This study aimed to analyse the trend and spatial–temporal clusters of risk of transmission of COVID-19 in northeastern Brazil. We conducted an ecological study using spatial and temporal trend analysis. All confirmed cases of COVID-19 in the Northeast region of Brazil were included, from 7 March to 22 May 2020. We used the segmented log-linear regression model to assess time trends, and the local empirical Bayesian estimator, the global and local Moran indexes for spatial analysis. The prospective space–time scan statistic was performed using the Poisson probability distribution model. There were 113 951 confirmed cases of COVID-19. The average incidence rate was 199.73 cases/100 000 inhabitants. We observed an increasing trend in the incidence rate in all states. Spatial autocorrelation was reported in metropolitan areas, and 178 municipalities were considered a priority, especially in the states of Ceará and Maranhão. We identified 11 spatiotemporal clusters of COVID-19 cases; the primary cluster included 70 municipalities from Ceará state. COVID-19 epidemic is increasing rapidly throughout the Northeast region of Brazil, with dispersion towards countryside. It was identified high risk clusters for COVID-19, especially in the coastal side.
Introduction: Schistosomiasis, caused by infection from Schistosoma mansoni, is a disease that represents an important public health problem for Brazil, especially for states in the Northeast region. Thus, the aim of this study is to present a new epidemiological profile for the disease in a municipality with low prevalence in the state of Alagoas, Brazil. Methods: A cross-sectional study was conducted through a coproparasitological and malacological survey. A structured questionnaire was applied to the study participants to survey possible risk factors and a spatial analysis (kernel density) was used to measure the risk of infection. Results: Of the 347 participants, 106 (30.5%) were infected by Schistosoma mansoni, most of them from the urban area of the municipality (68.9%; 73/106). A 3-fold risk of infection was found for individuals living in the urban area and a risk of 2.15 times for self-declared farmers. Biomphalaria glabrata and B. straminea were the species found in the municipality, but no animals were diagnosed as infected by the parasite. Spatial analysis showed a random distribution of vectors and human cases of the disease, and the formation of two clusters of human cases in the urban area was seen. Conclusions: A new epidemiological profile for schistosomiasis from S. mansoni infection was presented in a municipality of low endemicity: a high proportion of positive individuals in the urban area; presence of snails without positive diagnosis for S. mansoni infection; random distribution of vectors and human cases; and absence of association between classical risk factors and human infection.
Schistosomiasis mansoni is a parasitic disease very associated with social, economic, cultural and political factors, and the state of Alagoas is one of Brazil's most endemic states for parasitosis. Thus, this article aims to present the epidemiological profile of schistosomiasis in municipalities of the 7th health region of Alagoas for the period from 2010 to 2016. This is a descriptive and quantitative research that was performed from the data obtained by Information System of the Schistosomiasis Control Program (SISPCE) and System of Notification of Diseases of Information (SINAN) of the Unified Health System (SUS). All municipalities in the studied region have a positivity ranging between 0.25% and 13.03%, which characterizes them as low prevalence municipalities. As for the positivity, only one municipality presented in any period of the study a moderate infection intensity. All municipalities in the study area reported severe cases of the disease in SINAN during the study period. Two species of epidemiologically important snails were recorded in two cities of the health region under study, B. glabrata and B. straminea, and only the animals of the first species were found positive for Schistosoma mansoni infection. Thus, the data from the present study show that the 7th health region of Alagoas presents schistosomiasis as a relevant public health problem, which requires that measures to contain the disease to improve the quality of life of the population of this region.
Resumo Objetivo: Analisar aspectos relacionados com a positividade para esquistossomose em área de baixa prevalência, no Brasil. Métodos: Estudo transversal, realizado no primeiro semestre de 2020, quando foram analisadas a proporção de positividade, em função do número de lâminas de Kato-Katz, o desempenho diagnóstico do teste e a estimação da positividade a partir dos dados do Sistema de Informação do Programa de Vigilância e Controle da Esquistossomose (SISPCE). Resultados: Foram analisadas 2.088 lâminas de 348 indivíduos, sendo a proporção de positividade de 11,8%, 26,7% e 31,0% para 1, 4 e 6 lâminas analisadas, respectivamente. Houve concordância excelente (índice Kappa = 0,91) na comparação entre as leituras de 4 e 6 lâminas. Foi estimada subnotificação de 2,1 vezes nos dados do SISPCE. Conclusão: Ampliar o número de lâminas aumentou a positividade do Kato-Katz, o que pode contribuir para maximizar o controle da doença enquanto problema de Saúde Pública.
RESUMO: A esquistossomose é uma relevante doença para a saúde pública do Brasil e de Alagoas, sendo importante a investigação da presença da doença em áreas endêmicas e não endêmicas para o progresso de erradicação desse agravo. Assim, o objetivo do estudo foi realizar uma investigação dos moluscos e das larvas de trematódeos em uma área não endêmica para a esquistossomose mansoni. O estudo foi realizado em Santana do Ipanema, Alagoas, por meio da captura dos caramujos no riacho Camoxinga e análise da positividade para larvas de trematódeos, incluindo larvas do Schistosoma mansoni, agente etiológico da esquistossomose mansoni. Além disso, foi realizada a análise da constância de captura das espécies e da influência dos períodos de estiagem e de chuva e da precipitação média mensal sobre a abundância das espécies de caramujos, para o período de agosto de 2018 a julho de 2019. Em todo período, foram capturados 2.431 caramujos, estando 443 (18,2%) mortos. Os animais capturados vivos (1.988) pertenciam às espécies Biomphalaria straminea (Dunker, 1848) (Planorbidae) (989; 40%), Melanoides tuberculatus (Müller, 1774) (Thiaridae) (792; 32%), Pomacea lineata (Spix, 1827) (Ampullariidae) (133; 5,4%), Drepanotrema depressissimun (Moricand, 1839) (53; 2,18%), Physa marmorata (Guilding, 1828) (19; 0,78%) e Cyanocyclas brasiliana (Deshayes, 1854) (2; 0,03%). Além disso, B. straminea e M. tuberculatus foram as espécies constantemente coletadas e que apresentaram status de abundantes para a área de estudo. Em relação as duas espécies de maior constância e abundância na área de estudo, B. straminea e M. tuberculatus não foi possível estabelecer relação entre a abundância dos animais e o período de coleta (chuvoso ou seco, p = 0.2336). O maior número de animais foi capturado nos meses de junho e julho de 2019 para B. straminea e M. tuberculatus, respectivamente. O aumento no número de animais coletados começou a ocorrer com o aumento dos índices pluviométricos janeiro a abril de 2019 com uma redução das chuvas e da abundância dos animais em maio de 2019 seguida de uma posterior elevação nos dois parâmetros, até o fim do período estudado. Constatou-se uma relação linear entre a pluviosidade e a abundância dos caramujos da espécie B. straminea. A análise da infecção dos animais coletados por larvas de trematódeos mostrou que nenhum animal da espécie B. straminea estava infectado por larvas do Schistosoma mansoni. Por outro lado, foi diagnosticado caramujos das espécies B. straminea, D. depressissimun e M. tuberculatus eliminando cercárias das espécies Longifurcate pharyngeate distome – Estregeocercária, Echinocercária sp. e Xiphidiocercaria que foram liberadas do molusco M. tuberculatus, D. depressissimum e B. straminea. Esta pesquisa notifica a distribuição de diferentes espécies de caramujos sendo o primeiro relato da presença dos moluscos M. tuberculatus, D. depressissimum, Physa marmorata, Pomacea insularum, Cyanocyclas brasiliana no Riacho Camoxinga, demonstrando a importância de estudos da malacofauna em área não endêmicas para a esquistossomose para assim promover a prevenção e controle desses animais de importância médica, uma vez que estes invertebrados podem atuar como hospedeiros intermediários de trematódeos. PALAVRAS-CHAVE: Malacofauna, Schistosoma mansoni, Doenças parasitárias.
Objective: To identify priority areas for schistosomiasis control, we analysed the epidemiological characteristics, temporal trends and spatial patterns of schistosomiasisrelated mortality in the state of Minas Gerais from 2000 to 2019. Methods: Ecological and time-series study with spatial analysis techniques on deaths from Schistosomiasis mansoni. A log-linear regression model was used to identify changes in mortality rates. Moran's global index, local indicators of spatial association and a retrospective spatio-temporal permutation model were applied to identify the spatial and temporal distribution of mortality rates and assist in identifying priority areas for interventions. Results: A total of 1290 deaths from schistosomiasis were recorded between 2000 and 2019, with an average mortality rate of 0.33 deaths/100,000. Although the overall mortality rate in the state of Minas Gerais decreased significantly over time (average annual percentage change = À9.6; 95% confidence interval = À14.4 to À4.6; p < 0.001), it increased in the mesoregions of Jequitinhonha, Mucuri Valley, and Rio Doce Valley. Spatial analysis identified the displacement and emergence of high-risk clusters from the central region of the state to the mesoregion of Rio Doce Valley. Conclusion: Temporal changes and shifting of high-risk areas from the central region to the mesoregion of Rio Doce Valley may indicate possible failures in early diagnosis and treatment of the schistosomiasis control program in these areas. Our research contributes to a better understanding of the spatio-temporal dynamics of death rates due to schistosomiasis infections and might help health authorities to direct resources most efficiently to avoid serious clinical outcomes in Minas Gerais.
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