RESUMO
In mid-June 2019, 3 months after cyclone Idai landfall in Mozambique, health authorities of Nhamatanda district reported an outbreak of Pellagra. Applying a mixed-method protocol, we carried out an investigation to characterize cases of pellagra, identify the associated factors for the outbreak using a case-control study, and explore the perceived impact on food security (availability, access, and usage) before and after Idai. We collected data from 121 cases and 121 controls and conducted in-depth interviews with 69 heads of households. The cases were more likely to be female (P < 0.01) and less educated (P < 0.01) than controls. Insufficient consumption of chicken and peanut before cyclone Idai arrival were statistically associated with pellagra (P < 0.05). From interviewed households' heads, 51% were experiencing food shortages even before the cyclone hit. Cyclone Idai served as a trigger to reduce niacin consumption below the threshold that protected Nhamatanda population from pellagra and caused a ≈2,300 case (707.9/100,000 inhabitants) outbreak.
Assuntos
Tempestades Ciclônicas , Surtos de Doenças , Pelagra/epidemiologia , Pelagra/etiologia , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Moçambique/epidemiologia , Razão de Chances , Pele/patologiaRESUMO
Influenza A viruses undergo frequent antigenic mutations and may thus cause seasonal epidemics and pandemics. The aim of this study was to recover the epidemiological history of the pandemic influenza A(H1N1)pdm09 in Brazil. A descriptive study was conducted in 2009-2010. The Brazilian Information System for reportable diseases (SINAN) was the data source. A total of 105,054 suspected cases of influenza A(H1N1)pdm09 were reported to SINAN. Of these, 53,797 (51.2%) were classified as the new influenza virus subtype. Among the confirmed cases, 56.7% were female, the mean age was 26.31 (SD ± 18.1) years. Fever was the most common sign among the confirmed cases (99.7%) and the presence of comorbidities was reported in 32.5% of cases. In 2009 there were confirmed cases in all 26 Brazilian States and the Federal District. The incidence (per 100,000 inhabitants) of severe influenza in the population was 28.0 in 2009 and 0.5 in 2010. The states of Paraná (301.3), Santa Catarina (36.0) and Rio Grande do Sul (27.4) presented the highest incidence; 46.4% of the confirmed cases were hospitalized and 47,643 were cured (93.8%). The case-fatality rate was 3.9% in 2009. The pandemic virus A(H1N1)pdm09 hit Brazil between April/2009 and December/2010 with an important difference in the geographic pattern distribution of the cases from the northeast to the south of the country. Children and young adults were the most affected. The limitations of the study were data quality and inconsistencies in the final classification of cases in SINAN. This study highlights the urgent need for improvements in the surveillance of emerging diseases in Brazil.
Assuntos
Vírus da Influenza A Subtipo H1N1 , Influenza Humana/epidemiologia , Pandemias , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Influenza Humana/virologia , Masculino , Pessoa de Meia-Idade , Gravidez , Fatores Socioeconômicos , Adulto JovemRESUMO
Based on database linkage, the objective of this study was to describe the epidemiological profile of notified cases and deaths from the new viral subtype of influenza during the influenza pandemic. Secondary data were used from the SINAN (Information System for Notifiable Diseases) and SIM (Mortality Information System) for the years 2009 and 2010. Linkage identified 5,973 deaths of cases notified as pandemic influenza. Of these, 2,170 (36.33%) had been classified in the SINAN as confirmed pandemic influenza, 215 (3.6%) as due to other infectious agents, and 3,340 (55.92%) as ruled out. After linkage, some cases in the SINAN database that were closed as death from influenza (n = 658) or death from other causes (n = 847) could not be located in the SIM database. Database linkage can improve the surveillance system and monitoring of morbidity and mortality. We recommend strengthening influenza surveillance in Brazil using linkage of Ministry of Health databases.
Assuntos
Bases de Dados Factuais , Monitoramento Epidemiológico , Vírus da Influenza A Subtipo H1N1 , Influenza Humana/epidemiologia , Pandemias/estatística & dados numéricos , Adulto , Brasil/epidemiologia , Causas de Morte , Comorbidade , Feminino , Humanos , Influenza Humana/mortalidade , MasculinoRESUMO
Resumo: O objetivo deste estudo foi o de descrever, com base no relacionamento entre os sistemas de informação SINAN (Sistema de Informação de Agravos de Notificação) e SIM (Sistema de Informações sobre Mortalidade), o perfil epidemiológico dos casos notificados de influenza por novo subtipo viral que evoluíram para óbito, durante a pandemia da doença. Foram utilizados dados secundários de ambos os sistemas referentes aos anos de 2009 e 2010. O relacionamento identificou 5.973 óbitos de casos notificados como influenza pandêmica. Destes, 2.170 (36,33%) haviam sido classificados no SINAN como confirmados para a enfermidade; 215 (3,6%), como infecção por outro agente infeccioso; e 3.340 (55,92%), como descartados. Após o relacionamento, alguns casos, que, no SINAN, foram encerrados com evolução para óbito por influenza (n = 658) ou óbito por outras causas (n = 847), não foram encontrados no SIM. O relacionamento entre os bancos de dados pode aprimorar o sistema de vigilância e o dimensionamento da morbimortalidade. Recomendamos o fortalecimento da vigilância da influenza no país com o uso do relacionamento entre os sistemas de informação do Ministério da Saúde.
Abstract: Based on database linkage, the objective of this study was to describe the epidemiological profile of notified cases and deaths from the new viral subtype of influenza during the influenza pandemic. Secondary data were used from the SINAN (Information System for Notifiable Diseases) and SIM (Mortality Information System) for the years 2009 and 2010. Linkage identified 5,973 deaths of cases notified as pandemic influenza. Of these, 2,170 (36.33%) had been classified in the SINAN as confirmed pandemic influenza, 215 (3.6%) as due to other infectious agents, and 3,340 (55.92%) as ruled out. After linkage, some cases in the SINAN database that were closed as death from influenza (n = 658) or death from other causes (n = 847) could not be located in the SIM database. Database linkage can improve the surveillance system and monitoring of morbidity and mortality. We recommend strengthening influenza surveillance in Brazil using linkage of Ministry of Health databases.
Resumen: El objetivo de este estudio fue el de describir, a partir de la relación entre los sistemas de información, el perfil epidemiológico de los casos notificados y que evolucionaron hacia el óbito por gripe, debido a un nuevo subtipo viral durante la pandemia de gripe. Se utilizaron datos secundarios, años 2009 y 2010, del Sistema de Información sobre Enfermedades de Notificación Obligatoria (SINAN) y Sistema de Información sobre Mortalidad (SIM). La relación identificó 5.973 óbitos de casos notificados como gripe pandémica. De esos, 2.170 (36,33%) habían sido clasificados en el SINAN y confirmados como gripe pandémica, 215 (3,6%) como infección por otro agente infeccioso y 3.340 (55,92%) como descartados. Tras la relación, algunos casos en el SINAN que fueron cerrados con la evolución, donde el óbito por gripe (n = 658) u óbito por otras causas (n = 847) no se encontraron en el banco del SIM. La relación entre los bancos de datos puede perfeccionar el sistema de vigilancia y el dimensionamiento de la morbimortalidad. Recomendamos el fortalecimiento de la vigilancia de la gripe en el país con el uso de la relación entre los sistemas de información del Ministerio de la Salud.
Assuntos
Humanos , Masculino , Feminino , Adulto , Bases de Dados Factuais , Influenza Humana , Vírus da Influenza A Subtipo H1N1 , Pandemias/estatística & dados numéricos , Monitoramento Epidemiológico , Brasil/epidemiologia , Comorbidade , Causas de Morte , Influenza Humana/mortalidadeRESUMO
OBJECTIVE: To describe the clinical aspects of cases of influenza A(H1N1)pdm09 in Brazil. METHODS: A descriptive study of cases reported in Sistema de Informação de Agravos de Notificação (SINAN), 2009-2010. RESULTS: As the final classification, we obtained 53,797 (56.79%) reported cases confirmed as a new influenza virus subtype, and 40,926 (43.21%) cases discarded. Fever was the most common sign, recorded in 99.74% of the confirmed and 98.92% of the discarded cases. Among the confirmed cases, the presence of comorbidities was reported in 32.53%, and in 38.29% of the discarded cases. The case fatality rate was 4.04%; 3,267 pregnant women were confirmed positive for influenza A new viral subtype and 2,730 of them were cured. The case fatality rate of pregnant women was 6.88%. CONCLUSION: The findings suggested concern of the health system with pregnant women, and patients with comorbidities and quality of care may have favored a lower mortality. We recommend that, when caring for patients with severe respiratory symptoms, with comorbidities, or pregnant women, health professionals should consider the need for hospital care, as these factors make up a worse prognosis of infection by the pandemic influenza virus.
Assuntos
Vírus da Influenza A Subtipo H1N1 , Influenza Humana/epidemiologia , Lesão Pulmonar/epidemiologia , Pandemias/estatística & dados numéricos , Complicações Infecciosas na Gravidez/epidemiologia , Fumar/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Criança , Pré-Escolar , Comorbidade , Tosse/complicações , Notificação de Doenças/estatística & dados numéricos , Feminino , Febre/complicações , Humanos , Lactente , Recém-Nascido , Influenza Humana/complicações , Masculino , Pessoa de Meia-Idade , Gravidez , Vigilância em Saúde Pública , Adulto JovemRESUMO
ABSTRACT Objective: To describe the clinical aspects of cases of influenza A(H1N1)pdm09 in Brazil. Methods: A descriptive study of cases reported in Sistema de Informação de Agravos de Notificação (SINAN), 2009-2010. Results: As the final classification, we obtained 53,797 (56.79%) reported cases confirmed as a new influenza virus subtype, and 40,926 (43.21%) cases discarded. Fever was the most common sign, recorded in 99.74% of the confirmed and 98.92% of the discarded cases. Among the confirmed cases, the presence of comorbidities was reported in 32.53%, and in 38.29% of the discarded cases. The case fatality rate was 4.04%; 3,267 pregnant women were confirmed positive for influenza A new viral subtype and 2,730 of them were cured. The case fatality rate of pregnant women was 6.88%. Conclusion: The findings suggested concern of the health system with pregnant women, and patients with comorbidities and quality of care may have favored a lower mortality. We recommend that, when caring for patients with severe respiratory symptoms, with comorbidities, or pregnant women, health professionals should consider the need for hospital care, as these factors make up a worse prognosis of infection by the pandemic influenza virus. .
RESUMO Objetivo: Descrever os aspectos clínicos dos casos de influenza A(H1N1)pdm09 no Brasil. Métodos: Foi desenvolvido um estudo descritivo dos casos notificados no Sistema de Informação de Agravos de Notificação (SINAN) de 2009 a 2010. Resultados: Obtivemos como classificação final 53.797 (56,79%) casos notificados confirmados como influenza por novo subtipo viral e 40.926 (43,21%) descartados. Febre foi o sinal mais frequente, sendo registrada em 99,74% dos casos confirmados e em 98,92% dos descartados. Entre os confirmados, a presença de comorbidades foi notificada em 32,53% dos casos confirmados e entre 38,29% dos casos descartados. A taxa de letalidade foi de 4,04%. Das 3.267 gestantes confirmadas para influenza por novo subtipo viral, 2.730 evoluíram para cura. A taxa de letalidade de gestantes foi de 6,88%. Conclusão: Os achados sugeriram sensibilidade do sistema de saúde para com gestantes e portadores de comorbidades, e que a qualidade do cuidado pode ter favorecido a uma menor mortalidade. Recomendamos aos profissionais de saúde que, diante de casos de influenza pandêmica que apresentem gravidade do quadro clínico, comorbidades ou que estejam gestantes, seja considerada a assistência hospitalar, pois esses fatores compõem um pior prognóstico do quadro da infecção pelo vírus pandêmico da influenza. .