Health Surveillance Activities Research Articles

Filamentous fungi in water used in hemodialysis treatment: a persistence challenge for health surveillance

Introduction: Fungi usually are resistant to disinfection and has pathogenic potential; however, they are not legally controlled in hemodialysis water (HW). Objective: Filamentous fungi (FF) were evaluated in HW from a tertiary hospital in southeast of São Paulo state (Brazil) and is a reference medical center providing service to millions of people every year. Method: A total of 84 water samples were collected in seven hydraulic system points during a period of one year and FF was identified by macroscopic and microscopic features. Results: FF were detected in all points ranging from 1 to 334 CFU/100 mL. Nine genera along the hydraulic system were identified, including Acremonium, Alternaria, Aspergillus, Beltrania, Bipolaris, Cladosporium, Exophiala, Fusarium, and Penicillium. Conclusions: Most fungi are ubiquitous and some cause human infection and mycotoxins producers. The various genera found reveal possible failures in treatment and distribution system, either through inadequate hygiene practices or infusion of these microorganisms into the pipes. FF detection is needed bearing mind immunological vulnerability of patients under hemodialysis treatment requiring continuous health surveillance actions.

Society for Maternal-Fetal Medicine Position Statement: Gun violence and pregnancy

The Society for Maternal-Fetal Medicine (SMFM) acknowledges gun violence as a public health crisis in the United States, with a significant impact on pregnant and postpartum people. We recognize the urgent need for a robust, equitable, data-driven approach to mitigate the impact of access to firearms and accompanying violence on pregnant and postpartum individuals and communities. As such, SMFM endorses the following policy principles:- SMFM calls on relevant government agencies and public funders to support and finance anti-violence and firearm safety research, public health surveillance activities, education, and other initiatives. These initiatives should acknowledge and address the connection between access to firearms and the health and safety of pregnant and postpartum people, as well as their families and communities.- SMFM strongly opposes legislation or regulations that impede or limit clinician-patient discussions about firearms.- SMFM calls for enhanced access to mental health care services for pregnant and postpartum people.- SMFM calls for additional support for individuals experiencing intimate partner violence and their families.- SMFM supports the creation of and funding for training programs for maternal-fetal medicine (MFM) subspecialists and all clinicians about firearms and domestic violence prevention.- SMFM supports laws and regulations that restrict individuals with protective or restraining orders and those with intimate partner violence or stalking convictions from purchasing and owning firearms.

Detection of non-tuberculous mycobacteria in native wildlife species at conservation risk of Argentina.

Non-tuberculous Mycobacteria (NTM) are mainly environmental but can cause opportunistic infections and diseases in humans and animals. Livestock and wild animals can be infected with NTM. In Argentina, there are native wild species facing conservation risks, and they are the focus of protection and reintroduction projects designed to preserve biodiversity in various ecoregions. The aim of this study was to report the presence of NTM in samples collected from four endangered native wild species from nine Argentine provinces, as part of their pre-release health assessment. A total of 165 samples from giant anteater, peccary, tapir and pampas deer were obtained, these included either bronchoalveolar or endotracheal lavages, or oropharyngeal, nasopharyngeal or tracheal swabs. Bacteriological culture followed by molecular identification and sequencing were performed. A total of 27 NTM were detected, including Mycobacterium avium subsp. hominissuis, M. intracellulare, M. terrae, M. gordonense, M. kumamotonense, M. fortuitum, M. saskatchewanense, and M. genavense. Results revealed a 16,36% NTM recovery rate, with the giant anteater showing the highest prevalence among the mammals under study. In Argentina, due to extensive production systems, the interaction between domestic and wild species sharing the same environment is frequent, increasing the exposure of all the species to these NTM. In this way, the transmission of infectious agents from one to another is feasible. Moreover, NTMs might interfere with the diagnosis of bovine tuberculosis and paratuberculosis. These findings emphasize the importance of active health surveillance in conservation programs. It highlights the need to address NTM epidemiology in wildlife and its impact on conservation and public health.

Citizen Science for Enhanced Dengue Vector Surveillance in Solomon Islands: A Methods Paper

Arthropod-borne arboviral diseases—including dengue, Zika, and chikungunya—place a substantial burden on the health of populations, globally. Dengue alone is endemic in more than 100 countries and causes more than 96 million symptomatic cases and approximately 40,000 deaths annually. The recent surge in arboviral disease outbreaks, coupled with the World Health Organization’s newly published vector control guidelines, accentuates the imperative to understand the dispersion of disease-carrying mosquitoes across diverse spatial and temporal scales. However, traditional surveillance mechanisms often fall short because of workforce limitations, logistical complexities, jurisdictional boundaries, and budgetary constraints, especially in low- and low-middle-income countries. In this article, we systematically report the design, implementation, and iterative enhancement of a groundbreaking school-based citizen science initiative for augmenting mosquito surveillance in the Solomon Islands. Key reflections encompass the initiative’s role in supporting routine government-led disease vector monitoring, sustainability through integration and fostering participant engagement, and the amalgamation of citizen-collected data with government surveillance activities. The article also discusses the impact of the citizen science initiative with regard to the Solomon Islands’ pursuit of the Sustainable Development Goals. Our findings underscore the potential of citizen science methods to support and extend public health surveillance activities and to serve as a community-engagement-for-behaviour-change tool in resource-constrained contexts.

A response playbook for early detection and population surveillance of new SARS-CoV-2 variants in a regional public health laboratory.

Timely genomic surveillance is required to inform public health responses to new SARS-CoV-2 variants. However, the processes involved in local genomic surveillance introduce inherent time constraints. The Regional Innovative Public Health Laboratory in Chicago developed and employed a genomic surveillance response playbook for the early detection and surveillance of emerging SARS-CoV-2 variants. The playbook outlines modifications to sampling strategies, laboratory workflows, and communication processes based on the emerging variant's predicted viral characteristics, observed public health impact in other jurisdictions and local community risk level. The playbook outlines procedures for implementing and reporting enhanced and accelerated genomic surveillance, including supplementing whole genome sequencing (WGS) with variant screening by quantitative PCR (qPCR). The ability of the playbook to improve the response to an emerging variant was tested for SARS-CoV-2 Omicron BA.1. Increased submission of clinical remnant samples from local hospital laboratories enabled detection of a new variant at an average of 1.4% prevalence with 95% confidence rather than 3.5% at baseline. Genotyping qPCR concurred with WGS lineage assignments in 99.9% of 1541 samples with results by both methods, and was more sensitive, providing lineage results in 90.4% of 1833 samples rather than 85.1% for WGS, while significantly reducing the time to lineage result. The genomic surveillance response playbook provides a structured, stepwise, and data-driven approach to responding to emerging SARS-CoV-2 variants. These pre-defined processes can serve as a template for other genomic surveillance programs to streamline workflows and expedite the detection and public health response to emerging variants. Based on the processes piloted during the Omicron BA.1 response, this method has been applied to subsequent Omicron subvariants and can be readily applied to future SARS-CoV-2 emerging variants and other public health surveillance activities.

Prevention, social emancipation, and paradigmatic transition: a 40-year interdisciplinary Brazilian trajectory on accidents and disasters.

The article, in the form of an essay, systematizes a 40-year-long professional trajectory of interdisciplinary and socially engaged experiences around the analysis and prevention of accidents and disasters. This study was mainly developed within the scope of research and postgraduate studies in Public Health in Brazil, driven by the sanitarian movement and the construction of Brazilian Unified National Health System (SUS) in its search for democracy and social and health justices. Its empirical basis involved workers' health and environmental surveillance actions organized in networks led by SUS in conjunction with universities, unions, social movements, environmental nongovernmental organizations (NGO), and Public Prosecutors' Offices. Events of greater socio-environmental complexity in sectors such as steel, petrochemicals, mining, agribusiness, and energy forged the search for new epistemic and interdisciplinary references that encompassed two new justices, i.e., environmental and cognitive. This essay systematizes this trajectory of conceptual contributions in three movements from the 1980s to the present day (each corresponding to a socio-political and institutional context) to reflect on paradigmatic transition movements in the analysis and prevention of accidents and disasters from an interdisciplinary perspective. It ends by suggesting abyssal and emancipatory prevention to face different current crises, including environmental, health, democratic, and civilizing ones.

Prevenção, emancipação social e transição paradigmática: uma trajetória interdisciplinar de 40 anos no Brasil sobre acidentes e desastres

Abstract: The article, in the form of an essay, systematizes a 40-year-long professional trajectory of interdisciplinary and socially engaged experiences around the analysis and prevention of accidents and disasters. This study was mainly developed within the scope of research and postgraduate studies in Public Health in Brazil, driven by the sanitarian movement and the construction of Brazilian Unified National Health System (SUS) in its search for democracy and social and health justices. Its empirical basis involved workers’ health and environmental surveillance actions organized in networks led by SUS in conjunction with universities, unions, social movements, environmental nongovernmental organizations (NGO), and Public Prosecutors’ Offices. Events of greater socio-environmental complexity in sectors such as steel, petrochemicals, mining, agribusiness, and energy forged the search for new epistemic and interdisciplinary references that encompassed two new justices, i.e., environmental and cognitive. This essay systematizes this trajectory of conceptual contributions in three movements from the 1980s to the present day (each corresponding to a socio-political and institutional context) to reflect on paradigmatic transition movements in the analysis and prevention of accidents and disasters from an interdisciplinary perspective. It ends by suggesting abyssal and emancipatory prevention to face different current crises, including environmental, health, democratic, and civilizing ones.

Habitual physical activity and sedentary behavior as predictors of dynapenia in older adults: a cross-sectional study.

Dynapenia is a risk factor of mortality. Therefore, the development of low-cost and easy-to-apply tools is essential to optimize the health surveillance actions of older people. To compare the time spent on habitual physical activity (HPA) and sedentary behavior (SB) among dynapenic and non-dynapenic older adults and ascertain the predictive ability of these behaviors on outcome. A cross-sectional population epidemiological survey was conducted involving 208 older adults. HPA and SB were quantified using the International Physical Activity Questionnaire, and dynapenia was identified by handgrip strength (women: 18.37 kgf; men: 26.75 kgf). The prevalence was 24.50%. In both sexes, dynapenic individuals reported a HPA median time of 70.00 minutes/week (min/wk), while non-dynapenic women and men reported HPA median times of 240.00 and 280.00 min/wk, respectively (P < 0.05). For SB among dynapenic individuals, a median of 388.75 min/day was observed in women and 428.57 min/d in men. In contrast, non-dynapenic women and men had 291.42 and 274.28 min/day in SB (P < 0.05), respectively. The best cutoff HPA to discriminate the outcome was 150.00 min/wk in women (sensitivity: 73.30%; specificity: 60.67%) and 140.00 min/wk in men (sensitivity, 71.43%; specificity, 61.54%). The best cutoff SB was 381.43 min/day in women (sensitivity, 53.30%; specificity, 84.80%) and 351.43 min/day in men (sensitivity, 71.43%; specificity, 73.85%). Older individuals with dynapenia spent less time on HPA and more time in SB. Furthermore, HPA was found to be a better discriminator of dynapenic individuals, and SB better discriminated non-dynapenic individuals.

Distúrbio de Voz Relacionado ao Trabalho: um olhar sobre o passado, o presente e o futuro

Abstract Introduction: Work-Related Voice Disorder (WRVD) is a highly prevalent condition, especially among teachers. In 2018, the Brazilian Ministry of Health (BMH) issued the WRVD Protocol to its identification and reporting as a means to subsidize health surveillance actions. Objective: to summarize the history, debate outcomes, challenges, and reflections about WRVD in Brazil. Methods: theoretical essay based on a literature review, documents, and records of social actors’ involvement in the WRVD recognition process. Results: WRVD recognition followed a cumbersome trajectory comprising three phases: Protocol design and initial WRVD recognition; Improvement of exchanges with international communities; WRVD classification as a work-related disease (WRD), decision that was later repealed and then repristinated. Conclusion: WRVD recognition process unfolded into a “sociopolitical imbroglio,” prompting initiatives by the Legislative Branch and the Brazilian National Health Council, and its recognition by the Bahia and Espirito Santo states. Challenges arose following changes in work, implementation of healthcare paths, and professional training for managing WRVD.

Epidemiology of visceral leishmaniasis in municipalities of Mato Grosso and the performance of surveillance activities: an updated investigation.

Visceral leishmaniasis (VL) is considered a globally neglected disease. To address the problem of VL endemic to Brazil, the Visceral Leishmaniasis Control Program (VLCP) was created, which recommends the development of health surveillance actions such as the identification of human and canine cases, vector control and prevention of disease. We aimed to investigate the epidemiological situation of VL in municipalities of the State of Mato Grosso (MT) and assess the execution of VLCP activities. Data on human cases were obtained from the Information System for Notifiable Diseases (SINAN), and data from entomological and canine inquiry were provided by the State's Health Department. Analyzes from the period 2019 - 2021 recorded 30 cases of human VL, distributed among 16 municipalities. Vectors were identified in 50% of the municipalities where entomological investigations were carried out, and the predominant specie was Lutzomyia longipalpis. A total of 15,585 dogs were subjected to serological examination, of which 18.91% tested seropositive for Leishmania infantum. However, it must be emphasized that only three municipalities conducted consecutive inquiries involving canine VL. Although VL is distributed widely throughout the State, only a few municipalities have undertaken the actions of the VLCP, thus highlighting the neglected status of the disease.

Evaluation of the Australian first few X household transmission project for COVID-19

BackgroundThe Australian First Few X (FFX) Household Transmission Project for COVID-19 was the first prospective, multi-jurisdictional study of its kind in Australia. The project was undertaken as a partnership between federal and state health departments and the Australian Partnership for Preparedness Research on Infectious Disease Emergencies (APPRISE) and was active from April to October 2020.MethodsWe aimed to identify and explore the challenges and strengths of the Australian FFX Project to inform future FFX study development and integration into pandemic preparedness plans. We asked key stakeholders and partners involved with implementation to identify and rank factors relating to the strengths and challenges of project implementation in two rounds of modified Delphi surveys. Key representatives from jurisdictional health departments were then interviewed to contextualise findings within public health processes and information needs to develop a final set of recommendations for FFX study development in Australia.ResultsFour clear recommendations emerged from the evaluation. Future preparedness planning should aim to formalise and embed partnerships between health departments and researchers to help better integrate project data collection into core public health surveillance activities. The development of functional, adaptable protocols with pre-established ethics and governance approvals and investment in national data infrastructure were additional priority areas noted by evaluation participants.ConclusionThe evaluation provided a great opportunity to consolidate lessons learnt from the Australian FFX Household Transmission Project. The developed recommendations should be incorporated into future pandemic preparedness plans in Australia to enable effective implementation and increase local utility and value of the FFX platform within emergency public health response.

Portrait of training and worker health surveillance actions in Santa Catarina

Portrait of training and worker health surveillance actions in Santa Catarina

A Atenção Primária à Saúde e o cuidado aos usuários com COVID-19 nas regiões brasileiras

Abstract The aim of this study was to describe the role of PHC in the delivery of care to COVID-19 patients, identifying facilitating factors and constraints to the response of PHC teams to the pandemic. We conducted a cross-sectional survey-based study with a nationally representative sample of primary health care centers (PCCs). A total of 907 PCCs from the country’s five regions participated in the study. Data was collected between July and November 2021 using an online survey. The results show that PCCs in the South and Southeast were better prepared to respond to the pandemic in terms of availability of personal protective equipment and communications facilities, while PCCs in the North and Northeast performed better for health surveillance actions, educational activities, contact tracing, case monitoring and notification of cases in the influenza surveillance system. Seventy per cent of PCCs administered COVID-19 vaccines at national level and 28% and 25% had to suspend the first and second doses of the vaccine, respectively. The findings show that primary care services played an important role in the response to the pandemic despite challenges caused by the lack of national coordination.

Epidemiology and control of trachoma in the state of Ceará, Northeast Brazil, 2007-2021

To analyze the epidemiology, surveillance, and control strategies for trachoma in the state of Ceará, northeast Brazil, from 2007 to 2021. This ecological study was based on secondary data from the Information System on Notifiable Diseases of the Secretary of Health of the state of Ceará. Data from school and home surveys for trachoma detection obtained during the study period were analyzed, the percentage of positivity was estimated, and sociodemographic and clinico-epidemiological factors were investigated. The coverage of trachoma surveillance and control actions in Ceará municipalities increased from 12.5% in 2007 to 55.9% in 2019, but with an average restriction of 8.0% during the COVID-19 pandemic. The estimated trachoma positivity (mean overall positivity) was less than 5.0% (2.76%, 95% CI 1.2-5.2), with a higher proportion of cases in the 5-9-year age group (45.0%, 95% CI 44.6-45.4), in females (53.2%, 95% CI 52.8-53.6), and rural areas (52.6%, 95% CI 52.2-53.0). Positivity above 10.0% was observed in the Litoral Leste/Jaguaribe and Sertão Central regions, with a higher occurrence of the follicular inflammatory clinical form (98.1%, 95% CI 98.0-98.2). Trachoma remains in the state of Ceará and is likely underreported. Despite recent advances, the fragility of health surveillance activities compromises the recognition of the actual magnitude and distribution of trachoma in the state. Accurate information is fundamental for planning, monitoring, and evaluating surveillance and disease control.

Lessons Learned from the COVID-19 Pandemic and How Blood Operators Can Prepare for the Next Pandemic.

Humans interact with virus-infected animal hosts, travel globally, and maintain social networks that allow for novel viruses to emerge and develop pandemic potential. There are key lessons-learned from the coronavirus diseases 2019 (COVID-19) pandemic that blood operators can apply to the next pandemic. Warning signals to the COVID-19 pandemic included outbreaks of Severe acute respiratory syndrome-related coronavirus-1 (SARS-CoV-1) and Middle East respiratory syndrome-related coronavirus (MERS-CoV) in the prior two decades. It will be critical to quickly determine whether there is a risk of blood-borne transmission of a new pandemic virus. Prior to the next pandemic blood operators should be prepared for changes in activities, policies, and procedures at all levels of the organization. Blood operators can utilize “Plan-Do-Study-Act” cycles spanning from: vigilance for emerging viruses, surveillance activities and studies, operational continuity, donor engagement and trust, and laboratory testing if required. Occupational health and donor safety issues will be key areas of focus even if the next pandemic virus is not transfusion transmitted. Blood operators may also be requested to engage in new activities such as the development of therapeutics or supporting public health surveillance activities. Activities such as scenario development, tabletop exercises, and drills will allow blood operators to prepare for the unknowns of the next pandemic.

Yellow fever virus investigation in tissues of vampire bats Desmodus rotundus during a wild yellow fever outbreak in Brazilian Atlantic Forest

In the last decade a large outbreak of Yellow Fever (YF) has been observed in Brazilian Atlantic Forest region, traditionally a non-endemic area. In this scenario, the role of wild mammal species as YF reservoirs can be questioned, especially the hematophagous bat, Desmodus rotundus. So, the objective of this study was to analyze molecularly the presence of the YF virus (YFV) in hematophagous bats during a YF outbreak in Brazil. Twenty-one samples were collected from seven adult male hematophagous bats D. rotundus. As YFV is considered a viscerotropic and neurotropic virus, samples of liver, kidney and brain were collected and molecularly analyzed using the RT qPCR technique. The animals were captured according to ethical protocols during a YF outbreak in Brazil in 2017, from a region of the Brazilian Atlantic Forest. The results revealed that the analyzed tissue samples were not infected with the YFV. The negative results for this bat species allow us to infer that other animals may be reservoirs of this virus in this ecosystem and they probably have not been identified yet. Therefore, health surveillance actions are essential to monitor the role of wild animals in the YF dissemination in Brazilian Atlantic Forest and alert to the possibility of new geographic amplification of areas where YF occurs. This research encourages the new search about the role of wild animals on YFV transmission and reinforces the importance of epidemiological surveillance in the transmission of human infectious diseases.

Australian veterinarians' perspectives on the contribution of the veterinary workforce to the Australian animal health surveillance system.

This study investigated the involvement of private veterinarians in surveillance activities and the veterinary workforce's contribution to the Australian animal health surveillance system. The perception that there is overall a decreased engagement by veterinarians in surveillance outcomes at a time when there is increased need for bolstering of surveillance systems was investigated. Three key questions were considered: (1) What is the current contribution of private veterinarians to the Australian surveillance system? (2) What is the veterinary professions capacity to assume a more prominent role in surveillance? (3) What is the interest and ability of the veterinary profession in Australia to undertake this surveillance role now and into the future? Semi-structured telephone interviews were conducted with 17 private veterinarians with data analyzed qualitatively to identify key themes. Results demonstrate that private veterinarians are aware of their responsibilities and are engaged in surveillance activities at both formal and informal levels. The key challenges associated with current and future contributions were related to workload, remuneration, conflicts of interest and clarity over how responsibility for surveillance is shared amongst those involved in the system. The study has demonstrated that even amongst an engaged population, barriers do need to be addressed if private veterinarians are to be tasked with increasing their involvement in animal health surveillance activities.

Novel variant Hendra virus genotype 2 infection in a horse in the greater Newcastle region, New South Wales, Australia

In October 2021, the first contemporary detection of Hendra virus genotype 2 (HeV-g2) was made by veterinary priority disease investigation in a horse near Newcastle, New South Wales, Australia, as part of routine veterinary priority disease surveillance.This discovery followed an update of Hendra virus diagnostic assays following retrospective identification of this variant from 2015 via sentinel emerging infectious disease research, enabling timely detection of this case. The sole infected horse was euthanized in moribund condition. As the southernmost recognised HeV spill-over detection to date, it extends the southern limit of known cases by approximately 95 km. The event occurred near a large urban centre, characterised by equine populations of diverse type, husbandry, and purpose, with low HeV vaccination rates.Urgent multi-agency outbreak response involved risk assessment and monitoring of 11 exposed people and biosecurity management of at-risk animals. No human or additional animal cases were recognised.This One Health investigation highlights need for research on risk perception and strategic engagement to support owners confronted with the death of companion animals and potential human exposure to a high consequence virus. The location and timing of this spill-over event diverging from that established for prototype HeV (HeV-g1), highlight benefit in proactive One Health surveillance and research activities that improve understanding of dynamic transmission and spill-over risks of both HeV genotypic lineages and related but divergent emerging pathogens.

Factors linked to participant attrition in a longitudinal occupational health surveillance program.

For occupational medical screening programs focused on long-term health surveillance, participant attrition is a significant barrier to success. We investigate demographic, medical history, and clinical data from National Supplemental Screening Program (NSSP) examinees for association with likelihood of return for a second exam (rescreening). A total of 15,733 individuals completed at least one NSSP exam before December 31, 2016; of those, 4832 also completed a second exam on or before December 31, 2019. Stepwise logistic regression models were used to identify variables associated with whether a participant was rescreened in the NSSP. Individuals were less likely to return for rescreening if they had a history of any cancer; cardiovascular problems; diabetes or kidney disease; or if they used insulin. Age at time of first exam and job site category significantly influenced likelihood of return. Workers categorized as "guests" were more likely to return. Participants were less likely to return if they had an abnormal urinalysis, abnormal pulmonary function, pneumoconiosis, aortic atherosclerosis, or hearing loss at their initial exam. Participants who received a chest X-ray at their initial screening were more likely to return. The presence of health problems is strongly linked to screening program attrition. Participants who are older at the time of their initial screening exam are less likely to return. The discovery of several strong demographic, medical, and job associations reveals the importance for medical screening programs to understand and address factors that influence participant retention and, consequently, the effectiveness of long-term health surveillance activities.

Health Surveillance actions during the COVID-19 pandemic

Introdução: Em tempos de pandemia de COVID-19, a vigilância sanitária, assim como outros setores da saúde, precisou se adaptar para desenvolver suas atividades em um novo contexto desafiador. Objetivo: Descrever a atuação de profissionais da Vigilância Sanitária (Visa) no enfrentamento da pandemia da COVID-19. Método: Trata-se de um relato de experiência acerca do trabalho em Visa durante a pandemia em um Núcleo Regional de Saúde do estado da Bahia. Resultados: Foram relatadas ações realizadas em uma barreira sanitária, com acolhimento, palestra, testagem dos sintomáticos respiratórios e notificação, bem como a oferta de atividades de educação permanente em saúde, de forma presencial e on-line, por meio de reunião com os gestores municipais e demais ações realizadas pela equipe, tendo-se como destaque o caráter intrasetorial e intersetorial. Conclusões: A experiência do trabalho realizado coaduna com as propostas do Plano Estadual de Contingências para Enfrentamento do Novo Coronavírus. Salientamse as parcerias como de fundamental importância para os profissionais da Visa e de outros setores, frente à complexidade do momento pandêmico. A experiência ainda representa um aprendizado em lidar com novas ferramentas tecnológicas, que permitiram criar espaços de reflexão dos processos de trabalho, bem como de novas possibilidades de abordagem diante dos desafios atuais.