Valeria Saraceni

The COVID-19 pandemic posed significant challenges, including rehospitalization of patients due to SARS-CoV-2 reinfection, particularly in the context of variants of concern and Brazil’s COVID-19 vaccination campaign. This study aimed to estimate the rate of rehospitalizations due to reinfection in the municipality of Rio de Janeiro (2020–2022), assess the impact of individual vaccination status, and identify factors associated with this outcome. Cohort study including individuals aged 18 years or older who were hospitalized with Severe Acute Respiratory Illness (SARI) resulting from SARS-CoV-2 infection in Rio de Janeiro. Data from four administrative databases (SIPNI, e-SUS Notifica, SIVEP-Gripe, and SIM) were integrated through record linkage. Rehospitalizations due to reinfection were defined as those occurring ≥90 days after the initial hospitalization. Annual rehospitalization rates were calculated per 100 person-years. The analysis included demographics, hospital discharge disposition, and vaccination-related variables. Cox proportional hazards models with deaths considered as competing risks were used. Of the 59,001 individuals included, 1,957 (3.3%) experienced rehospitalization. The main finding was that a complete vaccination regimen with a booster (≥3 doses) was associated with a 39% reduction in the risk of rehospitalization (sHR: 0.61; 95% CI: 0.52–0.73), while older age, multimorbidity, and Black race/skin color emerged as significant risk factors. Full vaccination with booster doses offered protection against COVID-19-related rehospitalization; however, racial inequities, advanced age, and comorbidities remain important risk factors. Public health policies that expand periodic booster vaccination, strengthen health education, and address social vulnerabilities are urgently needed as a fundamental strategy for preventing future pandemics.

Motivation: With the scaling frequency and intensity of extreme heat events across the globe, it is critical for public institutions to develop early detection systems and continuous monitoring of these events and their impacts. In Brazil, Rio de Janeiro was the first city to publish its heat protocol, with the Rio Heat Dashboard as a central component of this system. Implementation: The dashboard was implemented using R/Shiny and integrates climatic and health data from multiple sources. General features: The application comprises real-time heat exposure monitoring and automatic alert level classification, which is monitored daily by multiple municipal actors and supports activation of actions specified in the heat protocol. It also features a health impact module, which lists each heat event and its impact on mortality, and primary care and emergency visits. Availability: The source for full reproducibility is available through https://github.com/joaohmorais/RioHeatDashboard .

Under a climate change scenario, extreme heat episodes show an increase in frequency and intensity, with a scaling impact in Latin American cities. Recently, Rio de Janeiro City developed its heat protocol, using the amount of hours spent over specific heat thresholds as its trigger metric. This study gathers mortality data by 17 causes of death in Rio, over a 12.5-year period (2012–2024). We use Distributed Lag Nonlinear Models to assess the relationship between heat exposure and mortality among younger (0–64 years) and elderly (65+ years) age groups, comparing temperature and heat index as exposure metrics. Additionally, we evaluate whether including measures of exposure duration contributes to the explanation of heat-related mortality. In the study period, there were 466,121 deaths in the city from natural causes. Of the 17 causes of death, six showed a significant association with heat among the younger age group (0–64), while 13 were significant among the elderly. Particularly elevated relative risks were observed for deaths due to diabetes, Alzheimer’s and dementia, hypertensive diseases, urinary tract infections, and deaths by undetermined causes. Even though no clear conclusion was reached on the temperature and heat index comparison, the inclusion of exposure duration showed a relevant additional effect for explaining mortality across broader cause groups. The results characterize cause-specific heat-related mortality in Rio and show potential on the use of exposure period metrics to better understand heat-mortality relationships and guide definitions for heat warning systems.

The study of severe maternal morbidity (SMM) is an important strategy for improving the quality of obstetric care. The objective of this study is to assess SMM cases recorded in the Hospital Information System of the Unified Health System (SIH/SUS), which contains public funded hospitalizations, and in the database of the National Supplementary Health Agency (ANS), which contains hospitalizations paid for by health plans. This is a cross-sectional study using obstetric hospitalizations of women aged 10–49 years from both databases in the period 2015–2022. We assessed SMM cases using the World Health Organization’s criteria for potentially life-threatening conditions (PLTC). Of the 26 PLTC criteria, 22 were operationalized through diagnoses during hospitalization, using International Classification of Diseases-10 codes, or medical procedures, using specific codes of each database. We estimated the frequency and odds ratio of death for each isolated criterion, for grouped criteria and for the total number of SMM cases, as well as the frequency of deaths according to the number of SMM criteria. We identified 18,807,757 obstetric hospitalizations in the SIH/SUS and 3,776,986 in the ANS database. The estimated proportion of SMM was 8.51% and 7.30% in SIH/SUS and ANS, respectively. Most cases presented only one criterion. Differences were observed among sectors, with a higher frequency of procedure-based criteria in the ANS database, compatible with the greater availability of resources in private services. The proportion of deaths increased with the increase in the number of criteria, and more severe criteria presented a higher odds ratio of death. The results indicate that it is possible to estimate the number of SMM cases in the country, both in public and private hospitalizations. Continued investment in the quality of recording in both databases are necessary so that the estimates can truly reflect the maternal morbidity of Brazilian women.

Background: Short-course tuberculosis preventive therapy with isoniazid and rifapentine (HP) is widely recommended, but the acceptability and safety of one month of daily HP (1HP) compared to three months of weekly HP (3HP) is uncertain. We compared treatment with these two regimens in people with a positive latent tuberculosis infection test and without HIV infection. We hypothesized that 1HP would have greater treatment completion and fewer targeted safety events than 3HP. Methods and findings: We conducted a Phase 4 randomized trial of 1HP versus 3HP in adolescents and adults without HIV infection with recent tuberculosis exposure and a positive latent tuberculosis infection test in two sites in Brazil. The primary outcomes were successful completion of >90% of medication as ascertained by self-report, pill counts, and pharmacologic monitoring, and safety. Treatment safety was defined as occurrence of Grade > 2 targeted events or discontinuation of treatment for side effects. We randomized 500 individuals to 1HP (249) and 3HP (251); 193 males and 307 females, with a median age of 39 years. Treatment completion was 89.6% for 1HP recipients versus 84.1% for 3HP recipients (site-adjusted risk difference 5.2%, [95% CI: [−0.1%, 11.2%], p = 0.10). Targeted > Grade 2 adverse safety events or treatment discontinuation occurred in 16.1% of 1HP recipients and 10.4% of 3HP recipients (site-adjusted risk difference 6.1%, [95%CI: [−0.04%, 12.3%], p = 0.05). The proportions who discontinued treatment for any side effect were 7.2% for 1HP and 4.4% for 3HP. The risk difference for the primary safety outcome adjusted for site and baseline demographic and clinical covariates was 3.4% (95% CI [−2.3,9.1%], p = 0.24). The trial was not designed to ascertain efficacy. Conclusion: Both 1HP and 3HP had high rates of treatment success. Participants assigned to 1HP had more targeted safety events, mostly low-grade. Neither regimen was superior to the other. These results will inform global guidelines for tuberculosis preventive therapy. NCT04703075 ( clinicaltrials.gov ).

Resumo A preparação e resposta às emergências em saúde pública envolve o investimento em sistemas de detecção precoce, alerta e resposta. Esse artigo analisa a estratégia de utilização de dados de atendimentos da Rede de Urgência e Emergência unida à aplicação de modelos de detecção de tendências para geração automatizada de alertas, implementada no município do Rio de Janeiro. A partir de categorias da CID-10 marcadas nos dados dos atendimentos, séries temporais de interesse à vigilância em saúde foram monitoradas. Um modelo aditivo generalizado (GAM) foi ajustado às séries para suavização, determinação da inclinação e geração dos alertas. Na comparação de tendências para COVID-19 entre os dados do SIVEP/e-SUS e os atendimentos da Rede de Urgência e Emergência, verificou-se ganho na velocidade de identificação de sinais de crescimento. No monitoramento das diarreias, o alerta gerado permitiu a deflagração de estratégias de vigilância pelas unidades de resposta rápida. Os resultados exaltam a potencialidade desses dados na identificação de possíveis emergências de saúde pública, favorecendo uma atuação mais moderna para a vigilância em saúde.

Tuberculosis (TB) deaths occur early, mainly during the two months comprising the intensive treatment phase compared to other causes of death. Understanding the distinct TB mortality patterns provides more effective health care for specific groups. This study aimed to apply a data mining technique to examine whether there are distinct mortality patterns associated with diverse patient profiles within a cohort notified with TB in the city of Rio de Janeiro, Brazil. This was a retrospective cohort study using a probabilistic linkage between the Brazilian Information System for Notifiable Diseases (SINAN) and the Brazilian Mortality Information System (SIM). An association rule data mining technique was applied using the Apriori algorithm to evaluate patterns associated with causes of death. TB deaths were associated with adult men with short survival time. Deaths from AIDS with TB occurred during the treatment period and were more associated with women. In contrast, deaths from AIDS without a mention of TB were more frequent among younger men and Black/Mixed-race adults. Deaths from external causes occurred later, one year after diagnosis, and were related to young men. Deaths from other causes that were linked to longer survivals were associated with older white individuals with higher education. The Apriori algorithm provided the extraction of relevant knowledge from secondary data, such as identifying distinct subgroups of people who can benefit from specific actions, with a consequent positive effect for TB control.

Introduction: The COVID-19 pandemic posed significant challenges, including rehospitalization of patients due to SARS-CoV-2 reinfection, particularly in the context of variants of concern and Brazil’s COVID-19 vaccination campaign. This study aimed to estimate the rate of rehospitalizations due to reinfection in the municipality of Rio de Janeiro (2020–2022), assess the impact of individual vaccination status, and identify factors associated with this outcome. Methods: Cohort study including individuals aged 18 years or older who were hospitalized with Severe Acute Respiratory Illness (SARI) resulting from SARS-CoV-2 infection in Rio de Janeiro. Data from four administrative databases (SIPNI, e-SUS Notifica, SIVEP-Gripe, and SIM) were integrated through record linkage. Rehospitalizations due to reinfection were defined as those occurring ≥90 days after the initial hospitalization. Annual rehospitalization rates were calculated per 100 person-years. The analysis included demographics, hospital discharge disposition, and vaccination-related variables. Cox proportional hazards models with deaths considered as competing risks were used. Results: Of the 59,001 individuals included, 1,957 (3.3%) experienced rehospitalization. The main finding was that a complete vaccination regimen with a booster (≥3 doses) was associated with a 39% reduction in the risk of rehospitalization (HR: 0.61; 95% CI: 0.52–0.73), while older age, multimorbidity, and Black race/ethnicity emerged as significant risk factors. Conclusion: Full vaccination with booster doses offered protection against COVID-19-related rehospitalization; however, racial inequities, advanced age, and comorbidities remain important risk factors. Public health policies that expand periodic booster vaccination, strengthen health education, and address social vulnerabilities are urgently needed as a fundamental strategy for preventing future pandemics.

Objective: In July of 2021, the Brazilian National Ministry of Health integrated three months of once-weekly isoniazid plus rifapentine (3HP) into the National Guidelines for Tuberculosis Control as a first-line tuberculosis preventive therapy (TPT) option for people living with HIV (PLHIV) and tuberculosis household contacts (HHCs). As part of the Unitaid-sponsored Increasing Market and Public Health Outcomes through Scaling up Affordable Access Models of Short Course Preventive Therapy for TB project to implement short-course TPT, we evaluated 3HP uptake, completion, and tolerability among PLHIV and pediatric HHCs in Brazil. Methods: We conducted a multicenter single-arm pragmatic project to roll out 3HP for PLHIV and HHCs in the 2- to 14-year age bracket in the cities of Rio de Janeiro and Manaus, Brazil. Participants were identified, treated, and monitored in accordance with Brazilian national tuberculosis guidelines. De-identified patient-level data on treatment initiation, adverse events, and completion were collected and analyzed. Results: From October of 2021 to March of 2023, 380 PLHIV (77.6% of whom were male; median age, 40 years [IQR, 31-51]) and 74 HHCs (54.1% of whom were male; median age, 8.6 years [IQR, 5.1-11.8]) were enrolled in the study. Treatment completion rates were 83.7% among PLHIV and 82.4% among HHCs. Completion rates were higher in Rio de Janeiro than in Manaus (PLHIV: 86.0% vs. 79.6%; HHCs: 85.2% vs. 80.9%), although completion of 10 doses was similar (PLHIV: 86.4% vs. 86.1%). Adverse event-related discontinuation was low (PLHIV: 2.4%; HHCs: 2.7%). One person living with HIV developed active tuberculosis during treatment. At six months of follow-up, 99.6% of the PLHIV remained free of tuberculosis. Conclusions: The 3HP regimen was successfully introduced, had high treatment completion rates, and was well tolerated. Widespread use of 3HP for TPT may accelerate tuberculosis elimination in Brazil.