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Brazil experienced one of the fastest increasing numbers of coronavirus disease (COVID-19) cases worldwide. The Sao Paulo State (SPS) reported a high incidence, particularly in Sao Paulo municipality. This study aimed to identify clusters of incidence and mortality of hospitalized patients with severe acute respiratory syndrome for COVID-19 in the SPS, in 2020-2021, and describe the origin flow pattern of the cases. Cases and mortality risk area clusters were identified through different analyses (spatial clusters, spatio-temporal clusters, and spatial variation in temporal trends) by weighting areas. Ripley's K12-function verified the spatial dependence between the cases and infrastructure. There were 517,935 reported cases, with 152,128 cases resulting in death. Of the 470,441 patients hospitalized and residing in the SPS, 357,526 remained in the original municipality, while 112,915 did not. Cases and death clusters were identified in the Sao Paulo metropolitan region (SPMR) and Baixada Santista region in the first study period, and in the SPMR and the Campinas, Sao Jose do Rio Preto, Barretos, and Sorocaba municipalities during the second period. We highlight the priority areas for control and surveillance actions for COVID-19, which could lead to better outcomes in future outbreaks.

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ABSTRACT Brazil experienced one of the fastest increasing numbers of coronavirus disease (COVID-19) cases worldwide. The Sao Paulo State (SPS) reported a high incidence, particularly in Sao Paulo municipality. This study aimed to identify clusters of incidence and mortality of hospitalized patients with severe acute respiratory syndrome for COVID-19 in the SPS, in 2020-2021, and describe the origin flow pattern of the cases. Cases and mortality risk area clusters were identified through different analyses (spatial clusters, spatio-temporal clusters, and spatial variation in temporal trends) by weighting areas. Ripley's K12-function verified the spatial dependence between the cases and infrastructure. There were 517,935 reported cases, with 152,128 cases resulting in death. Of the 470,441 patients hospitalized and residing in the SPS, 357,526 remained in the original municipality, while 112,915 did not. Cases and death clusters were identified in the Sao Paulo metropolitan region (SPMR) and Baixada Santista region in the first study period, and in the SPMR and the Campinas, Sao Jose do Rio Preto, Barretos, and Sorocaba municipalities during the second period. We highlight the priority areas for control and surveillance actions for COVID-19, which could lead to better outcomes in future outbreaks.

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OBJECTIVES: To retrospectively describe severe cases of hospitalized patients and deaths related to the COVID-19 epidemic in the state of São Paulo, starting from the date of the first record, with symptoms onset on 02/10/2020 up to 05/20/2021. METHODS: This is a descriptive study carried out using the Influenza Epidemiological Surveillance System (Sistema de Vigilância Epidemiológica da Gripe - SIVEP-Gripe) database. The rates of incidence, mortality, and accumulated incidence in the period were calculated, stratified by age group and Regional Health Department (RHD). In addition, severe cases were geocoded to analyze their spread across the state; and the Effective R, which determines the spread potential of a virus within a population, was calculated. RESULTS: There was a significant increase in severe cases and deaths recorded in the period of one year, with incidence and mortality rates being heterogeneous within the state. The most critical periods regarding the incidence of severe cases occurred between May and July 2020 and between March and April 2021. The RHD in São José do Rio Preto, Expanded São Paulo, and Araçatuba concentrated the highest incidence and mortality rates. Severe cases and deaths were more frequent in men and in the population over 60 years, while the main risk conditions related to deaths were heart disease (59%) and diabetes (42,8%). CONCLUSIONS: These results not only provide a detailed profile for more efficient control action plan, but will also allow the historical understanding of the COVID-19 evolution within the state of São Paulo.

OBJETIVO: Descrever, de forma retrospectiva, os casos graves de pacientes hospitalizados e os óbitos relacionados à epidemia de COVID-19 no estado de São Paulo, desde a data do primeiro registro, com início de sintomas em 10 de fevereiro de 2020 até registros disponíveis em 20 de maio de 2021. MÉTODOS: Trata-se de um estudo descritivo realizado por meio da base de dados do Sistema de Vigilância Epidemiológica da Gripe. Foram calculadas as taxas de incidência, mortalidade e incidência acumulada no período, estratificadas por faixa etária e agrupadas de acordo com cada Departamento Regional de Saúde. Os casos graves foram geocodificados para a análise de seu espalhamento pelo estado e foi calculado o R efetivo, que estima o potencial de propagação de um vírus em uma população. RESULTADOS: Houve aumento significativo dos casos graves e óbitos registrados no período de um ano, e as taxas de incidência e mortalidade foram heterogêneas no estado. Os períodos mais críticos em relação à incidência de casos graves ocorreram entre maio e julho de 2020 e entre março e abril de 2021. Os Departamentos Regionais de Saúde de São José do Rio Preto, Grande São Paulo e Araçatuba concentraram as maiores taxas de incidência e mortalidade. Os casos graves e óbitos foram mais frequentes nos homens e na população acima de 60 anos, e as principais condições de risco relacionadas aos óbitos foram cardiopatia (59%) e diabetes (42,8%). CONCLUSÕES: Espera-se que esses resultados ofereçam embasamento e possam contribuir para uma ação de controle mais eficiente da COVID-19, além de permitir o entendimento histórico de sua evolução no estado.

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Coronavirus Disease 2019 pandemic remains a threat to public health. We report 2 cases of Coronavirus Disease 2019 infection in the same healthcare professional in Brazil. Genomic analysis identified that primoinfection was caused by the endemic lineage B.1.1.33 while reinfection by the lineage B.1.1.44, a lineage with an additional V1176F mutation in S protein.

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From February 26, 2020 to March 11, 2021, coronavirus disease 2019 (COVID-19) pandemic resulted in 11,439,558 cases and 277,102 deaths in Brazil. Among them, 2,195,130 cases and 63,965 deaths occurred in Sao Paulo State, Southeast Brazil. The recent emergence and rise of new variants of SARS-CoV-2 is of concern because of their higher transmissibility and possible association with more severe disease. Cases of SARS-CoV-2 reinfections have been described since December 2020 in Brazil. This report describes two cases of COVID-19 reinfection, that occurred five and six months after the first infection, during the second wave of the pandemic in Sao Paulo State. Both patients presented mild symptoms in the two COVID-19 episodes and different lineages of SARS-CoV-2 were identified: B.1.1.33 and B.1.1.28 lineages in case 1 and B1.1.128 and P. 2 lineages in case 2.

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Coronavirus Disease 2019 pandemic remains a threat to public health. We report 2 cases of Coronavirus Disease 2019 infection in the same healthcare professional in Brazil. Genomic analysis identified that primoinfection was caused by the endemic lineage B.1.1.33 while reinfection by the lineage B.1.1.44, a lineage with an additional V1176F mutation in S protein.

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From February 26, 2020 to March 11, 2021, coronavirus disease 2019 (COVID-19) pandemic resulted in 11,439,558 cases and 277,102 deaths in Brazil. Among them, 2,195,130 cases and 63,965 deaths occurred in Sao Paulo State, Southeast Brazil. The recent emergence and rise of new variants of SARS-CoV-2 is of concern because of their higher transmissibility and possible association with more severe disease. Cases of SARS-CoV-2 reinfections have been described since December 2020 in Brazil. This report describes two cases of COVID-19 reinfection, that occurred five and six months after the first infection, during the second wave of the pandemic in Sao Paulo State. Both patients presented mild symptoms in the two COVID-19 episodes and different lineages of SARS-CoV-2 were identified: B.1.1.33 and B.1.1.28 lineages in case 1 and B1.1.128 and P. 2 lineages in case 2.

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Long-term care facilities for older adults present a high risk of outbreaks since they concentrate often more frail and vulnerable individuals. OBJECTIVE: To describe the epidemiological characteristics of influenza-like illness outbreaks and cases among older people in long-term care facilities in the state of São Paulo, Brazil. METODS: The analysis was performed through an exploratory and descriptive approach, with records from the outbreak module of the National System of Notifiable Diseases between January 2020 and June 2021. RESULTS: Outbreaks of influenza-like illness in this department represented 24.93% of all notifications. The highest concentration was seen in the state capital and metropolitan area. A total of 1 018 confirmed outbreaks were observed, involving 6 110 cases and 1 240 deaths among older people. Of these cases, 71.67% were confirmed for coronavirus disease 19 (COVID-19), 12.77% for the influenza virus, and 15.56% for other respiratory viruses. The percentages regarding death outcomes were similar, with a 20.29% lethality of influenza-like illness. Within the studied group, the older adults were the most affected. A statistical difference was observed between cases and deaths. CONCLUSIONS: Owing to the current scenario and the known vulnerabilities of these facilities, there is an urgent need for joint and articulated action by various administrative levels in order to minimize the devastating effects of influenza-like illness outbreaks (especially of COVID19) in older adults at long-term care homes. The strengthening of information systems and their interoperability are considered of utmost importance in order to improve the quality of information on outbreaks, which is essential during a pandemic.

Instituições de longa permanência para idosos são locais que apresentam um alto risco de surtos epidêmicos, visto que concentram indivíduos, frequentemente mais frágeis e vulneráveis. OBJETIVO: Descrever as características epidemiológicas de surtos de síndrome gripal entre idosos em instituições de longa permanência no estado de São Paulo. MÉTODOS: A análise foi realizada através de uma abordagem exploratória e descritiva, utilizando-se de registros do Sistema de Informações de Agravos de Notificação, módulo surto, entre janeiro de 2020 e junho de 2021. RESULTADOS: Surtos de síndrome gripal neste departamento representaram 24,93% do total de notificações. A maior concentração de surtos ocorreu na capital e região metropolitana. Foram observados 1018 surtos confirmados, envolvendo 6110 casos e 1240 óbitos em idosos. Entre estes casos, 71,67% foram confirmados para COVID-19, 12,77% para o vírus Influenza e 15,56%, para outros vírus respiratórios. Óbitos apresentaram porcentagens semelhantes, com a letalidade de síndrome gripal sendo de 20,29%. No grupo estudado, idosos mais longevos foram os mais acometidos. Houve diferença estatística entre casos e óbitos. CONCLUSÕES: Devido ao cenário atual e às conhecidas vulnerabilidades destas instituições, há a necessidade urgente de uma ação conjunta e articulada por parte de diversas esferas administrativas para minimizar os efeitos devastadores de surtos de síndrome gripal, especialmente os de COVID-19, em instituições de longa permanência. O fortalecimento de sistemas de informação e sua interoperabilidade são considerados de vital importância para melhorar a qualidade da informação sobre surtos institucionais, a qual é essencial durante uma pandemia.

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RESUMO: Objetivo: Descrever, de forma retrospectiva, os casos graves de pacientes hospitalizados e os óbitos relacionados à epidemia de COVID-19 no estado de São Paulo, desde a data do primeiro registro, com início de sintomas em 10 de fevereiro de 2020 até registros disponíveis em 20 de maio de 2021. Métodos: Trata-se de um estudo descritivo realizado por meio da base de dados do Sistema de Vigilância Epidemiológica da Gripe. Foram calculadas as taxas de incidência, mortalidade e incidência acumulada no período, estratificadas por faixa etária e agrupadas de acordo com cada Departamento Regional de Saúde. Os casos graves foram geocodificados para a análise de seu espalhamento pelo estado e foi calculado o R efetivo, que estima o potencial de propagação de um vírus em uma população. Resultados: Houve aumento significativo dos casos graves e óbitos registrados no período de um ano, e as taxas de incidência e mortalidade foram heterogêneas no estado. Os períodos mais críticos em relação à incidência de casos graves ocorreram entre maio e julho de 2020 e entre março e abril de 2021. Os Departamentos Regionais de Saúde de São José do Rio Preto, Grande São Paulo e Araçatuba concentraram as maiores taxas de incidência e mortalidade. Os casos graves e óbitos foram mais frequentes nos homens e na população acima de 60 anos, e as principais condições de risco relacionadas aos óbitos foram cardiopatia (59%) e diabetes (42,8%). Conclusões: Espera-se que esses resultados ofereçam embasamento e possam contribuir para uma ação de controle mais eficiente da COVID-19, além de permitir o entendimento histórico de sua evolução no estado.

ABSTRACT: Objectives: To retrospectively describe severe cases of hospitalized patients and deaths related to the COVID-19 epidemic in the state of São Paulo, starting from the date of the first record, with symptoms onset on 02/10/2020 up to 05/20/2021. Methods: This is a descriptive study carried out using the Influenza Epidemiological Surveillance System (Sistema de Vigilância Epidemiológica da Gripe - SIVEP-Gripe) database. The rates of incidence, mortality, and accumulated incidence in the period were calculated, stratified by age group and Regional Health Department (RHD). In addition, severe cases were geocoded to analyze their spread across the state; and the Effective R, which determines the spread potential of a virus within a population, was calculated. Results: There was a significant increase in severe cases and deaths recorded in the period of one year, with incidence and mortality rates being heterogeneous within the state. The most critical periods regarding the incidence of severe cases occurred between May and July 2020 and between March and April 2021. The RHD in São José do Rio Preto, Expanded São Paulo, and Araçatuba concentrated the highest incidence and mortality rates. Severe cases and deaths were more frequent in men and in the population over 60 years, while the main risk conditions related to deaths were heart disease (59%) and diabetes (42,8%). Conclusions: These results not only provide a detailed profile for more efficient control action plan, but will also allow the historical understanding of the COVID-19 evolution within the state of São Paulo.

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Registros de casos de leishmaniose tegumentar na cidade de São Paulo, em parques e seusentornos, desde a década de 1970, e o início da expansão da área de transmissão da leishmaniosevisceral, no final dos anos de 1990, levaram o Centro de Controle de Zoonoses do município deSão Paulo (atualmente Divisão de Vigilância de Zoonoses) a desenvolver coletas sistematizadasde flebotomíneos em 12 áreas florestais da cidade, representadas por dez parques: Alfredo Volpi,Anhanguera, Cantareira (Núcleo Pedra Grande), do Carmo, Ecológico Tietê, Fundação ParqueZoológico, Guarapiranga, Jaraguá, Previdência e Tenente Siqueira Campos (Trianon), e em doisfragmentos de matas residuais: do Instituto Butantan e da Secretaria da Agricultura do Estado deSão Paulo. As coletas foram realizadas com armadilhas automáticas luminosas tipos New Jersey(NJ) e Center of Disease Control (CDC), entre 1981 e 2001. Flebotomíneos foram encontradosem 10/12 áreas amostradas. Nos parques Guarapiranga e Siqueira Campos (Trianon) as coletasforam negativas. No total das demais áreas, coletou-se 2.638 espécimes de flebotomíneos (79%fêmeas e 21% machos) de 23 espécies, pertencentes a 11 gêneros Brumptomyia...

Reports of cutaneous leishmaniasis cases in areas in and near urban parks in the city of São Paulosince the 1970s, and the spread of visceral leishmaniasis since the end of the 1990s led the Centrode Controle de Zoonoses (currently the Divisão de Vigilância de Zoonoses) of the municipalityof São Paulo to undertake systematic collections of phlebotomine sand flies in 12 forested areas,represented by 10 parks: Alfredo Volpi, Anhanguera, Cantareira (Núcleo Pedra Grande), do Carmo,Ecológico Tietê, Fundação Parque Zoológico, Guarapiranga, Jaraguá, Previdência and TenenteSiqueira Campos (Trianon), and two fragments of residual forest: of the Instituto Butantan andof the Secretariat of Agriculture of the state of São Paulo. The collections were carried out usingautomatic light traps, New Jersey (NJ) and Center of Disease Control (CDC) types, between1981 and 2001. In the Guarapiranga and Tenente Siqueira Campos (Trianon) parks the collectionswere negative. In the all other areas 2,638 sand flies (79% female and 21% male) of 23 species,belonging to 11 genera, were captured: Brumptomyia (5), Evandromyia (1), Expapillata (1),Lutzomyia (1), Martinsmyia (1), Migonemyia (1), Nyssomyia (3), Pintomyia (3), Psathyromyia(3), Psychodopygus (3) and Sciopemyia (1), and also four taxa identified only at the genus level.The Cantareira park presented the greatest species richness (15 species + 1 Brumptomyia sp.).Pintomyia fischeri was collected at all the above...

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The identification of individuals with respiratory symptoms (RS) is important for the early detection of tuberculosis. The aim of this study was to estimate the prevalence of RS in three administrative regions of the Federal District, Brazil. For this, we used the 30 by 7 cluster sampling technique proposed by the World Health Organization. Individuals with RS were defined as those aged 15 years or older living in the administrative regions of Estrutural, Itapoã, or Varjão and reporting a cough lasting at least 3 weeks at the date of the interview. The prevalence of RS was 5.7% in Estrutural and Varjão (95% CI: 2.4-9.0) and 4.8% in Itapoã (95%CI: 1.6-7.9), with a design effect close to 1.0. In Estrutural and Itapoã, fewer years of schooling, and in Itapoã and Varjão, lower income, were associated with RS. Cigarette smoking was associated with the presence of RS in all regions. The prevalence of RS in the three administrative regions investigated is consistent with that of other areas with a similar socioeconomic profile.

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A captação de sintomáticos respiratórios (SR) é importante para a detecção precoce de tuberculose. O objetivo deste estudo foi estimar a prevalência de SR em três regiões administrativas (RA) do Distrito Federal, Brasil. Para tanto, foi utilizada a técnica de amostragem por conglomerados (30 por 7) proposta pela Organização Mundial da Saúde. Foram definidos como SR os indivíduos com 15 anos ou mais residentes nas RAs Estrutural, Itapoã ou Varjão e que apresentassem tosse há pelo menos 3 semanas na data da entrevista. A prevalência de SR em Estrutural e Varjão foi de 5,7 por cento (IC95 por cento: 2,4 a 9,0), e em Itapoã, de 4,8 por cento (IC95 por cento: 1,6 a 7,9), com efeito de desenho próximo de 1,0. Em Estrutural e Itapoã, menos anos de estudo, e em Itapoã e Varjão, menor renda, estiveram associados com ser SR. O tabagismo esteve associado com a presença de sintomas respiratórios em todas as RAs. A prevalência de SR está de acordo com aquela encontrada em outras áreas com perfil socioeconômico semelhante ao das áreas estudadas.

The identification of individuals with respiratory symptoms (RS) is important for the early detection of tuberculosis. The aim of this study was to estimate the prevalence of RS in three administrative regions of the Federal District, Brazil. For this, we used the 30 by 7 cluster sampling technique proposed by the World Health Organization. Individuals with RS were defined as those aged 15 years or older living in the administrative regions of Estrutural, Itapoã, or Varjão and reporting a cough lasting at least 3 weeks at the date of the interview. The prevalence of RS was 5.7 percent in Estrutural and Varjão (95 percent CI: 2.4-9.0) and 4.8 percent in Itapoã (95 percentCI: 1.6-7.9), with a design effect close to 1.0. In Estrutural and Itapoã, fewer years of schooling, and in Itapoã and Varjão, lower income, were associated with RS. Cigarette smoking was associated with the presence of RS in all regions. The prevalence of RS in the three administrative regions investigated is consistent with that of other areas with a similar socioeconomic profile.

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INTRODUCTION: This paper describes the investigation to confirm an outbreak of hepatitis A, presents the case distribution by person, time and place, formulates a hypothesis concerning the mode of transmission and presents the recommended measures for prevention and control. METHODS: A descriptive study of a case series and an environmental research were conducted. RESULTS: An outbreak of hepatitis A was confirmed beginning in March 2009. Forty one (71%) individuals in the town received untreated water in their households. Thermotolerant coliform bacteria were detected in 20/58 (34%) water samples. CONCLUSIONS: Consumption of contaminated water was the main hypothesis of virus transmission.

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INTRODUÇÃO: Os objetivos desse estudo foram confirmar a existência de um surto de hepatite A, descrever o evento por pessoa, tempo e lugar, formular hipóteses sobre modo de transmissão e propor medidas de prevenção e controle. MÉTODOS: Realizado um estudo descritivo do tipo série de casos e investigação ambiental. RESULTADOS: Ocorreu um surto a partir de março de 2009. Quarenta e uma (71 por cento) pessoas recebiam água sem tratamento no seu domicílio. Foram detectados coliformes termotolerantes em 20/58 (34 por cento) amostras de água. CONCLUSÕES: A investigação sugere que a hipótese principal para esse surto foi à ingestão de água contaminada.

INTRODUCTION: This paper describes the investigation to confirm an outbreak of hepatitis A, presents the case distribution by person, time and place, formulates a hypothesis concerning the mode of transmission and presents the recommended measures for prevention and control. METHODS: A descriptive study of a case series and an environmental research were conducted. RESULTS: An outbreak of hepatitis A was confirmed beginning in March 2009. Forty one (71 percent) individuals in the town received untreated water in their households. Thermotolerant coliform bacteria were detected in 20/58 (34 percent) water samples. CONCLUSIONS: Consumption of contaminated water was the main hypothesis of virus transmission.

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Capybara (Hydrochaeris hydrochaeris), the largest rodent in the world, is widely distributed in South America. These animals live in areas with abundant water, which makes them a potential reservoir for Leptospira. The objective of this study was to investigate seroconversion, leptospiremia, and leptospiruria in capybaras experimentally infected with a virulent strain of Leptospira interrogans serovar Pomona. Seven capybaras were used: one control and six infected. Agglutinins against serovar Pomona were initially detected in serum 6 or 7 day after innoculation with Leptospira (10(9)-10(11) organisms, given i.v.), peaked (titer, approximately 3,200) between 9 and 27 day, and were still present at 83 day (end of study). The earliest and latest isolation of leptospires from the blood was from 2-12 day and from urine, 9-19 day after exposure. However, polymerase chain reaction and isolation results from kidney and liver samples were negative for leptospires. The control animal tested negative on all diagnostic tests. Hence, the capybara can serve as a host for Leptospira.

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