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Background Although rare, Guillain-Barré Syndrome (GBS) has a high economic burden, with consequences for families and society. This study aimed to estimate the total cost of GBS, per individual and per variant of the disease, as well as its effect on household income, from the perspective of patients. Methods This was a cost-of-illness study from the perspective of patients and their families, with a time horizon from disease onset to 6 mo after discharge. The total cost of GBS was estimated by bottom-up microcosting, considering direct and indirect costs. Results The median cost of GBS per individual was US$1635.5, with direct costs accounting for 64.3% of this amount. Among the variants analyzed, acute motor sensory axonal neuropathy (US$4660.1) and acute inflammatory demyelinating polyneuropathy (US$2017.0) exhibited the highest costs compared with acute motor axonal neuropathy (US$1635.5) and Miller Fisher Syndrome (US$1464.8). The costs involved compromise more than 20% of the household income of 22 (47.8%) patients. Conclusions This study demonstrated how costly GBS can be. It is hoped that decision-makers will analyze these results with a view to improving the structure of healthcare services.

There are millions of waste pickers worldwide that are predominantly located in low- and middle-income countries. They survive on sorting and selling reusable orrecyclable materials discarded by society.While sorting, they are exposed to occupational risks and hazards, including cuts from sharp objects and medical wastes, that could be contaminated by infectious diseases. Because of these exposures, a study was conducted to determine the prevalence of syphilis and other sexually transmitted infections (STI's) among waste pickers. A cross-sectional study using a semi-structured questionnaire and blood samples for serological tests were collected. A total of 1,025 waste pickers were interviewed. Most participants were women (67.54%), without a partner (70.11%), were an average of 40 years old, and had between 3 and 4 children. There were 755 samples collected for syphilis, 791 for HIV, 866 for hepatitis B, and 859 for hepatitis C. Of these samples, 28 (3.70%) waste pickers had reagent serology for syphilis, 6 (0.75%) for HIV; 6 (0.69%) for acute hepatitis B and 1 (0.11%) for hepatitis C. Overall, this study identified the serological status of waste pickers; this information can be used to encourage waste pickers to seek health treatment for STIs and receive education to understand the risks associated with being exposed to medical waste or syringes.

To evaluate factors affecting corneal endothelial cell density (ECD) under enucleation and preservation time studies at Eye Bank of the Federal District of Brazil. We conducted a case–control study collecting data from 1128 corneas where death-to-enucleation time and enucleation-to-preservation time were within 24 h. Low cell count were those corneas with an ECD less than 2000 cells/mm2 and high cell count was defined as those with ECD greater than 2000 cells/mm2. We calculated the independent risk factors related to: cause of death, donor age, death-to-enucleation time, enucleation-to-preservation time and primary graft failure. Correlation analysis was used to assess which parameters influence ECD: death-to-enucleation time, enucleation-to-preservation time, average cell area (AVE), coefficient of variation and percentage of hexagonal cells. Of the total number of corneas, 1004 had ECD data and were selected for the study. 87.4% (n = 877) had high cell counts with 2699 ± 412 cells/mm2. The mean donor age was 38.8 ± 16 years. The most common causes of death were external causes (48.6%, n = 488). Longer times from death-to-enucleation, up to 24 h were not associated with a decrease in ECD (OR 0.58; P = 0.44) or risk of graft survival (P = 0.74). Enucleation-to-preservation intervals greater than 12 h showed increased risk of graft survival (P = 0.04). AVE was the main parameter for ECD (R2 = 0.96, P

Objective To estimate the effectiveness of the inactivated whole virus vaccine, CoronaVac (Sinovac Biotech), against symptomatic covid-19 in the elderly population of São Paulo state, Brazil during widespread circulation of the gamma variant. Design Test negative case-control study. Setting Community testing for covid-19 in São Paulo state, Brazil. Participants 43 774 adults aged ≥70 years who were residents of São Paulo state and underwent reverse transcription polymerase chain reaction (RT-PCR) testing for SARS-CoV-2 from 17 January to 29 April 2021. 26 433 cases with symptomatic covid-19 and 17 622 test negative controls with covid-19 symptoms were formed into 13 283 matched sets, one case with to up to five controls, according to age, sex, self-reported race, municipality of residence, previous covid-19 status, and date of RT-PCR test (±3 days). Intervention Vaccination with a two dose regimen of CoronaVac. Main outcome measures RT-PCR confirmed symptomatic covid-19 and associated hospital admissions and deaths. Results Adjusted vaccine effectiveness against symptomatic covid-19 was 24.7% (95% confidence interval 14.7% to 33.4%) at 0-13 days and 46.8% (38.7% to 53.8%) at ≥14 days after the second dose. Adjusted vaccine effectiveness against hospital admissions was 55.5% (46.5% to 62.9%) and against deaths was 61.2% (48.9% to 70.5%) at ≥14 days after the second dose. Vaccine effectiveness ≥14 days after the second dose was highest for the youngest age group (70-74 years)—59.0% (43.7% to 70.2%) against symptomatic disease, 77.6% (62.5% to 86.7%) against hospital admissions, and 83.9% (59.2% to 93.7%) against deaths—and declined with increasing age. Conclusions Vaccination with CoronaVac was associated with a reduction in symptomatic covid-19, hospital admissions, and deaths in adults aged ≥70 years in a setting with extensive transmission of the gamma variant. Vaccine protection was, however, low until completion of the two dose regimen, and vaccine effectiveness was observe to decline with increasing age among this elderly population.

BackgroundA two-dose regimen of ChAdOx1 coronavirus disease 19 (Covid-19) vaccine with an inter-dose interval of three months has been implemented in many countries with restricted vaccine supply. However, there is limited evidence for the effectiveness of ChAdOx1 by dose in elderly populations in countries with high prevalence of the Gamma variant of severe acute respiratory syndrome 2 (SARS-CoV-2).MethodsWe conducted a test-negative case-control study to estimate the effectiveness of ChAdOx1 vaccine in adults aged 60 years or older during a Gamma-variant-associated epidemic in São Paulo state, Brazil, between 17 January and 2 July 2021. Cases and matched test-negative controls were individuals, identified from surveillance databases, who experienced an acute respiratory illness and underwent SARS-CoV-2 RT-PCR testing. We used conditional logistic regression to estimate the effectiveness by dose against RT-PCR-confirmed Covid-19, Covid-19 hospitalization, and Covid-19-related death.Results61,164 individuals were selected into matched case-control pairs. Starting ≥28 days after the first dose, adjusted effectiveness of a single dose of ChAdOx1 was 33.4% (95% CI, 26.4 to 39.7) against Covid-19, 55.1% (95% CI, 46.6 to 62.2) against hospitalization, and 61.8% (95% CI, 48.9 to 71.4) against death. Starting ≥14 days after the second dose, the adjusted effectiveness of the two-dose schedule was 77.9% (95% CI, 69.2 to 84.2) against Covid-19, 87.6% (95% CI, 78.2 to 92.9) against hospitalization, and 93.6% (95% CI, 81.9 to 97.7) against death.ConclusionsCompletion of the ChAdOx1 vaccine schedule afforded significantly increased protection over a single dose against mild and severe Covid-19 outcomes in elderly individuals during widespread Gamma variant transmission.

Background The inadequate management of solid waste impacts populations’ health and quality of life, and disproportionately affects developing countries. This study aims to describe a protocol for epidemiological diagnosis, the purpose being to estimate the prevalence of chronic and communicable and non communicable diseases in waste pickers, and the occupational and environmental risk factors to which these are exposed. Methods This is a cross-sectional study, based on survey design in an area of extreme social vulnerability – the largest garbage dump in Latin America. Using a multidimensional research protocol, divided in three stages: 1- The identification of the subjects, and the scheduling of tests; 2- Situational diagnosis through interviews, anthropometric evaluation, measuring blood pressure, collecting hair and nail samples to detect exposure to heavy metals and undertaking laboratory tests; 3- The return of the waste pickers to receive the test results, followed by referral to the health team and to report occupational accidents. Results One thousand twenty-five waste pickers undertook tests and interviews. The majority were women (67.0%), with 36–45 years old (45.7%), and 96.0% had children. In total, 27.3% of the participants did not attend to any school and 47.7% were educated only up to primary level. The majority of waste pickers (68.70%) reported accidents and most of them (89.69%) were related to sharp objects. The mean time working in this open dump was 15 years. According the anthropometric measure, 32.6% were overweight and 21.1% were obese. The most common reported diseases were: osteomuscular disorders (78.7%); arboviruses (28.6%); episodic diarrhea (24.9%); hypertension (24.2%); bronchitis (14.3%); intestinal worms (12.6%) and diabetes (10.1%). According to the blood tests, the values outside the reference limits were: Uric acid (23.89%); creatinine (54.06%); GGT range (16.04%); SGOT - Serum Glutamic Oxaloacetic Transaminase (5.29%); SGPT - serum Glutamic-Pyruvic Transaminase (35.52%). Conclusions This study is the first to evaluate multiple risks and diseases in the majority of waste pickers working in the largest garbage dump of a continent. These findings highlight the importance to address urgently the environmental, social and health impacts related to the management of solid waste in developmental countries to protect these workers and their families. Electronic supplementary material The online version of this article (10.1186/s12889-019-6879-x) contains supplementary material, which is available to authorized users.

RESUMO O objetivo foi caracterizar o ambiente de trabalho por meio da Norma Regulamentadora 17 do Ministério do Trabalho (NR-17); avaliar a fadiga residual e estimar o risco da sua exposição e a presença de desconforto musculoesquelético de profissionais da saúde que atuam em um hospital público. Trata-se de estudo transversal composto por duas etapas: (1) observação do ambiente de trabalho por meio da NR-17, adaptada em checklist; e (2) avaliação do desconforto e fadiga por meio de questionários. Os dados foram analisados descritivamente. A associação entre fadiga e desconforto foi verificada pelo qui-quadrado e o teste de Mann-Whitney comparou a idade, tempo de instituição e carga horária (horas/semana) entre os grupos estratificados (com fadiga/sem fadiga e com desconforto/sem desconforto). Foram avaliados 20 setores, dos quais a Farmácia teve a maior frequência de inadequação (83%) e a UTI Adulto mostrou-se o mais adequado (24% de itens inadequados). Verificou-se uma alta prevalência de desconforto, principalmente na coluna. A fadiga estava presente em mais de 70% dos profissionais. Indivíduos com maior idade apresentaram mais queixas de desconforto. O presente estudo demonstrou uma alta frequência de inadequações ergonômicas em ambiente de trabalho hospitalar, principalmente no setor da Farmácia e Ambulatório. A alta prevalência de desconforto na coluna e a fadiga demonstram a relevância de ações preventivas no ambiente hospitalar. RESUMEN El objetivo fue caracterizar el ambiente laboral por medio de la Norma Reguladora n.º 17 del Ministerio de Trabajo (NR-17); evaluar la fatiga residual y también estimar el riesgo de exposición y la presencia de incomodidad musculoesquelética de profesionales de la salud que actúan en un hospital público. Este estudio transversal consta de dos fases: (1) la observación del entorno de trabajo por la NR-17, lista de control adaptada; y (2) la evaluación de la incomodidad y la fatiga por medio de cuestionarios. Los datos se analizaron de forma descriptiva. La asociación entre fatiga y molestia se verificó mediante el test chi-cuadrado, y la prueba de Mann-Whitney se utilizó para comparar la edad, el tiempo de institución y la carga horaria (horas/semana) entre los grupos estratificados (con fatiga/sin fatiga y con incomodidad/sin molestias). Se evaluaron 20 sectores, de los cuales la Farmacia tuvo la mayor frecuencia de inadecuación (83%) y la UCI Adulto se mostró la más adecuada (un 24% de ítems inadecuados). Se observó una alta prevalencia de incomodidad, principalmente en la columna. La fatiga estaba presente en más del 70% de los profesionales. Los individuos de mayor edad presentaron más quejas de malestar. El presente estudio demostró una alta frecuencia de inadecuaciones ergonómicas en el ambiente laboral hospitalario, principalmente en el sector de la Farmacia y del Ambulatorio. La alta prevalencia de incomodidad en la columna y la fatiga demuestran la relevancia de acciones preventivas en el ambiente hospitalario. ABSTRACT This study’s objective was to employ Regulation-17 (NR-17) of Brazil’s Ministry of Labor to describe the work environment of health professionals of a public hospital, while also evaluating fatigue and estimating their risk of exposure to it, as well as the presence of musculoskeletal discomfort. This was a cross-sectional study consisting of two phases: 1) Observation of the work environment by means of the NR-17, adapted as a checklist; 2) Evaluation of discomfort and fatigue by means of questionnaires. Data were analyzed descriptively. The association between fatigue and discomfort was assessed using the chi-square test, while the Mann-Whitney test was used to compare age, service time at the institution and weekly working hours across the stratified groups (with fatigue/without fatigue, with discomfort/without discomfort). Twenty sectors were evaluated. The sector with the highest frequency of inadequacy was Pharmacy (83% inadequate items), while the Adult ICU was the most adequate (only 24% inadequate items). There was a high prevalence of discomfort, especially in the spine. Fatigue was present in more than 70% of professionals. Older individuals presented more complaints of discomfort. This study demonstrates a high frequency of ergonomic inadequacies in the hospital’s work environment, mainly in the Pharmacy and Ambulatory sectors. The high prevalence of spine discomfort and fatigue emphasizes the relevance of preventive actions in the hospital environment.

Background Mass vaccination is being used in response to coronavirus disease (COVID-19) epidemics, including those driven by emerging variants of concern. We evaluated the effectiveness of the inactivated whole-virus vaccine, CoronaVac, against symptomatic COVID-19 in the elderly population of Sao Paulo State, Brazil during widespread circulation of the P.1 variant. Methods We conducted a test-negative, case-control study of adults ≥70 years of age from Sao Paulo State from January 17 to April 29, 2021, during which vaccination with a two-dose regimen of CoronaVac was implemented. We identified RT-PCR-confirmed COVID-19 cases as well as controls who had a symptomatic illness with a negative RT-PCR test from national surveillance and state vaccination databases. Controls were pair-matched to cases by age category, sex, self-report race, municipality, prior COVID-19 status, and date of RT-PCR testing. We estimated vaccine effectiveness, adjusted for age and comorbidities, using conditional logistic regression. Findings We selected 7,950 matched pairs with a mean age of 76 years from 26,433 COVID-19 cases and 17,622 test-negative controls. Adjusted vaccine effectiveness was 18.2% (95% CI, 0.0 to 33.2) and 41.6% (95% CI, 26.9 to 53.3) in the period 0-13 and ≥14 days, respectively, after the 2nd dose. Administration of a single vaccine dose was not associated with reduced odds of COVID-19. Vaccine effectiveness ≥14 days after the 2nd dose declined with increasing age and was 61.8% (95% CI 34.8 to 77.7), 48.9% (95% CI 23.3 to 66.0) and 28.0% (95% CI 0.6 to 47.9) among individuals 70-74, 75-79 and ≥80 years of age, respectively (pinteraction = 0.05). Interpretation CoronaVac was 42% effective in the real-world setting of extensive P.1 transmission, but significant protection was not observed until completion of the two-dose regimen and vaccine effectiveness declined with increasing age. These findings underscore the need to maintain non-pharmaceutical interventions when mass vaccination with CoronaVac is used as part of an epidemic response. Funding Pan American Health Organization. Research in context Evidence before this study We searched Pubmed for articles published from inception of the pandemic until May 10, 2021, with no language restrictions, using the search terms “vaccine”, “COVID-19”, “SARS-CoV-2”, “elderly”, “age”, “older”. Randomised controlled trials (RCTs) have yielded varying estimates (51-84%) for the effectiveness of the inactivated whole-virus vaccine, CoronaVac, against symptomatic COVID-19. Current evidence is lacking on whether CoronaVac or other COVID-19 vaccines are effective against disease caused by the SARS-CoV-2 variant of concern, P.1, or in a setting of extensive P.1 circulation. No studies have reported the real-world effectiveness of CoronaVac and other inactivated vaccines among elderly individuals, a population that was underrepresented in RCTs of these vaccines. Added value of this study In a population-based matched test-negative case-control study, we found that a two-dose regimen of CoronaVac had an effectiveness of 42% in preventing symptomatic COVID-19 among adults ≥70 years of age during an epidemic associated with widespread P.1 variant transmission. Significant protection was not observed until the period ≥14 days after administration of the second dose. We observed a significant decline in vaccine effectiveness with increasing age in the elderly population. Implications of all the available evidence In the setting of extensive P.1 transmission, the effectiveness of CoronaVac in adults ≥70 years of age was similar to that observed in RCTs conducted in younger populations prior to the emergence of P.1. These findings provide supportive evidence for the use of this vaccine in countries that are experiencing P.1-associated epidemics. However, significant protection was not detected until after administration of the second dose, indicating that vaccination in countries where CoronaVac supplies are constrained may need to prioritize completion of the two dose regimen among the highest risk populations. The delay in achieving vaccine-mediated protection also underscores the need to initiate and maintain non-pharmaceutical interventions when mass vaccination with CoronaVac is used in a response to an epidemic. National immunisation programs should optimise the vaccination of the very elderly (≥80 years), accounting for specific vaccines or vaccination schemes.

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant, Gamma, emerged in the city of Manaus in late 2020 during a large resurgence of coronavirus disease (COVID-19), and has spread throughout Brazil. The effectiveness of vaccines in settings with widespread Gamma variant transmission has not been reported. Methods We performed a matched test-negative case-control study to estimate the effectiveness of an inactivated vaccine, CoronaVac, in healthcare workers (HCWs) in Manaus, where the Gamma variant accounted for 86% of genotyped SARS-CoV-2 samples at the peak of its epidemic. We performed an early analysis of effectiveness following administration of at least one vaccine dose and an analysis of effectiveness of the two-dose schedule. The primary outcome was symptomatic SARS-CoV-2 infection. Findings For the early at-least-one-dose and two-dose analyses the study population was, respectively, 53,176 and 53,153 HCWs residing in Manaus and aged 18 years or older, with complete information on age, residence, and vaccination status. Among 53,153 HCWs eligible for the two-dose analysis, 47,170 (89%) received at least one dose of CoronaVac and 2,656 individuals (5%) underwent RT-PCR testing from 19 January, 2021 to 13 April, 2021. Of 3,195 RT-PCR tests, 885 (28%) were positive. 393 and 418 case-control pairs were selected for the early and two-dose analyses, respectively, matched on calendar time, age, and neighbourhood. Among those who had received both vaccine doses before the RT-PCR sample collection date, the average time from second dose to sample collection date was 14 days (IQR 7-24). In the early analysis, vaccination with at least one dose was associated with a 0.50-fold reduction (adjusted vaccine effectiveness (VE), 49.6%, 95% CI 11.3 to 71.4) in the odds of symptomatic SARS-CoV-2 infection during the period 14 days or more after receiving the first dose. However, we estimated low effectiveness (adjusted VE 36.8%, 95% CI -54.9 to 74.2) of the two-dose schedule against symptomatic SARS-CoV-2 infection during the period 14 days or more after receiving the second dose. A finding that vaccinated individuals were much more likely to be infected than unvaccinated individuals in the period 0-13 days after first dose (aOR 2.11, 95% CI 1.36-3.27) suggests that unmeasured confounding led to downward bias in the vaccine effectiveness estimate. Interpretation Evidence from this test-negative study of the effectiveness of CoronaVac was mixed, and likely affected by bias in this setting. Administration of at least one vaccine dose showed effectiveness against symptomatic SARS-CoV-2 infection in the setting of epidemic Gamma variant transmission. However, the low estimated effectiveness of the two-dose schedule underscores the need to maintain non-pharmaceutical interventions while vaccination campaigns with CoronaVac are being implemented. Funding Fundacao Oswaldo Cruz (Fiocruz); Municipal Health Secretary of Manaus; Fundacao de Vigilância em Saude do Amazonas

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant, Gamma, emerged in the city of Manaus in late 2020 during a large resurgence of coronavirus disease (COVID-19), and has spread throughout Brazil. The effectiveness of vaccines in settings with widespread Gamma variant transmission has not been reported.MethodsWe performed a matched test-negative case-control study to estimate the effectiveness of an inactivated vaccine, CoronaVac, in healthcare workers (HCWs) in Manaus, where the Gamma variant accounted for 86% of genotyped SARS-CoV-2 samples at the peak of its epidemic. We performed an early analysis of effectiveness following administration of at least one vaccine dose and an analysis of effectiveness of the two-dose schedule. The primary outcome was symptomatic SARS-CoV-2 infection.FindingsFor the early at-least-one-dose and two-dose analyses the study population was, respectively, 53,176 and 53,153 HCWs residing in Manaus and aged 18 years or older, with complete information on age, residence, and vaccination status. Among 53,153 HCWs eligible for the two-dose analysis, 47,170 (89%) received at least one dose of CoronaVac and 2,656 individuals (5%) underwent RT-PCR testing from 19 January, 2021 to 13 April, 2021. Of 3,195 RT-PCR tests, 885 (28%) were positive. 393 and 418 case- control pairs were selected for the early and two-dose analyses, respectively, matched on calendar time, age, and neighbourhood. Among those who had received both vaccine doses before the RT-PCR sample collection date, the average time from second dose to sample collection date was 14 days (IQR 7-24). In the early analysis, vaccination with at least one dose was associated with a 0.50-fold reduction (adjusted vaccine effectiveness (VE), 49.6%, 95% CI 11.3 to 71.4) in the odds of symptomatic SARS-CoV-2 infection during the period 14 days or more after receiving the first dose. However, we estimated low effectiveness (adjusted VE 36.8%, 95% CI -54.9 to 74.2) of the two-dose schedule against symptomatic SARS-CoV-2 infection during the period 14 days or more after receiving the second dose. A finding that vaccinated individuals were much more likely to be infected than unvaccinated individuals in the period 0-13 days after first dose (aOR 2.11, 95% CI 1.36-3.27) suggests that unmeasured confounding led to downward bias in the vaccine effectiveness estimate.InterpretationEvidence from this test-negative study of the effectiveness of CoronaVac was mixed, and likely affected by bias in this setting. Administration of at least one vaccine dose showed effectiveness against symptomatic SARS-CoV-2 infection in the setting of epidemic Gamma variant transmission. However, the low estimated effectiveness of the two-dose schedule underscores the need to maintain non-pharmaceutical interventions while vaccination campaigns with CoronaVac are being implemented.FundingFundação Oswaldo Cruz (Fiocruz); Municipal Health Secretary of ManausResearch in ContextEvidence before this studyWe searched PubMed for articles published from inception of the pandemic until April 3, 2021, with no language restrictions, using the search terms “P.1” AND “vaccine” AND “SARS-CoV-2”. Additionally, we searched for “CoronaVac” AND “SARS-CoV-2”. Early studies have found plasma from convalescent COVID-19 patients and sera from vaccinated individuals have reduced neutralisation of the SARS-CoV-2 variant, Gamma or P.1, compared with strains isolated earlier in the pandemic. Pfizer BNT162b2 mRNA, Oxford-AstraZeneca ChAdOx1, and CoronaVac are the only vaccines for which such data has been published to date.No studies reported effectiveness of any vaccine on reducing the risk of infection or disease among individuals exposed to P.1 or in settings of high P.1 transmission.Added value of this studyThis study finds that vaccination with CoronaVac was 49.4% (95% CI 13.2 to 71.9) effective at preventing COVID-19 in a setting with likely high prevalence of the Gamma Variant of Concern. However, an analysis of effectiveness by dose was underpowered and failed to find significant effectiveness of the two-dose schedule of CoronaVac (estimated VE 37.1%, 95% CI -53.3 to 74.2).Implications of all the available evidenceThese findings are suggestive for the effectiveness of CoronaVac in healthcare workers in the setting of widespread P.1 transmission but must be strengthened by observational studies in other settings and populations. Based on this evidence, there is a need to implement sustained non-pharmaceutical interventions even as vaccination campaigns continue.

Background Treatment outcomes were evaluated of a cohort of new pulmonary tuberculosis (TB) cases that were rifampicin resistant, multidrug-resistant, or extensively resistant during 2013 and 2014 in Brazil. The objective of this study is to identify factors associated with unfavorable treatment outcomes for drug-resistant TB cases. Methods The Brazilian Special Tuberculosis Treatment Information System (SITE-TB) was the main data source. The independent variables were classified into four blocks (block I: individual characteristics; block II: clinical characteristics and proposed treatment; block III: treatment follow-up characteristics; and block IV: TB history). The category of successful therapeutic outcome was compared with lost to follow-up, failure, and death. Considering the multiple outcomes as the dependent variable, the odds ratios (OR) and its respective 95% confidence interval (95% CI) were estimated by multinomial logistic regression. Results After applying the exclusion criteria, 980 (98.8%) individuals were included in the study. Of these, 621 (63.4%) had successful treatment, 163 (16.6%) lost to follow-up, 76 (7.8%) failed, and 120 (12.2%) died. Important factors associated with lost to follow-up in the final model included use of illicit drugs (OR = 2.5 95% CI: 1.57–3.82). Outcome failure was associated with having disease in both lungs (OR = 2.0; 95% CI: 1.09–3.62) and using more than one or not using injectable medication (OR = 2.8; 95% CI: 1.05–7.69). Major factors for the death outcome were at least 60 years old (OR = 3.4; 95% CI: 1.90–6.03) and HIV positive (OR = 2.7; 95% CI: 1.45–4.83). Conclusions The factors associated with unfavorable treatment outcomes were different. Some of these factors are specific to each outcome, which reflects the complexity of providing care to these individuals.

Background Recently developed immunosuppressive drugs, especially TNF antagonists, may enhance the risk of granulomatous infections, including leprosy. We aimed to evaluate the leprosy detection rate in patients under immunosuppression due to rheumatological, dermatological and gastroenterological diseases. Methods We performed a systematic review of the literature by searching the PubMed, EMBASE, LILACS, Web of Science and Scielo databases through 2018. No date or language restrictions were applied. We included all articles that reported the occurrence of leprosy in patients under medication-induced immunosuppression. Results The search strategy resulted in 15,103 articles; finally, 20 articles were included, with 4 reporting longitudinal designs. The detection rate of leprosy ranged from 0.13 to 116.18 per 100,000 patients/year in the USA and Brazil, respectively. In the meta-analysis, the detection rate of cases of leprosy per 100,000 immunosuppressed patients with rheumatic diseases was 84 (detection rate = 0.00084; 95% CI = 0.0000–0.00266; I2 = 0%, p = 0.55). Conclusion Our analysis showed that leprosy was relatively frequently detected in medication-induced immunosuppressed patients suffering from rheumatological diseases, and further studies are needed. The lack of an active search for leprosy in the included articles precluded more precise conclusions. Trial registration This review is registered in PROSPERO with the registry number CRD42018116275.

BACKGROUND: Despite the well-known role of parents as caregivers, few studies have addressed their health outcomes related to the Zika virus epidemic. METHODS: A cross-sectional study was carried out with 146 primary caregivers of children 15–26 months of age, with laboratory and/or clinical evidence of Zika infection between August and October 2017 in three Brazilian municipalities: João Pessoa and Campina Grande in the state of Paraíba and Fortaleza in the state of Ceará. Caregivers reported on their child’s life and health, family circumstances and underwent screening for stress using the Parenting Stress Index-Short Form. Children were evaluated for developmental delays and clinical outcomes. Differences in the prevalence of risk factors between caregivers with high or clinically relevant stress and those with normal stress were evaluated. RESULTS: Of the 146 participants, 13% (n=19) were classified as having high or clinically relevant stress, all of them mothers. The two risk factors significantly and independently associated with high levels of stress, compared with individuals with normal stress levels, were “reporting difficulty in covering basic expenses” (adjusted OR 3.6 (95% CI 1.1–11.8; p = 0.034)) and “having a child with sleep problems” (adjusted OR 10.4 (95% CI 1.3–81.7; p = 0.026)). CONCLUSIONS: Some factors seem to contribute significantly more than others to the level of stress experienced by caregivers of children with evidence of Zika virus congenital infection. Interventions and preventive strategies should also target caregivers, who in turn will be able to respond to the unique characteristics of their child.

Treating hepatitis C virus (HCV) infections reduces overall mortality and the risk of multiple extrahepatic complications. Direct-acting antivirals (DAAs) are molecules that target specific non-structural proteins of the virus, resulting in the disruption of viral replication and infection. This report describes the activities undertaken to assess the cure of HCV in patients of different age groups, supported by the Viral Hepatitis National Program of the Unified Health System in Brazil.Around 11,000 patients wereevaluated in an electronic retrospective cohort, which used therapeutic schemes with Sofosbuvir (SOF), Daclatasvir (DCV), Simeprevir (SMV), and an association of Ombitasvir, Veruprevir/Ritonavir and Dasabuvir (3D) with or without Ribavirin (RBV), with sustained virologic response (SVR) or viral cure after a 12-week treatment. We conducted logistic regressions to identify factors independently associated with positive response to DAA-based therapies.Among evaluated patients, 57.1% were male; 48.3% identified as white; 78.3% were over 50 years old; 44.1% were from the Southeast region; 47.7% had genotype 1b; and 84.5% were treated for 12 weeks. The SVR rates with DAAs ranged from 87% to 100%. Genotypes 1 and 4 had a better response (96.3 to 100% of SVR) to therapy with DAAs, and genotypes 2 and 3 had SVR of 90.6% to 92.2%. Different treatment periods showed SVR with an average of 95.0% and 95.9% for 12 and 24 weeks, respectively. In the odds ratio assessment, we verified that females were half as likely (OR 0.5; CI 95% 0.4-0.6) to have a negative response to therapy, when compared to males, and that genotypes 2 and 3 were around twice more likely (OR 1.5-2.2; CI 95% 0.7-2.9; 1.2-3.6 and OR 2.7-2.8; CI 95% 2.0-3.8, respectively) to not have SVR after therapy when compared to genotype 1. Patients aged between 50 and 69 years old were 1.2 times (OR 1,2; CI95% 0,7-1,9) more likely to not have SVR when treated with DAAs, when compared to other age groups.This study is the first of this magnitude to be held in a Latin-American country with high SVR results, supported by a free-of-charge universal and public health system. We confirm the high performance of DAA-based therapies which support the Brazilian public health policy decision of adopting them as an important part of the country’s strategy to eliminate HCV by 2030.

OBJECTIVES Despite free access to antiretroviral therapy (ART) from 1996 onward, and treatment for all people living with HIV (PLWHIV) from 2013, mortality in Brazil has not homogeneously decreased. We investigated to what extent delayed ART, hepatitis coinfections and sociodemographic factors predict all-cause mortality in Brazilian PLWHIV. DESIGN We included PLWHIV at least 18 years, with complete CD4 cell count data, followed up between 2007 and 2015 in Brazil. METHODS After multiple imputation, an extended Cox model helped estimate the effects of fixed and time-varying covariates on mortality. RESULTS The study population (n = 411 028) were mainly male (61%), white (55%), 40 years or less (61%), heterosexually HIV infected (71%), living in the Southeast region (48%) and had basic education (79%). Hepatitis C virus and hepatitis B virus coinfection prevalences were 2.5 and 1.4%, respectively. During a 4-year median follow-up, 61 630 deaths occurred and the mortality rate was 3.45 (95% confidence interval: 3.42-3.47) per 100 person-years. Older age, male sex, non-white ethnicity, illiteracy/basic education and living outside the Southeast and Central-West regions were independently associated with increased mortality. The main modifiable predictors of mortality were delayed ART (i.e. CD4 cell count

INTRODUCTION: The coronavirus disease (COVD-19) outbreak has overburdened the surveillance of severe acute respiratory infections (SARIs), including the laboratory network. This study was aimed at correcting the absence of laboratory results of reported SARI deaths. METHODS: The imputation method was applied for SARI deaths without laboratory information using clinico-epidemiological characteristics. RESULTS: Of 84,449 SARI deaths, 51% were confirmed with COVID-19 while 3% with other viral respiratory diseases. After the imputation method, 95% of deaths were reclassified as COVID-19 while 5% as other viral respiratory diseases. CONCLUSIONS: The imputation method was a useful and robust solution (sensitivity and positive predictive value of 98%) for missing values through clinical & epidemiological characteristics.

International audience; Mortality among individuals co-infected with HIV and hepatitis C virus (HCV) is relatively high. We evaluated the association between psychoactive substance use and both HCV and non-HCV mortality in HIV/HCV co-infected patients in France, using Fine and Gray's competing-risk model adjusted for socio-demographic, clinical predictors and confounding factors, while accounting for competing causes of death. Over a 5-year median follow-up period, 77 deaths occurred among 1028 patients. Regular/daily cannabis use, elevated coffee intake, and not currently smoking were independently associated with reduced HCV-mortality (adjusted sub-hazard ratio [95% CI] 0.28 [0.10-0.83], 0.38 [0.15-0.95], and 0.28 [0.10-0.79], respectively). Obesity and severe thinness were associated with increased HCV-mortality (2.44 [1.00-5.93] and 7.25 [2.22-23.6] versus normal weight, respectively). Regular binge drinking was associated with increased non-HCV-mortality (2.19 [1.10-4.37]). Further research is needed to understand the causal mechanisms involved. People living with HIV/HCV co-infection should be referred for tobacco, alcohol and weight control interventions and potential benefits of cannabis-based therapies investigated.

Background Brazil is a signatory to the World Health Organization End TB Strategy and the United Nations Sustainable Development Goals. This study aims to characterize tuberculosis (TB) deaths and TB mortality rates in Brazil for the period 1997–2017. Methods We performed an ecological study based on information for TB deaths between 1997 and 2017 extracted from the Mortality Information System of the Brazilian Ministry of Health. Data included gender, age group and geographic regions. The trends in mortality rates were estimated using Joinpoint regression analysis, which identifies years in which there is a change in slope of the time series by the Monte Carlo permutation. Results Between 1997 and 2017 there were 104 172 recorded TB deaths in Brazil and the mortality rates were higher for men and the elderly. The age-adjusted mortality rate decreased from 4.2 per 100 000 in 1997 to 3.0 per 100 000 in 2003 to 2.0 per 100 000 in 2017. The average percentage reduction from 1997 to 2003 was 6.2% (95% confidence interval [CI] −7.7 to −4.7) per year, while from 2003 to 2017 it was 3.0% (95% CI −3.4 to −2.5) per year, representing a slowdown in the rate of decline. Conclusion The high number of deaths and the slowdown in the decline of mortality rates from TB in Brazil maintain the disease as an important public health concern and an obstacle to reaching goals set by international commitments.

Resumo: O objetivo do trabalho foi avaliar a cobertura e a confiabilidade do encerramento dos casos de tuberculose drogarresistente (TB DR), do Sistema de Informação de Tratamentos Especiais de Tuberculose (SITE-TB), que ocorreram no Brasil no período de 2013 a 2016, a partir de relacionamentos probabilísticos com o Sistema de Informação de Agravos de Notificação (SINAN), Gerenciador de Ambiente Laboratorial (GAL) e Sistema de Informações sobre Mortalidade (SIM). Os casos de TB DR com início de tratamento entre 2013 e 2016 no Brasil constituíram a população do estudo. O relacionamento com o SINAN avaliou a cobertura e estimou a subnotificação dos casos de TB DR. Aplicou-se o método de captura-recaptura, com uso do estimador de Chapman. O relacionamento com o GAL identificou casos diagnosticados pelo laboratório que não estavam notificados no SITE-TB. O relacionamento com o SIM avaliou a confiabilidade do encerramento óbito no SITE-TB, utilizando o coeficiente kappa. Estimou-se uma população de 2.945 (IC95%: 2.365-3.602) casos novos de TB DR com o estimador de Chapman. No GAL, foram encontrados 1.626 indivíduos não notificados no SITE-TB, mesmo com exame laboratorial confirmatório de resistência aos medicamentos antiTB. Classificou-se como excelente, PABAK (prevalance and bias adjusted kappa) de 0,86 (IC95%: 0,85-0,87), a concordância entre o desfecho óbito do SITE-TB e o SIM. Os resultados mostraram que ainda temos lacunas relacionadas ao diagnóstico e ao tratamento da TB DR no Brasil. A subnotificação no SITE-TB de casos de TB DR representa um desafio para o controle da doença. A localização desses indivíduos e o início precoce do tratamento devem constituir uma ação priorizada nos serviços de saúde. Abstract: The study aimed to assess the coverage and reliability of drug-resistant tuberculosis (DR-TB) case closure in the Information System on Special Treatments for Tuberculosis (SITE-TB in Portuguese) in Brazil from 2013 to 2016, based on probabilistic linkage with the Information System on Diseases of Notification (SINAN), Laboratory Environment Manager (GAL), and Mortality Information System (SIM). The study population consisted of DR-TB cases that initiated treatment from 2013 to 2016 in Brazil. Linkage with SINAN assessed the coverage and estimated underreporting of DR-TB cases. The capture-recapture method was applied, using the Chapman estimator. Linkage with GAL identified cases diagnosed by the laboratory that had not been reported to SITE-TB. Linkage with SIM assessed the reliability of case closure by death in SITE-TB, using the kappa coefficient. We estimated a population of 2,945 (95%CI: 2,365-3,602) new cases of DR-TB with the Chapman estimator. We located 1,626 individuals in the GAL database that had not been reported to SITE-TB, even with laboratory confirmation of drug resistance. PABAK (prevalance and bias adjusted kappa) of 0.86 (95%CI: 0.85-0.87) was classified as excellent for the agreement in death as the outcome between the SITE-TB and SIM databases. The results pointed to persistent gaps related to diagnosis and treatment of DR-TB in Brazil. Underreporting of DR-TB cases in the SITE-TB database poses a challenge for TB control. Identification of these individuals and early start of treatment should be prioritized in health services. Resumen: El objetivo de este trabajo fue evaluar la cobertura y fiabilidad del cierre de casos de tuberculosis resistente a multiple medicamentos (TB DR; por sus siglas en portugués) en el Sistema de Información de Tratamientos Especiales de Tuberculosis (SITE-TB), que se produjeron en Brasil durante el período de 2013 a 2016, a partir de relaciones probabilísticas con el Sistema de Información de Enfermedades de Notificación (SINAN por sus siglas en portugués), Gestor de Ambiente de Laboratorio (GAL) y Sistema de Información sobre Mortalidad (SIM). La población del estudio fueron los casos de TB DR con inicio de tratamiento entre 2013 y 2016 en Brasil. La relación con el SINAN evaluó la cobertura y estimó la subnotificación de los casos de TB DR. Se aplicó el método de captura-recaptura, utilizando el estimador de Chapman. La relación con el GAL identificó casos diagnosticados por el laboratorio que no estaban notificados en el SITE-TB. La relación con el SIM evaluó la fiabilidad del cierre óbito en el SITE-TB, utilizando el coeficiente kappa. Se estimó que para una población de 2.945 (IC95%: 2.365-3.602) casos nuevos de TB DR con el estimador de Chapman. Se encontraron en el GAL a 1.626 individuos no notificados en el SITE-TB, incluso con examen de laboratorio confirmatorio de resistencia a los medicamentos antiTB. Se clasificó como excelente, PABAK (prevalance and bias adjusted kappa) de 0,86 (IC95%: 0,85-0,87), la concordancia entre el resultado óbito del SITE-TB y el SIM. Los resultados mostraron que todavía existen lagunas relacionadas con el diagnóstico y el tratamiento de la TB DR en Brasil. La subnotificación en el SITE-TB de casos de TB DR representa un desafío para el control de la enfermedad. La localización de esos individuos y el inicio precoz del tratamiento debe ser una acción priorizada en los servicios de salud.

Background Zika infection during pregnancy (ZIKVP) is known to be associated with adverse outcomes. Studies on this matter involve both rare outcomes and rare exposures and methodological choices are not straightforward. Cohort studies will surely offer more robust evidences, but their efficiency must be enhanced. We aim to contribute to the debate on sample selection strategies in cohort studies to assess outcomes associated with ZKVP. Main body of the abstract A study can be statistically more efficient than another if its estimates are more accurate (precise and valid), even if the studies involve the same number of subjects. Sample size and specific design strategies can enhance or impair the statistical efficiency of a study, depending on how the subjects are distributed in subgroups pertinent to the analysis. In most ZIKVP cohort studies to date there is an a priori identification of the source population (pregnant women, regardless of their exposure status) which is then sampled or included in its entirety (census). Subsequently, the group of pregnant women is classified according to exposure (presence or absence of ZIKVP), respecting the exposed:unexposed ratio in the source population. We propose that the sample selection be done from the a priori identification of groups of pregnant women exposed and unexposed to ZIKVP. This method will allow for an oversampling (even 100%) of the pregnant women with ZKVP and a optimized sampling from the general population of pregnant women unexposed to ZIKVP, saving resources in the unexposed group and improving the expected number of incident cases (outcomes) overall. Conclusion We hope that this proposal will broaden the methodological debate on the improvement of statistical power and protocol harmonization of cohort studies that aim to evaluate the association between Zika infection during pregnancy and outcomes for the offspring, as well as those with similar objectives.

Central-line bloodstream infection (CLABSI) increases hospital mortality. A cohort study was conducted in a Brazilian hospital to estimate the disability-adjusted life year (DALY) of CLABSI using modified World Health Organization (WHO) methodology. CLABSI DALY was 20.44 per 1,000 inpatients, most were the result of premature death (20.42 per 1,000 inpatients). DALY can be useful to guide and measure the impact of healthcare infection prevention.Infect Control Hosp Epidemiol 2017;38:606–609

Background In Brazil there are 926,742 people living with HIV/AIDS (PLWHA). Despite the introduction of antiretroviral therapy (ART) in 1996 and treatment for all in 2014, mortality has increased in some regions. This study aimed to estimate the factors associated with overall mortality in PLWHA to recommend public health actions. Methods We studied PLWHA aged ≥18 years old, followed-up from 2007 to 2015 in the universal health system in Brazil. We used a national database (disease reporting, laboratory tests, ART and death notifications). Kaplan-Meier method and Cox model were used in survival analysis. The outcome was all-cause deaths. The explanatory variables measured at baseline were sociodemographic characteristics, HIV transmission mode and coinfections by hepatitis B (HBV) and C (HCV). The time-varying variables were CD4 cell count, viral load (VL) and ART status. Results Study population (n = 411,281) was mainly male (61%), under 40 years old (61%), Caucasian (37%), with basic education (43%), heterosexual HIV-infection mode (41%), resident in Southeast region (48%). The co-infection rate was 2.5% for HCV, and 1.4% for HBV. Median time to ART initiation was 83 days. During the follow-up period (median: 4 years), 61,757 deaths occurred (6% HCV-coinfected and 2% HBV-coinfected). The global mortality rate was 3.44 [95% confidence interval: 3.42-3.47] per 100 person-years (PY) during 1,793,417 PY. The factors associated with increased mortality in multivariable analyses were male gender, age over 40, non-Caucasian race, HIV infection by drug use, resident in North, Northeast and South regions, HCV and HBV coinfection, VL ≥ 200 copies/mL and starting ART with CD4 Conclusions Although PLWHA start ART in less than 3 months after the beginning of follow-up, there is still late treatment (at CD4 Key messages The results of our study show that all populations should be target for HIV screening regardless of risk group. PLWHA coinfected with hepatitis B and hepatitis C should be also early treated for hepatitis coinfections.

Dengue virus (DENV) transmission by blood transfusion is an important route of viral acquisition during outbreaks. The prevalence of DENV markers (viral RNA, NS1, anti-DENV IgM, and IgG) among blood donors in Central-West Brazil has never been evaluated. Our aim was to evaluate the full set of serological and molecular markers for DENV among blood donors of the Federal District of Brazil during an extensive outbreak in 2016. We found an anti-DENV IgM prevalence of 6.74% (n = 32/475). Of 475, 20 samples (4.21%) were also anti-DENV IgG positive. All samples were non-reactive for NS1 and DENV RNA. Our results imply that a significant proportion of the tested donors had experienced asymptomatic infection. More studies are necessary to evaluate the real prevalence of DENV viremia in blood donors from the Federal District of Brazil and if specific measures are needed to routinely test the blood donors for DENV RNA during outbreaks.

Although multidrug therapy is considered an effective treatment for leprosy, antimicrobial resistance is a serious concern. We performed a systematic review of studies on the diagnostic accuracy and screening of tests for antimicrobial resistance in leprosy. This review was registered in PROSPERO (CRD42020177958). In April 2020, we searched for studies in the PubMed, EMBASE, Web of Science, Scopus, Scielo, and LILACS databases. A random effects regression model was used for the meta-analysis. We included 129 studies. Molecular tests for dapsone resistance had a sensitivity of 78.8% (95% confidence interval [CI] = 65.6–87.9) and a specificity of 97.0% (95% CI = 94.0–98.6). Molecular tests for rifampicin resistance had a sensitivity and specificity of 88.7% (95% CI = 80.0–93.9) and 97.3% (95% CI = 94.3–98.8), respectively. Molecular tests for ofloxacin resistance had a sensitivity and specificity of 80.9% (95% CI = 60.1–92.3) and 96.1% (95% CI = 90.2–98.5), respectively. In recent decades, no increase in the resistance proportion was detected. However, the growing number of resistant cases is still a clinical concern.

Background Guillain-Barre syndrome (GBS) is a serious, acute paralytic neuropathy of autoimmune aetiology, usually associated with a previous infection. The current study aims to estimate the costs of GBS associated with Zika virus (ZIKV) infection in Brazil. Methods A cost-of-illness study was conducted from the perspective of the Brazilian public health system (Sistema Unico de Saude [SUS]) and Brazilian society for the year 2016. Direct and indirect costs were estimated by a mixed macrocosting and microcosting approach. Results The total cost of ZIKV-associated GBS in Brazil was US$11 997 225.85, consisting of the costs of symptomatic ZIKV infection before onset of GBS (direct costs US$2011.51, indirect costs US$19 780.53) and the costs that followed development of GBS (direct costs US$4 722 980.89, indirect costs US$7 252 452.92). The cost of treatment with human immunoglobulin (US$3 263 210.50) and the cost of productivity losses associated with potential years of working life lost due to early mortality (US$4 398 551.72) were particularly noteworthy. Conclusions These findings suggest that ZIKV-associated GBS is costly to Brazil, especially due to productivity losses and hospitalization. This highlights the importance of investing in the prevention of ZIKV infection and in the care of patients with GBS.

Resumo Objetivo: descrever os eventos adversos relacionados com a assistência à saúde resultantes em óbito. Métodos: estudo descritivo das notificações registradas no Sistema de Notificações para a Vigilância Sanitária (Notivisa) no Brasil, de junho/2014 a junho/2016; notificações registradas como ‘outros’ em ‘tipo de incidente’ foram reclassificadas. Resultados: foram registrados 417 óbitos, a maioria em adultos e idosos (85%), sem diferenças entre sexos; os estados de São Paulo (N=92), Paraná (N=75) e Minas Gerais (N=66) foram os maiores notificadores; os hospitais contribuíram com 97% dos registros, com concentração nos setores ‘terapia intensiva’ e ‘internação’; houve investigação pela unidade notificadora em 5% das notificações; na reclassificação do tipo de incidente, recuperaram-se 52 registros; o tipo de incidente mais comum foi ‘falhas durante a assistência à saúde’ (50%). Conclusão: notificações resultantes em óbito ocorreram principalmente em hospitais; foram identificadas falhas no registro e necessidade de investigação de grande proporção dos óbitos. Resumen Objetivo: describir los eventos adversos relacionados con la asistencia sanitaria que resultaran en muerte. Métodos: estudio descriptivo de las notificaciones registradas en el Sistema de Notificaciones para la Vigilancia Sanitaria (Notivisa) en Brasil entre junio/2014-junio/2016; las notificaciones registradas como ‘otros’ en la variable ‘tipo de incidente’ fueron reclasificadas. Resultados: se registraron 417 casos, la mayoría en adultos y ancianos (85%), sin predominio de sexo; los estados de São Paulo (N=92), Paraná (N=75) y Minas Gerais (N=66) fueron los mayores notificantes; los hospitales contribuyeron con el 97% de los registros; la investigación por la unidad notificante se produjo en el 5% de los casos; en la reclasificación, se recuperaron 52 registros; el tipo de incidente más común fue ‘fallas durante la asistencia sanitaria’ (50%). Conclusión: las notificaciones de eventos resultantes de la muerte son principalmente de hospitales; se identificaron fallas en el registro y necesidad de más investigación de las muertes. Abstract Objective: to describe the adverse events related to health care resulting in death. Methods: a descriptive study of reports recorded in the Brazilian Health Surveillance Notification System (Notivisa) in Brazil from Jun 2014 to Jun 2016; notifications recorded as 'other' in the 'incident type' were recoded. Results: 417 cases were recorded, mostly in adults and the elderly (85%), with no sex differences; the states of São Paulo (N=92), Paraná (N=75) and Minas Gerais (N=66) were the main reporter; hospitals contributed to 97% of the records, principally in the intensive care and hospitalization sectors; the investigation by the notifying unit occurred in 5% of cases; in the recode of the type of incident, 52 records were recovered; the most common type of incident was 'failures during health care' (50%). Conclusion: notifications resulting in death occurred mainly in hospitals; were identified failure to register and need to investigate the large proportion of deaths.

Objectives To identify scenarios based on socioeconomic, epidemiological and operational healthcare factors associated with tuberculosis incidence in Brazil. Design Ecological study. Settings The study was based on new patients with tuberculosis and epidemiological/operational variables of the disease from the Brazilian National Information System for Notifiable Diseases and the Mortality Information System. We also analysed socioeconomic and demographic variables. Participants The units of analysis were the Brazilian municipalities, which in 2015 numbered 5570 but 5 were excluded due to the absence of socioeconomic information. Primary outcome Tuberculosis incidence rate in 2015. Data analysis We evaluated as independent variables the socioeconomic (2010), epidemiological and operational healthcare indicators of tuberculosis (2014 or 2015) using negative binomial regression. Municipalities were clustered by the k-means method considering the variables identified in multiple regression models. Results We identified two clusters according to socioeconomic variables associated with the tuberculosis incidence rate (unemployment rate and household crowding): a higher socioeconomic scenario (n=3482 municipalities) with a mean tuberculosis incidence rate of 16.3/100 000 population and a lower socioeconomic scenario (2083 municipalities) with a mean tuberculosis incidence rate of 22.1/100 000 population. In a second stage of clusterisation, we defined four subgroups in each of the socioeconomic scenarios using epidemiological and operational variables such as tuberculosis mortality rate, AIDS case detection rate and proportion of vulnerable population among patients with tuberculosis. Some of the subscenarios identified were characterised by fragility in their information systems, while others were characterised by the concentration of tuberculosis cases in key populations. Conclusion Clustering municipalities in scenarios allowed us to classify them according to the socioeconomic, epidemiological and operational variables associated with tuberculosis risk. This classification can support targeted evidence-based decisions such as monitoring data quality for improving the information system or establishing integrative social protective policies for key populations.

RESUMO Objetivo Avaliar o desconforto musculoesquelético, a capacidade para o trabalho e a fadiga residual em profissionais de enfermagem que atuam em Hospital. Método Estudo transversal com profissionais de um hospital público de médio porte. Foram utilizados o questionário nórdico de sintomas, o índice de capacidade para o trabalho e a escala de necessidade de descanso (fadiga). Os dados foram analisados descritivamente e aplicaram-se testes inferenciais com o intuito de verificar a associação da fadiga e a capacidade para o trabalho e comparar a fadiga entre os setores analisados. Resultados Participaram da pesquisa 110 profissionais. Um total de 86,24% dos trabalhadores relatou desconforto osteomuscular, com maior prevalência na coluna cervical, torácica e lombar. Aproximadamente 43% dos profissionais apresentaram fadiga residual. Verificou-se associação significante entre fadiga e redução da capacidade para o trabalho (p

O parvovírus B19 (B19V) pode ser transmitido por via respiratória, verticalmente - da mãe para o feto - e via transfusão de sangue e transplante de órgãos. A infecção por transfusão de sangue ou hemoderivados ocorre devido à resistência do B19V aos métodos de inativação viral. Nosso estudo avaliou a presença do ácido desoxirribonucleico (DNA) B19V e a prevalência de imunoglobulina da classe G (IgG) anti-B19V em mulheres em idade fértil, doadoras de sangue do Distrito Federal, Brasil. Nossos resultados demonstraram a ausência de DNA de B19V nesses doadores. No entanto, foi observada a soroprevalência de IgG anti-B19V em 60,7% dessa população. Este estudo fornece dados importantes da circulação do B19V no Centro-Oeste do Brasil. Parvovirus B19 (B19V) can be transmitted by the respiratory route, vertically - from the mother to the fetus - and via blood transfusion or organ transplantation. Infection by transfusion of blood or blood products occurs due to the resistance of B19V to viral inactivation methods. Our study evaluated the presence of B19V deoxyribonucleic acid (DNA) and the prevalence of anti-B19V class G immunoglobulin (IgG) in women of childbearing age blood donors of the Federal District, Brazil. Our results demonstrated the absence of B19V DNA in these blood donors. However, the seroprevalence for anti-B19V IgG was observed in 60.7% of this population. This study provides important data of B19V circulation in the Center-West of Brazil.

A Constituição Federal de 1988 introduziu o Benefício de Prestação Continuada (BPC) possibilitando a inclusão de pessoas com deficiência. Estudo descritivo, com dados municipais agregados, da distribuição temporal e geográfica da incidência de microcefalia relacionada ao Zika vírus no Brasil e dados das concessões de BPC a crianças com diagnóstico de microcefalia. Apresentam-se dados sobre a demanda e a concessão do BPC para crianças com microcefalia desde 2009. Os casos de microcefalia e/ou alteração do sistema nervoso central foram obtidos do Ministério da Saúde e totalizaram 2.366 casos confirmados de 01/01/2015 a 31/12/2016. A série histórica da concessão de BPC de 2009 a 2016 foi elaborada a partir de dados do Instituto Nacional do Seguro Social e mostrou, até 2014, uma linha de base com a média de 200 benefícios anuais para crianças menores de 48 meses com microcefalia. Em 2016 as concessões aumentaram oito vezes atingindo 1.603 benefícios concedidos a crianças de 731 municípios, das 27 Unidades da Federação. A Região Nordeste concentrou 73% dos BPC concedidos, mas, ainda assim, isto representou menos do que 65% da demanda de casos incidentes. É preciso reforçar a implementação do sistema de referência integrado, inclusive com busca ativa, para que todas as crianças com direito ao BPC tenham acesso. The Brazilian Federal Constitution of 1988 introduced the Continuous Cash Benefits (BCP), allowing the inclusion of people with disabilities. This is a descriptive study with aggregate municipal data about the time and geographic distribution of the incidence of microcephaly related to the Zika virus in Brazil and data of the BCP grants to children diagnosed with microcephaly. Data on the demand and BCP grants to children with microcephaly since 2009 are shown. Cases of microcephaly and/or central nervous system disorders were obtained from the Ministry of Health and totaled 2,366 confirmed cases from January 1, 2015 to December 31, 2016. The historical series of BCP granted from 2009 to 2016 was based on data from the National Institute of Social Security and showed, until 2014, a baseline with an average of 200 annual benefits for children younger than 48 months with microcephaly. In 2016, grants increased eight times, reaching 1,603 benefits granted to children of 731 municipalities spread in the 27 States. The Northeast accounted for 73% of the BCPs granted, however, this was less than 65% of the demand for incident cases. The implementation of the integrated referral system, including active search, should be strengthened to ensure access to all children entitled to BCP.

Texto completo: acesso restrito. p.359-363 Submitted by Edileide Reis (leyde-landy@hotmail.com) on 2015-03-06T14:50:28Z No. of bitstreams: 1 Wildo Navegantes de Araújo.pdf: 469736 bytes, checksum: 6a3c3d1fbf68162baf4150cee7c160dd (MD5) Approved for entry into archive by Flávia Ferreira (flaviaccf@yahoo.com.br) on 2015-05-11T16:21:59Z (GMT) No. of bitstreams: 1 Wildo Navegantes de Araújo.pdf: 469736 bytes, checksum: 6a3c3d1fbf68162baf4150cee7c160dd (MD5) Made available in DSpace on 2015-05-11T16:21:59Z (GMT). No. of bitstreams: 1 Wildo Navegantes de Araújo.pdf: 469736 bytes, checksum: 6a3c3d1fbf68162baf4150cee7c160dd (MD5) Previous issue date: 2013 Leptospirosis disproportionately affects residents of urban slums. To understand the knowledge, attitudes, and practices regarding leptospirosis, we conducted a cross-sectional study among residents of an urban slum community in Salvador, Brazil. Of the 257 residents who were interviewed, 225 (90%) were aware of leptospirosis and more than two-thirds of respondents correctly identified the modes of disease transmission and ways to reduce exposure. However, study participants who performed risk activities such as cleaning open sewers had limited access to protective clothing such as boots (33%) or gloves (35%). Almost all respondents performed at least one activity to prevent household rat infestation, which often included use of an illegal poison. Our findings support the need for interventions targeted at the individual and household levels to reduce risk of leptospirosis until large-scale structural interventions are available to residents of urban slum communities.

To identify risk factors for death from pandemic (H1N1) 2009, we obtained data for 157 hospitalized patients with confirmed cases of this disease. Multivariate analysis showed that diabetes and class III obesity were associated with death. These findings helped define priority vaccination groups in Brazil.

OBJECTIVETo identify risk factors related toMycobacterium abscessussubsp.bolletiiinfection during an outbreak, associated with laparoscopic surgery and to propose recommendations for preventing new cases.DESIGNA retrospective cohort study.SETTINGA private hospital in Manaus, Brazil.PATIENTSA cohort of 222 patients who underwent laparoscopic surgery between July 2009 and August 2010 by a single surgical team.METHODSWe collected information about the patients and the surgical procedure using a standard form. We included sex, age, and variables withP≤0.2 in the bivariate analysis in a logistic regression model. Additionally, we reviewed the procedures for reprocessing the laparoscopic surgery equipment, and the strains obtained with culture were identified by molecular methods.RESULTSWe recorded 60 (27%) cases of infection. After multivariate analysis, the duration of surgery beyond 1 hour (odds ratio [OR] 2.4; 95% confidence interval [CI] 1.2–4.5), not to have been the first operated patient on a given day (OR, 2.7; 95% CI, 1.4–5.2), and the use of permanent trocar (OR, 2.2; 95% CI, 1.1–4.2) were associated with infection. We observed that the surgical team attempted to sterilize the equipment in glutaraldehyde solution when sanitary authorities had already prohibited it. Eleven strains presented 100% DNA identity with a single strain, known as BRA100 clone.CONCLUSIONSBecause contaminated material can act as vehicle for infection, ensuring adequate sterilization processing of video-assisted surgery equipment was crucial to stopping this single clonal outbreak of nonturbeculous mycobacteria in Brazil.Infect Control Hosp Epidemiol 2015;36(1): 81–86

Background The Norway rat (Rattus norvegicus) is the principal reservoir for leptospirosis in many urban settings. Few studies have identified markers for rat infestation in slum environments while none have evaluated the association between household rat infestation and Leptospira infection in humans or the use of infestation markers as a predictive model to stratify risk for leptospirosis. Methodology/Principal Findings We enrolled a cohort of 2,003 urban slum residents from Salvador, Brazil in 2004, and followed the cohort during four annual serosurveys to identify serologic evidence for Leptospira infection. In 2007, we performed rodent infestation and environmental surveys of 80 case households, in which resided at least one individual with Leptospira infection, and 109 control households. In the case-control study, signs of rodent infestation were identified in 78% and 42% of the households, respectively. Regression modeling identified the presence of R. norvegicus feces (OR, 4.95; 95% CI, 2.13–11.47), rodent burrows (2.80; 1.06–7.36), access to water (2.79; 1.28–6.09), and un-plastered walls (2.71; 1.21–6.04) as independent risk factors associated with Leptospira infection in a household. We developed a predictive model for infection, based on assigning scores to each of the rodent infestation risk factors. Receiver operating characteristic curve analysis found that the prediction score produced a good/excellent fit based on an area under the curve of 0.78 (0.71–0.84). Conclusions/Significance Our study found that a high proportion of slum households were infested with R. norvegicus and that rat infestation was significantly associated with the risk of Leptospira infection, indicating that high level transmission occurs among slum households. We developed an easily applicable prediction score based on rat infestation markers, which identified households with highest infection risk. The use of the prediction score in community-based screening may therefore be an effective risk stratification strategy for targeting control measures in slum settings of high leptospirosis transmission., Author Summary The Norway rat is an important reservoir for urban leptospirosis, a life-threatening zoonotic disease. In urban settings, leptospirosis transmission occurs primarily in the peri-domiciliary environment of the slums. Rodent control is one of the most frequent strategies to prevent leptospirosis, but the identification of domiciles at higher risk of transmission is challenging. We compared households where an individual with evidence of recent leptospirosis infection resided and households where none of the residents had evidence for infection. Houses with evidence of leptospirosis transmission had higher levels of rodent infestation and environmental conditions related to rodents. We propose a new methodology to easily characterize slum households, based on environmental characteristics, at different levels of risk for leptospirosis transmission. The findings of this study indicate that evaluation for rodent infestation intensity and environmental features may be a feasible strategy for targeting augmented control measures for leptospirosis.

A century after its discovery, Chagas disease (CD) is still considered a public health problem. Mortality caused by CD between 2000 and 2010 was described according to the specific underlying cause, year of occurrence, gender, age range, and region of Brazil. The standardized mortality rate decreased 32.4%, from 3.4% in 2000 to 2.3% in 2010. Most of the deaths (85.9%) occurred in male patients who were > 60 years of age caused by cardiac involvement. The mortality rate caused by cardiac involvement decreased in all regions of Brazil, except in the North region, where it increased by 1.6%. The Northeast had the smallest and the Central-West had the largest decrease. The mortality rate caused by a compromised digestive tract increased in all regions. Despite the control of transmission by vector and blood transfusions, CD should remain on the list of priority diseases for the public health service in Brazil, and surveillance actions cannot be interrupted.

In 2006, a total of 178 cases of acute Chagas disease were reported from the Amazonian state of Para, Brazil. Eleven occurred in Barcarena and were confirmed by visualization of parasites on blood smears. Using cohort and case-control studies, we implicated oral transmission by consumption of acai palm fruit.

This study sought to characterize the performance, suggest hypotheses about problems identified and propose recommendations to employees of the National Agency for Sanitary Surveillance (ANVISA) Coordination of Ports, Airports, Borders and Bonded precincts of the state of Para. We used a cross-sectional study demographic data, information about those grievances and present performance in Occupational Health. Data were analyzed in EpiInfo 6.04d. We interviewed 91% crowded servers in Para state. The chronic non-communicable diseases were the most evident, with a prevalence of musculoskeletal injuries. It is recommended more attention to occupational health surveillance for Anvisa in the Para State.

SUMMARYIn order to estimate influenza-associated excess mortality in southern Brazil, we applied Serfling regression models to monthly mortality data from 1980 to 2008 for pneumonia/influenza- and respiratory/circulatory-coded deaths for all ages and for those aged ⩾60 years. According to viral data, 73·5% of influenza viruses were detected between April and August in southern Brazil. There was no clear influenza season for northern Brazil. In southern Brazil, influenza-associated excess mortality was 1·4/100 000 for all ages and 9·2/100 000 person-years for persons aged ⩾60 years using underlying pneumonia/influenza-coded deaths and 10·0/100 000 for all ages and 86·6/100 000 person-years for persons aged ⩾60 years using underlying respiratory/circulatory-coded deaths. Influenza-associated excess mortality rates for southern Brazil are similar to those published for other countries. Our data support the need for continued influenza surveillance to guide vaccination campaigns to age groups most affected by this virus in Brazil.

Este trabalho trata-se de estudo descritivo, cujo objetivo foi descrever o perfil de mortalidade pelo vírus da hepatite B (VHB) no Brasil e regiões, com base nos dados disponíveis no Sistema de Informações sobre Mortalidade (SIM). Constituíram a população de estudo os óbitos pelo VHB registrados no SIM durante o período de 1º de janeiro de 2000 a 31 de dezembro de 2009. A taxa bruta de mortalidade no país permaneceu constante; a proporção de óbitos por hepatocarcinoma com VHB como causa associada não ultrapassou 7%. A taxa de mortalidade padronizada foi maior na Região Norte, e a mortalidade proporcional foi maior no sexo masculino. Em 2009, os anos potenciais de vida perdidos (APVP) no sexo masculino foram maiores no grupo etário de 50 a 59 anos; no sexo feminino, no grupo de 40 a 49 anos. O maior aumento da taxa de APVP ocorreu no sexo masculino (60 a 69 anos). Esta pesquisa reforça a importância de se aumentarem as medidas de prevenção contra a hepatite B, além de se ampliar o acesso ao diagnóstico precoce para que haja a redução da mortalidade nas próximas décadas.

This study was supported by federal funds from the National Council for Scientific and Technological Development (CNPq; grants 303539/2004?6 and 303475/2005?6), Oswaldo Cruz Institute? FIOCRUZ. Ministry of Health. Secretariat of Health Surveillance. Field Epidemiology Training Program. Bras?lia, DF, Brazil. Ministry of Health. Secretariat of Health Surveillance. Field Epidemiology Training Program. Bras?lia, DF, Brazil. Ministry of Health. Secretariat of Health Surveillance. Field Epidemiology Training Program. Bras?lia, DF, Brazil. Ministry of Health. Secretariat of Health Surveillance. Field Epidemiology Training Program. Bras?lia, DF, Brazil. Ministry of Health. Secretariat of Health Surveillance. Field Epidemiology Training Program. Bras?lia, DF, Brazil / Ministry of Health. Secretariat of Health Surveillance. Waterborne and Foodborne Infectious Diseases Coordination. Bras?lia, DF, Brazil. Ministry of Health. Secretariat of Health Surveillance. Field Epidemiology Training Program. Bras?lia, DF, Brazil / Ministry of Health. Secretariat of Health Surveillance. Waterborne and Foodborne Infectious Diseases Coordination. Bras?lia, DF, Brazil. Ministry of Health. Secretariat of Health Surveillance. Field Epidemiology Training Program. Bras?lia, DF, Brazil. Ministry of Health. Secretariat of Health Surveillance. Waterborne and Foodborne Infectious Diseases Coordination. Bras?lia, DF, Brazil. Acre State Secretariat of Health. Department of Epidemiological Surveillance. Rio Branco, AC, Brazil. Acre State Secretariat of Health. Department of Epidemiological Surveillance. Rio Branco, AC, Brazil. Ministry of Health. Oswaldo Cruz Foundation. Oswaldo Cruz Institute. Laboratory of Comparative Virology. Rio de Janeiro, RJ, Brazil. Ministry of Health. Oswaldo Cruz Foundation. Oswaldo Cruz Institute. Laboratory of Comparative Virology. Rio de Janeiro, RJ, Brazil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Ministry of Health. Secretariat of Health Surveillance. Public Health Laboratory Network. Bras?lia, DF, Brazil. Minist?rio da Sa?de. Secretaria de Vigil?ncia em Sa?de. Instituto Evandro Chagas. Ananindeua, PA, Brasil. Ministry of Health. Oswaldo Cruz Foundation. Oswaldo Cruz Institute. Laboratory of Comparative Virology. Rio de Janeiro, RJ, Brazil. Ministry of Health. Secretariat of Health Surveillance. Field Epidemiology Training Program. Bras?lia, DF, Brazil / Ministry of Health. Oswaldo Cruz Foundation. Gon?alo Moniz Institute. Salvador, BA, Brazil. Ministry of Health. Secretariat of Health Surveillance. Field Epidemiology Training Program. Bras?lia, DF, Brazil / Centers for Disease Control and Prevention. Coordinating Office for Global Health. Division of Global Public Health Capacity Development. Atlanta, Georgia, USA. An epidemic of acute gastroenteritis occurred in Rio Branco City, Acre State, in Brazil's Amazon region in 2005. An investigation was conducted to confirm the etiology and identify possible risk factors for death. Methods: Rio Branco municipality surveillance data for the period May to October 2005 were reviewed. In a case?control study, children who died following acute gastroenteritis were compared to age-matched controls with acute gastroenteritis who survived. Rotavirus A (RV-A) was investigated in 799 stool samples and genotyped by reverse transcription polymerase chain reaction (RT-PCR). Results: The cumulative incidence of diarrhea in children aged 5 years was 21 percent. A fatal outcome was significantly associated with uncovered household water storage containers. RV-A was identified in 88 percent of samples and G9 was the prevalent genotype (71 percent). Conclusions: Oral rehydration solution and boiling or chlorinating drinking water likely limited mortality. This epidemic was caused by RV-A genotype G9. After the outbreak, a rotavirus vaccine was introduced into the official childhood immunization schedule in Brazil.

To the Editor: Brazilian purpuric fever (BPF), a Haemophilus aegyptius–caused febrile hemorrhagic illness of children that begins with conjunctivitis and has a case-fatality rate of 40%–90% (1,2), was first recognized during a 1984 outbreak. Before June 2007, 69 cases were reported worldwide; 65 were from Brazil (1–3). To our knowledge, the disease had not been reported in the Amazon region until this investigation, which was precipitated by the report of 5 cases of a compatible syndrome in Anajas, Para State, Brazil, in August 2007. To determine whether recent reports of BPF were accurate, we reviewed medical records of the hospital in Anajas. We identified cases by using the following definition: fever >38.5oC , abdominal pain, vomiting, purpura, and antecedent conjunctivitis during July 1–September 30, 2007, in a child 3 months–10 years of age; absence of signs or symptoms of meningitis in those children; and laboratory exclusion of meningococcal infection. In addition, we searched retrospectively and prospectively for conjunctivitis among pupils of the elementary schools of Anajas during July–September 2007. We found 7 children with illnesses that met our case definition. From 2 children with nonfatal illness, we collected blood, serum, conjunctival swabs, and cerebrospinal fluid (CSF). All specimens were submitted for bacterial culture in half agar chocolate without bacitracin; serum and CSF were also subjected to real-time PCR for detection of Neisseria meningitides, Streptococcus pneumoniae, and Haemophilus influenzae serotypes a, b, c, and d and to conventional PCR for the ompP2 gene of H. influenzae. All serum samples were also tested by hemagglutination inhibition for Flavivirus, Oropouche, Catu, Caraparu, Tacaiuma, Mayaro, Mucambo, western equine encephalitis, eastern equine encephalitis, Guaroa, Maguari, Ilheus, Rocio, and St. Louis encephalitis; by immunoglobulin M antibody-capture ELISA for dengue and yellow fever; and, when reactive for dengue, by reverse transcription–PCR for dengue types 1, 2, 3, and 4. Because of the remoteness of the outbreak site, samples for bacterial culture were collected on locally available blood agar enriched with rabbit serum without antimicrobial drug–selective agents, rather than on the recommended chocolate agar enriched with horse serum and bacitracin (1). Samples were transported over several days by open boat at ambient temperature (≈35 oC) in improvised containers without an incubator. Serum and CSF samples were thawed and refrozen repeatedly for removal of aliquots before testing. Microbiologic and virologic testing was conducted at the Para State Health Laboratory and Evandro Chagas Institute. Serum and CSF samples were tested by PCR at Adolfo Lutz Institute. We identified 7 case-patients (median age 4 years, range 2–8 years): 6 from review of charts at the local hospital and 1 from active search in the rural community. Onset of illness was August 1 for the first case-patient and August 31 for the last. Five (71%) did not receive antimicrobial drugs and died within 24 hours after fever onset; 2 were treated with amoxicillin within 24 hours after fever onset and survived (Table). Table Characteristics of 7 case-patients with suspected Brazilian purpuric fever, Amazon region, Brazil, August 2007* Laboratory tests showed leukopenia on the day of hospital admission (Table). All case-patients had antecedent conjunctivitis. All except the first case-patient had had physical contact with a previous case-patient through school or family; 5 were related (siblings or cousins). The period from exposure to onset of fever was 8–21 days. Of 1,598 elementary school pupils investigated for conjunctivitis, 111 (7%) reported symptoms of conjunctivitis during July–September 2007. Reported treatment included home remedies and a nonprescription, locally available, cream containing a sulfa drug. Review of municipal hospital records during June 1–September 30, 2007, identified no additional cases of conjunctivitis. After the last case-patient died, 17 other persons were identified with purulent conjunctivitis: 4 at the municipal hospital and 13 during active case-finding in schools and the community. All were treated with oral amoxicillin and chloramphenicol optic solution, and 76 contacts were treated prophylactically with oral rifampin. No further suspected BPF cases were detected. Test results for acute arbovirus infection and PCR were negative for all patients (Table). This outbreak of highly fatal illness is clinically compatible with BPF. Compatible features included young age, antecedent purulent conjunctivitis, signs and symptoms (i.e., antecedent conjunctivitis, fever 39.5Co–41.0Co, abdominal pain, nausea, vomiting, petechiae or ecchymoses), and high case-fatality rate. Epstein-Barr infection has reportedly produced similar symptoms (4) but with an illness lasting >7 days in contrast to the

Backgound and Objectives: The Hospital Information System of the Brazilian National Health System (SIH/SUS) is a system geared to the management of hospital environments. The objective of this study was to evaluate the SIH/SUS how a tool for the malaria surveillance in Amazonia Legal. Methods: Were reviewed the records of hospital admissions caused by malaria of the SIH/SUS in the Amazonia Legal through January 1st, 1999 to December 31th, 2005. The evaluation was based on Updated Guidelines for Evaluating Public Health Surveillance Systems from Centers for Disease Control and Prevention. Results: Hospital admissions caused by malaria represent 0.98% (118,775) of total admissions followed the International Classification of Disease, by place of residence during the period in the Amazonia Legal, 41% (48,674) was recorded as unspecified malaria. Were recorded 150 deaths, and 100% for unspecified malaria. The curve of the rate of hospitalization is downward, 0.96% in 1998, 0.60% in 2000 and 0.46% in 2005.The costs to the Brazilian National Health System of the hospital admissions caused by unspecified malaria was R$ 7,595,701.36. Conclusion: The overall results of the evaluations of attributes and the response that the system provides for effective surveillance of the disease, make the system useful. It should establish a routine operation of this system as a source of information in the surveillance health services. KEYWORDS: Malaria, Surveillance. Hospitalization. Evaluation. Information System.