Veruska Maia da Costa

Objective: to describe the training experience of community leaders recruited to participate in Event-Based Surveillance (EBS) in Brazil and Cabo Verde, to characterize their profile, and to describe the use of a mobile application for recording EBS signs. Methods: this descriptive study details the training of community leaders to use a mobile data collection tool for EBS. Leaders were recruited through participatory mapping and snowball sampling in bothcountries. Training workshops included theoretical and practical sessions, focusing on health surveillance concepts, leadership roles, and the use of a digital application to report potential hazards to health known as “signals”. Data were collected via questionnaires and monitored through a digital dashboard. Results: training activities began in July 2024, and 89 leaders were trained, 39 in Brazil and 50 in Cabo Verde. Most participants had lived in their communities for over five years and had completed at least upper secondary education. Approximately 73% reported familiarity with health surveillance, and 63% with event-based surveillance. Following the training, 77% of Brazilian and 72% of Cabo Verdean leaders actively reported signals weekly. Reports began to occur in epidemiological week 34 of 2024. From epidemiological weeks 34 to 52 of 2024, 626 reports were submitted, with 71 classified as signals and 16 as potential public health risks. Conclusion: the pilot demonstrates that community leaders can be effectively trained to participate in Event-based surveillance, thereby contributing to the early detection of health threats. Participatory approaches and tailored training materials were fundamental to overcoming recruitment and technological challenges by involving community leaders in the evaluation of training content, using locally adapted language and examples, and providing hands-on training and continuous technical support. Continuous engagement and integration into local health systems are essential for long-term success through regular feedback mechanisms, supervision, and alignment with routine surveillance workflows.

Background: Schistosomiasis, caused by Schistosoma haematobium, is a neglected disease that affects millions of people, primarily in developing countries. Methods: We describe cases of urogenital schistosomiasis that occurred in Cabo Verde between 2022 and 2023 along with their possible associated risk factors. This analytical, cross-sectional study included 229 suspected cases. Results: Of 229 cases, 53 (23.1%) were confirmed. The most affected age group was 15-24 years, with an incidence rate of 12 cases per 1,000 inhabitants. Male patients were more affected, with a male-to-female ratio of 12:1. The most common symptoms were hematuria (58.7%) and dysuria (17.3%). The incidence of the disease was 6.8 times higher among individuals who had contact with water from tanks. Conclusion: This study revealed the emergence of urogenital schistosomiasis in Cabo Verde, highlighting the need to strengthen surveillance, prevention, and control measures.

Schistosomiasis is a public health problem with economic consequences in endemic areas. Cabo Verde is an insular country with no registry of schistosomiasis. In May 2022, a patient was reported with S. haematobium in urinalysis. An investigation was conducted to confirm diagnostic and outbreak, transmission sources to prevent additional illness. Two studies were conducted. First, using the snowball approach, starting with the first case identified. Second, using retrospective medical records. Suspected, confirmed, and discarded case definitions for urinary schistosomiasis (SCHu) were adopted. Interviews and urine samples were collected. An environmental investigation was conducted to identify the host snail. Identified 10 suspected cases, 8 (72.7%) were confirmed, the median age of 15 years (range: 7-24), all male with hematuria, living in a small community. In Schu's cases interviewed, 4(57.1%) walked barefoot in water and 3(75%) swam in water tanks. In a retrospective study, 28,702 medical records were evaluated, from which 49 suspected SCHu cases, 23(47%) interviewed, 19(82.6%) negatives, and 4(17.4%) did not collect samples. This is the first schistosomiasis record in Cabo Verde. The infection mechanism remains unknown as the specific reservoir was not found (Bulinus). We recommend epidemiological inspections and environmental assessment in communities to elucidate SCHu source transmission.

Lista de Siglas/Abreviaturas 18 F-FDG – fluordesoxiglicose marcado com flúor-18 123 I-MIBG – meta-iodo-benzil-guanidina marcado com iodo-123 […] Diretriz da SBC sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas – 2023 Lista de Siglas/Abreviaturas 18 F-FDG – fluordesoxiglicose marcado com flúor-18 123 I-MIBG – meta-iodo-benzil-guanidina marcado com iodo-123 […] Diretriz da SBC sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas – 2023

Since the Brazilian Ministry of Health’s 1992 revision to the case definition of acquired immunodeficiency syndrome (AIDS), there has been scientific evidence showing that certain endemic infectious and parasitic processes, such as Chagas disease, visceral leishmaniasis, and paracoccidioidomycosis, can induce opportunistic behaviour in individuals with advanced Human Immunodeficiency Virus (HIV). This situation requires distinct clinical protocols within the healthcare network and epidemiological surveillance measures. These actions aim to incorporate clinical events as indications of AIDS.

Para o reconhecimento da magnitude da doença de Chagas crônica no Brasil, é necessário rearticular as ações de vigilância em saúde, buscando o desenvolvimento de uma ampla rede hierarquizada de serviços distribuída geograficamente, para prover atendimento aos milhares de cidadãos acometidos pela infecção por Trypanosoma cruzi. O objetivo do trabalho foi elaborar um modelo de priorização de municípios para a vigilância da doença de Chagas crônica, a fim de ofertar cuidado integral às pessoas afetadas pela enfermidade. Para isso, foi realizada uma análise multicritério utilizando o algoritmo PROMETHEÉ II implementado no software Pradin. Os critérios de avaliação do modelo foram compostos de três índices construídos a partir de indicadores (a) epidemiológicos diretamente relacionados à doença de Chagas crônica, (b) decorrentes da evolução da doença de Chagas crônica, e (c) relacionados ao acesso aos serviços de saúde. A Escala Fundamental de Saaty foi utilizada para definição dos pesos dos indicadores, com maior importância aos diretamente relacionados à doença de Chagas crônica e àqueles com maior confiabilidade e respectiva qualidade de informação. A avaliação da consistência dos modelos se deu em comparação com dados disponíveis das áreas historicamente endêmicas, com a distribuição de casos agudos, e outras análises de sensibilidade. O modelo mais adequado foi definido por 1.345 municípios de média prioridade, 1.003 de alta e 601 como muito alta prioridade para doença de Chagas crônica, com maiores proporções nas regiões Sudeste e Nordeste. A priorização permite à gestão racionalizar e direcionar recursos, sendo essencial para identificar os territórios onde as pessoas infectadas estão vivendo, a fim de promover a assistência integral e melhorar a qualidade de vida.

Brazilian spotted fever (BSF) is a highly lethal disease caused by Rickettsia spp. and is transmitted by ticks of the genus Amblyomma . Understanding the epidemiology of BSF in each region can help direct health surveillance actions. The objective of this study was to determine the spatial distribution of vectors and the incidence of BSF in the state of São Paulo. Spatial analysis included confirmed BSF cases between 2009 and 2019; occurrences were registered by municipalities of the state. There were 752 confirmed BSF cases, with incidences ranging between 0.01 and 10.37/10,000 inhabitants. Moran's Global Index for BSF was 0.20 (p = .001), which was indicative of spatial dependence. Moran's map located a cluster of 20 high priority municipalities for BSF and showed that Amblyomma sculptum is the vector involved in Rickettsia rickettsii transmission in these locations. Spatial analysis identified clusters formed by 47, 20 and seven significant municipalities for the presence of A. sculptum , Amblyomma aureolatum and Amblyomma ovale vectors, respectively. Surveillance and prevention actions are necessary in areas that are at high risk for BSF and in areas where the presence of vectors was significant.

Bovine brucellosis, a zoonotic disease endemic to Brazil, is a serious public health problem. It is a notifiable disease that, like tuberculosis, is regulated through a national control and eradication program. The epidemiological status of bovine brucellosis must be characterized in order to direct measures aimed at controlling the disease. This study focused on analyzing the spatial and temporal distribution of bovine brucellosis in Brazil. An ecological and time series study was conducted based on secondary data reported by the National Animal Health Information System for cases of bovine brucellosis diagnosed in Brazil (2014 - 2018). The gross and average incidence rate of brucellosis was estimated per state. Joinpoint regression was applied to calculate the annual percentage change (APC) in incidence and to identify states with significant trend changes. Spatial analysis of animals with brucellosis was performed using Kernel density estimation. A total of 19,631 animals with bovine brucellosis were confirmed, and the average incidence rate varied from 0.03 to 33.93/100,000 cattle in Brazil. The highest density of positive animals was found in the states of Santa Catarina and Paraná, which can be considered areas of greater transmission of Brucella abortus. Reductions in gross incidence rates were observed in Paraná (APC: -13.2; 95% confidence interval [CI]: -20.3 – -5.4; p=0.01), Rondônia (APC: -44.7; 95%CI: -62.0 - -19.4; p=0.01), Mato Grosso do Sul (APC: -59.0; 95%CI: -77.7 - -24.5; p=0.01), Acre (APC: -40.0; 95%CI: -50.0 - -28.0; p=0.00), and Ceará (APC: -37.9; 95%CI: -50.9 - -21.4; p=0.00). The incidence rate significantly increased in Tocantins (APC: 122.1; 95%CI: 4.5 - 372.2; p=0.04). The findings of this study will be helpful in guiding surveillance and prevention measures aimed at reducing the incidence of bovine brucellosis in Brazil.

O objetivo do artigo foi confirmar e descrever um surto da doença de Chagas aguda por transmissão oral na mesorregião Oeste Potiguar, Rio Grande do Norte, Brasil. Trata-se de um estudo descritivo do tipo série de casos, tendo como fonte de dados os registros de atendimentos médicos e entrevistas com os casos suspeitos entre 16 de setembro e 19 de novembro de 2015. Realizou-se pesquisa entomológica nas prováveis localidades de infecção dos casos de doença de Chagas aguda. Foram confirmados 18 casos de doença de Chagas aguda em residentes de quatro municípios do Rio Grande do Norte. Os sinais e sintomas mais relatados foram febre e fraqueza (n = 18), seguidos de mialgia (n = 17), prostração, inapetência e edema de membros inferiores (n = 15). A mediana de duração da febre foi de 20 dias (intervalo: 6 a 45 dias). Quinze casos foram confirmados por critério laboratorial e três por vínculo epidemiológico com clínica compatível. Todos os casos confirmados relataram ter consumido caldo de cana da mesma procedência. Foram capturados 110 triatomíneos na fazenda onde ocorreu a moagem da cana consumida. Os insetos estavam no peridomicílio, em amontoados de lenha e próximos ao engenho. A maioria dos exemplares capturados era da espécie Triatoma brasiliensis, e apresentou um índice de infecção natural de 63%. Foi confirmado surto da doença de Chagas de transmissão oral por ingestão de caldo de cana contaminado por triatomíneo infectado, evidenciado pelo vínculo epidemiológico entre os casos investigados e a pesquisa entomológica no local provável de infecção.