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Abstract Objective Child sexual violence is a multidimensional problem of many contemporary societies, affecting people of all sexes, social stratum and age groups. Offenses involving children and adolescents are more serious, given their total or partial dependence on parents and caregivers. Information on child sexual violence in Brazil is found in raw form and without detail. The objective was to compare the information with social and economic data in the state of Paraná. Methods The authors conducted a retrospective study of secondary data from the Notifiable Diseases Information System (SINAN) on cases of sexual violence involving victims aged 0 to 19 years. Results are presented according to notification characteristics. The authors applied exploratory spatial data analysis to assess spatial autocorrelations and investigated relationships by the ordinary least squares regression model. Results Between 2017 and 2021, there were 13,403 reports of child sexual violence in Paraná State, Brazil. Most victims (82.8%) were female and aged between 10 and 14 years. The majority of sexual violence cases (67.8%) occurred in the home environment. The highest rates on a population basis were observed in the North Central and Greater Curitiba regions, mainly in cities with higher population density and with higher rates of other types of violence. Conclusion The results provide data that can promote a broader understanding of the distribution of sexual violence and the state and associated variations. It is expected to improve the provision of care for victims of child sexual violence and assist in strategic planning to prevent future offenses.

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Tityus serrulatus Lutz & Mello (Scorpiones: Buthidae) is a scorpion endemic to Brazil adapted to synanthropic life, colonising and proliferating in the most populous urban areas in the country. Here, we evaluated its activity pattern in an urban cemetery in the municipality of Americana, state of São Paulo, Brazil. Additionally, we tested the effects of species reproduction and climatic seasons on the activity pattern. The Saudade Municipal Cemetery was sampled between 17:00 and 22:00 h during 455 nights from April 2006 to December 2013. The circular mean and the peak of activity were quantified for the total number of specimens, and for specimens with and without broods. Activity patterns were inferred using a rosette diagram. Circular analysis of variance was used to investigate if activity patterns changed across climatic seasons (wet and dry seasons). A total of 25,969 records (467 specimens with broods) were obtained in the field. The circular mean varied between 19:44 and 19:48 h, and the peak of activity occurred between 18:00 and 20:00 h for all groups. Peaks of activity differed from that recorded under laboratory conditions (between 21:00 and 23:00 h). Activity patterns did not differ for specimens with broods, suggesting that the reproductive condition does not alter the species activity pattern. The activity pattern differed between wet and dry seasons for all specimens and specimens without broods, but differences were small and probably biologically irrelevant, probably because the species tolerates a wide variation in abiotic conditions. Deepening the knowledge of the behaviour activity of T. serrulatus can have practical applications for health surveillance agencies, aiming to increase the effectiveness of scorpion control in urban areas.

Tityus serrulatus Lutz & Mello (Scorpiones: Buthidae) é um escorpião endêmico do Brasil adaptado à vida sinantrópica, colonizando e proliferando nas áreas urbanas mais populosas do país. Aqui avaliamos seu padrão de atividade em um cemitério urbano no município de Americana, estado de São Paulo, Brasil. Adicionalmente, testamos os efeitos da reprodução da espécie e das estações climáticas sobre o padrão de atividade. O Cemitério Municipal da Saudade foi amostrado entre 17:00 h e 22:00 h durante 455 noites, de abril de 2006 a dezembro de 2013. A média circular e o pico de atividade foram quantificados para o número total de espécimes, espécimes com e sem ninhadas. Os padrões de atividade foram inferidos usando um diagrama de roseta. Análises de variância circular foram utilizadas para investigar se os padrões de atividade mudavam com as estações climáticas (estações chuvosa e seca). Um total de 25.969 registros (467 espécimes com ninhadas) foram obtidos em campo. A média circular variou entre 19:44 h e 19:48 h e o pico de atividade ocorreu entre 18:00 h e 20:00 h para todos os grupos. Os picos de atividade diferiram dos registados em condições de laboratório (entre 21:00 h e 23:00 h). Os padrões de atividade não diferiram para os espécimes com ninhadas, sugerindo que a condição reprodutiva não altera o padrão de atividade da espécie. O padrão de atividade diferiu entre as estações chuvosa e seca para todos os espécimes e os espécimes sem ninhadas, mas as diferenças foram pequenas e provavelmente biologicamente irrelevantes, provavelmente porque a espécie tolera uma grande variação nas condições abióticas. Preencher lacunas sobre o comportamento de T. serrulatus pode ter aplicações práticas para órgãos de vigilância sanitária, visando aumentar a eficácia do controle de escorpiões em áreas urbanas.

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Introdução:A hanseníase é uma enfermidade infectocontagiosa que pode gerar desde a incapacidade as sequelas físicas quando não tratada precocemente. Objetivo:Descrever o perfil epidemiológico da Hanseníase em Bacabal no estado do Maranhão. Metodologia:Trata-se de um estudo transversal, retrospectiva com abordagem quantitativa, sobre casos de hanseníase registrados no Sistema de Informação de Agravos de Notificação no período de 2008 a 2017 sendo analisados por estatística descritiva. Resultados:Foram diagnosticados 1.309 casos, na faixa etária de 20 a 34 anos (25,7%), sexo masculino (60,2%), raça/pretos (39,8%), com ensino fundamental (63,5%), ocupação de agropecuários (32,3%), atenção básica notificou a maioria dos casos (49,9%) e residiam na zona urbana (78,7%). Verificou-se que a classificação operacional predominante foi em casos Multibacilar (76%), na forma clínica dimorfa (60,9%), múltiplas lesões de 2 a 5 (33%), sem nervos afetados (60,6%) e os pacientes não tiveram nenhuma incapacidade física (45,5%). Apenas 43% dos casos realizaram a baciloscopia e a poliquimioterapia Multibacilar com 12 doses predominou com 75,8% nos casos diagnosticados. A maioria dos casos eram classificados como novos (77,8%), foram detectados por demanda espontânea (38,5%) e mais da metade foram curados (80,3%). Conclusões:A hanseníase é uma doença endêmica na região se configurando um problema saúde pública devido a elevada magnitude dos casos. Ressalta-se a importância da realização de atividades educativas com enfoque na prevenção através da busca ativa para o diagnóstico precoce; no intuito de rastrear casos e contatos na comunidade a fim de reduzir as sequelas físicas sendo um fator determinante para o enfrentamento da doença (AU).

Introduction:Leprosy is an infectious disease that can cause disability and physical sequelae when not treated early.Objective:To describe the epidemiological profile of leprosy in Bacabal, state of Maranhão. Methodology:This was a cross-sectional, retrospective, quantitative study on leprosy cases reported to the Notifiable Diseases Information System from 2008 to 2017. Data were analyzed using descriptive statistics. Results:A total of 1,309 cases were diagnosed, in the age group of 20 to 34 years (25.7%), male (60.2%), black race (39.8%), with elementary education (63.5%), and working in agriculture (32.3%). Primary care reported most cases (49.9%), and the majority of cases were from urban areas (78.7%). The predominant operational classification was multibacillary cases (76%), in the dimorphic clinical form (60.9%), from 2 to 5 multiple lesions (33%), without affected nerves (60.6%), and no physical disability (45.5%). Only 43% of cases underwent bacilloscopy, and multibacillary polychemotherapy with 12 doses was the most common treatment, accounting for 75.8% of diagnosed cases. Most cases were classified as new (77.8%) and were detected by spontaneous demand (38.5%), and more than Half were cured (80.3%).Conclusions: Leprosy is a disease endemic to the region and represents a public health challenge due to the high magnitude of cases. The importance of educational activities focusing on prevention through an active search for early diagnosis is highlighted to track cases and contacts in the community toreduce physical sequelae, which are crucial in combating the disease (AU).

Introducción: La lepra es una enfermedad infectocontagiosa que puede generar desde la discapacidad a consecuencias físicas si no se trata precozmente. Objetivo:Describir el perfil epidemiológico de la Lepra en Bacabal, estado de Maranhão. Metodología:Se trata de un estudio transversal, retrospectiva con abordaje cuantitativo, sobre casos de lepra registrados en el Sistema de Información de Enfermedades de Notificación Obligatoria en el período de 2008 a 2017 analizados por estadística descriptiva. Resultados:Se diagnosticaron 1.309 casos, con edad entre 20 a 34 años (el 25,7%), varones (el 60,2%), raza/negros (el 39,8%), con enseñanza básica (el 63,5%), ocupación de agropecuarios (el 32,3%), la atención primaria reportó la mayor parte de los casos (el 49,9%) y vivían en zonas urbanas (el 78,7%). Se verificó que la clasificaciónoperacional predominante fue en casos Multibacilar (el 76%), en la forma clínica dimorfa (el 60,9%), múltiples lesiones de 2 a 5 (el 33%), sin niervos afectados (el 60,6%) y los pacientes no tuvieron ninguna incapacidad física (el 45,5%). Solo el 43% de los casos se realizaron la baciloscopia y la poliquimioterapia Multibacilar con 12 dosis predominó con el 75,8% en los casos diagnosticados. La mayoría de los casos eran clasificados como nuevos (el 77,8%), se detectó por demanda espontánea (el 38,5%) y másde la mitad se curaron (el 80,3%). Conclusiones: La lepra es una enfermedad endémica en la región se configurando un problema salud pública debido a la elevada magnitud de los casos. Se subraya la importancia de la realización de actividades educativas con hincapié en la prevención por intermedio de la búsqueda activa para el diagnóstico temprano; en el intuito de rastrear casos y contactos en la comunidad con la finalidad de reducir las discapacidades físicas que son un factor determinante para afrontar enfrentar la enfermedad (AU).

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Objective: To calculate the alcohol per capita consumption (APC) in Brazil (Brazil APC) using national data and to establish the Brazil APC as gold standard for the country, replacing the indicator previously calculated by the World Health Organization (WHO) based on international data. Method: The Brazilian public data sources necessary for calculating the recorded APC were selected, and the alcohol concentration was defined by beverage category. For the variables of tourist APC and unrecorded APC, which are unavailable in Brazil, estimates from the United Nations (UN) and the WHO were used. The Brazil APC indicator was calculated and compared to the indicator produced by the WHO through analysis of the medians obtained for the period from 2005 to 2020. Results: The national alcohol consumption indicator was 9.2 liters per capita in 2005, reaching 9.8 in 2020. The WHO indicator showed a consumption of 8.4 liters per capita in 2005, decreasing until 2016 and slightly increasing to 7.8 in 2020. Conclusion: The Brazil APC was calculated based on national sources and showed a distinct trend compared to the WHO indicator, which showed a decrease. The regular and transparent provision of this indicator through government channels will support the development of policies to address alcohol consumption in the country.

Objetivo: Calcular el indicador del consumo de alcohol per cápita en Brasil a partir de datos nacionales, con miras a establecerlo como patrón de referencia para el país en sustitución del indicador calculado anteriormente por la Organización Mundial de la Salud a partir de datos internacionales. Métodos: Se seleccionaron las fuentes públicas de datos de Brasil necesarias para estructurar el cálculo del consumo de alcohol per cápita registrado y se definió la concentración de alcohol por clase de bebida. Para las variables de consumo de alcohol per cápita por parte de turistas y consumo per cápita no registrado, que no están disponibles en Brasil, se utilizaron estimaciones de las Naciones Unidas y de la Organización Mundial de la Salud. Se calculó el indicador del consumo de alcohol per cápita en Brasil y se comparó con el indicador elaborado por la OMS mediante un análisis de las medianas correspondientes al período 2005-2020. Resultados: El indicador nacional del consumo de alcohol fue de 9,2 litros per cápita en el 2005, con un aumento a 9,8 en el 2020. El indicador de la Organización Mundial de la Salud mostró un consumo de 8,4 litros per cápita en el 2005, con una reducción hasta el 2016 y un leve aumento a 7,8 en el 2020. Conclusión: Se calculó el consumo de alcohol per cápita en Brasil a partir de fuentes nacionales, lo que mostró una tendencia distinta de la tendencia descendente del indicador de la Organización Mundial de la Salud. La disponibilidad transparente y regular de este indicador por medio de los canales gubernamentales permitirá su seguimiento, con lo cual se podrán formular políticas para enfrentar el consumo de alcohol en el país.

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To assess the temporal and spatial dynamics of chikungunya incidence and its association with social vulnerability indicators in Brazil, an ecological and population-based study was conducted herein, with confirmed cases of chikungunya and based on clinical and clinical-epidemiological criteria from 2017 to 2023. Data were obtained from the Notifiable Diseases Information System and social vulnerability indicators were extracted from the official platform of the United Nations Development Program and the Social Vulnerability Atlas. Temporal, spatial, and global spatial regression models were employed. The temporal trend showed that in 2017, the incidence increased by 1.9%, and this trend decreased from 2020 to 2021 (-0.93%). The spatial distribution showed heterogeneity and positive spatial autocorrelation (I: 0.71; p < 0.001) in chikungunya cases in Brazil. Also, the high-risk areas for the disease were concentrated in the northeast and north regions. The social vulnerability indicators associated with the outcome were those related to income, education, and housing conditions. Our analyses demonstrate that chikungunya continues to be a serious health concern in Brazil, but specially in the northeast and north regions. Lastly, mapping risk areas can provide evidence for the development of public health strategies and disease control in endemic regions.

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Inadequate practices during complementary feeding are associated with malnutrition, especially in children experiencing vulnerable conditions and social inequality. The aim of this study was to evaluate the trends in complementary feeding indicators (CFIs) according to participation in a Brazilian cash transferu program-the Bolsa Família Program (BFP). This was a time-series study with secondary data from 600,138 children assisted from 2015 to 2019 and registered within the Brazilian Food and Nutrition Surveillance System. The CFIs assessed were food introduction, minimum meal frequency and appropriate consistency, minimum dietary diversity, iron-rich food, vitamin A-rich food, ultra-processed food consumption, and zero vegetable or fruit consumption. Prevalence and 95% confidence intervals were calculated for the CFIs according to BFP, the region of residence, and the child's age. The Prais-Winsten regression method was used to analyze the temporal trend. There was a steady trend for all CFIs of a healthy diet. A decrease in ultra-processed food consumption for both BFP (-10.02%) and non-BFP children (-9.34%) was observed over the years. Children residing in the North and Northeast regions and those enrolled in the BFP were more distant from the recommended feeding practices when compared to the other regions and non-BFP children. The results highlight the relevance of nutritional surveillance and the need to improve food and nutrition public policies for children aged 6-23 months, particularly for those experiencing greater social vulnerability.

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Chikungunya, arbovirose que provoca febre e artralgia debilitante, demonstra potencial crônico e incapacitante por longos períodos, não havendo vacinas ou terapias específicas. Recentemente, a doença evoluiu da condição negligenciada para uma ameaça à saúde pública, impactando milhões de pessoas em regiões tropicais e subtropicais. Este estudo analisa a produção do conhecimento sobre a Chikungunya, na perspectiva da Vigilância em Saúde. Trata-se de metodologia exploratória-descritiva, com análise bibliométrica. Realizou-se a coleta nas bases Scopus e Web of Science para artigos de 2008 a 2022. A análise revelou uma série temporal de produção destacando a contribuição de Estados Unidos, Brasil e França. Identificaram-se como áreas mais produtivas: doenças transmissíveis, medicina tropical e parasitologia, fundamentais à Vigilância em Saúde e ao planejamento de políticas públicas. Quanto aos pesquisadores, Weaver, Scott C., Failloux, Anna-Bella e De Lamballerie, Xavier foram relevantes no cenário global, indicando a importância da colaboração e da abordagem interdisciplinar.

Chikungunya, an arbovirus that causes fever and debilitating arthralgia, has potential to be chronic and incapacitating for long periods, and there are no vaccines or therapies available for it. Recently, the disease has evolved from a neglected condition to public health threat, impacting millions in tropical and subtropical regions. This study analyzed the knowledge production about chikungunya, from the perspective of Health Surveillance, using an exploratory-descriptive methodology and bibliometric analysis. Articles from 2008 to 2022 were collected from Scopus and Web of Science databases. The analysis showed a production time series, highlighting the contribution of United States, Brazil, and France. The most productive areas were identified as: communicable diseases, tropical medicine and parasitology, which are fundamental to Health Surveillance and public policy planning. Regarding researchers, Weaver, Scott C., Failloux, Anna-Bella, and De Lamballerie, Xavier were relevant in the global scenario, indicating the importance of collaboration and of the interdisciplinary approach.

El chikungunya, arbovirus que causa fiebre y artralgia debilitante, tiene potencial de ser crónico e incapacitante por largos periodos, todavía no hay vacunas ni terapias. Recientemente, la enfermedad ha pasado de afección desatendida a amenaza para la salud pública, afectando a millones en regiones tropicales y subtropicales. Este estudio analiza la producción de conocimientos sobre chikungunya, desde la perspectiva de la Vigilancia Sanitaria. Se utilizó una metodología exploratoria-descriptiva con análisis bibliométrico. Se recompilaron artículos de Scopus y Web of Science, 2008-2022. El análisis reveló una serie temporal de producción, destacando la contribución de EEUU, Brasil y Francia. Se identificaron como áreas más productivas: enfermedades transmisibles, medicina tropical y parasitología, fundamentales para la Vigilancia Sanitaria y la planificación de políticas públicas. En cuanto a los investigadores, Weaver, Scott C., Failloux, Anna-Bella y De Lamballeire, Xavier fueron relevantes en el escenario global, indicando la importancia de la colaboración y del enfoque interdisciplinario.

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BACKGROUND: The high levels of recent transmission of leprosy worldwide demonstrate the necessity of epidemiologic surveillance to understand and control its dissemination. Brazil remains the second in number of cases around the world, indicating active transmission of Mycobacterium leprae (M. leprae) in the population. At this moment, there is a consensus that the bacillus is transmitted by inter-human contact, however, different serologic, molecular, and histopathological approaches indicate the existence of non-human transmission sources. METHODS AND RESULTS: The qPCR assay was used to amplify the molecular targets 16S RNAr and RLEP, in samples of liver, spleen, and ear of wild animals belonging to Didelphimorphia and Rodentia orders, in highly endemic areas of Mato Grosso, Brazil. The RLEP repetitive sequence was positive in 202 (89.0%) samples, with 96 (42.3%) of these also being positive for the 16S gene. Regarding the collection sites, it was observed that the animals were found in areas profoundly deforested, close to urban areas. CONCLUSIONS: Our results suggest that wild animals can play an important role in the maintenance of M. leprae in endemic regions with major anthropic action in Brazil. Therefore, integrating human, animal, and environmental health care with the One Health initiative is highly efficient for the development of effective strategies to contain and control leprosy in Brazil.

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[This corrects the article DOI: 10.3389/fpubh.2023.1330347.].

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INTRODUCTION: Food insecurity (FI) experienced during pregnancy represents a relevant public health problem, as it negatively affects maternal and child health. OBJECTIVE: To investigate the prevalence of FI among pregnant women during the COVID-19 pandemic and determine associated factors. METHODS: A cross-sectional study was carried out in the period from 2021 to 2022, with a representative sample of 423 women resulting from a sample calculation based on the average (2912 births) that occurred in the years 2016 to 2020 in the only maternity hospital in the municipality. After analyzing the medical records, interviews were carried out with the postpartum women using a standardized questionnaire and the Brazilian Food Insecurity Scale. Poisson regression with robust variance was used to calculate prevalence ratios and 95% confidence intervals to measure associations. RESULTS: FI was observed in 57.0% of cases and was associated with age under 20 years (PR = 1.52; 95% CI 1.29; 1.79), receipt of government assistance (PR = 1.31; 95% CI 1.10; 1.55), loss of family employment (PR = 1.40; 95% CI 1.20; 1.64), greater number of residents (PR = 1.17; 95% CI 1.00; 1.37), and prenatal care in a public institution (PR = 1.53; 95% CI 1.04; 2.26). CONCLUSION: There was a high prevalence of FI cases, associated with socioeconomic, demographic, and prenatal care characteristics during the COVID-19 pandemic.

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OBJECTIVES: Disease surveillance is an essential component of public health and a core function of National Public Health Institutes (NPHIs), including to better prepare and respond to infectious diseases outbreaks. Strengthening NPHIs in their efforts to establish and maintain efficient surveillance systems is an opportunity to ensure future outbreak preparedness and response; yet, guidance on how to increase and prioritise capacity building efforts is limited. This study sought to investigate approaches to capacity building and training for disease surveillance at national level and understand the potential role of NPHIs. STUDY DESIGN: Qualitative study. METHODS: This is a qualitative study, based on a literature review and interviews undertaken between June and November 2022. Fifty seven in-depth interviews were conducted in five countries: Côte d'Ivoire, Ecuador, Madagascar, Namibia, and the Kingdom of Saudi Arabia. Participants included a range of professionals from government, NPHIs, academic institutions and the private sector. Interviews were thematically analysed. RESULTS: Selected countries varied in terms of their disease surveillance capacities, as well as in the structure of their surveillance systems and decision-making. Research identified shared priority areas for action at national level, identifying common challenges and opportunities: 1) capacity building, here specifically the need for a training agenda at national level to ensure sustainability and guide donor funded training offers; 2) data tools and technology-to help decision-makers select the best software tool to address countries' identified need; 3) data sharing-the need for clear data sharing standards and norms for national to international data sharing; and 4) genomic sequencing-the need for national genomic surveillance strategies and reporting guidelines. CONCLUSION: Addressing challenges and using opportunities to strengthen disease surveillance at national level is an important step to build capacity in this area and to help prevent future epidemic and pandemics globally. The findings of this study help decision-makers to identify priority areas for capacity building and understand the potential role and significance of NPHIs.

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Background: CYD-TDV (Dengvaxia®) was the first dengue vaccine approved, launched in Brazil in 2015 for individuals aged 9-44 years. We aimed to estimate the effectiveness of CYD-TDV in preventing symptomatic dengue cases during a campaign targeting individuals aged 15-27 years in selected municipalities in Paraná, Brazil. Additionally, we examined whether a history of dengue, as recorded by the surveillance system, modified the vaccine's effectiveness. Methods: We conducted a case-cohort analysis comparing the frequency of vaccination, with at least one dose of CYD-TDV, in individuals with dengue confirmed by RT-PCR, identified by the surveillance system during 2019 and 2020, with the vaccination coverage in the target population. Moreover, in a case-control design using weighted controls, we assessed the documented history of dengue as a modifier of the vaccine's effectiveness. We used a logistic random-effects regression model, with data clustered in municipalities and incorporating covariates such as the incidence of dengue before the campaign, age, and sex. We calculated vaccine effectiveness (VE) as (1-relative risk) x 100%. Findings: 1869 dengue cases were identified, which had a vaccination frequency significantly lower than the overall vaccination coverage in the target population (50.3% vs. 57.2%, respectively; overall VE: 21.3%; 95% confidence interval [CI]: 13.4%-28.4%). In individuals with a documented history of dengue, vaccination had a VE of 71% (95% CI: 58%-80%) in reducing the incidence of dengue. However, vaccination was not associated with a significant reduction in the overall dengue case risk in individuals without a documented history of dengue (VE: 12%; 95% CI: -21% to 36%). In this last stratum, vaccination was associated with reduced cases due to DENV-1 and DENV-4, but an excess of DENV-2 cases. Interpretation: Vaccination led to a significant reduction in reported dengue cases within the target population. The case-control design suggested that this reduction was primarily driven by the benefits observed in individuals with a documented history of dengue. In endemic regions with limited serological testing facilities, a previous history of dengue diagnosis recorded by epidemiological surveillance could be used to triage candidates for CYD-TDV vaccination. Funding: Research supported by Sanofi.

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Health surveillance guides public policies, allows for the monitoring of occupational exposures that may cause health risks, and can prevent work-related diseases. The scoping review protocol herein is designed to map studies on the surveillance of occupational exposure to volatile organic compounds (VOCs) in gas stations and identify the governmental agencies and public health measures in different countries. This review protocol is based on the Joanna Briggs Institute manual and guided by the PRISMA Extension for Scoping Reviews. It includes research articles, theses, dissertations, and official documents on surveillance measures for occupational exposure to VOCs (i.e., benzene, ethylbenzene, toluene, and xylene) in gas stations from different countries. All languages and publication dates will be considered, and a spreadsheet will be used to extract and analyze qualitative and quantitative data. The final version will present the main surveillance measures implemented, responsible entities, results, challenges, limitations, and potential gaps in gas stations.

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OBJECTIVE: Child sexual violence is a multidimensional problem of many contemporary societies, affecting people of all sexes, social stratum and age groups. Offenses involving children and adolescents are more serious, given their total or partial dependence on parents and caregivers. Information on child sexual violence in Brazil is found in raw form and without detail. The objective was to compare the information with social and economic data in the state of Paraná. METHODS: The authors conducted a retrospective study of secondary data from the Notifiable Diseases Information System (SINAN) on cases of sexual violence involving victims aged 0 to 19 years. Results are presented according to notification characteristics. The authors applied exploratory spatial data analysis to assess spatial autocorrelations and investigated relationships by the ordinary least squares regression model. RESULTS: Between 2017 and 2021, there were 13,403 reports of child sexual violence in Paraná State, Brazil. Most victims (82.8%) were female and aged between 10 and 14 years. The majority of sexual violence cases (67.8%) occurred in the home environment. The highest rates on a population basis were observed in the North Central and Greater Curitiba regions, mainly in cities with higher population density and with higher rates of other types of violence. CONCLUSION: The results provide data that can promote a broader understanding of the distribution of sexual violence and the state and associated variations. It is expected to improve the provision of care for victims of child sexual violence and assist in strategic planning to prevent future offenses.

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Introduction. During the development of the SARS-CoV-2 pandemic in Antioquia, we experienced epidemiological peaks related to the α, É£, ß, ƛ, and δ variants. δ had the highest incidence and prevalence. This lineage is of concern due to its clinical manifestations and epidemiological characteristics. A total of 253 δ sublineages have been reported in the PANGOLIN database. The sublineage identification through genomic analysis has made it possible to trace their evolution and propagation. Objective. To characterize the genetic diversity of the different SARS-CoV-2 δ sublineages in Antioquia and to describe its prevalence. Materials and methods. We collected sociodemographic information from 2,675 samples, and obtained 1,115 genomes from the GISAID database between July 12th, 2021, and January 18th, 2022. From the analyzed genomes, 515 were selected because of their high coverage values (>90%) to perform phylogenetic analysis and to infer allele frequencies of mutations of interest. Results. We characterized 24 sublineages. The most prevalent was AY.25. Mutations of interest as L452R, P681R, and P681H were identified in this sublineage, comprising a frequency close to 0.99. Conclusions. This study identified that the AY.25 sublineage has a transmission advantage compared to the other δ sublineages. This attribute may be related to the presence of the L452R and P681R mutations associated in other studies with higher evasion of the immune system and less efficacy of drugs against SARS-CoV-2.

Introducción. Durante el desarrollo de la pandemia por SARS-CoV-2 en Antioquia se presentaron picos epidemiológicos relacionados con las variantes α, É£, ß, ƛ y δ, donde δ tuvo la mayor incidencia y prevalencia. Este linaje se considera una variante de preocupación dadas las manifestaciones clínicas que desencadena y sus características epidemiológicas. Se han informado 253 sublinajes δ en la base de datos PANGOLIN. La identificación de estos sublinajes mediante análisis genómico ha permitido rastrear su evolución y propagación. Objetivo. Caracterizar la diversidad genética de los diferentes sublinajes δ de SARSCoV-2 en Antioquia y determinar su prevalencia. Materiales y métodos. Se recopiló información sociodemográfica de 2.675 muestras y de 1.115 genomas del repositorio GISAID entre el 12 de julio de 2021 y el 18 de enero de 2022. Se seleccionaron 501 por su alto porcentaje de cobertura (>90 %) para realizar análisis filogenéticos e inferencia de frecuencias alélicas de mutaciones de interés. Resultados. Se caracterizaron 24 sublinajes donde el más prevalente fue AY.25. En este sublinaje se identificaron mutaciones de interés como L452R, P681R y P681H, que comprendían una frecuencia cercana a 0,99. Conclusiones. Este estudio permitió identificar que el sublinaje AY.25 tiene una ventaja de transmisión en comparación con los otros sublinajes δ. Esto puede estar relacionado con la presencia de las mutaciones L452R y P681R que en otros estudios se han visto asociadas con una mayor transmisibilidad, evasión del sistema inmunitario y menor eficacia de los medicamentos contra SARS-CoV-2.

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BACKGROUND: The COVID-19 pandemic has caused significant disruptions to everyday life and has had social, political, and financial consequences that will persist for years. Several initiatives with intensive use of technology were quickly developed in this scenario. However, technologies that enhance epidemiological surveillance in contexts with low testing capacity and healthcare resources are scarce. Therefore, this study aims to address this gap by developing a data science model that uses routinely generated healthcare encounter records to detect possible new outbreaks early in real-time. METHODS: We defined an epidemiological indicator that is a proxy for suspected cases of COVID-19 using the health records of Emergency Care Unit (ECU) patients and text mining techniques. The open-field dataset comprises 2,760,862 medical records from nine ECUs, where each record has information about the patient's age, reported symptoms, and the time and date of admission. We also used a dataset where 1,026,804 cases of COVID-19 were officially confirmed. The records range from January 2020 to May 2022. Sample cross-correlation between two finite stochastic time series was used to evaluate the models. RESULTS: For patients with age 18 years, we find time-lag () = 72 days and cross-correlation () ~ 0.82, = 25 days and ~ 0.93, and = 17 days and ~ 0.88 for the first, second, and third waves, respectively. CONCLUSIONS: In conclusion, the developed model can aid in the early detection of signs of possible new COVID-19 outbreaks, weeks before traditional surveillance systems, thereby anticipating in initiating preventive and control actions in public health with a higher likelihood of success.

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BACKGROUND: Surveillance of healthcare-associated infections (HAIs) is an essential component of hospital infection prevention and control systems. We aimed to assess the quality of the data compiled by the Brazilian HAI Surveillance System from pediatric (PICUs) and neonatal intensive care units (NICUs), between 2012 and 2021. METHODS: Data Quality Review, including adherence, completeness, internal consistency, consistency over time, and consistency of population trend, were computed at both national and state levels based on quality metrics from World Health Organization Toolkit. Incidence rates (or incidence density) of ventilator-associated pneumonia (VAP) and central line-associated bloodstream infection (CLABSI) were obtained from the Brazilian National Nosocomial Infections Surveillance (NNIS) system. Data on sepsis-related mortality, spanning the period from 2012 to 2021, were extracted from the Brazilian National Health Service database (DATASUS). Additionally, correlations between sepsis-related mortality and incidence rates of VAP or CLABSI were calculated. RESULTS: Throughout the majority of the study period, adherence to VAP reporting remained below 75%, exhibiting a positive trend post-2016. Widespread outliers, as well as inconsistencies over time and in population trends, were evident across all 27 states. Only four states maintained consistent adherence levels above 75% for more than 8 years regarding HAI incidence rates. Notably, CLABSI in NICUs boasted the highest reporting adherence among all HAIs, with 148 periods out of 270 (54.8%) exhibiting reporting adherence surpassing 75%. Three states achieved commendable metrics for CLABSI in PICUs, while five states demonstrated favorable results for CLABSI in NICUs. CONCLUSIONS: While adherence to HAI report is improving among Brazilian states, an important room for improvement in the Brazilian NNIS exists. Additional efforts should be made by the Brazilian government to improve the reliability of HAI data, which could serve as valuable guidance for hospital infection prevention and control policies.

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Motivated by the implementation of a SARS-Cov-2 sewer surveillance system in Chile during the COVID-19 pandemic, we propose a set of mathematical and algorithmic tools that aim to identify the location of an outbreak under uncertainty in the network structure. Given an upper bound on the number of samples we can take on any given day, our framework allows us to detect an unknown infected node by adaptively sampling different network nodes on different days. Crucially, despite the uncertainty of the network, the method allows univocal detection of the infected node, albeit at an extra cost in time. This framework relies on a specific and well-chosen strategy that defines new nodes to test sequentially, with a heuristic that balances the granularity of the information obtained from the samples. We extensively tested our model in real and synthetic networks, showing that the uncertainty of the underlying graph only incurs a limited increase in the number of iterations, indicating that the methodology is applicable in practice.

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BACKGROUND: Obstetric causes are classified as direct (complications of pregnancy, childbirth or the puerperium) or indirect (caused by pregnancy but not directly caused by it). This study aimed to analyze maternal mortality from obstetric causes in Brazil from 2011 to 2021. METHODS: This was an ecological study on mortality and live births. The outcomes were the specific risk of mortality from direct and indirect cause adjustment and death during pregnancy and the puerperium. Binary and multiple linear logistic regressions were used to assess the influence of sociodemographic factors and maternal and child health indicators on maternal mortality and time of death (pregnancy and puerperium). RESULTS: Regarding mortality during pregnancy and during the puerperium, increased (p = 0.003) and decreased (p = 0.004) mortality over the years, respectively; residing in the northern region was associated with lower (p < 0.05) and greater (p = 0.035) odds; and the Maternal Mortality Committee was the primary and least active source of investigation, respectively (p < 0.0001). The number of deaths from indirect causes increased with age (p < 0.001) and in the northern region (p = 0.011) and decreased in the white (< 0.05) and stable union (0.002) regions. Specifically, for mortality risk, the age group [women aged 15-19 years presented an increase in cesarean section (p < 0.001) was greater than that of women who had < 4 antenatal visits (p < 0.001)], education [women who completed high school (8 to 11 years) was greater when they had < 4 prenatal visits (p = 0.018)], and marital status [unmarried women had more than 4 antenatal visits (p < 0.001); cesarean birth (p = 0.010) and < 4 antenatal visits (p = 0.009) were predictors of marriage; and women in a stable union who had < 4 prenatal visits and live births to teenage mothers (p < 0.001) were predictors]. Women who had no education (p = 0.003), were divorced (p = 0.036), had cesarean deliveries (p < 0.012), or lived in the north or northeast (p < 0.008) had higher indirect specific mortality risk. CONCLUSIONS: Sociodemographic factors and maternal and child health indicators were related to different patterns of obstetric mortality. Obstetric mortality varied by region, marital status, race, delivery, prenatal care, and cause of death.

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Objective: To perform a systematic review of scientific publications addressing the use of stratification methods to define risk areas for measles transmission. Method: Articles published in English, Portuguese, and Spanish in journals indexed in the SciELO, PubMed, and LILACS databases were selected. The search terms risk assessment AND measles were used without date limits. Editorials, opinion articles, individual-level observational studies, and publications that did not focus on the application of methods to stratify measles transmission risk areas were excluded. Year of publication, authorship, country where the study was performed, objective, geographic level of analysis, method used, indicators, and limitations were recorded in a data form. Results: Thirteen articles published between 2011 and 2022 in nine countries from the six World Health Organization (WHO) regions were selected. Of these, 10 referred to the Measles Risk Assessment Tool developed by the WHO/Centers for Disease Control and Prevention. Only one study adapted the tool to the local context. The risk stratification indicators used in the selected studies focused on a combination of the following dimensions: population immunity, quality of surveillance systems, and epidemiologic status. The systematic output of data with adequate quality and coverage was a noteworthy aspect hindering risk stratification. Conclusion: There seems to be limited dissemination of measles risk stratification strategies, especially at local levels. The need to train human resources to process and interpret risk analyses as part of the routine of surveillance services is emphasized.

Objetivo: Realizar una revisión sistemática de las publicaciones científicas en las que se han abordado experiencias de aplicación de métodos de estratificación para definir las zonas de riesgo de transmisión del sarampión. Métodos: Se seleccionaron artículos publicados en español, inglés o portugués en revistas indizadas en las bases de datos SciELO, PubMed y LILACS. En la búsqueda se utilizaron los descriptores "risk assessment" y "measles", sin limitaciones en la fecha de publicación. Se excluyeron editoriales, artículos de opinión, estudios de observación de pacientes individuales y publicaciones que no tratasen de la aplicación de métodos de estratificación de zonas de riesgo de transmisión del sarampión. Se empleó un formulario para extraer la información sobre año de publicación, autoría, país de realización del estudio, objetivo, escala geográfica, método utilizado, indicadores y limitaciones. Resultados: Se seleccionaron 13 artículos publicados entre el 2011 y el 2022 en nueve países de las seis regiones de la Organización Mundial de la Salud (OMS). En 10 de ellos se utilizó como referencia la herramienta de evaluación del riesgo de sarampión creada por la OMS y los Centros para el Control y la Prevención de Enfermedades de Estados Unidos. Solamente en un estudio se adaptó la herramienta al contexto local. Los indicadores utilizados para la estratificación del riesgo se basaron en una combinación de las dimensiones de inmunidad poblacional, calidad de los sistemas de vigilancia y situación epidemiológica. Entre las dificultades de la estratificación del riesgo se destaca la de generación sistemática de datos con una cobertura y calidad adecuadas. Conclusión: Las estrategias de estratificación del riesgo de transmisión del sarampión siguen sin estar, al parecer, muy extendidas, en especial a nivel local. Cabe reiterar la necesidad de fomentar la capacitación de recursos humanos para procesar e interpretar los análisis de riesgo en las operaciones habituales de los servicios de vigilancia.