National Health Surveillance System Research Articles

Determinants of mortality status and population attributable risk fractions of the North West Province, South African site of the international PURE study

BackgroundMortality data and comparative risk assessments from sub-Saharan Africa are limited. There is an urgent need for high quality population health surveys to be conducted, to improve the national health surveillance system. Our aim was to perform a comparative risk assesment and report on the mortality status and cause of death data of participants from a South African site of the international Prospective Urban Rural Epidemiology study.Methods1 921 Black participants were included, with a median observational time of 13 years resulting in 21 525 person-years. We performed a comparative risk assessment considering four health status domains: locality (rural vs. urban), socio-economic status (SES) (education and employment), lifestyle factors (physical activity, smoking and alcohol consumption) and prevalent diseases (human immunodeficiency virus (HIV), type 2 diabetes mellitus and hypertension). Next, population-attributable fractions (PAFs) were calculated to determine the mortality risk attributable to modifiable determinants.Results577 all-cause deaths occurred. Infectious diseases (28.1% of all deaths) were the most frequent cause of death, followed by cardiovascular disease (CVD) (22.4%), respiratory diseases (11.6%) and cancer (11.1%). The three main contributors to all-cause mortality were HIV infection, high SES and being underweight. HIV infection and underweight were the main contributors to infectious disease mortality and hypertension, the urban environment, and physical inactivity to CVD mortality. HIV had the highest PAF, followed by physical inactivity, alcohol and tobacco use and hypertension (for CVD mortality).ConclusionThis African population suffers from a quadruple burden of disease. Urban locality, high SES, prevalent disease (HIV and hypertension) and lifestyle factors (physical inactivity, tobacco and alcohol use) all contributed in varying degrees to all-cause and cause-specific mortalities. Our data confirm the public health importance of addressing HIV and hypertension, but also highlights the importance of physical inactivity, tobacco use and alcohol consumption as focal points for public health strategies to produce the most efficient mortality reduction outcomes.

Hypertension in Pregnancy: Current Challenges and Future Opportunities for Surveillance and Research.

Hypertension in pregnancy (HP) includes eclampsia/preeclampsia, chronic hypertension, superimposed preeclampsia, and gestational hypertension. In the United States, HP prevalence doubled over the last three decades, based on birth certificate data. In 2019, the estimated percent of births with a history of HP varied from 10.1% to 15.9% for birth certificate data and hospital discharge records, respectively. The use of electronic medical records may result in identifying an additional third to half of undiagnosed cases of HP. Individuals with gestational hypertension or preeclampsia are at 3.5 times higher risk of progressing to chronic hypertension and from 1.7 to 2.8 times higher risk of developing cardiovascular disease (CVD) after childbirth compared with individuals without these conditions. Interventions to identify and address CVD risk factors among individuals with HP are most effective if started during the first 6 weeks postpartum and implemented during the first year after childbirth. Providing access to affordable health care during the first 12 months after delivery may ensure healthy longevity for individuals with HP. Average attendance rates for postpartum visits in the United States are 72.1%, but the rates vary significantly (from 24.9% to 96.5%). Moreover, even among individuals with CVD risk factors who attend postpartum visits, approximately 40% do not receive counseling on a healthy lifestyle. In the United States, as of the end of September 2023, 38 states and the District of Columbia have extended Medicaid coverage eligibility, eight states plan to implement it, and two states proposed a limited coverage extension from 2 to 12 months after childbirth. Currently, data gaps exist in national health surveillance and health systems to identify and monitor HP. Using multiple data sources, incorporating electronic medical record data algorithms, and standardizing data definitions can improve surveillance, provide opportunities to better track progress, and may help in developing targeted policy recommendations.

Some Aspects of Animal Husbandry in Africa

It is emphasized that animal husbandry, which has existed since ancient times in many regions of Africa and is one of the most important areas of human activity, is an integral part of the socio-cultural code of the African population. To date, pastoralism plays an important role not only in the economic, but also in the social sphere of the inhabitants of vast regions of the continent; the size of herds is the main criterion for assessing the property and social status of its owner. Being the subject of trade and direct exchange, cattle bring a significant and stable income to their sellers, while at the same time performing the function of a bride price at the conclusion of marriages. The challenges of our time require a certain degree of flexibility and adaptability from the population of livestock regions, which is associated with inevitable changes in the centuries-old way of life and the system of socio-cultural ties. Attention is drawn to the fact that the tradition of husbandry is influenced by numerous factors of modern development: climate change and epizootics of recent decades have a negative imprint on livestock activities. High losses of livestock, a reduction in their per capita population over time, combined with demographic growth, have had a negative impact on the well-being of pastoralists, significantly increasing their poverty level. The governments of many African countries, in which husbandry plays a leading role, have an interest not only in maintaining existing positions, but also in improving them. In situations of epizootic danger, national livestock health surveillance systems in African countries are approached by international partners, including FAO, WHO, as well as one of the world’s leading organization whose functions include the formation of links in the field of veterinary medicine, ensuring the interaction of national and regional veterinary authorities – the International Epizootic Office (OIE). Continuous field research in livestock regions in a number of African countries provides significant assistance in the fight against livestock diseases. The use of modern information technologies in epizootiological diagnostics is increasingly becoming the basis of anti-epizootic and preventive measures.

Epidemiology of Dengue in Argentina during the 2010/11 to 2019/20 Seasons: A Contribution to the Burden of Disease.

Dengue is an important public health problem in Argentina, as in many other countries. We reviewed and updated information on the dengue disease burden in Argentina over a 10-year period. We conducted a retrospective descriptive study from 2010 to 2020 based on data from the National Health Surveillance System. The main outcomes included dengue cases, incidence rates, deaths, and serotype distribution by season, age group, and region. A total of 109,998 confirmed cases of dengue were reported. Seasonality stands out, prevailing during summer and autumn. Two main outbreaks (seasons 2015/16 and 2019/20), with increasing magnitude, were observed. The 2019/20 season showed the highest number of cases (58,731) and incidence rate (135/100,000). The Northeast region had the highest number of cases and incidence rate. In 2020, for the first time, autochthonous cases were registered in the Cuyo region. The only region with no autochthonous cases was the South. Adolescents and young adults showed the highest incidence rate. The case fatality rate for the period was 0.05%. Four serotypes circulated, but the predominant one was DEN-1 (78%). Dengue has been expanding temporally and spatially. Although the DEN-1 serotype widely predominated, the increasing circulation of other serotypes raises concerns regarding re-exposure and the severity of future cases. Understanding epidemiological trends is key to defining public prevention and control policies.

Age and socio-economic status affect dengue and COVID-19 incidence: spatio-temporal analysis of the 2020 syndemic in Buenos Aires City.

In early 2020, Argentina experienced the worst dengue outbreak in its history, concomitant with first-to-date increasing COVID-19 cases. Dengue epidemics in temperate Argentina have already been described as spatially heterogeneous; in the previous 2016 outbreak, transmission occurred 7.3 times more frequently in slums compared to the rest of Buenos Aires City (CABA). These informal settlements have deficient sanitary conditions, precarious housing and high incidence of social vulnerabilities. The purpose of this work was to study the spatio-temporal patterns of the 2020 dengue epidemic in CABA in relation to socio-economic living conditions of its inhabitants and its interaction with the onset of COVID-19. The study considered the period between Jan 1st and May 30th 2020. Dengue and COVID-19 databases were obtained from the National Health Surveillance System; each record was anonymized and geo-localized. The city was divided according to census tracts and grouped in four socio-economic strata: slums, high, mid and low residential. An aligned-rank transform ANOVA was performed to test for differences in the incidence of dengue and COVID-19, and age at death due to COVID-19, among socio-economic strata, four age categories and their interaction. The incidence by cluster was calculated with a distance matrix up to 600 m from the centroid. Spatial joint dengue and COVID-19 risk was estimated by multiplying the nominal risk for each disease, defined from 1 (low) to 5 (high) according to their quantiles. During the study period, 7,175 dengue cases were registered in CABA (incidence rate 23.3 cases per 10,000 inh), 29.2% of which occurred in slums. During the same period, 8,809 cases of COVID-19 were registered (28.6 cases per 10,000 inh); over half (51.4%) occurred in slums, where the median age of cases (29 years old) was lower than in residential areas (42 years old). The mean age of the deceased was 58 years old in slums compared to 79 years old outside. The percentage of deaths in patients under 60 years old was 56% in slums compared to 8% in the rest of the city. The incidence of both diseases was higher in slums than in residential areas for most age categories. Spatial patterns were heterogeneous: dengue presented higher incidence values in the southern sector of the city and the west, and low values in highly urbanized quarters, whereas COVID-19 presented higher values in the east, south, high populated areas and slums. The lowest joint risk clusters were located mainly in high residential areas, whereas high joint risk was observed mainly in the south, some western clusters, the historical part of the city and center north. The social epidemiological perspective of dengue and COVID-19 differed, given that socio environmental heterogeneity influenced the burden of both viruses in a different manner. Despite the overwhelming effect of the COVID-19 pandemic, health care towards other diseases, especially in territories with pre-existing vulnerabilities, should not be unattended.

Detection of plasma anti-lipopolysaccharide (LPS) antibodies against enterohemorrhagic Escherichia coli (EHEC) in asymptomatic kindergarten teachers from Buenos Aires province

In Argentina, hemolytic uremic syndrome (HUS) caused by EHEC has the highest incidence in the world. EHEC infection has an endemo-epidemic behavior, causing 20–30% of acute bloody diarrhea syndrome in children under 5 years old. In the period 2016–2020, 272 new cases per year were notified to the National Health Surveillance System. Multiple factors are responsible for HUS incidence in Argentina including person-to-person transmission. In order to detect possible EHEC carriers, we carried out a preliminary study of the frequency of kindergarten teachers with anti-LPS antibodies against the most prevalent EHEC serotypes in Argentina. We analyzed 61 kindergarten teachers from 26 institutions from José C. Paz district, located in the suburban area of Buenos Aires province, Argentina. Fifty-one percent of the plasma samples had antibodies against O157, O145, O121 and O103 LPS: 6.4% of the positive samples had IgM isotype (n=2), 61.3% IgG isotype (n=19) and 32.3% IgM and IgG (n=10). Given that antibodies against LPS antigens are usually short-lived specific IgM detection may indicate a recent infection. In addition, the high percentage of positive samples may indicate a frequent exposure to EHEC strains in the cohort studied, as well as the existence of a large non-symptomatic population of adults carrying pathogenic strains that could contribute to the endemic behavior through person-to-person transmission. The improvement of continuous educational programs in kindergarten institutions could be a mandatory measure to reduce HUS cases not only in Argentina but also globally.

SARS-CoV-2 seroprevalence in the city of Puerto Madryn: Underdiagnosis and relevance of children in the pandemic.

BackgroundReported cases of COVID-19 may be underestimated due to mild or asymptomatic cases and a low testing rate in the general population.Research questionWhat is the seroprevalence of SARS-CoV-2 infection in the general population and how it compares with the data on SARS-CoV-2 cases reported by a national health surveillance system (SNVS 2.0).Study design and methodsThis was a population-based, seroepidemiological, cross-sectional study in the city of Puerto Madryn, a middle size city in the Province of Chubut, Argentina. The study period was between March 3 and April 17, 2021. The sample size was calculated using the technique of calculation of confidence intervals for a proportion. Participants were selected using stratified and cluster probability sampling. A total of 1405 subjects were invited to participate in the study. Participants were divided into the following four age groups: 1) 0 to 14, 2) 15 to 39, 3) 40 to 64, and 4) 65 or older. After informed consent was obtained, a blood sample was taken by puncture of the fingertip, and a structured questionnaire was administered to evaluate demographics, socioeconomic status, level of education, comorbidities and symptoms suggestive of COVID-19.COVID-19 seroprevalence was documented using an immunoenzymatic test for the in vitro detection of IgG antibodies specific to the spike protein of SARS-CoV-2.ResultsA total of 987 participants completed the survey. Seropositivity in the full study population was 39,2% and in those under 15 years of age, 47.1%. Cases reported by the SNSV 2.0 amounted to 9.35% of the total population and 1.4% of those under 15 years of age.InterpretationThe prevalence of COVID-19 infection in the general population is four times higher than the number of cases reported by the SNVS 2.0 in the city of Puerto Madryn. For each child under the age of 15 identified by the SNVS 2.0 with COVID-19, there are more than 30 unrecognized infections. Seroepidemiological studies are important to define the real extent of SARS-CoV-2 infection in a particular community. Children may play a significant role in the progression of the current pandemic.

Mechanisms and Contextual Factors Affecting the Implementation of Animal Health Surveillance in Tanzania: A Process Evaluation.

A strong animal health surveillance system is an essential determinant of the health of animal and human population. To ensure its functionality and performance, it needs to be evaluated regularly. Therefore, a process evaluation was conducted in this study to assess animal health surveillance processes, mechanisms and the contextual factors which facilitate or hinder uptake, implementation and sustainability of the system in Tanzania. A mixed-method study design was used to evaluate the national animal health surveillance system guided by a framework for process evaluation of complex interventions developed by Moore and others. The system was assessed against standard guidelines and procedures using the following attributes: fidelity, adherence, exposure, satisfaction, participation rate, recruitment and context. Quantitative and qualitative data were collected using a cross-sectional survey, key informant interviews, document review, site visits and non-participant observation. Data from questionnaires were downloaded, cleaned and analyzed in Microsoft™ Excel. Qualitative data were analyzed following deductive thematic and content analysis methods. Fidelity attribute showed that case identification is mainly based on clinical signs due to limited laboratory services for confirmation. Data collection was not well-coordinated and there were multiple disparate reporting channels. Adherence in terms of the proportion of reports submitted per month was only 61% of the target. District-level animal health officials spent an average of 60% of their weekly time on surveillance-related activities, but only 12% of them were satisfied with the surveillance system. Their dissatisfaction was caused by large area coverage with little to no facilitation, poor communication, and lack of a supporting system. The cost of surveillance data was found to be 1.4 times higher than the annual surveillance budget. The timeliness of the system ranged between 0 and 153 days from the observation date (median = 2 days, mean = 6 days). The study pointed out some deviations in animal health surveillance processes from the standard guidelines and their implication on the system's performance. The system could be improved by developing a user-friendly unified reporting system, the active involvement of subnational level animal health officials, optimization of data sources and an increase in the horizon of the financing mechanism.

Fine particulate matter air pollution and under-5 children mortality in China: A national time-stratified case-crossover study.

Under-5 mortality rate is an important indicator in Millennium Development Goals and Sustainable Development Goals. To date, no nationally representative studies have examined the effects of fine particulate matter (PM2.5) air pollution on under-5 mortality. To investigate the association of short-term exposure to PM2.5 with under-5 mortality from total and specific causes in China. We used the national Maternal and Child Health Surveillance System to identify under-5 mortality cases during the study period of 2009 to 2019. We adopted a time-stratified case-crossover study design at the individual level to capture the effect of short-term exposure to daily PM2.5 on under-5 mortality, using conditional logistic regression models. A total of 61,464 under-5 mortality cases were included. A 10μg/m3 increase in concentrations of PM2.5 on lag 0-1 d was significantly associated with a 1.15% (95%confidence interval: 0.65%, 1.65%) increase in under-5 mortality. Mortality from diarrhea, pneumonia, digestive diseases, and preterm birth were significantly associated with exposure to PM2.5. The effect estimates were larger for neonatal mortality (<28days), female children, and in warm seasons. We observed steeper slopes in lower ranges (<50μg/m3) of the concentration-response curve between PM2.5 and under-5 mortality, and positive associations remained below the 24-h PM2.5 concentration limit recommended by WHO Air Quality Guidelines and China Air Quality Standards. This nationwide case-crossover study in China demonstrated that acute exposure to PM2.5 may significantly increase the risk of under-5 mortality, with larger effects for neonates, female children, and during warm seasons. Relevant control strategies are needed to remove this roadblock to achieving under-5 mortality targets in developing countries.

Leveraging Sub-national Collaboration and Influence for Improving Animal Health Surveillance and Response: A Stakeholder Mapping in Tanzania.

Animal health surveillance plays a vital role in ensuring public health, animal welfare, and sustainable food production by monitoring disease trends, early detecting (new) hazards, facilitating disease control and infection, and providing data for risk analysis. Good stakeholder collaboration across the sector can lead to better communication, better science and decision-making and more effective surveillance and response. An understanding of relevant stakeholders, their interests and their power can facilitate such collaboration. While information on key stakeholders in animal health surveillance is available at the national level in Tanzania, it is missing at the subnational level. The study aimed to explore the existing stakeholders' collaborations and influences at the subnational level through stakeholder mapping and to determine potential leverage points for improving the national animal health surveillance system. A qualitative design was used, involving consultative workshops with government animal health practitioners in Sumbawanga, Sikonge and Kilombero districts of Tanzania from December 2020 to January 2021. Data were collected using an adapted USAID stakeholder collaboration mapping tool with the following steps: (i) Define the objective (ii) Identify all stakeholders (iii) Take stock of the current relationships (iv) Determine resource-based influence (v) Determine non-resource based influence and (vi) Review and revise the collaboration map. Forty-five stakeholders were identified in all three districts and grouped into four categories: private sector and non-government organizations (n = 16), government (n = 16), community (n = 9) and political leaders (n = 4). Animal health practitioners had a stronger relationship with community stakeholders as compared to other categories. The results also showed that most of the stakeholders have non-resource-based influence compared to resource-based influence. The private sector and non-government organizations have a relatively higher number of resource-based influential stakeholders, while political leaders have more non-resource-based influence. The mapping exercise demonstrated that the system could benefit from community mobilization and sensitization, resource mobilization and expanding the horizon of surveillance data sources. Some of the leverage points include integration of surveillance activities into animal health services, clear operational processes, constant engagement, coordination and incentivization of stakeholders. The diversity in the identified stakeholders across the districts suggests that collaborations are contextual and socially constructed.

Considerations for transgender population health research based on US national surveys

Transgender identities and health are highly politicized in the United States leading to restrictions on relevant data collection in national health surveillance systems. This has serious implications on transgender population health research; an urgent area of study given the systemic discrimination faced by transgender individuals and the resultant social and health inequities. In this precarious political climate, obtaining high-quality data for research is challenging and in recent years, two data sources have formed the foundation of transgender health research in the United States, namely the 2015 United States Transgender Study and the Behavioral Risk Factor Surveillance System after the launch of the optional Sexual Orientation and Gender Identity Module in 2014. While useful, there are serious challenges to using these data to study transgender health, specifically related to survey weighting methodologies, ascertainment of gender identity, and study design. In this article, we detail these challenges and discuss the strengths and weaknesses of various methodological approaches that have been implemented as well as clarify several common errors that exist in the literature. We feel that this contribution is necessary to provide accurate interpretation of the evidence that currently informs policy and priority setting for transgender population health and will provide vital insights for future studies with these now ubiquitous sources of data in the field.

Digital Surveillance Through an Online Decision Support Tool for COVID-19 Over One Year of the Pandemic in Italy: Observational Study.

BackgroundItaly has experienced severe consequences (ie, hospitalizations and deaths) during the COVID-19 pandemic. Online decision support systems (DSS) and self-triage applications have been used in several settings to supplement health authority recommendations to prevent and manage COVID-19. A digital Italian health tech startup, Paginemediche, developed a noncommercial, online DSS with a chat user interface to assist individuals in Italy manage their potential exposure to COVID-19 and interpret their symptoms since early in the pandemic.ObjectiveThis study aimed to compare the trend in online DSS sessions with that of COVID-19 cases reported by the national health surveillance system in Italy, from February 2020 to March 2021.MethodsWe compared the number of sessions by users with a COVID-19–positive contact and users with COVID-19–compatible symptoms with the number of cases reported by the national surveillance system. To calculate the distance between the time series, we used the dynamic time warping algorithm. We applied Symbolic Aggregate approXimation (SAX) encoding to the time series in 1-week periods. We calculated the Hamming distance between the SAX strings. We shifted time series of online DSS sessions 1 week ahead. We measured the improvement in Hamming distance to verify the hypothesis that online DSS sessions anticipate the trends in cases reported to the official surveillance system.ResultsWe analyzed 75,557 sessions in the online DSS; 65,207 were sessions by symptomatic users, while 19,062 were by contacts of individuals with COVID-19. The highest number of online DSS sessions was recorded early in the pandemic. Second and third peaks were observed in October 2020 and March 2021, respectively, preceding the surge in notified COVID-19 cases by approximately 1 week. The distance between sessions by users with COVID-19 contacts and reported cases calculated by dynamic time warping was 61.23; the distance between sessions by symptomatic users was 93.72. The time series of users with a COVID-19 contact was more consistent with the trend in confirmed cases. With the 1-week shift, the Hamming distance between the time series of sessions by users with a COVID-19 contact and reported cases improved from 0.49 to 0.46. We repeated the analysis, restricting the time window to between July 2020 and December 2020. The corresponding Hamming distance was 0.16 before and improved to 0.08 after the time shift.ConclusionsTemporal trends in the number of online COVID-19 DSS sessions may precede the trend in reported COVID-19 cases through traditional surveillance. The trends in sessions by users with a contact with COVID-19 may better predict reported cases of COVID-19 than sessions by symptomatic users. Data from online DSS may represent a useful supplement to traditional surveillance and support the identification of early warning signals in the COVID-19 pandemic.

Excess mortality among patients with severe mental disorders and effects of community-based mental healthcare: a community-based prospective study in Sichuan, China.

High-quality primary care reduces premature mortality in the general population, but evidence for psychiatric patients in China is scarce. To confirm excess mortality in patients with severe mental illness (SMI), and to examine the impact of community-based mental healthcare and other risk factors on their mortality. We included 93 655 patients in 2012 and 100 706 in 2013 from the national mental health surveillance system in Sichuan, China to calculate the standardised mortality ratio (SMR). A total of 112 576 patients were followed up from 2009 to 2014 for model analyses. We used growth models to quantify the patterns of change for community management measures, high-risk behaviour, disease stability and medication adherence of patients over time, and then used multilevel proportional hazard models to examine the association between change patterns of management measures and mortality. The SMR was 6.44 (95% CI 4.94-8.26) in 2012 and 7.57 (95% CI 5.98-9.44) in 2013 among patients with SMI aged 15-34 years, and diminished with age. Unfavourable baseline socioeconomic status increased the hazard of death by 38-50%. Positive changes in high-risk behaviour, disease stability and medication adherence had a 54% (95% CI 47-60%), 69% (95% CI 63-73%) and 20% (4-33%) reduction in hazard of death, respectively, versus in those where these were unchanged. High excess mortality was confirmed among younger patients with SMI in Sichuan, China. Our findings on the relationships between community management and socioeconomic factors and mortality can inform community-based mental healthcare policies to reduce excess mortality among patients with SMI.

Towards an integrated animal health surveillance system in Tanzania: making better use of existing and potential data sources for early warning surveillance

BackgroundEffective animal health surveillance systems require reliable, high-quality, and timely data for decision making. In Tanzania, the animal health surveillance system has been relying on a few data sources, which suffer from delays in reporting, underreporting, and high cost of data collection and transmission. The integration of data from multiple sources can enhance early detection and response to animal diseases and facilitate the early control of outbreaks. This study aimed to identify and assess existing and potential data sources for the animal health surveillance system in Tanzania and how they can be better used for early warning surveillance. The study used a mixed-method design to identify and assess data sources. Data were collected through document reviews, internet search, cross-sectional survey, key informant interviews, site visits, and non-participant observation. The assessment was done using pre-defined criteria.ResultsA total of 13 data sources were identified and assessed. Most surveillance data came from livestock farmers, slaughter facilities, and livestock markets; while animal dip sites were the least used sources. Commercial farms and veterinary shops, electronic surveillance tools like AfyaData and Event Mobile Application (EMA-i) and information systems such as the Tanzania National Livestock Identification and Traceability System (TANLITS) and Agricultural Routine Data System (ARDS) show potential to generate relevant data for the national animal health surveillance system. The common variables found across most sources were: the name of the place (12/13), animal type/species (12/13), syndromes (10/13) and number of affected animals (8/13). The majority of the sources had good surveillance data contents and were accessible with medium to maximum spatial coverage. However, there was significant variation in terms of data frequency, accuracy and cost. There were limited integration and coordination of data flow from the identified sources with minimum to non-existing automated data entry and transmission.ConclusionThe study demonstrated how the available data sources have great potential for early warning surveillance in Tanzania. Both existing and potential data sources had complementary strengths and weaknesses; a multi-source surveillance system would be best placed to harness these different strengths.

Candidemia: An Infection Prevention Issue?

(See the Major Article by Suzuki et al on pages 689–96.) Candidemia has consistently ranked in the top 5 causes of nosocomial bloodstream infections in the past 2 decades [1, 2]. In this issue of Clinical Infectious Diseases, Suzuki and colleagues present the temporal trends of candidemia incidence over a period of 18 years within the US veterans healthcare system, concluding that infection prevention interventions implemented over the time span of their study have had an effect in decreasing the incidence of this infection. The National Health and Safety Network surveillance (NHSN) system of the Centers for Disease Control and Prevention (CDC) has indeed shown a gradual decrease central line-associated blood stream infections (CLABSI) over the past 2 decades or so in the United States [2], this being a result of focus on this infection as a national healthcare safety priority since...

1382. Varicella Burden Disease in Argentina: 4 Years after National Vaccination Strategy

BackgroundIn Argentina, around 150,000-180,000 total Varicella (VZV) cases per year (c/y) are registered; however, underreport exists and some 400,000 cases are estimated to occur annually. Varicella vaccine (VV) was included in the National Immunization Schedule (NIS) in 2015, with a 1-dose schedule administered at 15 months-of-age. We aimed to describe and to compare the epidemiological situation of VZV infections in Argentina in two periods: pre (2010-2014) and post (2016-2018) vaccine introduction in NIS.Global Incidence rates and vaccine coverages Incidence rates (age groups) MethodsBefore-and-after study comparing cases and incidence rates (100,000) of varicella reported to the National Health Surveillance System between pre-vaccination period (Pre-VV) and post-vaccination (Post-VV), excluding year of intervention (2015) since it was considered a transition year. Epi Info 7 was used for data analysis.ResultsVaccination coverage (VC) for 2015 was 44.7%; 74.4% in 2016; 76.8% in 2017 and 81% in 2018 (Figure 1). 728,392 cases of VZV were notified (R=363.1) in Pre-VV period and 222,305 cases in Post-VV (R=180.7), with a global incidence rate reduction of 49% (95%CI= 40.9-56.2; p< 0.001). Both 12-24 months of age and 2-4 years old groups (Pre-VV R=2,253 and Post-VV R=900; Pre-VV R=2,399 and Post-VV R=875, respectively) showed the greatest reductions in incidence rates (-59.3% [95%CI 58.7-60] p< 0.001 and -61.7% [95%CI 61.3-62] p< 0.001). Age groups not affected by vaccination (< 1 year, 5-9 years and 10-14 years) presented minor but significant reductions (-56.4% [95%CI 55.6-57.3] p< 0.001; -35% [95%CI 34.5-35.4] p< 0.001; and -28.6% [95%IC 27.6-29.7] p< 0.001 respectively) (Figure 2).ConclusionA decreasing trend in VZV number of cases and incidence rates was observed, especially in children less than 5 years old, despite suboptimal VC. The reduction of VZV cases in non-vaccinated age groups could be related to a decline in the transmission risk. Improving VC will likely reflect a greater impact on the burden of disease.Disclosures All Authors: No reported disclosures

Institutionalization of health surveillance evaluation practices: improving the management through modeling of interventions

Introdução: No Brasil, a incorporação da teoria avaliativa no Sistema Nacional de Vigilância Sanitária (SNVS) vem fomentando processos de gestão focados na avaliação de resultados, por meio da modelização das ações de vigilância sanitária e da construção de indicadores de efetividade. Nas esferas estaduais e municipais, destaca-se o projeto “Institucionalização de práticas avaliativas: a gestão estratégica da vigilância sanitária baseada em evidências”, que propõe estratégias indutoras de práticas avaliativas na gestão da Vigilância Sanitária (Visa). Objetivo: Apresentar os resultados decorrentes da modelização em quatro instituições de Visa brasileiras. Método: Estudo de avaliabilidade, fundamentado em Leviton et al., realizado entre julho e dezembro de 2019, nas Visa estaduais de Minas Gerais e Santa Catarina e nas municipais de Belo Horizonte e Florianópolis. A modelagem foi desenvolvida em quatro oficinas de trabalho, considerando o protagonismo de técnicos e gestores que constituíram Comitês Condutores Locais para elaboração dos modelos lógicos, sob tutoria de consultores. Resultados: O delineamento das ações de vigilância sanitária permitiu descrever seus componentes, as ações estratégicas e os efeitos esperados. Apesar da diversidade organizacional das Visa, os seguintes componentes prevaleceram nos quatro modelos lógicos: Gestão; Regulação; Controle e Monitoramento do Risco Sanitário; Comunicação e Educação Para a Saúde. Conclusões: A partir da modelagem, os usuários incorporaram informações sobre a operacionalização da intervenção. Espera-se, a partir de então, que sejam capazes de influenciar o pensamento, as práticas e as regras de ação coletiva de outras pessoas para qualificar a tomada de decisão e subsidiar processos de mudança institucional.

Indicators for evaluating health surveillance actions: a narrative review of the literature

Introdução: O campo da vigilância sanitária acumula experiência na construção de indicadores de processos para monitoramento das ações planejadas – gerenciais, administrativas e técnicas – o que tem contribuído para a organização do processo de trabalho no Sistema Nacional de Vigilância Sanitária (SNVS). Entretanto, ainda se depara com incipiência na estruturação de indicadores de efetividade de suas ações. Objetivo: Identificar na literatura a existência de fontes de informações e indicadores voltados à mensuração da efetividade da ação de vigilância sanitária, tomando-se como referência a proposta teórico-metodológica para avaliação das ações de vigilância sanitária. Método: Estudo descritivo exploratório, do tipo revisão narrativa da literatura, acerca da identificação de possíveis indicadores de efetividade relacionados aos componentes de modelagem proposta para ações de visa. Realizaram-se buscas nas bases de dados PubMed/MEDLINE, Scopus, Lilacs, Cochrane Library e SciELO e em sistemas de informação públicos. Resultados: A partir dos cinco componentes que descrevem a intervenção (Gestão, Regulação, Controle do risco sanitário, Monitoramento do risco sanitário e Informação, comunicação e educação), foram identificados 29 possíveis indicadores que utilizam fontes de dados já existentes e podem ser considerados para o desenvolvimento de pesquisas avaliativas que contribuam para a análise dos efeitos oriundos da execução das ações de vigilância sanitária. Conclusões: Com base nas evidências encontradas, da existência de fontes de informação e indicadores relacionados aos cinco componentes do modelo, observa-se que a construção de indicadores para avaliação das ações de vigilância sanitária é possível e factível, sendo fundamental enfrentar desafios tecnológicos como a interoperabilidade entre os inúmeros sistemas de informação existentes e a definição de padrões a serem seguidos para troca de informações de interesse da gestão na busca da implantação de práticas avaliativas no SNVS.

History of the development and implementation of a national system for the management of product samples in Health Surveillance

Introdução: A informação é instrumento essencial para a tomada de decisões, e contribui para o processo “informação-decisão-ação”. Objetivo: Relatar a experiência do Instituto Nacional de Controle de Qualidade em Saúde no desenvolvimento e na implantação de um sistema de informação nacional para o gerenciamento de amostras de produtos de interesse à saúde – do recebimento no laboratório até a emissão dos laudos analíticos – e apresentar a possibilidade de sua contribuição ao Sistema Nacional de Vigilância Sanitária (SNVS). Método: Trata-se de um estudo de análise documental sobre o desenvolvimento e implantação do Harpya, suas evoluções e avanços de 1986 até 2020. O acesso ao sistema pelos usuários, a existência de base de dados centralizada, a implantação na Rede Nacional de Laboratórios de Vigilância Sanitária (RNLVISA) e a criação e utilização de catálogos padronizados nacionalmente foram discutidas. Resultados: Os dados e informações gerados pela RNLVISA sobre a qualidade de produtos podem gerar evidências científicas para a identificação do risco, sendo fundamentais para a tomada de decisões dos gestores. Além disso, contribuem para avaliação dos laboratórios e para o monitoramento dos produtos do mercado, subsidiando as ações de vigilância sanitária. Conclusões: Destaca-se a possibilidade de acesso aos dados em nível nacional por diferentes áreas técnicas da Agência Nacional de Vigilância Sanitária, subsidiando a coordenação do SNVS e, ainda, que as informações do Harpya podem contribuir com outros sistemas de informação na resolução dos problemas de saúde pública existentes no país.

National self-assessment process of patient safety practices in service, from 2016 to 2019: an analysis from the perspective of health surveillance

Introdução: O preenchimento do Formulário da Autoavaliação das Práticas de Segurança do Paciente elaborado pela Anvisa é realizado de forma voluntária e anual serviços de saúde com leitos de UTI e envolve a avaliação de indicadores de estrutura e processo, baseada na Resolução da Diretoria Colegiada da Anvisa nº 36, de 25 de julho de 2013. Objetivo: Analisar o processo de autoavaliação nacional realizado pela Anvisa sob a óptica da vigilância, no período de 2016 a 2019. Método: Realizou-se um estudo retrospectivo, de análise documental no qual foram analisadas e comparadas as informações que eram comuns em quatro Relatórios da Autoavaliação das Práticas de Segurança do Paciente em Serviços de Saúde. Resultados: Observou-se que houve aumento da participação dos hospitais da autoavaliação ao longo dos anos; que a meta prevista no Plano Integrado não foi alcançada; e que os indicadores de processo apresentaram menor conformidade que os de estrutura. Conclusões: Urge a necessidade de implementação de estratégias do Sistema Nacional de Vigilância Sanitária tanto para sensibilizar os gestores sobre a importância da autoavaliação das práticas de segurança do paciente, quanto para a implementação de melhorias nos serviços, bem como de políticas públicas consistentes que visem garantir assistência à saúde de qualidade para a população brasileira.