatal Intensive Care Units (NICU). Thus, this study aimed to investigate epidemiological indicators, risk factors, and lethality predictors associated with FI in a NICU. METHODS: This study included 1,510 neonates admitted to the NICU of a reference hospital in Brazil between 2015 and 2022. Demographic data, such as sex, birth weight, gestational age, and use of invasive devices were analyzed. RESULTS: Thirty neonates developed invasive FI, totaling 33 episodes and an incidence of 1.2 per 1,000 patient days. Candida albicans was the most frequent species (52.9 %), the bloodstream was the most affected site (78.9 %), and 72.7 % of infections occurred between 2015 and 2018. The lethality rate associated with FI was 33.3 %, and 90 % of deaths occurred within 30 days of diagnosis of infection. Weight < 750 g, prolonged hospital stay, use of parenteral nutrition, and broad-spectrum antimicrobials were independent risk factors for infection occurrence, especially glycopeptides and 4th generation cephalosporins, having a considerable role in the increase in fungal infections. Weight < 750 g was considered a significant predictor of lethality, and C. albicans had the highest lethality rate (40 %). CONCLUSION: These findings highlight the elevated lethality rate associated with these infections, reinforcing the importance of developing strategies to control FI within NICU.

Evaluation of Severe Acute Respiratory Syndrome surveillance caused by respiratory viruses in a pediatric unit, 2013 to 2019 / Avaliação da vigilância da Síndrome Respiratória Aguda Grave causada por vírus respiratórios em uma unidade pediátrica, 2013 a 2019

ABSTRACT Objective: To evaluate severe acute respiratory syndrome surveillance in a pediatric unit. Methods: Descriptive study of reported severe acute respiratory syndrome cases with the detection of respiratory viruses in the nasopharyngeal sample of patients hospitalized between 2013 and 2019, in a reference hospital in the Federal District, Brazil. Results: A total of 269 children had one or more viruses detected, resulting in 280 viruses, of which 152 (54%) were respiratory syncytial virus. The detection of respiratory syncytial virus was higher during the autumn-winter period. Children´s median age was 6.9 months, 156 (58%) were male, 104 (39%) had comorbidity, 197 (73%) required mechanical ventilation, 241 (90%) received antibiotics, and 146 (54%) oseltamivir. There were 19 (7%) deaths. The median time from symptom onset to sample collection was 5 days and the median time from sample collection to final results was 6 days. Conclusions: The system needs to reduce the time to deliver results so that inappropriate use of antibiotics and antivirals can be avoided. Moreover, the burden of viral pneumonia was relevant and the system must be flexible enough to include emerging viruses in order to be useful in responding to public health emergencies caused by respiratory viruses.

RESUMO Objetivo: Avaliar a vigilância da síndrome respiratória aguda grave em uma unidade pediátrica. Métodos: Estudo descritivo dos casos de síndrome respiratória aguda grave, notificados e com a detecção de vírus respiratório em amostra de nasofaringe de pacientes internados entre 2013 e 2019, em um hospital de referência do Distrito Federal. Resultados: Um total de 269 crianças tiveram algum vírus detectado, resultando em 280 vírus, sendo 152 (54%) vírus sincicial respiratório. A detecção do vírus sincicial respiratório foi maior durante o período de outono-inverno. A mediana da idade das crianças foi de 6,9 meses, 156 (58%) eram do sexo masculino, 104 (39%) tinham comorbidade, 197 (73%) necessitaram de ventilação mecânica, 241 (90%) receberam antibióticos e 146 (54%) oseltamivir. Ocorreram 19 (7%) óbitos. A mediana do tempo desde o início dos sintomas até a coleta da amostra foi de 5 dias, e do tempo da coleta até o resultado foi de 6 dias. Conclusões: O sistema necessita reduzir o tempo do resultado final para que seja possível evitar o uso inadequado de antibióticos e antivirais. Ademais, o impacto das pneumonias virais foi relevante e o sistema deve ser flexível suficiente para incluir vírus emergentes, para ser útil na resposta às emergências de saúde pública causada por vírus respiratórios.

Análisis FODA: fortalecimiento de la prevención y el control de la tuberculosis en post pandemia de COVID-19, Hospital Muñiz, Buenos Aires / SWOT analysis: strengthening tuberculosis prevention and control in post COVID-19 pandemic, Hospital Muñiz, Buenos Aires

Resumen Introducción : El proyecto de fortalecimiento en Vigi lancia Epidemiológica en Tuberculosis (VET) del Hospital Muñiz, Buenos Aires (Argentina), busca mejorar los re sultados operacionales relacionados en mayor medida al diagnóstico precoz de la enfermedad, estableciendo como objetivo la identificación oportuna de personas enfermas de tuberculosis (TB) que consultan posterior a la pandemia por COVID-19. Métodos : Se realizó un análisis FODA (Fortalezas, Oportunidades, Debilidades, Amenazas): una herramien ta esencial en la planeación estratégica, que proporciona información necesaria para la implementación de accio nes y medidas correctivas, generación de nuevos pro yectos de mejora, donde se evaluó la situación interna de la institución para determinar las FODA presentadas después de la pandemia COVID-19, a fin de desarrollar un fortalecimiento en VET, mediante vigilancia epide miológica de campo. Resultados : Se cuenta con personal capacitado, posi bilidad de diagnóstico precoz y control oportuno, gene rado desde la Unidad Febril de Urgencias. El servicio de guardia presenta adecuado control de la población con TB, que posibilita la coordinación y trabajo en conjunto con otros programas ministeriales. Existe capacidad de respuesta de la institución ante los brotes, epidemias y pandemias. Discusión : La aplicación de este proyecto incorporará una actividad de fortalecimiento en vigilancia epidemio lógica, donde el Hospital Muñiz, mediante el abordaje integral y la identificación de casos nuevos de respuesta a las necesidades de la población con TB. Se proporcio nará así información válida y confiable para la preven ción y control de la TB en la institución después de la pandemia por COVID-19.

Abstract Introduction : The Hospital Muñiz's "Strengthening Epidemiological Surveillance in Tuberculosis (VET) Proj ect" is focused on improving operational outcomes, spe cifically by enhancing early TB diagnosis. Our primary aim is to promptly identify individuals with tuberculo sis (TB) who seek care at our institution following the COVID-19 pandemic. Methods : A SWOT analysis (Strengths, Weaknesses, Opportunities, and Threats) was carried out. It is an essential tool in strategic planning, which provides information for the implementation of actions and corrective measures in the generation of new improvement projects. The internal situation of the institution was evaluated to determine SWOT after the COVID-19 pandemic, in order to strengthen VET, through field epidemiological surveillance. Results : There are trained personnel, the possibility of early diagnosis and its opportune control generated from the Febrile Emergency Unit. The on-call service has an adequate control of the TB population that enables coordination and joint work with other programs (HIV), response capacity of the institution to outbreaks, epi demics and pandemics. Discussion : The application of this project will in corporate a strengthening activity in epidemiological surveillance, where the Muñiz Hospital, through a com prehensive approach and the identification of new cases, responds to the needs of the local population with TB. This will provide valid and reliable information for the prevention and control of TB in the institution after the COVID-19 pandemic.

Viruela símica: características en población femenina, Buenos Aires, Argentina / Monkeypox: characteristics in female population, Buenos Aires, Argentina

Resumen La viruela símica es una enfermedad viral zoonótica debida a un virus del género Orthopoxvirus. Desde el 1 de enero de 2022, se ha notificado en 110 Estados Miembros de la OMS. Se presenta con fiebre, astenia, linfoadenopatías dolorosas y exantema. Dura entre 2 y 4 semanas. Suele ser autolimitada y se han descrito casos graves en personas inmunocomprometidas. El presente trabajo describe casos de viruela símica en mujeres, diagnosticados entre junio del 2022 y febrero del 2023 Se realizó un estudio observacional retrospectivo en la Uni dad Febril de Urgencias (UFU), revisando casos positivos (RT-PCR) para viruela símica y se seleccionó la población con sexo biológico femenino. Se consultó sobre compli caciones ginecológicas, patrón menstrual, dispareunia y dolor pélvico. Se realizaron 340 consultas por viruela símica, 214 (63%) fueron positivos, 211 casos (99%) de sexo masculino y 3 casos (1%) femeninos. Dentro de estos casos se encuentra una mujer trans, la cual no se incluyó. La edad promedio es de 31 años, inmunocom petentes, con reporte de serologías negativas para HIV, sífilis, hepatitis B y C. Ambos casos mantuvieron relacio nes sexuales sin método de barrera. Los síntomas más frecuentes fueron astenia y lesiones en piel, sobre todo en miembros superiores e inferiores, región perianal y genital. Como factor de riesgo presentaron contacto sexual sin protección. Dentro de los diagnósticos diferenciales, debe tenerse en cuenta otras infecciones de transmisión sexual (ITS). En seguimiento epidemiológico no refirieron complicaciones ginecológicas.

Abstract Monkeypox is a zoonotic viral disease caused by a virus of the genus Orthopoxvirus. As of January 1, 2022, it has been reported in 110 WHO Member States. It presents with fever, fatigue, painful lymphadenopathy, and rash. It lasts between 2 and 4 weeks. It is usually self-limited, but severe cases have been described in immunocompromised people. This study describes cases of monkeypox in women, diagnosed between June 2022 and February 2023, and it reports epidemiology, clinical aspects, and complications after infection. A retrospective observational study was carried out in the Febrile Emergency Unit (UFU), reviewing positive cases (RT-PCR) for monkeypox and the population with female biologi cal sex was selected. They were questioned about gyne cological complications, menstrual pattern, dyspareunia and pelvic pain. 340 consultations for monkeypox were made, 214 (63%) were positive, 211 cases (99%) male and 3 cases (1%) female. Among these cases is a trans woman, who was not included. The average age is 31 years, immunocompetent, with a negative serology report for HIV, syphilis, hepatitis B and C. Both cases had sexual intercourse without a barrier method. The most frequent symptoms are asthenia and skin lesions, especially in the upper and lower limbs, perianal and genital region. As a risk factor they presented unpro tected sexual contact. Within the differential diagnoses, other sexually transmitted infections (STIs) should be considered. There were no gynecological complications reported during follow-up.

Strengthening Multidrug-Resistant Tuberculosis Epidemiological Surveillance in Rio de Janeiro: a multidimensional analysis

ABSTRACT This study aimed to reinforce the importance of the epidemiological surveillance of multidrug-resistant tuberculosis (MDR-TB) in Rio de Janeiro State (RJ). Here, we reviewed seven articles we published between 2018 and 2022. This study had two phases. The quantitative phase where frequency was used to describe patient characteristics and regressions were used to evaluate the relationship between treatment outcomes and covariates. The qualitative phase where content analysis of the narratives was performed. Secondary (electronic systems) and primary (semi-structured interviews) data were used. We analyzed 2,269 MDR-TB, 58.1% MDR-TB, and 18.6% extensively drug-resistant TB (XDR-TB) cases, of which 44.3% exhibited unfavorable outcomes. Among the 140 patients with XDR-TB, 29.3% had not undergone prior treatment for MDR-TB. The primary resistance rate in MDR-TB cases was 14.7%, revealing significant demographic and clinical disparities, particularly among women, Caucasians, and those with higher education levels. The number of cases increased from 7.69% in 2000 to 38.42% in 2018, showing an increasing trend (AAPC = 9.4; 95% CI 1.4−18.0, p < 0.001), with 25.4% underreporting. A qualitative study confirmed a high proportion of primary resistance (64.5%) and delayed diagnosis of MDR-TB. In RJ, the diagnostic and therapeutic cascade of MDR-TB must be improved using molecular tests to achieve an early diagnosis of resistance and immediate initiation of appropriate treatment, promote social protection for MDR/XDR-TB patients and their families, enhance TB contact tracing, establish and monitor hospital surveillance centers integrated with Primary Care, and unify various information systems through interoperability for better integration.