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OBJECTIVE: To analyze human anti-rabies post-exposure prophylaxis notifications in Brazil. METHODS: This was a descriptive study using data from the Notifiable Diseases Information System in Brazil, from 2014 to 2019. RESULTS: A total of 4,033,098 anti-rabies medical consultations were notified, averaging 672,183 a year. Percentage care was higher among males (n = 2,111,369; 52.4%), those under 19 years old (n = 1,423,433; 35.3%), living in urban areas (n = 3,386,589; 88.1%), attacked by dogs (n = 3,281,190; 81.5%) and bitten (n = 3,575,717; 81.9%), mainly on the hands and feet (n = 1,541,201; 35.3%). The most frequent prophylactic procedure was observation plus vaccination (n = 1,736,036; 44.2%). Prophylactic procedure was appropriate in 57.8% (n = 2,169,689) of cases and inappropriate in 42.2% (n = 1,582,411) of cases. CONCLUSION: Although there were appropriate prophylactic procedures, we also found procedures that were inappropriate and which, when insufficient, can result in cases of human rabies and, when unnecessary, can result in waste, including shortage of immunobiological products.

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Objetivo: Analisar os atendimentos antirrábicos humanos de profilaxia pós-exposição no Brasil. Métodos: Estudo descritivo utilizando dados do Sistema de Informação de Agravos de Notificação no Brasil, de 2014 a 2019. Resultados: Foram notificados 4.033.098 atendimentos antirrábicos, com média de 672.183 ao ano. Houve maior percentual de atendimentos em pessoas do sexo masculino (n = 2.111.369; 52,4%), menores de 19 anos de idade (n = 1.423.433; 35,3%), residentes em área urbana (n = 3.386.589; 88,1%), agredidas por cães (n = 3.281.190; 81,5%) e com mordeduras (n = 3.575.717; 81,9%), principalmente em mãos e pés (n = 1.541.201; 35,3%). A conduta profilática mais frequente foi observação e vacina (n = 1.736.036; 44,2%). A conduta profilática foi adequada em 57,8% (n = 2.169.689) e inadequada em 42,2% (n = 1.582.411) dos casos. Conclusão: Apesar das condutas profiláticas adequadas, foram observadas indicações inadequadas que, quando insuficientes, podem acarretar casos de raiva humana e, quando desnecessárias, desperdícios, inclusive desabastecimento de imunobiológicos.

Objetivo: Analizar la atención antirrábica humana de profilaxis post exposición en Brasil, de 2014 a 2019. Métodos: Estudio descriptivo utilizando datos del Sistema de Información de Agravamientos de Notificación en Brasil, de 2014 a 2019. Resultados: Se notificaron 4.033.098 atendimientos antirrábicos, con un promedio de 672.183 al año. Hubo mayor porcentual de atención a personas del sexo masculino (n = 2.111.369; 52,4%), menores de 19 años (n = 1.423.433; 35,3%), residentes en área urbana (n = 3.386.589; 88,1%), agredidas por perros (n = 3.281.190; 81,5%) y con mordidas (n = 3.575.717; 81,9%), principalmente en las manos y pies (n = 1.541.201; 35,3%). La conducta profiláctica más frecuente fue la observación y vacuna (n = 1.736.036; 44,2%). La conducta profiláctica fue adecuada en 57,8% (n = 2.169.689) e inadecuada en 42,2% (n = 1.582.411) de los casos. Conclusión: A pesar de las conductas profilácticas adecuadas, se observaron indicaciones inadecuadas que, cuando insuficientes, pueden resultar en casos de rabia humana y, cuando desnecesarias, desperdicios, incluso desabastecimiento de inmunobiológicos.

Objective: To analyze human anti-rabies post-exposure prophylaxis notifications in Brazil. Methods: This was a descriptive study using data from the Notifiable Diseases Information System in Brazil, from 2014 to 2019. Results: A total of 4,033,098 anti-rabies medical consultations were notified, averaging 672,183 a year. Percentage care was higher among males (n = 2,111,369; 52.4%), those under 19 years old (n = 1,423,433; 35.3%), living in urban areas (n = 3,386,589; 88.1%), attacked by dogs (n = 3,281,190; 81.5%) and bitten (n = 3,575,717; 81.9%), mainly on the hands and feet (n = 1,541,201; 35.3%). The most frequent prophylactic procedure was observation plus vaccination (n = 1,736,036; 44.2%). Prophylactic procedure was appropriate in 57.8% (n = 2,169,689) of cases and inappropriate in 42.2% (n = 1,582,411) of cases. Conclusion: Although there were appropriate prophylactic procedures, we also found procedures that were inappropriate and which, when insufficient, can result in cases of human rabies and, when unnecessary, can result in waste, including shortage of immunobiological products.

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OBJECTIVE: To characterize the clinical-epidemiological profile of multisystem inflammatory syndrome in children temporally associated with COVID-19 (MIS-C), and to identify factors associated with MIS-C deaths in Brazil, 2020. METHODS: This was a cross-sectional study, using national MIS-C monitoring data. Logistical regression was performed to estimate crude and adjusted odds ratios (OR). RESULTS: Median case (n=652) age was 5 years, 57.1% were male, 52.0% were of brown race/skin color and 6.4% died. Likelihood of death was greater among those who presented O2 saturation <95% (ORa=4.35 - 95%CI 1.69;11.20) and altered urea results (ORa=5.18 - 95%CI 1.91;14.04); likelihood of death was lower when red skin blotches were not present (ORa=0.23 - 95%CI 0.09;0.62), when anticoagulants were used (ORa=0.32 - 95%CI 0.12;0.89) and when immunoglobulins were used (ORa=0.38 - 95%CI 0.15;1.01). CONCLUSION: Fatality ratios were higher among cases that presented O2 saturation <95% and altered urea results. Fatality ratios were lower among those with red skin blotches, and those who used immunoglobulins and anticoagulants.

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Objetivo: Caracterizar o perfil clínico-epidemiológico da síndrome inflamatória multissistêmica pediátrica temporalmente associada à COVID-19 (SIM-P) e identificar fatores associados aos óbitos de SIM-P no Brasil, 2020. Métodos: Estudo seccional, utilizando dados do monitoramento nacional da SIM-P. Empregou-se regressão logística para estimar razões de chances (OR, odds ratios ) brutas e ajustadas. Resultados: Os casos (n=652) apresentaram mediana de idade de 5 anos; 57,1% eram do sexo masculino e 52,0% de raça/cor da pele parda; 6,4% evoluíram a óbito. A chance de óbito foi significativamente maior nos que apresentaram saturação de O2<95% (ORa=4,35 - IC95% 1,69;11,20) e resultado alterado de ureia (ORa=5,18 - IC95% 1,91;14,04); e menor na ausência de manchas vermelhas pelo corpo (ORa=0,23 - IC95% 0,09;0,62), com uso de anticoagulantes (ORa=0,32 - IC95% 0,12;0,89) e imunoglobulinas (ORa=0,38 - IC95% 0,15;1,01). Conclusão: A letalidade foi maior entre casos que apresentaram saturação de O2<95% e ureia alterada; e menor nos que apresentaram manchas vermelhas, usaram imunoglobulinas e anticoagulantes.

Objetivo: Caracterizar el perfil clínico-epidemiológico de los casos por síndrome inflamatorio multisistémico pediátrico asociado temporalmente a la COVID-19 (SIM-PedS) e identificar factores asociados a los óbitos por SIM-PedS en Brasil, 2020. Métodos: Estudio transversal basado en datos del monitoreo nacional de la SIM-PedS, Brasil, 2020. Se utilizó regresión logística para estimar razones de probabilidades brutas y ajustadas (OR, odds ratio). Resultados: Los casos (n=652) presentaron edad mediana de 5 años, 57,1% eran hombres, 52,0% de raza/color pardo y 6,4% falleció. La probabilidad de muerte fue significativamente mayor entre aquellos con saturación de O2<95% (ORa=4,35 - IC95%1,69;11,20) y resultado alterado de urea (ORa=5,18 - IC95% 1,91;14,04); menor en ausencia de manchas rojas como erupción (ORa=0,23 - IC95% 0,09;0,62), con uso de anticoagulantes (ORa=0,32 - IC95% 0,12;0,89) e inmunoglobulinas (ORa=0,38 - IC95%0,15;1,01). Conclusión: La letalidad fue mayor entre casos que presentaron saturación de O2<95% y urea alterada, y menor entre aquellos con manchas rojas, que usaron inmunoglobulinas y anticoagulantes.

Objective: To characterize the clinical-epidemiological profile of multisystem inflammatory syndrome in children temporally associated with COVID-19 (MIS-C), and to identify factors associated with MIS-C deaths in Brazil, 2020. Methods: This was a cross-sectional study, using national MIS-C monitoring data. Logistical regression was performed to estimate crude and adjusted odds ratios (OR). Results: Median case (n=652) age was 5 years, 57.1% were male, 52.0% were of brown race/skin color and 6.4% died. Likelihood of death was greater among those who presented O2 saturation <95% (ORa=4.35 - 95%CI 1.69;11.20) and altered urea results (ORa=5.18 - 95%CI 1.91;14.04); likelihood of death was lower when red skin blotches were not present (ORa=0.23 - 95%CI 0.09;0.62), when anticoagulants were used (ORa=0.32 - 95%CI 0.12;0.89) and when immunoglobulins were used (ORa=0.38 - 95%CI 0.15;1.01). Conclusion: Fatality ratios were higher among cases that presented O2 saturation <95% and altered urea results. Fatality ratios were lower among those with red skin blotches, and those who used immunoglobulins and anticoagulants.

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Resumen Introducción: Actualmente Paraguay no cuenta con estudios de prevalencia de infección por geohelmintos transmitidos por contacto con el suelo en escolares de 6 a 12 años. Objetivo: Determinar la prevalencia e intensidad de infección por Ascaris lumbricoides, Trichuris trichiura y las uncinarias y las características socio culturalesambientales de la población afectada. Materiales y Métodos: Estudio descriptivo, de corte transversal, en tres zonas climáticas: semi tropical continental, semi tropical semi estépico y semi tropical húmedo. Se seleccionaron 1.404 escolares de 20 escuelas de ocho departamentos, de las tres zonas climáticas del país. Se analizaron exámenes coproparasitológicos in situ con el método Kato-Katz. Resultados: La prevalencia nacional de geohelmintiasis fue de 3,7% (IC95% = 2,8-4,8). Los factores de riesgo fueron el consumo de agua de pozo OR: 2,88 (IC95% = 1,64-2,07), piso de tierra en la vivienda OR: 2,56 (IC95% = 1,45-4,50) y falta de baño con arrastre de agua en los hogares OR: 2,29 (IC95% = 1,23-4,28). Conclusión: A pesar de que la prevalencia nacional de geohelmintiasis fue baja, se recomienda promocionar buenas prácticas higiénicas, el uso de calzado, y consumo de agua segura, así como diseñar intervenciones con los sectores pertinentes para mejorar el acceso al agua segura y a instalaciones mejoradas de saneamiento básico.

Introduction: Currently, Paraguay has no data on the prevalence of soil-transmitted geohelminth infection in schoolchildren aged 6 to 12 years. Aim: To determine the prevalence and intensity of infection by Ascaris lumbricoides, Trichuris trichiura and hookworms and the socio-cultural-environmental characteristics of the affected population. Methods: Descriptive, cross-sectional study, in three semi-tropical climatic zones: continental, semi steppe and humid. A total of 1,404 schoolchildren from 20 schools in eight departments were selected from the country's three climate zones. Copro-parasitological exams were analyzed in situ with the Kato-Katz method. Results: The national prevalence for geohelminthiasis was 3.73% (95% CI = 2.8-4.8). The risk factors found were consumption of well water OR: 2.88 (95% CI = 1.64-2.07), ground floor in housing OR: 2.56 (95% CI = 1.45-4.50) and lack of flushing water baths in households OR: 2.29 (95% CI = 1.23-4.28). Conclusion: Although the national prevalence of geohelminthiasis was low, it is recommended to promote good hygienic practices, use of footwear, and safe water consumption, as well as designing interventions with all relevant sectors to improve access to safe water and improved basic sanitation facilities.

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La influenza (FLU) causa morbilidad grave y mortalidad. El objetivo del estudio fue evaluar la incidencia, la etiología y el uso de recursos para la gripe en un barrio de bajos ingresos de Asunción, Paraguay mediante un estudio de cohorte prospectiva de base poblacional con muestreo aleatorio estratificado de viviendas de julio a Octubre de 2013. El monitoreo de los hogares para la identificación de los casos de enfermedad tipo influenza (ETI) fue telefónico. En aquellos pacientes con ETI, se tomaron hisopados nasofaríngeos para RT-PCR e IFI. Se establecieron los factores de riesgo para ETI por la prueba de chi cuadrado considerándose significativa p<0,05; además se calculó RR con IC95%. De 8.279 viviendas, 401 familias (2.065 personas) fueron monitoreadas; se identificaron 141 casos de ETI que representa una incidencia de 6,8% (IC95%: 5,5-7,6%); el 56% de los casos buscaron atención médica, en su mayoría (80%) en servicios públicos. Se testaron 84% de los hisopados nasofaríngeos, siendo positivo en el 22% para virus respiratorios; 86% FLU (63% FLU A, 37% FLU B). Se encontró asociación (p< 0,001) entre enfermar de ETI y tener edad menor de 5 años (RR: 2,43 (1,68-3,49). Este es el primer estudio que da información sobre la carga de Influenza en Paraguay. El monitoreo telefónico resultó ser una buena estrategia para monitoreo de los hogares para la identificación de los casos de ETI. El virus de la Influenza fue el patógeno más común identificado, con una alta demanda de asistencia médica, lo que resulta una carga sustancial para los servicios de salud.

Influenza (FLU) causes severe morbidity and mortality. This study aimed to evaluate the incidence, etiology and use of resources for influenza in a low-income neighborhood in Asunción, Paraguay through a prospective population base cohort with stratified random sampling of houses from July to October 2013. Monitoring of cases of influenza-like illness (ILI) was by telephone. In ETI cases, nasopharyngeal swabs were collected for RT-PCR and IFI. Risk factors for ETI were established using chi square test at p≤0.05; RR with CI 95% was also calculated. Of 8,279 homes, 401 families (2,065 people) were monitored; 141 ILI cases were identified, yielding an incidence of 6.8% (95% CI 5.5-7.6), 56% of cases sought medical attention, mostly (80%) in public health services. Among the ILIs, 84% of nasopharyngeal swabs were tested, 22% positive for respiratory viruses; 86% FLU (63% FLU A, 37% FLU B). An association (p<0.001) between ILI disease and aged less than 5 years (RR: 2.43 (1.68-3.49) was found. This is the first study that gives information on Influenza burden in Paraguay. Telephone monitoring was a good strategy for house monitoring in order to identify cases of ILI. Influenza virus was the most common pathogen identified, with a high demand for medical assistance, which results in a substantial burden for health services.

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O Programa de Treinamento em Epidemiologia Aplicada aos Serviços do Sistema Único de Saúde (EPISUS) é um programa de treinamento permanente e em serviço, baseado no Epidemic Intelligence Service do Centers for Disease Control and Prevention – Atlanta, GA, USA (CDC). Este estudo tem como objetivo caracterizar o contexto organizacional do EPISUS, descrever o perfil dos egressos formados desde sua implantação, bem como a inserção dos mesmos no SUS. Para tanto foi utilizando um enfoque de avaliação quantitativa.O EPISUS foi implantado no Brasil em 2000, por meio de um acordo de cooperação técnica entre o Ministério de Saúde e o CDC, financiado pelo Projeto VIGISUS. O programa apresenta como objetivos capacitar profissionais para o fortalecimento nas três esferas de governo no âmbito do SUS, para contribuir nas respostas às emergências epidemiológicas e eventos de interesse em saúde pública, integrando assim a rede Field Epidemiology Training Program, juntamente com 75 países. Em 10 anos, 89 profissionais entre biólogos,biomédicos, enfermeiros, farmacêuticos, médicos, médicos veterinários, nutricionistas e odontólogos realizaram o treinamento. Estes, procedentes de todas as regiões do país, sendo o Distrito Federal e os estados de São Paulo e Pernambuco responsáveis por mais 54,0% do total. Um 47,2% contavam com mestrado, 46,1% com especialização e 6,7% doutorado ao ingressarem no programa, e atualmente 24,7% dos egressos tiveram um incremento no nível de titulação após o treinamento. Do total 46,1% retornaram a seus Estados de origem e 100%atuaram em algum momento no SUS ou após o treinamento, 92,1% atuaram em algum momento em atividades relacionadas aos objetivos do programa e atualmente 70,5% atuam.Embora grande parte atue em áreas foco do programa, observa-se uma parcela fora. Neste contexto estratégias para um maior cumprimento dos objetivos do programa transcorrendo pela discussão quanto à retenção de egressos e sua inserção no SUS se faz necessária.

The Training in Epidemiology Applied to the Health Service (EPISUS) is a program ofongoing training and service, based on the Epidemic Intelligence Service of the Centers forDisease Control and Prevention - Atlanta, GA, USA (CDC). This study aims to characterizethe organizational context of EPISUS, describe the profile of graduates trained since itsimplementation, as well as the inclusion of the same in the SUS. To do so was using aquantitative approach. The EPISUS was implemented in Brazil in 2000 through a technicalcooperation agreement between the Ministry of Health and CDC, funded VIGISUS Project.The syllabus aims to train professionals to strengthen the three spheres of government withinthe SUS, to help in responding to emergencies and epidemiological events of public healthinterest, thus integrating the network Field Epidemiology Training Program, along with over75 countries. In 10 years, 89 professional biologists, biomedical scientists, nurses,pharmacists, physicians, veterinarians, nutritionists and dentists conducted the training. These,coming from all regions of the country, the Federal District and the states of São Paulo andPernambuco accounted for over 54.0% of the total. The moment we entered the program47.2% had master's specialization with 46.1% and 6.7% doctorate, and currently 24.7% ofgraduates had an increase in titer level after training. Of the total 46.1% returned to theirhome states and 100% worked sometime in SUS or after training, 92.1% worked at some timein activities related to the objectives of the program and currently work 70.5%. While much ofthe focus areas in acting program, there is a plot out in this context should enter intodiscussion topics for greater compliance program objectives permeating the discussionregarding retention of graduates and their integration into SUS.

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Objetivo: apresentar a metodologia e resultados da implantação da vigilância de fatores de risco e proteção para doenças e agravos não transmissíveis (DANT) em município de pequeno porte, Anchieta, no estado do Espírito Santo, Brasil, em 2010. Métodos: estudo transversal de base populacional com realização de exames bioquímicos, aferição da pressão arterial, avaliação antropométrica e eletrocardiograma da população-alvo. Resultados: aproximadamente 25,0 por cento dos entrevistados relataram consumo regular de refrigerante, 45,2 por cento, carne com gordura, e 22,5 por cento, abuso de bebida alcoólica; 14,1 por cento referiram ser inativos, 16,2 por cento, fumantes, 52,1 por cento apresentaram excesso de peso auto-referido, e 16,9 por cento, obesidade; sobre fatores de proteção, 5,0 por cento da população referiu consumir frutas e hortaliças conforme recomendado, e 3,6 por cento, atividade física no lazer; a prevalência de uso de cinto de segurança no banco da frente foi de 74,0 por cento, e 83,5 por cento dos motociclistas referiram utilizar capacete; entre os indivíduos que realizaram exames, 49,2 por cento apresentaram hipercolesterolemia, 46,0 por cento, lesão renal, 19,0 por cento, alteração em eletrocardiograma e 5,8 por cento, diabetes. Conclusão: a metodologia utilizada permitiu conhecer a prevalência dos fatores de risco e proteção para DANT em município de pequeno porte; ações de promoção da saúde, vigilância, prevenção e atenção estão sendo elaboradas com base nos resultados encontrados.

Objective: to present the methodology and results of the implementation of surveillance for risk and protective factors for non-communicable diseases (NCD) and injuries in a small city, Anchieta, in the State of Espírito Santo, Brazil, in 2010. Methods: a population-based cross sectional study with blood sample collection, blood pressure, anthropometric measurements and electrocardiogram of the target-population. Results: approximately 25.0 per cent adults interviewed reported drinking soft drinks regularly, 45.2 per cent, eat meat with visible fat, and 22.5 per cent, harmful use of alcohol; 14.1 per cent reported physical inactivity, 16.2 per cent, tobacco smoking, 52.1 per cent, self-reported overweight, and 16.9 per cent, obesity; among protective factors, 5.0 per cent reported fruit and vegetable intake as recommended, and 3.6 per cent, leisure time physical activity; prevalence of seat belt use in front seat was 74.0 per cent; helmet use was reported by 83.5 per cent of motorcyclists; among individuals who performed blood tests, 49.2 per cent had hypercholesterolemia, 46.0 per cent presented some stage of chronic kidney disease, 19.0 per cent, cardiovascular dysfunction according to electrocardiogram, and 5.8 per cent, diabetes. Conclusion: the methodology allowed to know the risk and protective factors for NCD in a small city of Brazil; actions on health promotion, surveillance, prevention and health care are being developed, based on the results of this study.

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O sistema de vigilância deve ser avaliado periodicamente, visando tornar mais efetivas e ágeis as medidas de controle de eventos adversos à saúde. Dessa forma, os objetivos desse estudo foram avaliar os atributos qualitativos e quantitativos do sistema de vigilância das intoxicações exógenas do Brasil de 2007 a 2009, período em que este se vinculava exclusivamente à Saúde do Trabalhador, por meio do Update Guidelines for Evaluating Public Health Surveillance Systems. Foi utilizado um formulário estruturado e o banco de dados do SINAN NET como fontes de dados. Dos 27 estados do Brasil, 16 responderam aos questionários. Os dados seguem o fluxo estabelecido pelo SINAN NET sem a definição de uma coordenadoria estadual. Conforme os parâmetros adotados, esse sistema de vigilância foi considerado simples, flexível, oportuno e instável. A qualidade de dados e a representatividade foram regulares; e a sensibilidade e o valor preditivo positivo foram baixos. Recomendamos estabelecer o fluxo do sistema de vigilância dentro das secretarias estaduais e elaborar guia das intoxicações exógenas, definindo os objetivos para esta vigilância.

The surveillance systems should be evaluated periodically with objective to become more agile and effective measures to control adverse health events. Thus, the aim of this study was to evaluate the qualitative and quantitative attributes of the Surveillance System for Exogenic Poisoning in Brazil from 2007 to 2009, during which it was linked exclusively to the Occupational Health. For this purpose, there was used the Update Guidelines for Evaluating Public Health Surveillance Systems. A structured questionnaires and database SINAN NET was used as data sources. Of the 27 states of Brazil, 16 answered the questionnaires. The data follow the flow established by Brazilian Surveillance System (SINAN NET), however without setting a statewide coordinating body. As the parameters adopted, the Surveillance System for Exogenic Poisoning was considered simple, flexible, timely and unstable. Data quality and representativeness were regular; and the sensitivity and Positive Predictive Value were low. We recommend establishing a Surveillance System's flow within the state and to develop a Guide for Exogenic Poisoning, defining the goals for this surveillance.