RESUMO
Human rabies transmitted by vampire bats reached new heights in Latin America in 2005. A total of 55 human cases were reported in several outbreaks, 41 of them in the Amazon region of Brazil. Peru and Brazil had the highest number of reported cases from 1975 to 2006. In Peru, outbreaks involving more than 20 cases of bat-transmitted human rabies were reported during the 1980s and 1990s. During this period, a smaller number of cases were reported from outbreaks in Brazil. A comparison of data from field studies conducted in Brazil in 2005 with those from the previous decade suggests similar bat-bite situations at the local level. The objective of this study was to review the epidemiological situation and, on the basis of this information, discuss possible factors associated with the outbreaks. Prevention and control measures already recommended for dealing with this problem are also reviewed, and some further suggestions are provided.
Assuntos
Quirópteros , Doenças Transmissíveis Emergentes/epidemiologia , Surtos de Doenças , Raiva/epidemiologia , Raiva/transmissão , Zoonoses/epidemiologia , Animais , Brasil/epidemiologia , Humanos , América Latina/epidemiologiaRESUMO
In 1992, Brazil adopted the goal of measles elimination by the year 2000; however, in 1997, after a 4-year period of good control, there was a resurgence of measles in Brazil. In 1999, to achieve the elimination goal, Brazil implemented the Supplementary Emergency Measles Action plan, with one measles surveillance technician designated to each state. Of 10,007 suspected measles cases reported during 1999, 908 (9.1%) were confirmed, and of them 378 (42%) were confirmed by laboratory analysis. Of 8358 suspected measles cases reported in 2000, 36 (0.4%) were confirmed (30 [83%] by laboratory); 92% of the discarded cases were classified on the basis of laboratory testing. In 2001, only 1 of 5599 suspected measles cases was confirmed, and it was an imported case from Japan. The last outbreak occurred in February 2000, with 15 cases. Current data suggest interruption of indigenous measles transmission in Brazil.
Assuntos
Programas de Imunização/métodos , Vacina contra Sarampo/administração & dosagem , Sarampo/prevenção & controle , Adolescente , Brasil/epidemiologia , Criança , Pré-Escolar , Humanos , Programas de Imunização/normas , Incidência , Lactente , Sarampo/epidemiologia , Sarampo/transmissão , Programas Nacionais de Saúde , Vigilância da PopulaçãoRESUMO
In this paper we present a historical analysis of the concept of inequality, and we also discuss how inequality has been viewed within the field of health. Natural and social inequalities are discussed, along with the concept of equity, theoretical explanations for inequality, and stratification in modern societies. Finally, we focus on the relationships between epidemiology and studies on social inequalities in health since epidemiology was established as a discipline, during the so-called bacteriological era, and at the present time, when there is a growing interest in social inequalities in health.
Assuntos
Epidemiologia , Justiça Social , América , Fatores SocioeconômicosRESUMO
OBJECTIVE: To analyze the inequalities found using health indicators in the states and regions of Brazil, according to 1999 socioeconomic and demographic indicators. METHODS: An exploratory ecological cross-sectional study was carried out. The units of analysis were Brazilian states (n = 27) and regions (n = 5). Descriptive measures of inequality were calculated. Pearson's correlation and also linear regression analysis were used to identify associations between health indicators and selected socio-economic and demographic indicators. The health indicators analyzed were: life expectancy at birth, infant mortality rate, mortality rate for children < 5 years due to acute diarrheal diseases and to acute respiratory infections, and deaths due to homicides and traffic accidents. RESULTS: Important gains were seen in life expectancy at birth over the 1991-1999 period, especially for males. There was a trend towards larger gains in states that had had lower life expectancy at birth in 1991, which produced greater homogeneity across Brazil in this indicator in recent years. The infant mortality rate decreased by 28% between 1991 and 1999. However, this indicator still varies widely among the regions--from 52.5 per 1,000 live births in the northeast to 17.1 per 1,000 in the south--and among states--from 64.0 per 1,000 in Alagoas to 15.1 per 1,000 in Rio Grande do Sul. With respect to children < 5 years, the mortality rate due to acute diarrheal diseases was equal to or higher than the national median (4.1 per 10,000) in all the north-eastern states, and the mortality rate due to acute respiratory infections was equal to or higher than the national median (10.8 per 10,000) in all the southern, southeastern, and central-western states. The mortality rates (standardized by sex and age) due to traffic accidents and to homicides in 1999 were 17.7 and 26.0 per 100,000 inhabitants, respectively. Extreme values were found in some states for mortality due to homicide (57.8 per 100,000 in Pernambuco) and traffic accidents (54.5 per 100,000 in Roraima). The mortality rate due to homicide was strongly associated with urbanization (P = 0.001). Higher mortality rates due to traffic accidents were associated with lower poverty levels (beta = -0.93; P < 0.001), lower literacy rates (beta = -1.16; P = 0.005), and larger population growth over the past decade (beta = 3.10; P = 0.016). CONCLUSIONS: The pattern of health inequality in Brazil indicates a polarization among regions and states as well as a juxtaposition of diseases associated with under-development and diseases linked to development, suggesting the need for a health system that is committed to addressing these issues.