Maria Cristina Schneider

As picadas de cobra representam um problema significativo de saúde pública no Brasil, com cerca de 30.000 casos registrados anualmente. Este estudo analisou a epidemiologia das picadas de cobra no Rio de Janeiro entre 2008 e 2017, período em que foram registrados 495 casos. A maioria dos incidentes (89,1%) foi causada por Bothrops spp., cujo veneno tem efeitos proteolíticos e anticoagulantes. Quase metade dos casos (49,8%) foi leve e 86,7% receberam antiveneno, principalmente Soro Antibotrópico. O atendimento oportuno (em até 3 horas) ocorreu em 42,4% dos casos, mas 36,8% foram tratados tardiamente ou não tiveram registro. Os acidentes ocorreram predominantemente em áreas urbanas (96,3%), afetando principalmente homens (68,1%) com idade média de 35 anos, principalmente nos membros inferiores. Manifestações locais — dor, edema e equimose — foram comuns (66,9% nos homens; 30,2% nas mulheres), enquanto sintomas sistêmicos foram raros. Distúrbios de coagulação apareceram em 46,1% dos casos, e os homens foram hospitalizados com mais frequência (67,3%), com uma internação média de sete dias. O Hospital Municipal Lourenço Jorge atendeu 88,7% dos casos. Análises estatísticas revelaram associações entre sexo e local da picada, idade e sintomas locais, e idade e uso de antiveneno. A análise multivariada indicou maior incidência em homens (1,47×) e na zona oeste (1,78×), enquanto idade mais jovem e temperaturas mais baixas tiveram efeitos protetores.

Every year, an estimated 2.7 million people suffer snakebites, causing up to 138,000 deaths. The WHO aims to reduce snakebite-related deaths and disabilities by 50% by 2030. This study presents data on variables related to the snakebite cases in the city of Rio de Janeiro between 2008 and 2017. During this period, 495 cases were recorded, 89.1% caused by snakes of the genus Bothrops (B. jararaca and B. jararacuçu), whose venom has proteolytic and hemorrhagic effects. Half of the cases were mild (49.8%), and 86.7% received antivenom treatment. Only 9.9% of victims were treated within the first hour, 42.4% within three hours, 15.7% after six hours, and 21.1% had no recorded treatment time. Recovery occurred in 89.5% of cases. Most bites happened in urban areas (96.3%) and affected mainly men (68.1%) aged 19–59 years (mean 35 years). The lower limbs were the most affected sites, and 43.4% of victims had no recorded occupation. Local manifestations such as pain, edema, and erythema were most frequent, while systemic symptoms were rare. Coagulation tests showed abnormalities in 46.1% of cases, and 20.9% of victims did not undergo testing. Men had a higher hospitalization rate (67.3%) and an average hospital stay of seven days. The Lourenço Jorge Municipal Hospital accounted for 88.7% of treatments, followed by Pedro II Hospital (6.3%), both located in the West Zone, which recorded the highest number of cases.

Snake bites are a global public health problem, with approximately 2.7 million cases annually. In Brazil, reporting snake bites is mandatory, with around 29,000 cases recorded each year, and antivenom is available free of charge in the public health system. In the city of Rio de Janeiro, there are around 150 reports annually. Knowing the spatial distribution of these accidents is essential for the efficient planning and allocation of antivenom. This study aimed to analyze the spatial autocorrelation of snake bites in the city of Rio de Janeiro between 2007 and 2017. This is an observational, cross-sectional study with data from SINAN. The highest prevalence rates were concentrated in the West Zone, an area where the two reference units for treating poisoning are located. The Moran index was 0.46, with high statistical significance (p < 0.001), indicating positive spatial autocorrelation and dependence between neighborhoods. The Moran’s Local Index (LISA) confirmed the West Zone as the area with the highest risk of incidence. The most affected neighborhoods showed population growth and an increase in occupied households, suggesting intense territorial expansion. The genus Bothrops spp was responsible for most cases of poisoning. About half of the victims received care within the ideal time frame for treatment, demonstrating that, although access to specialized care exists, there are still challenges in reducing response time and preventing cases.

Snakebites affect around three million people worldwide every year. It is an ecological, social, and economic phenomenon, as well as a neglected tropical disease that impacts tropical and subtropical countries and poor, rural populations with limited access to health services and antivenoms, which means that morbidity and mortality are considered in public policies and international agreements mediated by the World Health Organization. The objective of this study is to present a review of the importance of immediate diagnosis and treatment of snakebites. The lack of attention to this public health problem and crises in antivenom production have left millions of people vulnerable, with less chance of treatment. Underreporting, few epidemiological studies, production inefficiencies, little incentive for innovation or investment in new technological processes, inadequate market demand, low manufacturing volumes, storage limitations, distribution problems, and inadequate financing for acquisitions, as well as poor training of health professionals, reflect the risk of collapse in many parts of the world. It is necessary to encourage investment in public policies to serve vulnerable populations, promote continuing education for health professionals and vulnerable communities, and direct attention to this disease.

This study addresses the phenomenon of snakebite seasonality in the municipality of Rio de Janeiro during the period 2008–2017. During the analyzed period, 498 snakebite cases were reported in Rio de Janeiro, with a predominance of the Bothrops genus. Most bites occurred in urban areas of the West Zone, regions still characterized by forest remnants. The victim profile shows male predominance (about twice as frequent compared to females), mainly in the 20–59 age group (mean ages: 36 years for women / 37 years for men). A seasonal pattern was observed, with an increase in cases during the warm and humid months (November to April) and a decrease during the colder months (May to October), suggesting the influence of climatic factors—primarily temperature and humidity—but also the role of land use and occupation. The annual seasonality of snakebites is evident, with alternating periods of higher and lower incidence throughout the year. It was also observed that the increase in cases followed the rise in temperature. Unlike other regions of Brazil, such as the North and Northeast, Rio de Janeiro showed a trend of decreasing cases over time. The objective of this study is to present data on the seasonality of snakebites in Rio de Janeiro during the period 2008 to 2017.

Snakebites affect around three million people a year worldwide. The World Health Organization (WHO) considers them a neglected tropical disease that affects tropical and subtropical countries and poor and rural populations. The WHO's strategy to reduce morbidity and mortality includes ensuring safe and effective antivenom treatment for victims and accelerating antivenom production through public policies and international agreements. Countries in Asia and Africa have recorded the highest number of cases and deaths. Brazil has been producing its antivenom for years and distributes it free of charge in the public health system; however, production is a current concern. This study aims to highlight the challenges in accessing adequate treatment for snakebite accidents in Brazil and other high-incidence countries in Asia and Africa. We conducted a review of the literature and official websites related to the problem. The review suggests that most countries in these areas do not have easy access to antivenom, or it is not effective; several countries have antivenom as part of their public health system, such as India, Thailand and Brazil; however, challenges persist. There is an urgent need for global funding for research and production of snakebite antidotes.

The vision that everything is connected in this world is not new

Leptospirosis is a well-known disease that frequently occurs after floods. At the beginning of May 2024, a catastrophic flood occurred in the state of Rio Grande do Sul, Brazil, affecting two million people and leading to a state of calamity. Given the State’s high pre-flood leptospirosis rates, the disease became a major concern for decision-makers. This study aimed to estimate the rise in leptospirosis cases after the flood, assess the changes in case patterns before and after the disaster, and document the response of the state health surveillance center to the outbreak. We estimated the increase during the flood period (May to July 2024) by comparing it with the same period in the previous year as baseline. During the first three months of the catastrophic event, 6273 suspected cases of leptospirosis were reported to the surveillance system, and 958 cases were confirmed. The number of confirmed cases during the flood was 10.3-fold higher than the baseline. Spearman’s rank-order correlation coefficient was 0.77 (p-value < 0.0001) for the association of Health Regions regarding the rank in incidence rates of confirmed cases in the flood period and the proportion of the population with households flooded. Thirty deaths (three females) were confirmed, a 6.0-fold rise compared with 2023. The state responders carried out many activities, including epidemiological surveillance and the dissemination of information. Among the challenges faced was the lack of evidence in the literature supporting recommendations for antibiotic chemoprophylaxis for rescue personnel. Another difficulty concerned performing gold-standard laboratory diagnostic tests to confirm the enormous number of suspected cases reported during this catastrophe. Despite implementing many actions to mitigate its impact, leptospirosis remained a major challenge during the event. These findings may provide valuable insights for decision-makers facing similar situations in massive climate disasters.

The bacterial resistance to antibiotics (AMR-Bacteria) is one of the main global health problems. In 2019 alone, it was estimated that 1.27 million people died due to complications from resistant bacterial diseases. The One Health approach is the primary strategy in addressing AMR-Bacteria. Thus, this essay aimed to reflect on the application of the One Health approach in addressing AMR-Bacteria within the scope of agriculture. AMR-Bacteria is partially related to the intensive production of animal-origin foods. One of the main challenges for implementing the approach is the lack of communication among stakeholders. The solution to this impasse involves transdisciplinary training to form research networks and develop surveillance tools. One Health presupposes negotiation to build sustainable public policies. The search for strategies to address AMR-Bacteria involves considering the balance between the economic issue of food production, the physical well-being of animals, and the effects on the environment. Those wishing to implement the approach must form teams, combine methods and techniques, and involve different stakeholders. Through the lens of One Health, one can better understand how human actions contribute to the spread of AMR-Bacteria.

A resistência bacteriana a antibióticos (AMR-Bacteria) é um dos principais problemas de saúde global. Somente no ano de 2019, estimou-se que 1,27 milhão de pessoas morreu devido a complicações por doenças bacterianas resistentes. A abordagem One Health é a principal estratégia no enfrentamento da AMR-Bacteria. Assim, este ensaio objetiva refletir sobre a aplicação da abordagem Saúde Única no enfrentamento da AMR-Bacteria no âmbito da agropecuária. A AMR-Bacteria está parcialmente relacionada à produção intensiva de alimentos de origem animal. Um dos principais desafios para implantação da abordagem é a falta de comunicação entre atores. A solução para esse impasse perpassa o treinamento transdisciplinar para a formação de redes de pesquisa e desenvolvimento de ferramentas de vigilância. A Saúde Única pressupõe a negociação para construir políticas públicas sustentáveis. A busca por estratégias para o enfrentamento de AMR-Bacteria perpassa levar em consideração o equilíbrio entre a questão econômica da produção de alimentos, o bem-estar físico dos animais e os efeitos para o meio ambiente. Aqueles que desejam pôr em prática a abordagem devem formar equipes, combinar métodos e técnicas e envolver diferentes atores. A partir do olhar da Saúde Única pode-se conhecer melhor como ações humanas contribuem com a disseminação de AMR-Bacteria.