Notifiable Diseases Database Research Articles

Cohort profile: A population-based record linkage platform to address critical epidemiological evidence gaps in respiratory syncytial virus and other respiratory infections

IntroductionThe Western Australia (WA) Respiratory Infections Linked Data Platform is a population-based cohort established to investigate the epidemiology of RSV and other respiratory infections in children aged 0-10 years, incorporating microbiological testing patterns, hospital admissions, emergency department presentations, and socio-demographic data. MethodsThe cohort was formed through individual linkages between datasets from the WA Department of Health including the Birth and Death Registry, Midwives Notification System (MNS), Hospital Morbidity Data Collection, Emergency Department Data Collection, WA Notifiable Diseases Database, WA Register of Developmental Anomalies, WA Cerebral Palsy Register, WA Antenatal Vaccination Database, WA Family Connections, and PathWest Respiratory Virus Surveillance Data. Hospitalisations and emergency department presentations were temporally linked to routine respiratory viral surveillance data. ResultsThe cohort consists of 368,830 WA births between 1 January 2010 and 31 December 2020 with accompanying perinatal and demographic data, and with secondary care follow-up to 30 June 2022. Of these births, 24,660 (6.7%) identify as Aboriginal. A total of 4,077 (1.1%) children died from all causes during the study period (2010-2020), and 9.2% (33,818) of children were born preterm (<37 weeks). ConclusionThe Respiratory Infections Linked Data Platform enables epidemiological investigations, identifying virus-specific risk groups, risk factors, clinical presentation, viral testing patterns, long-term impacts and accurate measures of viral incidence rates in risk and population sub-groups This will not only aid in the calculation of cost-effectiveness estimates of interventions such as immunisations, but also provide guidance for design and implementation of such programs to priority groups. The Respiratory Infections Linked Data Platform will also enable evaluation of the direct and indirect effects of maternal and infant vaccines and new therapeutics. Analyses using this platform will also generate epidemiological data needed for other respiratory viruses on the vaccine pipeline such as parainfluenza virus and human metapneumovirus.

Syphilis and cardiovascular risk: a Taiwanese registry.

Studies on the impact of syphilis on the cardiovascular system in large populations are limited. This study investigated the effects of syphilis on cardiovascular outcomes. Medical records from 2010 to 2015 were retrieved from the Taiwan National Health Insurance Research Database, linked to the Notifiable Infectious Diseases database from the Taiwan Centers for Disease Control. Patients with syphilis were identified, excluding those with missing information, under 20 years of age, or with a history of human immunodeficiency virus infection, acute myocardial infarction, heart failure, aortic regurgitation, replacement of the aortic valve, aneurysm and/or dissection of the aorta, atrial fibrillation, ischaemic stroke, haemorrhagic stroke, and venous thromboembolism. Primary outcomes included new-onset acute myocardial infarction, heart failure, aortic regurgitation, aneurysm and dissection of the aorta, atrial fibrillation, ischaemic stroke, haemorrhagic stroke, venous thromboembolism, cardiovascular death, and all-cause mortality. A total of 28 796 patients with syphilis were identified from 2010 to 2015. After exclusions and frequency matching, 20 601 syphilis patients and 20 601 non-syphilis patients were analysed. The relative rate (RR) was utilized in the analysis, as the competing risk of death was not considered. Compared with patients without syphilis, patients with syphilis had increased risks of acute myocardial infarction (RR 38%, 95% confidence interval [CI] 1.19-1.60, P < .001), heart failure (RR 88%, 95% CI 1.64-2.14, P < .001), aortic regurgitation (RR 81%, 95% CI 1.18-2.75, P = .006), atrial fibrillation (RR 45%, 95% CI 1.20-1.76, P < .001), ischaemic stroke (RR 68%, 95% CI 1.52-1.87, P < .001), haemorrhagic stroke (RR 114%, 95% CI 1.74-2.64, P < .001), venous thromboembolism (RR 67%, 95% CI 1.23-2.26, P = .001), cardiovascular death (RR 155%, 95% CI 2.11-3.08, P < .001), and all-cause death (RR 196%, 95% CI 2.74-3.19, P < .001) but not for aneurysm and dissection of the aorta. This study demonstrates that patients with syphilis have a higher risk of cardiovascular events and all-cause mortality compared with those without syphilis.

Collecting a Sexual History During Shigellosis Case Investigations: Nationwide Practices and an Assessment of Data Quality.

Shigellosis is spread through the fecal-oral route, including sexual activity. The Centers for Disease Control and Prevention recommends collecting a sexual history from people diagnosed with shigellosis to enhance the understanding of its epidemiology and outbreak detection and the design of disease prevention messaging, although individual jurisdictions decide if and how this is done. Moreover, enteric disease interviewers typically receive in-depth general interviewing training, but often not sexual history question training. The goal of this project was to inform national practices around sexual history questions asked during shigellosis interviews by collecting information from U.S. state health agencies and evaluating sexual history data from people diagnosed with shigellosis in Colorado. From November 2021 to January 2022, information on sexual history questions asked of persons with reported shigellosis and accompanying training resources were collected from U.S. state health departments. Data completeness and quality of shigellosis sexual history questions from Colorado's notifiable disease database from 2018 to 2022 were also evaluated. Of 48 states, 54% reported routinely asking all adults about their sexual history during shigellosis interviews. Of 44 states, 18% indicated having accompanying training materials for interviewers. In Colorado, the proportion of unknown/missing responses to questions about recent sexual contact with male and female partners was lower for males (3.3% unknown and 3.3% missing) than females (5.4% and 6.2%) and highest among those 66 years and older (6.7% and 10%). Among those reporting new sexual partners, 93.5% indicated how they met. The evaluation of Colorado data demonstrates that routine collection of complete, high-quality, actionable sexual history data from all adults with reported shigellosis is feasible. Nearly half of the responding states indicated not doing so, and few had training resources. We recommend training enteric disease interviewers to routinely ask all adults with reported shigellosis about their sexual history, including new partner meeting location.

Antivenom access impacts severity of Brazilian snakebite envenoming: A geographic information system analysis.

Snakebite envenoming (SBE) is a neglected tropical disease capable of causing both significant disability and death. The burden of SBE is especially high in low- and middle-income countries. The aim of this study was to perform a geospatial analysis evaluating the association of sociodemographics and access to care indicators on moderate and severe cases of SBE in Brazil. We conducted an ecological, cross-sectional study of SBE in Brazil from 2014 to 2019 using the open access National System Identification of Notifiable Diseases (SINAN) database. We then collected a set of indicators from the Brazil Census of 2010 and performed a Principal Component Analysis to create variables related to health, economics, occupation, education, infrastructure, and access to care. Next, a descriptive and exploratory spatial analysis was conducted to evaluate the geospatial association of moderate and severe events. These variables related to events were evaluated using Geographically Weighted Poisson Regression. T-values were plotted in choropleth maps and considered statistically significant when values were <-1.96 or >+1.96. We found that the North region had the highest number of SBE cases by population (47.83/100,000), death rates (0.18/100,000), moderate and severe rates (22.96/100,000), and proportion of cases that took more than three hours to reach healthcare assistance (44.11%). The Northeast and Midwest had the next poorest indicators. Life expectancy, young population structure, inequality, electricity, occupation, and more than three hours to reach healthcare were positively associated with greater cases of moderate and severe events, while income, illiteracy, sanitation, and access to care were negatively associated. The remaining indicators showed a positive association in some areas of the country and a negative association in other areas. Regional disparities in SBE incidence and rates of poor outcomes exist in Brazil, with the North region disproportionately affected. Multiple indicators were associated with rates of moderate and severe events, such as sociodemographic and health care indicators. Any approach to improving snakebite care must work to ensure the timeliness of antivenom administration.

Risk Factors for Hospitalisation amongst Leptospirosis Patients in New Zealand.

Leptospirosis is a neglected zoonotic disease that is widespread in tropical and subtropical regions such as Oceania, which includes New Zealand. The incidence rate of leptospirosis in New Zealand remains high in comparison to other high-income countries, with over half of the notified patients hospitalised, and the factors associated with hospitalisation are poorly understood. This study aimed to estimate the risk factors for hospitalisation amongst leptospirosis patients using passive surveillance data: notifications from 1 January 1999 to 31 December 2017 extracted from New Zealand’s notifiable disease database. There were 771 hospitalised and 673 non-hospitalised patients. Multivariable logistic regression was used to identify risk factors. The year of notification was significantly and positively associated with hospitalisation, with adjusted (adj.) OR 1.03 (95% CI:1.01–1.05). Occupation was significantly associated with hospitalisation, with the adjusted odds of hospitalisation amongst dairy farmers notified with leptospirosis at adj. OR 1.44 (95% CI: 1.02–2.02) times the adjusted odds of hospitalisation amongst farmers that worked with other livestock. Seropositivity for Leptospira interrogans Copenhageni (adj. OR 5.96, 95% CI: 1.68–21.17) and Pomona (adj. OR 1.14, 95% CI: 0.74–1.74)) was more likely to result in hospitalisation when compared to Leptospira borgpetersenii Ballum (baseline). Seropositivity for Leptospira borgpetersenii Hardjo (adj. OR 0.71, 95% CI: 0.49–1.01) and Tarassovi (adj. OR 0.39, 95% CI: 0.23–0.66) was less likely to result in hospitalisation when compared to Ballum (baseline). All the estimates were additionally adjusted for the effect of sex, age, ethnicity, reported occupational exposure, geographical location, reported season, and deprivation status Although passive surveillance data has limitations we have been able to identify that the New Zealand dairy farming population may benefit from a targeted awareness campaign.

Profile of intoxications by drugs of abuse in Brazil.

In the last decade, there has been an increase in the consumption of drugs of abuse (DA) globally, considered a serious public health problem and, due to this abuse, there has been an increase in the occurrences of intoxications by these substances. Thus, the objective was to build an epidemiological profile of Brazilian intoxications due to DA. Therefore, a compilation of data about poisoning by DA in the National System of Toxic-Pharmacological Information (SINITOX) occurring between 1999 and 2017 was performed, evaluating variables of age group, circumstance, occurrence zones, gender, evolution and deaths. Additionally, a data survey was carried out in the DATASUS - SINAN (Information System for Notifiable Diseases) database, looking for the same parameters, in order to carry out a comparison between the databases. According to the data obtained, it was found that the profile of intoxication by DA is composed mainly of young men aged 20-29 years, coming from urban areas who become intoxicated, mainly by abuse as the main circumstance of intoxication. Intoxications evolve, mainly to cure without sequelae, with less recurrent deaths. Such results are compatible with other studies on DA poisoning. It is a relevant study to know the Brazilian profile on this type of intoxication, considering that it makes it possible to identify potential risk conditions to which individuals are exposed, and thus prioritize strategies to propose preventive measures in these cases of intoxication. However, caution is needed when analyzing the information from the two databases analyzed (SINITOX and DATASUS), as both have gaps.

Impact of Nonpharmaceutical Interventions on the Incidence of Respiratory Infections During the Coronavirus Disease 2019 (COVID-19) Outbreak in Korea: A Nationwide Surveillance Study.

Background Many countries have implemented non-pharmaceutical interventions (NPIs) to slow the spread of coronavirus disease 2019 (COVID-19). We aimed to determine whether NPIs led to the decline in the incidences of respiratory infections.Methods We conducted a retrospective, ecological study using a nationwide notifiable diseases database and a respiratory virus sample surveillance collected from January 2016 through July 2020 in the Republic of Korea. Intervention period was defined as February–July 2020, when the government implemented NPIs nationwide. Observed incidences in the intervention period were compared to the predicted incidences by autoregressive integrated moving average model and the 4-year mean cumulative incidences (CuIs) in the same months of the pre-intervention period.Results Five infectious diseases met the inclusion criteria: chickenpox, mumps, invasive pneumococcal disease, scarlet fever, and pertussis. The incidences of chickenpox and mumps during the intervention period were significantly lower than the prediction model. The CuIs of chickenpox and mumps were 36.4% (95% CI, 23.9–76.3) and 63.4% (95% CI, 48.0–93.3) of the predicted values. Subgroup analysis showed that the decrease in the incidence was universal for chickenpox, while mumps showed a marginal reduction among those aged <18 years, but not in adults. The incidence of respiratory viruses was significantly lower than both the predicted incidence (19.5%; 95% CI, 11.8–55.4%) and the 4-year mean CuIs in the pre-intervention period (24.5%; P<0.001).Conclusions The implementation of NPIs was associated with a significant reduction in the incidences of several respiratory infections in Korea.

COVID-19 in New Zealand and the impact of the national response: a descriptive epidemiological study

BackgroundIn early 2020, during the COVID-19 pandemic, New Zealand implemented graduated, risk-informed national COVID-19 suppression measures aimed at disease elimination. We investigated their impacts on the epidemiology of the first wave of COVID-19 in the country and response performance measures.MethodsWe did a descriptive epidemiological study of all laboratory-confirmed and probable cases of COVID-19 and all patients tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in New Zealand from Feb 2 to May 13, 2020, after which time community transmission ceased. We extracted data from the national notifiable diseases database and the national SARS-CoV-2 test results repository. Demographic features and disease outcomes, transmission patterns (source of infection, outbreaks, household transmission), time-to-event intervals, and testing coverage were described over five phases of the response, capturing different levels of non-pharmaceutical interventions. Risk factors for severe outcomes (hospitalisation or death) were examined with multivariable logistic regression and time-to-event intervals were analysed by fitting parametric distributions using maximum likelihood estimation.Findings1503 cases were detected over the study period, including 95 (6·3%) hospital admissions and 22 (1·5%) COVID-19 deaths. The estimated case infection rate per million people per day peaked at 8·5 (95% CI 7·6–9·4) during the 10-day period of rapid response escalation, declining to 3·2 (2·8–3·7) in the start of lockdown and progressively thereafter. 1034 (69%) cases were imported or import related, tending to be younger adults, of European ethnicity, and of higher socioeconomic status. 702 (47%) cases were linked to 34 outbreaks. Severe outcomes were associated with locally acquired infection (crude odds ratio [OR] 2·32 [95% CI 1·40–3·82] compared with imported), older age (adjusted OR ranging from 2·72 [1·40–5·30] for 50–64 year olds to 8·25 [2·59–26·31] for people aged ≥80 years compared with 20–34 year olds), aged residential care residency (adjusted OR 3·86 [1·59–9·35]), and Pacific peoples (adjusted OR 2·76 [1·14–6·68]) and Asian (2·15 [1·10–4·20]) ethnicities relative to European or other. Times from illness onset to notification and isolation progressively decreased and testing increased over the study period, with few disparities and increasing coverage of females, Māori, Pacific peoples, and lower socioeconomic groups.InterpretationNew Zealand's response resulted in low relative burden of disease, low levels of population disease disparities, and the initial achievement of COVID-19 elimination.FundingMinistry of Business Innovation and Employment Strategic Scientific Investment Fund, and Ministry of Health, New Zealand.

The epidemiology of listeriosis in pregnant women and children in New Zealand from 1997 to 2016: an observational study

BackgroundListeria monocytogenes causes the foodborne infection listeriosis. Pregnant women, infants and immunocompromised children are at increased risk for infection. The aim of this study was to describe the trends in the epidemiology of disease notifications and hospital admissions due to listeriosis in pregnant women aged 15 to 45 years and children aged less than 15 years in New Zealand (NZ) from 1997 to 2016.MethodsIn this population-based descriptive study, listeriosis notification and hospitalization rates from 1997 to 2016 were analyzed. Notification data were extracted from the Institute of Environmental Science and Research (ESR) Notifiable Diseases Database (EpiSurv) and hospitalization data were extracted from the National Minimum Dataset (NMDS). Pregnant women aged 15 to 45 years and children less than 15 years of age were included. Subgroup analysis was conducted for age and ethnicity. Outcomes of infection were described.ResultsIn the 20-year period considered, there were 147 pregnancy-associated cases of listeriosis either notified to ESR (n = 106) and/or coded in the NMDS (n = 99), giving a crude incidence rate of 12.3 (95% CI 10.4, 14.4) per 100,000 births. In addition, there were 22 cases in children aged 28 days to < 15 years (incidence =0.12, 95% CI 0.08 to 0.19 per 100,000). There were no trends observed over time in the incidence of pregnancy-associated listeriosis. Incidence rates of pregnancy-associated and childhood listeriosis were highest in people of Pacific and Asian ethnicity.ConclusionsNZ has a low incidence of listeriosis in pregnant women and children, however, the consequences of infection are frequently severe. Those of Pacific and Asian ethnicity have the highest rates of disease and future messaging around food safety should target these groups. This study provides important insights into the epidemiology of listeriosis in pregnant women and children in NZ.

Human immunodeficiency virus/acquired immunodeficiency syndrome epidemic in adolescents from a Brazilian metropolis (1978-2017).

INTRODUCTION:Prevalence of human immunodeficiency virus among adolescents is increasing. This study aimed to analyze this current situation in Rio de Janeiro City. METHODS:This was a retrospective longitudinal study using secondary data from the National System of Notifiable Diseases database of cases in adolescents aged 13-19 years.RESULTS:There were 885 acquired immunodeficiency syndrome cases from 1978 to 2017 and 445 human immunodeficiency virus new cases from 2014 to 2017. Over time, sexually transmitted human immunodeficiency virus/acquired immunodeficiency syndrome cases increase.CONCLUSIONS:Human immunodeficiency virus/acquired immunodeficiency syndrome epidemic in adolescents requires novel prevention policies.

Surveillance methods to detect the impact of a significant cold chain breach

In January 2015, a significant cold chain breach on a postnatal ward in a tertiary hospital in Sydney, Australia was noted to have been occurring since August 2013. Surveillance, amongst the 1178 mothers and 1178 babies affected, for vaccine-preventable diseases (VPDs) and adverse events following immunisation (AEFIs) using linkage with a notifiable diseases database was subsequently undertaken; no directly related instances of VPDs or AEFIs were detected. We evaluate this novel systematic surveillance method which has not been previously reported to determine whether it is effective in determining the impact of cold chain breaches on an individual and population level. The recommendation for revaccination of the affected mothers and subsequent surveillance was resource-intensive and future studies related to such incidents should focus on detailing the resources used to allow the costs versus benefits of such systematic surveillance to be determined.

New technologies to treatment of Spotted Fever, GVE VII - Santo Andre, SP, Brazil.

ObjectiveTo perform the spatial distribution of Spotted Fever in the Metropolitan Area of Sao Paulo Municipality (MRSP), coverage area of Epidemiological Surveillance Group VII – of Santo Andre (GVE7), to determine clusters of disease incidence, and through QR Code to be able to access data from any smartphone as an aid to the early treatment of new suspected cases.IntroductionThe use of new technologies such as Online Maps and the QR Code facilitates the knowledge dissemination in the health science, aiding in diagnostic elucidation and intelligent decisions making, thus offering an improvement in the quality of care provided to patients. Cases with suspected spotted fever should be approached as potentially serious, which may develop with shock within a few hours and, if not addressedcan progress to death. In the case of spotted fever, early onset determines the cure of these cases.MethodsThe spatial distribution of confirmed Spotted Fever cases was performed in the region of the seven municipalities inserted into GVE7, using the Information System of Notifiable Diseases (SINAN) database and Google Maps online tool, and determining clusters of disease incidence. The QR Code was generated through the QR Code Maker online tool to access map and to verify if the displacement of each new suspect case coincides with the incidence clusters of the disease, and to determine early treatment of these patients.ResultsDuring the study period, 496 suspected cases of Spotted Fever were reported, of which 64 cases were laboratory test confirmed with a lethality rate of 65%. Most of the probable infection sites are located near the regions close to forest remnants and near the dams. The main concentration of cases is in Recreio da Borda do CampoDistrict in Santo Andre, 27 cases (43% of total). The other priority areas for Spotted Fever occurrence in the MRSP in the period were the districts of Alvarenga, Cooperativa (border of Municipality of Diadema), and Montanhao (in the Municipality of Sao Bernardo do Campo).Figure 1. QR Code and Google Maps Spotted Fever Incidence Clusters, GVE VII Santo Andre.ConclusionsIn order to validate the use of these technologies as positive, it will be necessary to analyze the closure of the new suspected Spotted Fever cases treated in the region studied. Positive spatial correlation between neighboring areas may result from the disease having an occurrence characteristic in endemic areas and spreading to the nearest areas. We can conclude that the use of new technologies to determine the early onset of treatment for Spotted Fever suspected cases based on the origin of the patients treated in the region of GVE7 can determine the success in the evolution of these cases.ReferencesBarros-Silva PM, Pereira SV, Fonseca LX, Maniglia FV, de Oliveira SV, de Caldas EP. Febre maculosa: uma análise epidemiológica dos registros do sistema de vigilância do Brasil. Scientia Plena. 2014 Apr 25;10(4 (A)).Biggs HM. Diagnosis and management of tickborne rickettsial diseases: Rocky Mountain spotted fever and other spotted fever group rickettsioses, ehrlichioses, and anaplasmosis—United States. MMWR. Recommendations and Reports. 2016;65.Czuszynski K, Ruminski J. Interaction with medical data using QR-codes. InHuman System Interactions (HSI), 2014 7th International Conference on 2014 Jun 16 (pp. 182-187). IEEE.Dube S, Ndlovu S, Nyathi T, Sibanda K. QR Code based patient medical health records transmission: Zimbabwean case. InProceedings of informing science &amp; IT education conference (InSITE) 2015 (pp. 521-520).Kanzaki A, Natsuaki M, Matsutani S, Mase K, Nakajima E, Kataoka S, Konya H, Takeda A, Nishiura T, Takada N. Two cases of Japanese spotted fever infected in Rokko mountain near urban area of southern Hyogo Prefecture. The Journal of dermatology. 2018 Jun 1. https://doi.org/10.1111/1346-8138.14208Nasser JT, Lana RC, Silva CM, Lourenço RW, Silva DC, Donalísio MR. Urbanização da febre maculosa brasileira em município da região Sudeste: epidemiologia e distribuição espacial. Revista Brasileira de Epidemiologia. 2015 Apr; 18:299-312.Parra F. Reflexões sobre as relações entre usuário-interator e tecnologias emergentes a partir do QR Code. Temática. 2018 May 23;14(5).Pinter A ET AL.; A Febre Maculosa Brasileira na Região Metropolitana de São Paulo. Boletim Epidemiológico Paulista 2016;13(151):3-47.Raghavan RK, Goodin DG, Neises D, Anderson GA, Ganta RR. Hierarchical bayesian spatio–temporal analysis of climatic and socio–economic determinants of rocky mountain spotted fever. PloS one. 2016 Mar 4;11(3):e0150180.

HIV/AIDS Epidemic in Adolescents From a Brazilian Metropolis, 1978 - 2017

Background: Recent data from the Health Brazilian Ministry indicate that in the last 10 years there has been a greater increase in the HIV prevalence among adolescents. The objective of the study is to analyze the trend of the HIV / AIDS epidemic in adolescents in the city of Rio de Janeiro. Methods: Retrospective longitudinal study with secondary data from the National System of Notifiable Diseases database of HIV-AIDS cases among adolescents aged 13 to 19 years in the city of Rio de Janeiro, Brazil. For each case analyzed, from the beginning of the epidemic until June 2017, we assessed sociodemographic information, type of transmission and if the case advanced to death. Multilevel logistic models were used to estimate the mortality AIDS odds in adolescents. Findings: There were 885 AIDS cases in adolescents from 1978 to 2017 and 445 HIV cases from 2014 to 2017. The more recent the period, the higher the number of AIDS cases. In all periods, there were more nonwhite race AIDS cases than white ones. The percentage of AIDS cases in pregnant increased in the last two periods. Over the time, the percentage of AIDS cases transmitted through sexual route increases, while the cases transmitted through blood route decreases. Adjusted analyses indicated that the odds to die by AIDS was 63% higher in male, 66% lower for those who completed elementary school, about 3 times higher for those infected by injected drugs. Interpretation: The increase in AIDS rates in adolescents in and the high incidence of HIV in the last 4 years reveal that the epidemic is not controlled. There have been advances in secondary and tertiary prevention of AIDS and setbacks in primary prevention. Funding Statement: The authors state: This study did not receive funding. Declaration of Interest: None. Ethics Approval Statement: The Ethical Committee of Municipal Health Secretary of Rio de Janeiro approved the project, with the CAAE no 84670817.4.3001.5279 in April 16th 2018.

Hantavirus pulmonary syndrome in children: case report and case series from an endemic area of Brazil.

ABSTRACTHantavirus Cardiopulmonary Syndrome (HCPS) is an important emergent zoonosis associated with wild rodents in Brazil, where this viral infection in children is generally rare. We present HCPS in a child from the Pantanal Biome and a review of all reported pediatric cases in Mato Grosso State, an endemic area for HCPS in Brazil. The investigation used the Information System for Notifiable Diseases database (SINAN). A 12-year-old boy was hospitalized with fever and respiratory failure and hantavirus IgM and IgG antibodies were detected by ELISA in serum samples. During the period of 1999 to 2016, 32 HCPS pediatric cases confirmed by serology were reported to SINAN with a mortality rate of 34.4%. The possibility of hantavirus infection in children with acute febrile illness associated with respiratory failure should be considered mainly in recognized endemic areas as Mato Grosso State, contradicting a hypothesis that children are more protected from lung involvement.

Trends in Tuberculosis Incidence in the Australian-Born in Victoria: Opportunities and Challenges to Elimination.

Australia is a low tuberculosis incidence country. In the setting of increasing migration, we aimed to investigate the epidemiology and trends of tuberculosis in the Australian-born population in the state of Victoria between 1992 and 2017. We performed a retrospective descriptive analysis of demographic, clinical and outcome data extracted from a centralized notifiable disease database. The mean incidence of tuberculosis was 1.19 cases per 100,000 population per year with a small but significant reduction of 0.98% per year. The median age of cases decreased from 67.5 years in 1994 to 17 years in 2017. Among 0–14 year-olds, there was an increase from 0.13 cases per 100,000 population in 1996 to 2.15 per 100,000 population in 2017. Data for risk factors were available from 2002 onwards. The most common risk factor in the 0–14 year age group was a household contact with tuberculosis (85.1%), followed by having a parent from a high tuberculosis incidence country (70.2%). We found the rate of tuberculosis in the Australian-born population in Victoria is low. However, there has been an increase in incidence in children, particularly among those with links to countries with high tuberculosis incidence. This could threaten progress towards tuberculosis elimination in Australia.

The nature of attacks by wild boar (Sus scrofa) and wild boar/domestic pig hybrids (´javaporcos´) and the conduct of anti-rabies care in Brazil

Introduction: In Brazil, the wild boar is an exotic invasive species that has been reported as a disease reservoir in several parts of the world. The result of crossing a boar with a domestic pig is called, in Brazil, a ´´javaporco´´. In Brazilian territory, boars and javaporco have been recorded serving as food sources for blood-feeding bats (Desmodus rotundus), and the impacts of such interactions on human health are still unknown. Objetive: Characterize attacks by wild boar and javaporco on human, and anti-rabies treatment that follows such accidents. Methods: Reports and epidemiological investigation records of human rabies treatment from 2007 to 2017 stored in the National System of Notifiable Diseases database were analyzed by descriptive epidemiology. Results: 309 attacks - 271 (87%) by wild boar and 38 (12.3%) by javaporco were reported - an increase in the number of reports in the most recent years of the evaluated time series. Attacks occurred in all regions of the country, in 17 Federated Units and in 252 municipalities. Men were most commonly attacked sex (283 - 91.58%), with the most commonly attacked age group being 35 to 49 years (86 - 27.83%), and occupations being wire fence constructor (31 - 10.03%), retired or pensioner (15 - 4.85 %) and student (13 - 4.20%). Single lesions (197 - 63.75%), deep (248 - 80.25%), produced by bite (292 - 94.49%), in the lower limbs (159 - 51.45) were the most recorded. Most of the individuals attacked had no history of anti-rabies treatment (249 - 80.58%), and the treatment indicated was serum plus vaccine (162 - 52.42%). Conclusion: Given the rising profile of the attacks and the geographical expansion of the wild boar's range in Brazil, with the consequent risk of attacks this study has shown, the health authorities should be alert to episodes of aggression, which should be monitored and, after incidents the medical care guidelines of the National Rabies Control Program should be followed.

Characterization of rabies post-exposure prophylaxis in a region of the eastern Amazon, state of Pará, Brazil, between 2000 and 2014.

Animal bites are a serious public health issue, and prevention strategies have been consistently documented worldwide. The aim of this study was to characterize human anti-rabies treatment in 11 counties of the Salgado microregion, Pará state, Brazil, which borders the Bragantina microregion, where exposures of human rabies were reported in 2004 and 2005. A descriptive retrospective study was conducted using anti-rabies treatment notifications registered in the Information System for Notifiable Diseases (SINAN) database of the State Department of Public Health of Pará (SESPA) from January 2000 to December 2014. In this period, 13,403 exposures were reported, with a growing annual trend (Y=68.571x+344.96). The years 2012 and 2013 presented the highest exposure incidence. Salinópolis was the county with the highest average annual incidence per 10,000 persons (62.83), followed by São João de Pirabas (43.28) and São Caetano de Odivelas (41.27). Most patients were males (59.6%) and were 1-19years old (48.7%). The main species involved in aggressions were dogs (74.1%), followed by bats (13.1%) and cats (7.4%). Biting was the most common kind of exposure, mostly on the lower limbs (39.6%). This study shows that aggression by bats was the second most common cause of demand for the service in the region for the past 14years. The low quality of records may increase the difficulty of rabies surveillance in Pará.

Using record linkage to validate notification and laboratory data for a more accurate assessment of notifiable infectious diseases

BackgroundInfectious disease burden is commonly assessed using notification data. Using retrospective record linkage in Western Australia, we described how well notification data captures laboratory detections of influenza, pertussis and invasive pneumococcal disease (IPD).MethodsWe linked data from the Western Australian Notifiable Infectious Diseases Database (WANIDD) and the PathWest Laboratory Database (PathWest) pertaining to the Triple I birth cohort, born in Western Australia in 1996–2012. These were combined to calculate the number of unique cases captured in each dataset alone or in both datasets. To assess the impact of under-ascertainment, we compared incidence rates calculated using WANIDD data alone and using combined data.ResultsOverall, there were 5550 influenza, 513 IPD (2001–2012) and 4434 pertussis cases (2000–2012). Approximately 2% of pertussis and IPD cases and 7% of influenza cases were solely recorded in PathWest. Notification of influenza and pertussis cases to WANIDD improved over time. Overall incidence rates of influenza in children aged <5 years using both datasets was 10% higher than using WANIDD data alone (IRR = 1.1, 95% CI = 1.1–1.2).ConclusionsThis is the first time WANIDD data have been validated against routinely collected laboratory data. We anticipated all cases would be captured in WANIDD but found additional laboratory-confirmed cases that were not notified. Studies investigating pathogen-specific infectious disease would benefit from using multiple data sources.

Risk factors for differential outcome following directly observed treatment (DOT) of slum and non-slum tuberculosis patients: a retrospective cohort study.

BackgroundBrazil’s National Tuberculosis Control Program seeks to improve tuberculosis (TB) treatment in vulnerable populations. Slum residents are more vulnerable to TB due to a variety of factors, including their overcrowded living conditions, substandard infrastructure, and limited access to healthcare compared to their non-slum dwelling counterparts. Directly observed treatment (DOT) has been suggested to improve TB treatment outcomes among vulnerable populations, but the program’s differential effectiveness among urban slum and non-slum residents is not known.MethodsWe retrospectively compared the impact of DOT on TB treatment outcome in residents of slum and non-slum census tracts in Rio de Janeiro reported to the Brazilian Notifiable Disease Database in 2010. Patient residential addresses were geocoded to census tracts from the 2010 Brazilian Census, which were identified as slum (aglomerados subnormais -AGSN) and non-slum (non-AGSN) by the Census Bureau. Homeless and incarcerated cases as well as those geocoded outside the city’s limits were excluded from analysis.ResultsIn 2010, 6,601 TB cases were geocoded within Rio de Janeiro; 1,874 (27.4 %) were residents of AGSN, and 4,794 (72.6 %) did not reside in an AGSN area. DOT coverage among AGSN cases was 35.2 % (n = 638), while the coverage in non-AGSN cases was 26.2 % (n = 1,234). Clinical characteristics, treatment, follow-up, cure, death and abandonment were similar in both AGSN and non-AGSN TB patients. After adjusting for covariates, AGSN TB cases on DOT had 1.67 (95 % CI: 1.17, 2.4) times the risk of cure, 0.61 (95 % CI: 0.41, 0.90) times the risk of abandonment, and 0.1 (95 % CI: 0.01, 0.77) times the risk of death from TB compared to non-AGSN TB cases not on DOT.ConclusionWhile DOT coverage was low among TB cases in both AGSN and non-AGSN communities, it had a greater impact on TB cure rate in AGSN than in non-AGSN populations in the city of Rio de Janeiro.

Neonatal invasive pneumococcal disease: New Zealand experience in the era of pneumococcal vaccination.

Invasive pneumococcal disease (IPD) became a notifiable disease in New Zealand in 2008, and in the same year pneumococcal conjugate vaccine (PCV) was added to the childhood immunisation schedule. This was a retrospective study of IPD in infants aged <90 days reported to the national notifiable disease database, EpiSurv, from 1 January 2009 to 31 December 2013. All cases had Streptococcus pneumoniae isolated from a normally sterile site. IPD incidence was calculated for babies aged <90 and <30 days using the number of national IPD cases with a denominator of annual infant live births. Clinical, demographic and outcome data were reviewed for infants aged less than seven days (early onset). There were 29 cases of IPD in infants aged <90 days and 19 cases in infants aged <30 days. Of the nine early-onset cases, six occurred within the first 48 h. Six of the early-onset cases were infants of NZ Maori ethnicity. One infant died six hours after birth. Three infants developed long-term neurological or respiratory sequelae. Isolates from five of the early-onset cases were S. pneumoniae serotypes not covered by the PCV in use at the time of infection. Maternal vaccination with 23-valent pneumococcal vaccine would have covered 84% (16 of 19) of serotypes responsible for the cases in infants <30 days old. Strategies such as maternal vaccination or accelerated neonatal vaccination may be beneficial to protect neonates at high risk of IPD.