OVID-19 is a severe acute respiratory infection (SARI) that emerged in early December 2019 in Wuhan, China 1. The outbreak was declared a public health emergency of international concern by the World Health Organization on 30 January 2020. COVID-19 is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), an enveloped, single-stranded positive-sense RNA virus that belongs to the Betacoronavirus genus and Coronaviridae family 2. SARS-CoV-2 is closely related genetically to bat-derived SARS-like coronaviruses 3. Human-to-human transmission occurs primarily via respiratory droplets and direct contact, similar to human influenza viruses, SARS-CoV and Middle East respiratory syndrome coronavirus 4. The most commonly reported clinical symptoms are fever, dry cough, fatigue, dyspnoea, anosmia, ageusia, or some combination of these 1,4,5. As of 16 June 2020, more than 7.9 million cases have been confirmed worldwide, resulting in 434,796 deaths 6. Brazil declared COVID-19 a national public health emergency on 3 February 2020 7. After the development of a national emergency plan and the early establishment of molecular diagnostic facilities across Brazil's network of public health laboratories, the country reported its first confirmed COVID-19 case on 25 February 2020, in a traveller returning to São Paulo from northern Italy 8. São Paulo is the largest city in South America and no other Brazilian city receives a greater proportion of international flights 9. Currently, Brazil has one of the fastest-growing COVID-19 epidemics in the world, now accounting for 1,864,681 cases and 72,100 deaths, comprising over 55% of the total number of reported cases in Latin America and the Caribbean (as of 14 July 2020) 6. About 21% of Latin American and Caribbean populations are estimated to be at risk of severe COVID-19 illness 10. The region has been experiencing large outbreaks, with growing epidemics in Brazil,

Centers for Disease Control and Prevention.

Resumo: O Programa Nacional de Imunizações (PNI), coordenado pelo Ministério da Saúde, de forma compartilhada com as secretarias estaduais e municipais de saúde, vem se consolidando como uma das principais e mais relevantes intervenções em saúde pública, com a conquista de resultados importantes, como a certificação de área livre da circulação do poliovírus selvagem, a eliminação da circulação do vírus da rubéola e pelo importante impacto na redução dos casos e mortes pelas doenças imunopreveníveis, a partir da sua criação em 1973. O Brasil é um dos países que oferece o maior número de vacinas, de forma gratuita, com 15 vacinas para crianças, 9 para os adolescentes, cinco para os adultos e idosos. A partir dessa expansão do programa e da manutenção de elevadas coberturas vacinais, foi possível observar o rápido impacto na diminuição das doenças imunopreveníveis, mudando completamente o cenário epidemiológico dessas doenças no país, ao longo destas últimas quatro décadas. Atualmente, o país vive um contexto em que aumenta a parcela da população sem vacinação adequada. Na medida em que as doenças passam a não circular mais, justamente porque se mantiveram elevadas coberturas vacinais principalmente a partir dos anos 2000, muitas doenças tornaram-se desconhecidas, fazendo com que algumas pessoas não tenham noção do perigo representado por elas. É necessário, portanto, entender os múltiplos fatores que estão contribuindo para essa diminuição, criando, dessa forma, o risco de ressurgimento de doenças graves já controladas ou eliminadas na população.

the symptoms were consistent with Zika virus fever; there was laboratory confirmation for Zika and dengue.

Yellow Fever (YF) vaccination is suggested to induce a large number of adverse events (AE) and suboptimal responses in patients with autoimmune diseases (AID); however, there have been no studies on 17DD-YF primary vaccination performance in patients with AID. This prospective non-interventional study conducted between March and July, 2017 assessed the safety and immunogenicity of planned 17DD-YF primary vaccination in patients with AID. Adult patients with AID (both sexes) were enrolled, along with healthy controls, at a single hospital (Vitória, Brazil). Included patients were referred for planned vaccination by a rheumatologist; in remission, or with low disease activity; and had low level immunosuppression or the attending physician advised interruption of immunosuppression for safety reasons. The occurrence of AE, neutralizing antibody kinetics, seropositivity rates, and 17DD-YF viremia were evaluated at various time points (day 0 (D0), D3, D4, D5, D6, D14, and D28). Individuals evaluated (n = 278), including Valim et al. Yellow Fever Vaccination-Autoimmune Diseases patients with rheumatoid arthritis (RA; 79), spondyloarthritis (SpA; 59), systemic sclerosis (8), systemic lupus erythematosus (SLE; 27), primary Sjögren's syndrome (SS; 54), and healthy controls (HC; 51). Only mild AE were reported. The frequency of local and systemic AE in patients with AID and HC did not differ significantly (8 vs. 10% and 21 vs. 32%; p = 1.00 and 0.18, respectively). Patients with AID presented late seroconversion profiles according to kinetic timelines of the plaque reduction neutralization test (PRNT). PRNT-determined virus titers (copies/mL) [181 (95% confidence interval (CI), 144-228) vs. 440 (95% CI, 291-665), p = 0.004] and seropositivity rate (78 vs. 96%, p = 0.01) were lower in patients with AID after 28 days, particularly those with SpA (73%) and SLE (73%), relative to HC. The YF viremia peak (RNAnemia) was 5-6 days after vaccination in all groups. In conclusion, consistent seroconversion rates were observed in patients with AID and our findings support that planned 17DD-YF primary vaccination is safe and immunogenic in patients with AID.

Resumo Objetivo: Descrever os casos hospitalizados pela COVID-19 em profissionais de saúde no Brasil. Métodos: Estudo descritivo de tipo série de casos; foram incluídos aqueles com adoecimento entre 21 de fevereiro e 15 de abril de 2020, registrados no Sistema de Informação de Vigilância da Gripe (SIVEP-Gripe). Resultados: Dos 184 casos, 110 (59,8%) eram do sexo feminino, com mediana de idade de 44 anos (mínima-máxima: 23-85); 89 (48,4%) eram profissionais da enfermagem e 50 (27,2%) eram médicos. Ainda, 92 (50,0%) apresentavam comorbidade, predominando cardiopatias (n=37; 40,2%). Dos 112 profissionais com registro de evolução, 85 (75,9%) alcançaram cura e 27 (24,1%) foram a óbito, 18 destes do sexo masculino. Conclusão: O perfil dos profissionais de saúde hospitalizados por COVID-19 é semelhante ao da população quanto à idade e comorbidades; porém, diferente quanto ao sexo. As áreas profissionais mais acometidas foram a enfermagem e a medicina.

Social distancing measures have emerged as the predominant intervention for containing the spread of COVID-19, but evaluating adherence and effectiveness remains a challenge. We assessed the relationship between aggregated mobility data collected from mobile phone users and the time-dependent reproduction number R(t), using severe acute respiratory illness (SARI) cases reported by Sao Paulo and Rio de Janeiro. We found that the proportion of individuals staying home all day (isolation index) had a strong inverse correlation with R(t) (rho<-0.7) and was predictive of COVID-19 transmissibility (p<0.0001). Furthermore, indexs of 46.7% had the highest accuracy (93.9%) to predict R(t) below one. This metric can be monitored in real time to assess adherence to social distancing measures and predict their effectiveness for controlling SARS-CoV-2 transmission.

Objetivo: Caracterizar o perfil clínico-epidemiológico da síndrome inflamatória multissistêmica pediátrica temporalmente associada à COVID-19 (SIM-P) e identificar fatores associados aos óbitos de SIM-P no Brasil, 2020. Métodos: Estudo seccional, utilizando dados do monitoramento nacional da SIM-P. Empregou-se regressão logística para estimar razões de chances (OR, odds ratios) brutas e ajustadas. Resultados: Os casos (n=652) apresentaram mediana de idade de 5 anos; 57,1% eram do sexo masculino e 52,0% de raça/cor da pele parda; 6,4% evoluíram a óbito. A chance de óbito foi significativamente maior nos que apresentaram saturação de O 2 <95% (ORa=4,35 -IC 95% 1,69;11,20) e resultado alterado de ureia (ORa=5,18 -IC 95% 1,91;14,04); e menor na ausência de manchas vermelhas pelo corpo (ORa=0,23 -IC 95% 0,09;0,62), com uso de anticoagulantes (ORa=0,32 -IC 95% 0,12;0,89) e imunoglobulinas (ORa=0,38 -IC 95% 0,15;1,01). Conclusão: A letalidade foi maior entre casos que apresentaram saturação de O 2 <95% e ureia alterada; e menor nos que apresentaram manchas vermelhas, usaram imunoglobulinas e anticoagulantes.