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Martins FDM, Vidal AP, Giddaluru J, da Silva BM, Lee EK, Zhang P, Cardozo LE, Prete CA, Domingues HH, Sabino EC, Sampaio VDS, Monteiro WM, Nakaya HI. Temporal and spatial analysis of over 7,000 measles cases outbreak from 2018 to 2019 in the Brazilian Amazon. EINSTEIN-SAO PAULO 2024; 22:eAO0931. [PMID: 38567917 PMCID: PMC11081026 DOI: 10.31744/einstein_journal/2024ao0931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/10/2024] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE This study aimed to present a temporal and spatial analysis of the 2018 measles outbreak in Brazil, particularly in the metropolitan city of Manaus in the Amazon region, and further introduce a new tool for spatial analysis. METHODS We analyzed the geographical data of the residences of over 7,000 individuals with measles in Manaus during 2018 and 2019. Spatial and temporal analyses were conducted to characterize various aspects of the outbreak, including the onset and prevalence of symptoms, demographics, and vaccination status. A visualization tool was also constructed to display the geographical and temporal distribution of the reported measles cases. RESULTS Approximately 95% of the included participants had not received vaccination within the past decade. Heterogeneity was observed across all facets of the outbreak, including variations in the incubation period and symptom presentation. Age distribution exhibited two peaks, occurring at one year and 18 years of age, and the potential implications of this distribution on predictive analysis were discussed. Additionally, spatial analysis revealed that areas with the highest case densities tended to have the lowest standard of living. CONCLUSION Understanding the spatial and temporal spread of measles outbreaks provides insights for decision-making regarding measures to mitigate future epidemics.
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Affiliation(s)
- Felipe de Mello Martins
- Universidade do Estado do AmazonasEscola Superior de Ciências da SaúdeManausAMBrazilEscola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brazil.
- Fundação de Medicina Tropical Doutor Heitor Vieira DouradoManausAMBrazilFundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil.
| | - Alessandra Pinheiro Vidal
- Universidade do Estado do AmazonasEscola Superior de Ciências da SaúdeManausAMBrazilEscola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brazil.
- Fundação de Medicina Tropical Doutor Heitor Vieira DouradoManausAMBrazilFundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil.
| | - Jeevan Giddaluru
- Universidade de São PauloFaculdade de Ciências FarmacêuticasSão PauloSPBrazilFaculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Bernardo Maia da Silva
- Universidade do Estado do AmazonasEscola Superior de Ciências da SaúdeManausAMBrazilEscola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brazil.
- Fundação de Medicina Tropical Doutor Heitor Vieira DouradoManausAMBrazilFundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil.
| | - Eva K. Lee
- Georgia Institute of TechnologyCenter for Operations Research in Medicine and HealthcareAtlantaUSACenter for Operations Research in Medicine and Healthcare, Georgia Institute of Technology, Atlanta, USA.
| | - Peijue Zhang
- Georgia Institute of TechnologyCenter for Operations Research in Medicine and HealthcareAtlantaUSACenter for Operations Research in Medicine and Healthcare, Georgia Institute of Technology, Atlanta, USA.
| | - Lucas Esteves Cardozo
- Universidade de São PauloFaculdade de Ciências FarmacêuticasSão PauloSPBrazilFaculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Carlos Augusto Prete
- Universidade de São PauloEscola PolitécnicaDepartment of Electronic Systems EngineeringSão PauloSPBrazilDepartment of Electronic Systems Engineering, Escola Politécnica, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Helves Humberto Domingues
- Universidade de São PauloInstituto de Medicinal TropicalFaculdade de MedicinaSão PauloSPBrazilInstituto de Medicinal Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Ester Cerdeira Sabino
- Universidade de São PauloInstituto de Medicinal TropicalFaculdade de MedicinaSão PauloSPBrazilInstituto de Medicinal Tropical, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Vanderson de Souza Sampaio
- Fundação de Medicina Tropical Doutor Heitor Vieira DouradoManausAMBrazilFundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil.
- Rosemary Costa PintoFundação de Vigilância em Saúde do Amazonas DraManausAMBrazilFundação de Vigilância em Saúde do Amazonas Dra. Rosemary Costa Pinto, Manaus, AM, Brazil.
- Instituto Todos pela SaúdeSão PauloSPBrazilInstituto Todos pela Saúde, São Paulo, SP, Brazil.
| | - Wuelton Marcelo Monteiro
- Universidade do Estado do AmazonasEscola Superior de Ciências da SaúdeManausAMBrazilEscola Superior de Ciências da Saúde, Universidade do Estado do Amazonas, Manaus, AM, Brazil.
- Fundação de Medicina Tropical Doutor Heitor Vieira DouradoManausAMBrazilFundação de Medicina Tropical Doutor Heitor Vieira Dourado, Manaus, AM, Brazil.
- Universidade de São PauloFaculdade de Ciências FarmacêuticasSão PauloSPBrazilFaculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Helder I Nakaya
- Universidade de São PauloFaculdade de Ciências FarmacêuticasSão PauloSPBrazilFaculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, SP, Brazil.
- Hospital Israelita Albert EinsteinSão PauloSPBrazilHospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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Prieto Alvarado FE, Salas Suspes HP, Cortés Molano NP, Tavera PA. [Maintaining measles elimination status in Colombia during outbreak control, 2019Manutenção do status de eliminação do sarampo na Colômbia durante o controle de surtos, 2019]. Rev Panam Salud Publica 2023; 47:e165. [PMID: 38089106 PMCID: PMC10712572 DOI: 10.26633/rpsp.2023.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/10/2023] [Indexed: 03/08/2024] Open
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.
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Affiliation(s)
| | | | | | - Pilar Andrea Tavera
- Instituto Nacional de SaludBogotáColombiaInstituto Nacional de Salud, Bogotá, Colombia.
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Donalisio MR, Boing AC, Sato APS, Martinez EZ, Xavier MO, Almeida RLFD, Moreira RDS, Queiroz RCDS, Matijasevich A. Vaccination against poliomyelitis in Brazil from 2011 to 2021: successes, setbacks, and challenges ahead. CIENCIA & SAUDE COLETIVA 2023; 28:337. [PMID: 36651390 DOI: 10.1590/1413-81232023282.17842022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 11/17/2022] [Indexed: 01/17/2023] Open
Abstract
The drop in childhood vaccination coverage (VC), including poliomyelitis, has become a health concern. The objective was to analyze the temporal trend of coverage of the three doses of the polio vaccine in the first 12 months of life between 2011 and 2021, in addition to mapping vaccination coverage in Brazil, including the COVID-19 pandemic period. An ecological study was carried out using interrupted time series (STI) techniques and spatial analysis, with data from the National Immunization Program Information System. The VC trend was adjusted by the Newey-West variance estimator according to the federated units and the Brazilian Deprivation Index. The VC distribution was estimated by Bayesian models and the spatial clusters by the global and local Moran index, identifying areas of lower coverage in the health regions. There was a reduction in the VC over the period in all regions, being more pronounced in the North and Northeast regions and during the Covid-19 pandemic. The biggest drops were identified in states and health regions with greater social vulnerability after 2019. The drop in VC shows that the risk of reintroduction of the wild virus is imminent and the challenges need to be faced with the strengthening of the Brazilian Health System (SUS).
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Affiliation(s)
- Maria Rita Donalisio
- Departamento de Saúde Coletiva, Faculdade de Ciências Médicas, Universidade Estadual de Campinas. R. Tessália Vieira de Camargo 126, Cidade Universitária Zeferino Vaz. 13083-887 Campinas SP Brasil.
| | - Alexandra Crispim Boing
- Departamento de Saúde Pública, Universidade Federal de Santa Catarina. Florianópolis SC Brasil
| | | | - Edson Zangiacomi Martinez
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. Ribeirão Preto SP Brasil
| | - Mariana Otero Xavier
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo. São Paulo SP Brasil
| | | | - Rafael da Silveira Moreira
- Departamento de Medicina Social, Centro de Biociências, Universidade Federal de Pernambuco Centro. Recife PE Brasil
| | | | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo. São Paulo SP Brasil
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Donalisio MR, Boing AC, Sato APS, Martinez EZ, Xavier MO, Almeida RLFD, Moreira RDS, Queiroz RCDS, Matijasevich A. Vaccination against poliomyelitis in Brazil from 2011 to 2021: successes, setbacks, and challenges ahead. CIENCIA & SAUDE COLETIVA 2023. [DOI: 10.1590/1413-81232023282.17842022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Abstract The drop in childhood vaccination coverage (VC), including poliomyelitis, has become a health concern. The objective was to analyze the temporal trend of coverage of the three doses of the polio vaccine in the first 12 months of life between 2011 and 2021, in addition to mapping vaccination coverage in Brazil, including the COVID-19 pandemic period. An ecological study was carried out using interrupted time series (STI) techniques and spatial analysis, with data from the National Immunization Program Information System. The VC trend was adjusted by the Newey-West variance estimator according to the federated units and the Brazilian Deprivation Index. The VC distribution was estimated by Bayesian models and the spatial clusters by the global and local Moran index, identifying areas of lower coverage in the health regions. There was a reduction in the VC over the period in all regions, being more pronounced in the North and Northeast regions and during the Covid-19 pandemic. The biggest drops were identified in states and health regions with greater social vulnerability after 2019. The drop in VC shows that the risk of reintroduction of the wild virus is imminent and the challenges need to be faced with the strengthening of the Brazilian Health System (SUS).
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Increasing seroprevalence but waning herd immunity against measles after elimination: Longitudinal seroepidemiology of measles in Osaka Prefecture, Japan, 2003-2020. Vaccine 2022; 40:6581-6588. [PMID: 35927136 DOI: 10.1016/j.vaccine.2022.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/30/2022] [Accepted: 07/19/2022] [Indexed: 01/27/2023]
Abstract
Japan is one of the countries conducting longitudinal serosurveillance of vaccine-preventable diseases. We conducted surveillance of the local measles-specific antibody titer, calculated the effective reproduction number (Re), and compared data of four terms: term 1, 2003-2006 (before the introduction of the second shot of measles-containing vaccine); term 2, 2007-2010 (early term toward measles elimination); term 3, 2011-2014 (later term toward measles elimination); and term 4, 2015-2020 (after elimination of measles in Japan). Approximately 250 sera from volunteers aged 0 to ≥ 40 years were collected and examined for measles-specific IgG using the gelatin particle agglutination (PA) method annually from 2003 to 2020. Seroprevalence and the geometric mean of the PA antibody titer were examined by term. Re was calculated using the age-dependent proportion immune and contact matrix for each term. Of the 4,716 sera, 886 in term 1, 1,217 in term 2, 1,069 in term 3, and 1,544 in term 4 were collected. The seroprevalence gradually increased from term 1 (88.3% CI 86.0-90.3) to term 4 (95.7% CI 94.6-96.7), and the seroprevalence of term 1 was significantly lower than those of other terms (Fisher's exact test, p < 0.001), with PA titer ≥ 16 as positive. By contrast, PA antibody titers significantly decreased from term 1 (median 1,024) to term 4 (median 256) (Mann-Whitney U test, p < 0.001). With the protection level (PA titer ≥ 128 and ≥ 256) as positive, Re gradually increased from term 1 (1.8 and 2.3) to term 4 (2.5 and 4.8, respectively). Waning levels of measles antibodies potentially increase the measles susceptibility in Osaka, Japan. This trend might imply a limitation of vaccine-induced immunity in the absence of a natural booster for wild strains after measles elimination. This study provides a cue for maintaining continuous measles elimination status in the future.
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Gonçalves Maciel LH, Vieira da Rocha Neto C, Ferreira Martins Y, de Azevedo Furtado F, Cunha Teixeira P, Oliveira Dias MY, Batista Rodrigues YK, Ribeiro Piauilino IC, Damasceno Pinto S, Côrte Alencar AC, de Lima Gimaque JB, Gomes Mourão MP, Guimarães Lacerda MV, da Costa Castilho M, Bôtto-Menezes C. Prevalence of arboviruses and other infectious causes of skin rash in patients treated at a tertiary health unit in the Brazilian Amazon. PLoS Negl Trop Dis 2022; 16:e0010727. [PMID: 36228027 PMCID: PMC9560595 DOI: 10.1371/journal.pntd.0010727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 08/10/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In the clinical course of diseases such as arboviruses, skin rashes may appear, as is often seen in other infectious diseases. The aim of this study was to estimate the prevalence of arboviruses and other infectious causes of skin rash in a tertiary health unit in Manaus, Amazonas state, Western Brazilian Amazon. METHODOLOGY/PRINCIPAL FINDINGS This was a cross-sectional study of patients presenting with rash who sought care at Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD) from February 2018 to May 2019. Individuals of either gender, aged over 18 years, were invited to participate voluntarily. Infection by Zika virus (ZIKV), dengue virus (DENV), chikungunya virus (CHIKV), Mayaro virus (MAYV), Oropouche virus (OROV) and measles was evaluated using RT-qPCR (real-time polymerase chain reaction). Immunodiagnostic tests for EBV, CMV, HIV, syphilis, rubella and measles were also performed. A total of 340 participants were included, most were female (228, 67.1%) with an average age of 36.5 years (SD ± 12.2 years). The highest prevalence was of ZIKV monoinfections (65.3%, 222/340), followed by DENV (0.9%, 3/340) and CHIKV infection (0.3%, 1/340). No cases of MAYV, OROV or rubella were found. Other causes of skin rash were detected: measles (2.9%, 10/340), parvovirus B19 (0.9% 3/340), HIV (0.3%, 1/340) and syphilis 0.6% (2/340). The co-infections identified were ZIKV+HIV (0.3%, 1/340), ZIKV+measles (0.3%, 1/340), ZIKV+parvovirus B19 (0.3%, 1/340), ZIKV+EBV (0.3%, 1/340), EBV+parvovirus B19 (0.3%, 1/340), CMV+parvovirus B19 (0.6%, 2/340), CMV+syphilis (0.3%, 1/340), ZIKV+EBV+parvovirus B19 (0.3%, 1/340) and CMV+EBV+parvovirus B19 (0.9%, 3/340). Approximately one quarter of patients had no defined cause for their skin rash (25.3%, 86/340). CONCLUSIONS Despite the benign clinical evolution of most of the diseases diagnosed in this series of cases, syndromic surveillance of diseases such as syphilis and HIV are of utmost importance. Periodic serosurveillance might also aid in evaluating the trends of endemic diseases and eventual outbreaks.
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Affiliation(s)
| | - Cosmo Vieira da Rocha Neto
- Programa de Iniciação Científica, Fundação de Medicina Tropical Doutor Heitor Viera Dourado (FMT-HVD), Manaus, Amazonas, Brasil
| | - Yasmin Ferreira Martins
- Programa de Iniciação Científica, Fundação de Medicina Tropical Doutor Heitor Viera Dourado (FMT-HVD), Manaus, Amazonas, Brasil
| | | | - Pâmela Cunha Teixeira
- Fundação de Medicina Tropical Doutor Heitor Viera Dourado (FMT-HVD), Manaus, Amazonas, Brazil
| | - Maianne Yasmin Oliveira Dias
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, Brazil
| | | | | | - Sérgio Damasceno Pinto
- Fundação de Medicina Tropical Doutor Heitor Viera Dourado (FMT-HVD), Manaus, Amazonas, Brazil
| | | | | | - Maria Paula Gomes Mourão
- Fundação de Medicina Tropical Doutor Heitor Viera Dourado (FMT-HVD), Manaus, Amazonas, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, Brazil
| | - Marcus Vinicius Guimarães Lacerda
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, Brazil
- Fundação de Medicina Tropical Doutor Heitor Viera Dourado (FMT-HVD), Manaus, Amazonas, Brazil
- Instituto Leônidas e Maria Deane (ILMD–Fiocruz Amazônia), Manaus, Amazonas, Brazil
| | | | - Camila Bôtto-Menezes
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, Brazil
- Fundação de Medicina Tropical Doutor Heitor Viera Dourado (FMT-HVD), Manaus, Amazonas, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, Brazil
- * E-mail:
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Estofolete CF, de Andrade Gandolfi F, de Aguiar Milhim BH, da Silva GCD, Dourado FS, dos Santos BF, Vasilakis N, Nogueira ML. Reduced Prevalence of Measles Antibodies in a Cohort of Brazilian Children under 15 Years of Age. Vaccines (Basel) 2022; 10:1570. [PMID: 36298435 PMCID: PMC9610750 DOI: 10.3390/vaccines10101570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/17/2022] [Accepted: 09/19/2022] [Indexed: 11/17/2022] Open
Abstract
Measles is a highly contagious acute febrile disease responsible for sporadic but explosive outbreaks worldwide. Although it was considered eliminated from the Americas, the disease reemerged in 2017. This reemergence was linked to reduced immunization rates. Vaccination, early identification of cases, and blocking of the transmission chain are the most effective tools to combat measles, for which there is not a specific antiviral treatment. In this Brazilian prospective cross-sectional study, we investigated the prevalence of measles antibodies in children, a population vulnerable to significant morbidity and mortality from exposure to infection. Between December 2018 to November 2019, blood samples from 252 children were collected and assessed for the presence of measles-specific IgG antibodies and an overall prevalence of 75.8% was observed. We further stratified the cohort into age subgroups, none of which exhibited antibody presence levels above the herd immunity threshold of 94%. Moreover, the calculated number of secondary cases resulting from a case in any age group ranged from 3 to 4, demonstrating that even with partial vaccination coverage this disease is still concerning and highly transmissible. Despite global warnings about measles and previous efforts to combat the advance of the disease, data on antibody prevalence and vaccination coverage in several countries are still concerning and indicate that significant parts of the population could be affected. Seroprevalence studies like this one are important to highlight actual epidemiological conditions and emphasize the need for additional strategies to encourage immunization and avoid the potential impacts of measles, particularly in children who can be severely affected.
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Affiliation(s)
- Cassia Fernanda Estofolete
- Laboratório de Pesquisas em Virologia, Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto 15090-000, SP, Brazil
- Hospital de Base de São José do Rio Preto, São José do Rio Preto 15090-000, SP, Brazil
| | - Flora de Andrade Gandolfi
- Laboratório de Pesquisas em Virologia, Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto 15090-000, SP, Brazil
- Hospital da Criança e Maternidade de São José do Rio Preto, São José do Rio Preto 15091-240, SP, Brazil
| | - Bruno Henrique de Aguiar Milhim
- Laboratório de Pesquisas em Virologia, Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto 15090-000, SP, Brazil
| | - Gislaine Celestino Dutra da Silva
- Laboratório de Pesquisas em Virologia, Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto 15090-000, SP, Brazil
| | - Fernanda Simões Dourado
- Laboratório de Pesquisas em Virologia, Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto 15090-000, SP, Brazil
| | - Bárbara Ferreira dos Santos
- Laboratório de Pesquisas em Virologia, Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto 15090-000, SP, Brazil
- Hospital de Base de São José do Rio Preto, São José do Rio Preto 15090-000, SP, Brazil
| | - Nikos Vasilakis
- Department of Pathology, The University of Texas Medical Branch, Galveston, TX 77555, USA
- Department of Preventive Medicine and Population Health, The University of Texas Medical Branch, Galveston, TX 77555, USA
- Center for Vector-Borne and Zoonotic Diseases, The University of Texas Medical Branch, Galveston, TX 77555, USA
- Center for Biodefense and Emerging Infectious Diseases, The University of Texas Medical Branch, Galveston, TX 77555, USA
- Center for Tropical Diseases, The University of Texas Medical Branch, Galveston, TX 77555, USA
- Institute for Human Infection and Immunity, The University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Maurício Lacerda Nogueira
- Laboratório de Pesquisas em Virologia, Faculdade de Medicina de São José do Rio Preto (FAMERP), São José do Rio Preto 15090-000, SP, Brazil
- Hospital de Base de São José do Rio Preto, São José do Rio Preto 15090-000, SP, Brazil
- Department of Pathology, The University of Texas Medical Branch, Galveston, TX 77555, USA
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Repercussions of the COVID-19 pandemic on preventive health services in Brazil. Prev Med 2022; 155:106914. [PMID: 34953811 PMCID: PMC8716082 DOI: 10.1016/j.ypmed.2021.106914] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 10/12/2021] [Accepted: 12/12/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The increasing burden of non-communicable diseases and limited public financing are major challenges facing health care systems in Latin America. Although COVID-19 severely impacted the Brazilian health care system, it is crucial to further characterize the degree of disruption caused to public health efforts, in order to address and manage long term effects of this pandemic. We therefore quantified the demand for preventive and treatment services from the Brazilian Unified Health System (Sistema Único de Saúde/SUS) in 2020 to evaluate potential repercussions of COVID-19 in this setting. METHODS Using the SUS database, we compared preventative and treatment services rendered in 2020 to the same services rendered from 2017 to 19. We also evaluated the frequency of respiratory infection (RI) diagnoses during the pandemic, relative to the preceding years. RESULTS Compared to 2017-19, in 2020 non-urgent medical appointments decreased 1.4-fold (p = 0.0017), dental consultations 2.8-fold (p = 0.05), and immunization coverage 1.5 fold (p = 0.0005). The number of RI visits to SUS ambulatory care units in 2020 was 4.2 times higher than in preceding years (p = 0.0014), with a peak of 280,898 diagnoses in July 2020. CONCLUSION The COVID-19 pandemic appears to have led to a dramatic decline in preventative and treatment services provided by SUS to the Brazilian population. Our findings may aid decision-makers in formulating policies to increase the availability of outpatient services in the aftermath of the pandemic. Counter measures will be critical to avoid a resurgence in vaccine-preventable diseases and complications stemming from non-communicable, chronic health conditions.
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Oliveira GCCFD, Rodrigues RN, Silva MCD, Nascimento GLMD, Lanza FM, Gusmão JD, Oliveira VCD, Guimarães EADA. Cobertura vacinal infantil de hepatite A, tríplice viral e varicela: análise de tendência temporal em Minas Gerais, Brasil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2022; 25:e220010. [DOI: 10.1590/1980-549720220010.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/17/2022] [Indexed: 11/22/2022] Open
Abstract
RESUMO: Objetivo: Analisar a tendência temporal da cobertura vacinal de hepatite A, tríplice viral e varicela em um estado brasileiro no período de 2014 a 2020. Métodos: Estudo ecológico de séries temporais, que considerou dados dos 853 municípios de Minas Gerais que compõem as 14 regiões do estado, sendo estas as unidades territoriais de análise. Foram analisados registros de doses aplicadas das vacinas hepatite A, tríplice viral e varicela registrados no Sistema de Informação de Imunização do Brasil. As tendências foram estimadas pela regressão de Prais-Winsten e calculados os intervalos de confiança 95% das medidas de variação. Resultados: Identificaram-se baixas coberturas vacinais de hepatite A, tríplice viral e varicela. Coberturas acima de 95% foram observadas somente no ano de 2015 para a vacina contra hepatite A (98,8%) e, em 2016, para a varicela (98,4%). A vacina tríplice viral apresentou cobertura inferior a 95% em todos os anos analisados. Uma queda de 13,6 e 4,3% entre os anos de 2019 e 2020 foi identificada para as vacinas tríplice viral e hepatite A, respectivamente. Observou-se tendência decrescente na cobertura vacinal da hepatite A nas regiões Sul (p=0,041), Leste (p=0,030) e Norte (p=0,045); para a tríplice viral, nas regiões Jequitinhonha (p=0,002), Leste (p=0,004) e Norte (p=0,024). A cobertura crescente foi observada somente para a varicela em oito regiões do estado. Conclusões: Os dados apontam heterogeneidade no comportamento temporal das coberturas vacinais em Minas Gerais. A tendência decrescente em algumas regiões desperta preocupação pela possibilidade do recrudescimento de doenças, como o sarampo, até então controladas.
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Oliveira GCCFD, Rodrigues RN, Silva MCD, Nascimento GLMD, Lanza FM, Gusmão JD, Oliveira VCD, Guimarães EADA. Childhood vaccination coverage of hepatitis A, measles, mumps and rubella, and varicella: temporal trend analysis in Minas Gerais, Brazil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2022. [DOI: 10.1590/1980-549720220010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT: Objective: To analyze the temporal trend of vaccination coverage for hepatitis A, measles, mumps and rubella, and varicella in a Brazilian state from 2014 to 2020. Methods: An ecological, time-series study that considered data from 853 municipalities in the state of Minas Gerais that compose the 14 regions of the state, these being the territorial units of analysis. Records of applied doses of hepatitis A, measles, mumps and rubella, and varicella vaccines registered in the Brazilian Immunization Information System were analyzed. Trends were estimated by Prais-Winsten regression and 95% confidence intervals of measures of variation were calculated. Results: Low vaccine coverage of hepatitis A, measles, mumps and rubella, and varicella was identified. Coverages above 95% were observed only in 2015 for the vaccine against hepatitis A (98.8%) and, in 2016, for varicella (98.4%). The measles, mumps and rubella vaccine showed coverage of less than 95% in all analyzed years. Decreases of 13.6 and 4.3% between the years 2019 and 2020 were identified for the measles, mumps and rubella, and hepatitis A vaccines, respectively. There was a decreasing trend in hepatitis A vaccination coverage in the South (p=0.041), East (p=0.030), and North (p=0.045) regions; and for the measles, mumps and rubella in Jequitinhonha Valley (p=0.002), East (p=0.004), and North (p=0.024) regions. Increasing coverage was observed only for varicella in eight regions of the state. Conclusions: The data point to heterogeneity in the temporal behavior of vaccination coverage in Minas Gerais. The downward trend in some regions causes concern about the possibility of resurgence of diseases, such as measles, which until then had been controlled.
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Williams SG, Fontaine RE, Turcios Ruiz RM, Walke H, Ijaz K, Baggett HC. One Field Epidemiologist per 200,000 Population: Lessons Learned from Implementing a Global Public Health Workforce Target. Health Secur 2020; 18:S113-S118. [PMID: 32004135 DOI: 10.1089/hs.2019.0119] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The World Health Organization monitoring and evaluation framework for the International Health Regulations (IHR, 2005) describes the targets for the Joint External Evaluation (JEE) indicators. For workforce development, the JEE defines the optimal target for attaining and complying with the IHR (2005) as 1 trained field epidemiologist (or equivalent) per 200,000 population. We explain the derivation and use of the current field epidemiology workforce development target and identify the limitations and lessons learned in applying it to various countries' public health systems. This article also proposes a way forward for improvements and implementation of this workforce development target.
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Affiliation(s)
- Seymour G Williams
- Seymour G. Williams, MD, is Team Lead, Field Epidemiology Training Program; Robert E. Fontaine, MD, is Senior Advisor, Field Epidemiology Training Program; Reina M. Turcios Ruiz, MD, is Team Lead, Monitoring and Evaluation; all in the Workforce and Institute Development Branch, Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention (CDC), Atlanta, GA. Henry Walke, MD, is Director, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, GA. Kashef Ijaz, MD, is Principal Deputy Director, and Henry C. Baggett, MD, is Chief, Workforce and Institute Development Branch; both in the Division of Global Health Protection, Center for Global Health, CDC, Atlanta, GA. Dr. Williams and Dr. Baggett are senior co-authors. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention
| | - Robert E Fontaine
- Seymour G. Williams, MD, is Team Lead, Field Epidemiology Training Program; Robert E. Fontaine, MD, is Senior Advisor, Field Epidemiology Training Program; Reina M. Turcios Ruiz, MD, is Team Lead, Monitoring and Evaluation; all in the Workforce and Institute Development Branch, Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention (CDC), Atlanta, GA. Henry Walke, MD, is Director, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, GA. Kashef Ijaz, MD, is Principal Deputy Director, and Henry C. Baggett, MD, is Chief, Workforce and Institute Development Branch; both in the Division of Global Health Protection, Center for Global Health, CDC, Atlanta, GA. Dr. Williams and Dr. Baggett are senior co-authors. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention
| | - Reina M Turcios Ruiz
- Seymour G. Williams, MD, is Team Lead, Field Epidemiology Training Program; Robert E. Fontaine, MD, is Senior Advisor, Field Epidemiology Training Program; Reina M. Turcios Ruiz, MD, is Team Lead, Monitoring and Evaluation; all in the Workforce and Institute Development Branch, Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention (CDC), Atlanta, GA. Henry Walke, MD, is Director, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, GA. Kashef Ijaz, MD, is Principal Deputy Director, and Henry C. Baggett, MD, is Chief, Workforce and Institute Development Branch; both in the Division of Global Health Protection, Center for Global Health, CDC, Atlanta, GA. Dr. Williams and Dr. Baggett are senior co-authors. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention
| | - Henry Walke
- Seymour G. Williams, MD, is Team Lead, Field Epidemiology Training Program; Robert E. Fontaine, MD, is Senior Advisor, Field Epidemiology Training Program; Reina M. Turcios Ruiz, MD, is Team Lead, Monitoring and Evaluation; all in the Workforce and Institute Development Branch, Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention (CDC), Atlanta, GA. Henry Walke, MD, is Director, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, GA. Kashef Ijaz, MD, is Principal Deputy Director, and Henry C. Baggett, MD, is Chief, Workforce and Institute Development Branch; both in the Division of Global Health Protection, Center for Global Health, CDC, Atlanta, GA. Dr. Williams and Dr. Baggett are senior co-authors. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention
| | - Kashef Ijaz
- Seymour G. Williams, MD, is Team Lead, Field Epidemiology Training Program; Robert E. Fontaine, MD, is Senior Advisor, Field Epidemiology Training Program; Reina M. Turcios Ruiz, MD, is Team Lead, Monitoring and Evaluation; all in the Workforce and Institute Development Branch, Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention (CDC), Atlanta, GA. Henry Walke, MD, is Director, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, GA. Kashef Ijaz, MD, is Principal Deputy Director, and Henry C. Baggett, MD, is Chief, Workforce and Institute Development Branch; both in the Division of Global Health Protection, Center for Global Health, CDC, Atlanta, GA. Dr. Williams and Dr. Baggett are senior co-authors. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention
| | - Henry C Baggett
- Seymour G. Williams, MD, is Team Lead, Field Epidemiology Training Program; Robert E. Fontaine, MD, is Senior Advisor, Field Epidemiology Training Program; Reina M. Turcios Ruiz, MD, is Team Lead, Monitoring and Evaluation; all in the Workforce and Institute Development Branch, Division of Global Health Protection, Center for Global Health, US Centers for Disease Control and Prevention (CDC), Atlanta, GA. Henry Walke, MD, is Director, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Atlanta, GA. Kashef Ijaz, MD, is Principal Deputy Director, and Henry C. Baggett, MD, is Chief, Workforce and Institute Development Branch; both in the Division of Global Health Protection, Center for Global Health, CDC, Atlanta, GA. Dr. Williams and Dr. Baggett are senior co-authors. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention
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Hébert-Dufresne L, Scarpino SV, Young JG. Macroscopic patterns of interacting contagions are indistinguishable from social reinforcement. NATURE PHYSICS 2020; 16:426-431. [PMID: 34221104 PMCID: PMC8247125 DOI: 10.1038/s41567-020-0791-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 01/07/2020] [Indexed: 05/14/2023]
Abstract
From fake news to innovative technologies, many contagions spread as complex contagions via a process of social reinforcement, where multiple exposures are distinct from prolonged exposure to a single source.1 Contrarily, biological agents such as Ebola or measles are typically thought to spread as simple contagions.2 Here, we demonstrate that these different spreading mechanisms can have indistinguishable population-level dynamics once multiple contagions interact. In the social context, our results highlight the challenge of identifying and quantifying spreading mechanisms, such as social reinforcement,3 in a world where an innumerable amount of ideas, memes and behaviors interact. In the biological context, this parallel allows the use of complex contagions to effectively quantify the non-trivial interactions of infectious diseases.
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Affiliation(s)
- Laurent Hébert-Dufresne
- Department of Computer Science, University of Vermont, Burlington, VT 05405, USA
- Vermont Complex Systems Center, University of Vermont, Burlington, VT 05405, USA
- Département de physique, de génie physique et d'optique, Université Laval, Québec (Québec), Canada G1V 0A6
| | - Samuel V Scarpino
- Network Science Institute, Northeastern University, Boston, MA 02115, USA
- Marine & Environmental Sciences, Northeastern University, Boston, MA 02115, USA
- Physics, Northeastern University, Boston, MA 02115, USA
- Health Sciences, Northeastern University, Boston, MA 02115, USA
- Dharma Platform, Washington, DC 20005, USA
- ISI Foundation, 10126 Turin, Italy
| | - Jean-Gabriel Young
- Center for the Study of Complex Systems, University of Michigan, Ann Arbor, MI 48109, USA
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Measles-containing vaccines in Brazil: Coverage, homogeneity of coverage and associations with contextual factors at municipal level. Vaccine 2020; 38:1881-1887. [DOI: 10.1016/j.vaccine.2020.01.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 12/30/2019] [Accepted: 01/09/2020] [Indexed: 11/22/2022]
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Rodríguez-Morales AJ, Suárez JA, Risquez A, Cimerman S, Valero-Cedeño N, Cabrera M, Grobusch MP, Paniz-Mondolfi A. In the eye of the storm: Infectious disease challenges for border countries receiving Venezuelan migrants. Travel Med Infect Dis 2019; 30:4-6. [DOI: 10.1016/j.tmaid.2019.05.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 05/22/2019] [Indexed: 12/31/2022]
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15
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Trends and spatial distribution of MMR vaccine coverage in Brazil during 2007–2017. Vaccine 2019; 37:2651-2655. [DOI: 10.1016/j.vaccine.2019.04.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 04/05/2019] [Accepted: 04/09/2019] [Indexed: 11/23/2022]
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Pacheco FC, França GVA, Elidio GA, Oliveira CM, Guilhem DB. Decrease in the coverage of measles-containing vaccines and the risk of reestablishing endemic transmission of measles in Brazil. Int J Infect Dis 2019; 82:51-53. [PMID: 30878631 DOI: 10.1016/j.ijid.2019.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 11/18/2022] Open
Affiliation(s)
- Flávia C Pacheco
- Post-Graduation Program in Health Sciences, University of Brasília, Brasília-DF, Brazil; Secretariat of Health Surveillance, Ministry of Health, Brasília-DF, Brazil.
| | - Giovanny V A França
- Post-Graduation Program in Health Sciences, University of Brasília, Brasília-DF, Brazil; Secretariat of Health Surveillance, Ministry of Health, Brasília-DF, Brazil
| | - Guilherme A Elidio
- Secretariat of Health Surveillance, Ministry of Health, Brasília-DF, Brazil
| | - Cesar M Oliveira
- Department of Epidemiology & Public Health, University College London, London, UK
| | - Dirce B Guilhem
- Post-Graduation Program in Health Sciences, University of Brasília, Brasília-DF, Brazil
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