RESUMO
In 2018 there was a large yellow fever outbreak in São Paulo, Brazil, with a high fatality rate. Yellow fever virus can cause, among other symptoms, hemorrhage and disseminated intravascular coagulation, indicating a role for endothelial cells in disease pathogenesis. Here, we conducted a case-control study and measured markers related to endothelial damage in plasma and its association with mortality. We found that angiopoietin 2 is strongly associated with a fatal outcome and could serve as a predictive marker for mortality. This could be used to monitor severe cases and provide care to improve disease outcome.
Assuntos
Angiopoietina-2 , Biomarcadores , Febre Amarela , Vírus da Febre Amarela , Humanos , Estudos de Casos e Controles , Febre Amarela/mortalidade , Febre Amarela/sangue , Febre Amarela/virologia , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Angiopoietina-2/sangue , Biomarcadores/sangue , Brasil/epidemiologia , Idoso , Adulto JovemRESUMO
Introducción: La fiebre amarilla se ha convertido en una enfermedad reemergente y un problema para la salud pública. Se estima que afecta a más de 200 000 personas anualmente en las regiones tropicales de África, América del Sur y Centroamérica, con al menos 30 000 defunciones. Existen 47 países endémicos, de ellos 34 en el continente africano, que contribuyen con más del 90 por ciento de la morbilidad y mortalidad por fiebre amarilla en el planeta. Quienes viajan a lugares donde la enfermedad es endémica pueden importarla a otros países. Objetivo: Recopilar información científica actualizada sobre la fiebre amarilla en el contexto de su reemergencia. Métodos: Se realizó una síntesis de la información científica disponible en la literatura médica sobre la enfermedad. Se consultaron diferentes buscadores y bases de datos, como PubMed, Ebsco, Scielo, ClinicalKey y Google Académico. El periodo de búsqueda estuvo comprendido entre enero y mayo de 2019. Conclusiones: La circulación del virus de la fiebre amarilla continúa aumentando de una manera desconcertante en poblaciones humanas, tanto en África como en América del Sur y Centroamérica. En el ámbito de su reemergencia, no resulta suficiente la sostenibilidad de sistemas de vigilancia confiables, combinados con programas de control de la enfermedad. La divulgación de los conocimientos científicos alcanzados, puede contribuir a la actualización permanente del personal de salud en aras de lograr un accionar eficaz que conduzca a la disminución de la morbilidad y mortalidad por esta enfermedad en la población mundial(AU)
Introduction: Yellow fever has become a reemerging disease and a public health problem. It is estimated that it affects more than 200,000 people annually in the tropical regions of Africa, South America and Central America, with at least 30,000 deaths. There are 47 endemic countries, 34 of them on the African continent, which contribute more than 90percent of morbidity and mortality from yellow fever on the planet. Those who travel to places where the disease is endemic can import it to other countries. Objective: To collect up-to-date scientific information on yellow fever in the context of its re-emergence. Methods: A synthesis of the scientific information available in the medical literature on the disease was carried out. Different search engines and databases were consulted, such as PubMed, Ebsco, Scielo, ClinicalKey and Google Scholar. The search period was from January to May 2019. Conclusions: The circulation of the yellow fever virus continues to increase in a disconcerting way in human populations, both in Africa and in South and Central America. In the field of its re-emergence, the sustainability of reliable surveillance systems, combined with disease control programs, is not enough. The dissemination of the scientific knowledge achieved can contribute to the permanent updating of health personnel in order to achieve an effective action that leads to the reduction of morbidity and mortality from this disease in the world population(AU)
Assuntos
Humanos , Masculino , Feminino , Febre Amarela/mortalidade , Febre Amarela/prevenção & controle , Febre Amarela/epidemiologia , Controle de Doenças TransmissíveisRESUMO
OBJECTIVE. Yellow fever is a hemorrhagic disease caused by an arbovirus endemic in South America; outbreaks have occurred in recent years. The purpose of this study was to describe abdominal ultrasound findings in patients with severe yellow fever and correlate them with clinical and laboratory data. MATERIALS AND METHODS. A retrospective cohort study was performed between January and April 2018. The subjects were patients admitted to an ICU with polymerase chain reaction-confirmed yellow fever. Bedside sonography was performed within 48 hours of admission. Images were independently analyzed by two board-certified radiologists. Laboratory test samples were collected within 12 hours of image acquisition. Multivariable logistic regression analysis was performed to identify 30-day mortality predictors; p < .05 was considered statistically significant. RESULTS. Forty-six patients (40 [87%] men, six [13%] women; mean age, 47.5 ± 15.2 years) were evaluated with bedside sonography. Laboratory tests showed high serum levels of aspartate aminotransferase (5319 U/L), total bilirubin (6.2 mg/dL), and creati-nine (4.3 mg/dL). Twenty-six (56.5%) patients died within 30 days of admission (median time to death, 5 days [interquartile range, 2-9 days]). The most frequent ultrasound findings were gallbladder wall thickening (80.4%), increased renal cortex echogenicity (71.7%), increased liver parenchyma echogenicity (65.2%), perirenal fluid (52.2%), and ascites (30.4%). Increased renal echogenicity was associated with 30-day mortality (84.6% versus 55.0%; p = .046) and was an independent predictor of this outcome after multivariate analysis (odds ratio, 10.89; p = .048). CONCLUSION. Reproducible abdominal ultrasound findings in patients with severe yellow fever may be associated with severity of disease and prognosis among patients treated in the ICU.
Assuntos
Cavidade Abdominal/diagnóstico por imagem , Cavidade Abdominal/patologia , Ultrassonografia/métodos , Febre Amarela/sangue , Febre Amarela/mortalidade , Adulto , Idoso , Ascite/diagnóstico por imagem , Aspartato Aminotransferases/sangue , Bilirrubina/sangue , Brasil/epidemiologia , Estudos de Coortes , Creatinina/sangue , Feminino , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/patologia , Humanos , Córtex Renal/diagnóstico por imagem , Córtex Renal/patologia , Fígado/diagnóstico por imagem , Fígado/patologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Febre Amarela/patologia , Adulto JovemRESUMO
Yellow fever (YF) is a re-emerging viral zoonosis caused by the Yellow Fever virus (YFV), affecting humans and non-human primates (NHP). YF is endemic in South America and Africa, being considered a burden for public health worldwide despite the availability of an effective vaccine. Acute infectious disease can progress to severe hemorrhagic conditions and has high rates of morbidity and mortality in endemic countries. In 2016, Brazil started experiencing one of the most significant YF epidemics in its history, with lots of deaths being reported in regions that were previously considered free of the disease. Here, we reviewed the historical aspects of YF in Brazil, the epidemiology of the disease, the challenges that remain in Brazil's public health context, the main lessons learned from the recent outbreaks, and our perspective for facing future YF epidemics.
Assuntos
Epidemias/prevenção & controle , Saúde Pública , Zoonoses Virais/epidemiologia , Febre Amarela/epidemiologia , Animais , Brasil/epidemiologia , Doenças Endêmicas/prevenção & controle , Humanos , Primatas/virologia , Febre Amarela/mortalidade , Febre Amarela/prevenção & controle , Vacina contra Febre AmarelaRESUMO
BACKGROUND: Yellow fever (YF) is a viral hemorrhagic disease caused by an arbovirus from the Flaviviridae family. Data on the clinical profile of severe YF in intensive care units (ICUs) are scarce. This study aimed to evaluate factors associated with YF mortality in patients admitted to a Brazilian ICU during the YF outbreaks of 2017 and 2018. METHODS: This was a longitudinal cohort case series study that included YF patients admitted to the ICU. Demographics, clinical and laboratory data were analyzed. Cox regression identified independent predictors of death risk. RESULTS: A total of 114 patients were studied. The median age was 48 years, and 92.1% were males. In univariate analysis, jaundice, leukopenia, bradycardia, prothrombin time, expressed as a ratio to the international normalized ratio-(PT-INR), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, lactate, arterial pH and bicarbonate, Acute Physiology and Chronic Health Evaluation II (APACHE II) and Simplified Acute Physiology Score 3 (SAPS 3) severity scores, transfusion of fresh frozen plasma, acute renal failure (Acute Kidney Injury Network stage III (AKIN III)), hemodialysis, cumulative fluid balance at 72 h of ICU, vasopressor use, seizures and grade IV encephalopathy were significantly associated with mortality. In multivariate analysis, factors independently associated with YF mortality were PT-INR, APACHE II, and grade IV hepatic encephalopathy. CONCLUSIONS: In the large outbreak in Brazil, factors independently associated with death risk in YF were: PT-INR, APACHE II, and grade IV hepatic encephalopathy. Early identification of patients with YF mortality risk factors may be very useful. Once these patients with a poor prognosis have been identified, proper management should be promptly implemented.
Assuntos
Unidades de Terapia Intensiva , Febre Amarela/mortalidade , APACHE , Injúria Renal Aguda/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Surtos de Doenças , Feminino , Encefalopatia Hepática/diagnóstico , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Escore Fisiológico Agudo Simplificado , Febre Amarela/diagnóstico , Febre Amarela/epidemiologia , Adulto JovemRESUMO
OBJECTIVE: Describe the clinical and epidemiological profile of confirmed cases of yellow fever whose patients were hospitalized in a general hospital for infectious diseases in the State of Rio de Janeiro, Brazil, from March 11, 2017 to June 15, 2018, during a recent outbreak and factors associated with death. METHODS: This is a retrospective observational study with analysis of secondary databases of local epidemiological surveillance system, and complementary data collection from epidemiological investigation records and clinical records. Study variables included demographic, epidemiological, clinical, and laboratory data. A descriptive statistical analysis and a bivariate and multivariate analysis by logistic regression were performed to analyze factors associated with death. RESULTS: Fifty-two patients diagnosed with yellow fever were hospitalized, 86.5% male patients, median age 49.5 years, 40.4% rural workers. The most frequent signs and symptoms were fever (90.4%), jaundice (86.5%), nausea and/or vomiting (69.2%), changes in renal excretion (53.8%), bleeding (50%), and abdominal pain (48.1%), with comorbidity in 38.5% of all cases. The lethality rate was 40.4%. Factors significantly associated with a higher chance of death in the bivariate analysis were: bleeding, changes in renal excretion, and maximum values of direct bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), urea, and creatinine. In the multivariate analysis by logistic regression, only changes in renal excretion and ALT remained significant predictors of higher chance of death. A threshold effect was also observed for AST. The cutoff points identified as high risk for death were ALT > 4,000 U/L and AST > 6,000 U/L. CONCLUSIONS: This study contributed to the knowledge on the profile of confirmed cases of high severity yellow fever. The main factors associated with death were changes in renal excretion and elevated serum transaminases, especially ALT. High lethality emphasizes the need for early diagnosis and treatment, and the importance of increasing vaccination coverage.
Assuntos
Surtos de Doenças/estatística & dados numéricos , Mortalidade Hospitalar , Febre Amarela/mortalidade , Adolescente , Adulto , Idoso , Alanina Transaminase/sangue , Aspartato Aminotransferases/sangue , Bilirrubina/sangue , Brasil/epidemiologia , Creatinina/sangue , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Valores de Referência , Estudos Retrospectivos , Fatores de Risco , Estatísticas não Paramétricas , Fatores de Tempo , Ureia/sangue , Febre Amarela/sangue , Adulto JovemRESUMO
BACKGROUND: Yellow fever virus infection results in death in around 30% of symptomatic individuals. The aim of this study was to identify predictors of death measured at hospital admission in a cohort of patients admitted to hospital during the 2018 outbreak of yellow fever in the outskirts of São Paulo city, Brazil. METHODS: In this observational cohort study, we enrolled patients with yellow fever virus from two hospitals in São Paolothe Hospital das Clínicas, University of São Paulo and the Infectious Diseases Institute "Emilio Ribas". Patients older than 18 years admitted to hospital with fever or myalgia, headache, arthralgia, oedema, rash, or conjunctivitis were consecutively screened for inclusion in the present study. Consenting patients were included if they had travelled to geographical areas in which yellow fever virus cases had been previously confirmed. Yellow fever infection was confirmed by real-time PCR in blood collected at admission or tissues at autopsy. We sequenced the complete genomes of yellow fever virus from infected individuals and evaluated demographic, clinical, and laboratory findings at admission and investigated whether any of these measurements correlated with patient outcome (death). FINDINGS: Between Jan 11, 2018, and May 10, 2018, 118 patients with suspected yellow fever were admitted to Hospital das Clínicas, and 113 patients with suspected yellow fever were admitted to Infectious Diseases Institute "Emilio Ribas". 95 patients with suspected yellow fever were included in the study, and 136 patients were excluded. Three (3%) of 95 patients with suspected yellow fever who were included in the study were excluded because they received a different diagnosis, and 16 patients with undetectable yellow fever virus RNA were excluded. Therefore, 76 patients with confirmed yellow fever virus infection, based on detectable yellow fever virus RNA in blood (74 patients) or yellow fever virus confirmed only at the autopsy report (two patients), were included in our analysis. 27 (36%) of 76 patients died during the 60 day period after hospital admission. We generated 14 complete yellow fever virus genomes from the first 15 viral load-detectable samples. The genomes belonged to a single monophyletic clade of the South America I genotype, sub-genotype E. Older age, male sex, higher leukocyte and neutrophil counts, higher alanine aminotransferase, aspartate transaminase (AST), bilirubin, and creatinine, prolonged prothrombin time, and higher yellow fever virus RNA plasma viral load were associated with higher mortality. In a multivariate regression model, older age, elevated neutrophil count, increased AST, and higher viral load remained independently associated with death. All 11 (100%) patients with neutrophil counts of 4000 cells per mL or greater and viral loads of 5·1 log10 copies/mL or greater died (95% CI 72100), compared with only three (11%) of 27 (95% CI 229) among patients with neutrophil counts of less than 4000 cells per mL and viral loads of less than 5·1 log10 copies/mL. INTERPRETATION: We identified clinical and laboratory predictors of mortality at hospital admission that could aid in the care of patients with yellow fever virus. Identification of these prognostic markers in patients could help clinicians prioritise admission to the intensive care unit, as patients often deteriorate rapidly. Moreover, resource allocation could be improved to prioritise key laboratory examinations that might be more useful in determining whether a patient could have a better outcome. Our findings support the important role of the virus in disease pathogenesis, suggesting that an effective antiviral could alter the clinical course for patients with the most severe forms of yellow fever
Assuntos
Humanos , Febre Amarela/mortalidade , Brasil/epidemiologiaRESUMO
BACKGROUND: Little is known about clinical characteristics and management of severe yellow fever as previous yellow fever epidemics often occurred in times or areas with little access to intensive care units (ICU). We aim to describe the clinical characteristics of severe yellow fever cases requiring admission to the ICU during the 2018 yellow fever outbreak in São Paulo, Brazil. Furthermore, we report on preliminary lessons learnt regarding clinical management of severe yellow fever. METHODS: Retrospective descriptive cohort study. Demographic data, laboratory test results on admission, clinical follow-up, and clinical outcomes were evaluated. RESULTS: From 10 January to 11 March 2018, 79 patients with laboratory confirmed yellow fever were admitted to the ICU in a tertiary hospital in Sao Paolo because of rapid clinical deterioration. On admission, the median AST was 7,000 IU/L, ALT 3,936 IU/L, total bilirubin 5.3 ml/dL, platelet 74 × 103/mm3, INR 2.24 and factor V 37%. Seizures occurred in 24% of patients, even without substantial intracranial hypertension. The high frequency of pancreatitis and rapidly progressive severe metabolic acidosis were notable findings. 73% of patients required renal replacement therapy. The in-hospital fatality rate was 67%. Patients with diabetes mellitus had a higher case fatality rate (CFR) of 80%, while patients without diabetes had a CFR of 65%. Leading causes of death were severe gastrointestinal bleeding, epileptic status, severe metabolic acidosis, necrohemorrhagic pancreatitis, and multi-organ failure. CONCLUSIONS: Severe yellow fever is associated with a high CFR. The following management lessons were learnt: Anticonvulsant drugs in patients with any symptoms of hepatic encephalopathy or arterial ammonia levels >70 µmol/L was commenced which reduced the frequency of seizures from 28% to 17%. Other new therapy strategies included early institution of plasma exchange. Due to the high frequency of gastric bleeding, therapeutic doses of intravenous proton pump inhibitors should be administered.
Assuntos
Febre Amarela/mortalidade , Adulto , Brasil/epidemiologia , Surtos de Doenças , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Febre Amarela/diagnósticoRESUMO
Faced with the reemergence of yellow fever (YF) in the metropolitan region of São Paulo, Brazil, we developed a retrospective study to describe the cases of YF attended at the Institute of Infectology Emilio Ribas from January to March 2018 and analyze the factors associated with death, from the information obtained in the hospital epidemiological investigation. A total of 72 cases of sylvatic YF were confirmed, with 21 deaths (29.2% lethality rate). Cases were concentrated in males (80.6%) and in the age group of 30 to 59 years (56.9%). Two logistic regression models were performed, with continuous variables adjusted for the time between onset of symptoms and hospitalization. The first model indicated age (odds ratiosadjusted [ORadj]: 1.038; CI 95%: 1.008-1.212), aspartate aminotransferase (AST) (ORadj: 1.038; CI 95%: 1.005-1.072), and creatinine (ORadj: 2.343; CI 95%: 1.205-4.553) were independent factors associated with mortality. The second model indicated age (ORadj: 1.136; CI 95%: 1.013-1.275), alanine aminotransferase (ALT) (ORadj: 1.118; CI 95%: 1.018-1.228), and creatinine (ORadj: 2.835; CI 95%: 1.352-5,941). The risk of death in the model with continuous variables was calculated from the increase of 1 year (age), 1 mg/dL (creatinine), and 100 U/L for AST and ALT. Another logistic regression analysis with dichotomous variables indicated AST > 1,841 IU/L (ORadj: 12.92; CI 95%: 1.50-111.37) and creatinine > 1.2 mg/dL (ORadj: 81.47; CI 95%: 11.33-585.71) as independent factors associated with death. These results may contribute to the appropriate clinical management of patients with YF in health-care services and improve the response to outbreaks and public health emergencies.
Assuntos
Febre Amarela/diagnóstico , Febre Amarela/mortalidade , Adolescente , Adulto , Brasil/epidemiologia , Criança , Feminino , Hospitais , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Febre Amarela/epidemiologia , Adulto JovemRESUMO
BACKGROUND: Yellow fever virus infection results in death in around 30% of symptomatic individuals. The aim of this study was to identify predictors of death measured at hospital admission in a cohort of patients admitted to hospital during the 2018 outbreak of yellow fever in the outskirts of São Paulo city, Brazil. METHODS: In this observational cohort study, we enrolled patients with yellow fever virus from two hospitals in São Paolo-the Hospital das Clínicas, University of São Paulo and the Infectious Diseases Institute "Emilio Ribas". Patients older than 18 years admitted to hospital with fever or myalgia, headache, arthralgia, oedema, rash, or conjunctivitis were consecutively screened for inclusion in the present study. Consenting patients were included if they had travelled to geographical areas in which yellow fever virus cases had been previously confirmed. Yellow fever infection was confirmed by real-time PCR in blood collected at admission or tissues at autopsy. We sequenced the complete genomes of yellow fever virus from infected individuals and evaluated demographic, clinical, and laboratory findings at admission and investigated whether any of these measurements correlated with patient outcome (death). FINDINGS: Between Jan 11, 2018, and May 10, 2018, 118 patients with suspected yellow fever were admitted to Hospital das Clínicas, and 113 patients with suspected yellow fever were admitted to Infectious Diseases Institute "Emilio Ribas". 95 patients with suspected yellow fever were included in the study, and 136 patients were excluded. Three (3%) of 95 patients with suspected yellow fever who were included in the study were excluded because they received a different diagnosis, and 16 patients with undetectable yellow fever virus RNA were excluded. Therefore, 76 patients with confirmed yellow fever virus infection, based on detectable yellow fever virus RNA in blood (74 patients) or yellow fever virus confirmed only at the autopsy report (two patients), were included in our analysis. 27 (36%) of 76 patients died during the 60 day period after hospital admission. We generated 14 complete yellow fever virus genomes from the first 15 viral load-detectable samples. The genomes belonged to a single monophyletic clade of the South America I genotype, sub-genotype E. Older age, male sex, higher leukocyte and neutrophil counts, higher alanine aminotransferase, aspartate transaminase (AST), bilirubin, and creatinine, prolonged prothrombin time, and higher yellow fever virus RNA plasma viral load were associated with higher mortality. In a multivariate regression model, older age, elevated neutrophil count, increased AST, and higher viral load remained independently associated with death. All 11 (100%) patients with neutrophil counts of 4000 cells per mL or greater and viral loads of 5·1 log10 copies/mL or greater died (95% CI 72-100), compared with only three (11%) of 27 (95% CI 2-29) among patients with neutrophil counts of less than 4000 cells per mL and viral loads of less than 5·1 log10 copies/mL. INTERPRETATION: We identified clinical and laboratory predictors of mortality at hospital admission that could aid in the care of patients with yellow fever virus. Identification of these prognostic markers in patients could help clinicians prioritise admission to the intensive care unit, as patients often deteriorate rapidly. Moreover, resource allocation could be improved to prioritise key laboratory examinations that might be more useful in determining whether a patient could have a better outcome. Our findings support the important role of the virus in disease pathogenesis, suggesting that an effective antiviral could alter the clinical course for patients with the most severe forms of yellow fever. FUNDING: São Paulo Research Foundation (FAPESP).
Assuntos
Surtos de Doenças , Hospitalização , Febre Amarela/diagnóstico , Febre Amarela/mortalidade , Adulto , Fatores Etários , Brasil/epidemiologia , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Febre Amarela/epidemiologia , Vírus da Febre Amarela/isolamento & purificaçãoRESUMO
ABSTRACT OBJECTIVE Describe the clinical and epidemiological profile of confirmed cases of yellow fever whose patients were hospitalized in a general hospital for infectious diseases in the State of Rio de Janeiro, Brazil, from March 11, 2017 to June 15, 2018, during a recent outbreak and factors associated with death. METHODS This is a retrospective observational study with analysis of secondary databases of local epidemiological surveillance system, and complementary data collection from epidemiological investigation records and clinical records. Study variables included demographic, epidemiological, clinical, and laboratory data. A descriptive statistical analysis and a bivariate and multivariate analysis by logistic regression were performed to analyze factors associated with death. RESULTS Fifty-two patients diagnosed with yellow fever were hospitalized, 86.5% male patients, median age 49.5 years, 40.4% rural workers. The most frequent signs and symptoms were fever (90.4%), jaundice (86.5%), nausea and/or vomiting (69.2%), changes in renal excretion (53.8%), bleeding (50%), and abdominal pain (48.1%), with comorbidity in 38.5% of all cases. The lethality rate was 40.4%. Factors significantly associated with a higher chance of death in the bivariate analysis were: bleeding, changes in renal excretion, and maximum values of direct bilirubin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), urea, and creatinine. In the multivariate analysis by logistic regression, only changes in renal excretion and ALT remained significant predictors of higher chance of death. A threshold effect was also observed for AST. The cutoff points identified as high risk for death were ALT > 4,000 U/L and AST > 6,000 U/L. CONCLUSIONS This study contributed to the knowledge on the profile of confirmed cases of high severity yellow fever. The main factors associated with death were changes in renal excretion and elevated serum transaminases, especially ALT. High lethality emphasizes the need for early diagnosis and treatment, and the importance of increasing vaccination coverage.
RESUMO OBJETIVO Descrever o perfil clínico-epidemiológico dos casos confirmados de febre amarela internados em hospital geral de referência para doenças infecciosas no estado do Rio de Janeiro, Brasil, de 11 de março de 2017 a 15 de junho de 2018, durante recente surto e fatores associados ao óbito. MÉTODOS Estudo observacional retrospectivo, com análise de bases de dados secundários da vigilância epidemiológica local e coleta complementar de dados nas fichas de investigação epidemiológica e prontuários clínicos. As variáveis analisadas incluíram dados demográficos, epidemiológicos, clínicos e laboratoriais. Foi conduzida análise estatística descritiva bivariada e múltipla por regressão logística para estudo de fatores associados ao óbito. RESULTADOS Foram internados 52 casos confirmados, 86,5% deles homens, com mediana de idade de 49,5 anos e 40,4% trabalhadores rurais. Os sinais e sintomas mais frequentes foram: febre (90,4%), icterícia (86,5%), náuseas e/ou vômitos (69,2%), alterações de excreção renal (53,8%), hemorragias (50%) e dor abdominal (48,1%), com comorbidade em 38,5% dos casos. A letalidade foi de 40,4%. Os fatores associados significativamente à maior chance de óbito na análise bivariada foram: hemorragia, alterações de excreção renal e valores máximos de bilirrubina direta, aspartato aminotransferase (AST), alanina aminotransferase (ALT), ureia e creatinina. Na análise múltipla por regressão logística, apenas alterações de excreção renal e ALT permaneceram como preditores significativos de maior chance de óbito. Observou-se ainda efeito limítrofe para AST. Os pontos de corte identificados como de alto risco para óbito foram ALT > 4.000 U/L e AST > 6.000 U/L. CONCLUSÕES O estudo contribuiu para o conhecimento do perfil de casos confirmados de febre amarela com gravidade alta. Os principais fatores associados ao óbito foram a alteração da excreção renal e a elevação sérica de transaminases, sobretudo a ALT. A letalidade elevada reforça a necessidade de diagnóstico e tratamento precoces, e a importância do incremento da cobertura vacinal.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Idoso , Adulto Jovem , Febre Amarela/mortalidade , Surtos de Doenças/estatística & dados numéricos , Mortalidade Hospitalar , Aspartato Aminotransferases/sangue , Valores de Referência , Fatores de Tempo , Ureia/sangue , Febre Amarela/sangue , Bilirrubina/sangue , Brasil/epidemiologia , Modelos Logísticos , Análise Multivariada , Estudos Retrospectivos , Fatores de Risco , Estatísticas não Paramétricas , Creatinina/sangue , Alanina Transaminase/sangue , Pessoa de Meia-IdadeRESUMO
Yellow fever virus (YFV) has a long history of causing human disease. Today, YFV is persevered in jungle environments with occasional sporadic human outbreaks in South America and periodic intermediate human transmissions with occasional urban outbreaks in sub-Saharan Africa. The ever-present risk of outbreak is primarily controlled for via vaccination coverage to vulnerable human populations. Global vaccine supplies have been strained in the setting of recent outbreaks in Africa and Brazil. The increasingly global community of today has placed an ever-growing tension on the management and control of YFV. A historic outbreak of YFV in Brazil is tracked from January to April 2018 using the International Society for Infectious Diseases' (ISID) Program for Monitoring Emerging Diseases (ProMed). A narrative summary is generated from the review of 29 ProMed reports pertaining to the key words yellow fever and Brazil. Significant topics addressed include urban proximity, vaccination dose sparing with 1/5th standard dose, international travellers, epizootic trends, vaccine hesitancy, and mass immunisation campaigns. These topics are reviewed in detail for the current outbreak in comparison to previous outbreaks. Through close attention to these topics the degree and extent of the current outbreak was attenuated.
Assuntos
Controle de Doenças Transmissíveis , Surtos de Doenças , Febre Amarela/prevenção & controle , Adulto , Brasil/epidemiologia , Surtos de Doenças/prevenção & controle , Feminino , Humanos , Masculino , Vacinação em Massa , Pessoa de Meia-Idade , Febre Amarela/epidemiologia , Febre Amarela/mortalidade , Vírus da Febre Amarela/isolamento & purificação , Adulto JovemRESUMO
BACKGROUND: Yellow Fever (YF) is a high fatality rate disease (30-50%) caused by Flavivirus, present in some African and South American countries. In order to determine the magnitude and epidemiological distribution of YF cases, vaccination coverage and most affected regions in Brazil, a descriptive epidemiological study monitoring the last outbreak was undertaken in Portugal. METHOD: The Brazilian database "Portal da Saude" was used to collect data on cases of YF. We used Microsoft Excel on a weekly basis to update the suspected, confirmed and mortality cases as well as the case fatality rate and epizootics in non-human primates. RESULTS: Case Fatality Rate was 33.6%. A total and 82% of confirmed cases were males. The outbreak predominantly affected two south-eastern states, Minas Gerais and Espírito Santo, both with a very low vaccination coverage. CONCLUSIONS: The last outbreak of YF was by far the largest observed over the last few decades! Until the emergence of this outbreak, Espírito Santo, Bahia and Rio de Janeiro were states of low risk for YF and the vaccine not previously recommended. The World Health Organization's "Global Strategy to Eliminate Yellow Fever Epidemic" (EYE) should be on the way, to prevent YF outbreaks in Brazil and other countries in Africa and South America.
Assuntos
Febre Amarela/epidemiologia , Animais , Brasil/epidemiologia , Surtos de Doenças , Monitoramento Epidemiológico , Humanos , Portugal , Febre Amarela/mortalidade , Febre Amarela/prevenção & controle , Zoonoses/epidemiologiaAssuntos
Saúde Pública/história , Febre Amarela/história , Animais , Cidades , Cuba/epidemiologia , Culicidae , Morte , História do Século XVIII , História do Século XIX , História do Século XX , Humanos , Militares , Mosquitos Vetores , Estados Unidos , Febre Amarela/mortalidade , Febre Amarela/prevenção & controleRESUMO
OBJECTIVE: this study aims to describe the epidemiological characteristics of yellow fever in Brazil in the period 2000-2012. METHODS: this is a descriptive ecological epidemiological study, using information from Ministry of Health databases. RESULTS: 326 cases of yellow fever were confirmed in Brazil during this period, with 156 deaths and an average case fatality rate of 47.8%; the young male adult age group was the most affected; in epizootic terms, 2,856 suspected cases of yellow fever in non-human primates were reported and 31.1% of these were confirmed by laboratory tests; during the study period the area in which sylvatic transmission of the disease occurs was found to have expanded to densely population regions, such as South, Southeast and Midwest Brazil. CONCLUSION: the risk of urban yellow fever transmission persists, as sylvatic incidence of the disease has expanded to regions with high Aedes aegypti infestation, this being the mosquito responsible for urban transmission of the disease.
Assuntos
Febre Amarela/epidemiologia , Adolescente , Adulto , Aedes , Idoso , Idoso de 80 Anos ou mais , Animais , Brasil/epidemiologia , Criança , Pré-Escolar , Surtos de Doenças , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Primatas , Distribuição por Sexo , Febre Amarela/mortalidade , Febre Amarela/transmissão , Febre Amarela/veterinária , Adulto JovemAssuntos
Surtos de Doenças/estatística & dados numéricos , Febre Amarela/epidemiologia , África/epidemiologia , Brasil/epidemiologia , Surtos de Doenças/prevenção & controle , Humanos , Programas de Imunização , Peru/epidemiologia , Vigilância da População , Medição de Risco , América do Sul/epidemiologia , Febre Amarela/mortalidade , Febre Amarela/prevenção & controle , Vacina contra Febre Amarela/administração & dosagemRESUMO
OBJETIVO: o estudo visa descrever as características epidemiológicas da febre amarela no Brasil no período de 2000 a 2012. MÉTODOS: estudo epidemiológico, ecológico, descritivo, utilizando informações dos bancos de dados do Ministério da Saúde. RESULTADOS: foram confirmados 326 casos de febre amarela no país nesse período, com 156 óbitos e taxa de letalidade média de 47,8%; o grupo de adultos jovens do sexo masculino foi o mais acometido; nas epizootias, foi identificado um total de 2.856 primatas não humanos notificados com suspeita de febre amarela, 31,1% deles confirmados laboratorialmente; no período estudado, foi identificada expansão da área de transmissão silvestre da doença para regiões densamente povoadas, como Sul, Sudeste e Centro-Oeste. CONCLUSÃO: persiste o risco de transmissão urbana da febre amarela, pois a incidência silvestre da doença tem se expandido para regiões onde existe alta infestação do Aedes aegypti, mosquito transmissor do ciclo urbano da doença.
OBJETIVO: el estudio tiene como objetivo describir las características epidemiológicas de la fiebre amarilla en Brasil entre 2000 y 2012. MÉTODOS: estudio epidemiológico descriptivo, ecológico, utilizando información de bases de datos del Ministerio de Salud. RESULTADOS: se confirmaron 326 casos de fiebre amarilla en el país en este periodo, con un total de 156 muertes y una tasa de letalidad de 47,8%; el grupo de adultos jóvenes del sexo masculino fue el más afectado; se identificó un total de 2.856 primates notificados sospechosos de fiebre amarilla, de los cuales 31,1% fueron confirmados laboratoriálmente; en el período estudiado, identificamos una expansión del área de transmisión silvestre de la enfermedad a zonas densamente pobladas como el Sur, Sudeste y Centro-Oeste. CONCLUSIÓN: persiste el riesgo de transmisión de fiebre amarilla, ya que la incidencia de la enfermedad se ha extendido a regiones donde hay una alta infestación de Aedes aegypti, el mosquito transmisor del ciclo urbano de la enfermedad.
OBJECTIVE: this study aims to describe the epidemiological characteristics of yellow fever in Brazil in the period 2000-2012. METHODS: this is a descriptive ecological epidemiological study, using information from Ministry of Health databases. RESULTS: 326 cases of yellow fever were confirmed in Brazil during this period, with 156 deaths and an average case fatality rate of 47.8%; the young male adult age group was the most affected; in epizootic terms, 2,856 suspected cases of yellow fever in non-human primates were reported and 31.1% of these were confirmed by laboratory tests; during the study period the area in which sylvatic transmission of the disease occurs was found to have expanded to densely population regions, such as South, Southeast and Midwest Brazil. CONCLUSION: the risk of urban yellow fever transmission persists, as sylvatic incidence of the disease has expanded to regions with high Aedes aegypti infestation, this being the mosquito responsible for urban transmission of the disease.
Assuntos
Humanos , Animais , Masculino , Feminino , Febre Amarela/epidemiologia , Febre Amarela/mortalidade , Febre Amarela/transmissão , Febre Amarela/veterinária , Brasil/epidemiologia , Epidemiologia DescritivaRESUMO
We propose a method to analyse the 2009 outbreak in the region of Botucatu in the state of São Paulo (SP), Brazil, when 28 yellow fever (YF) cases were confirmed, including 11 deaths. At the time of the outbreak, the Secretary of Health of the State of São Paulo vaccinated one million people, causing the death of five individuals, an unprecedented number of YF vaccine-induced fatalities. We apply a mathematical model described previously to optimise the proportion of people who should be vaccinated to minimise the total number of deaths. The model was used to calculate the optimum proportion that should be vaccinated in the remaining, vaccine-free regions of SP, considering the risk of vaccine-induced fatalities and the risk of YF outbreaks in these regions.
Assuntos
Surtos de Doenças/estatística & dados numéricos , Modelos Estatísticos , Saúde Pública/métodos , Vacinação/mortalidade , Vacina contra Febre Amarela/efeitos adversos , Febre Amarela/prevenção & controle , Brasil/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Monitoramento Epidemiológico , Humanos , Medição de Risco/métodos , Febre Amarela/epidemiologia , Febre Amarela/mortalidadeRESUMO
BACKGROUND: Like many infectious agents, yellow fever (YF) virus only causes disease in a proportion of individuals it infects and severe illness only represents the tip of the iceberg relative to the total number of infections, the more critical factor for virus transmission. METHODS: We compiled data on asymptomatic infections, mild disease, severe disease (fever with jaundice or hemorrhagic symptoms) and fatalities from 11 studies in Africa and South America between 1969 and 2011. We used a Bayesian model to estimate the probability of each infection outcome. RESULTS: For YF virus infections, the probability of being asymptomatic was 0.55 (95% credible interval [CI] 0.37-0.74), mild disease 0.33 (95% CI 0.13-0.52) and severe disease 0.12 (95% CI 0.05-0.26). The probability of death for people experiencing severe disease was 0.47 (95% CI 0.31-0.62). CONCLUSIONS: In outbreak situations where only severe cases may initially be detected, we estimated that there may be between one and seventy infections that are either asymptomatic or cause mild disease for every severe case identified. As it is generally only the most severe cases that are recognized and reported, these estimates will help improve the understanding of the burden of disease and the estimation of the potential risk of spread during YF outbreaks.