SINAN Database Research Articles

ACIDENTE COM MATERIAL BIOLÓGICO EM SERVIDORES DA SAÚDE NA BAHIA

Os objetivos da pesquisa são descrever o perfil das ocorrências de acidentes de trabalho com material biológico em servidores da saúde no Estado da Bahia, além de identificar o perfil dos profissionais acidentados e delinear o tipo de exposição nos acidentes com material biológico. Trata-se de um estudo epidemiológico, retrospectivo, descritivo com abordagem quantitativa. A coleta de dados foi realizada no banco de dados do SINAN. Os dados foram analisados no Excel (2007). No período de cinco anos (2011 a 2015) foi notificado um total de 10.863 casos de acidente de trabalho com material biológico, sendo o ano de 2014 os profissionais estavam com maior risco, pois representou a taxa de 16,6% (2.506). O perfil é predominantemente com nível técnico (73%), sexo feminino (78%), a faixa etária de 30 a 39 anos (36,3%). O material biológico com maior transmissão é o sangue (87%) e a sorologia positiva para HIV apresentam 57 casos. Conclui-se que o conhecimento de dados epidemiológicos na instituição pode contribuir na compreensão de cenários de riscos nos quais os trabalhadores estão expostos e nesse contexto intervir com políticas e programas que visam estratégias de prevenção.

Mortality Predictors in Patients with Severe Dengue in the State of Amazonas, Brazil.

Dengue is a major public health problem in tropical and subtropical areas worldwide. There is a lack of information on the risk factors for death due to severe dengue fever in developing countries, including Brazil where the state of Amazonas is located. This knowledge is important for decision making and the implementation of effective measures for patient care. This study aimed to identify factors associated with death among patients with severe dengue, in Amazonas from 2001 to 2013. We conducted a retrospective cohort study based on secondary data from the epidemiological surveillance of dengue provided by the Fundação de Vigilância em Saúde do Amazonas, FVS (Health Surveillance Foundation) of the Secretaria de Saúde do Amazonas, SUSAM (Health Secretariat of the State of Amazonas). Data on dengue cases were obtained from the SINAN (Notifiable Diseases Information System) and SIM (Mortality Information System) databases. We selected cases of severe dengue with laboratory confirmation, including dengue-related deaths of residents in the state of Amazonas from January 1, 2001, to December 31, 2013. The explanatory variables analyzed were sex, age, level of education, spontaneous hemorrhagic manifestations, plasma extravasation and platelet count. Patients who died due to severe dengue had more hematuria, gastrointestinal bleeding, and thrombocytopenia than the survivors. Considering the simultaneous effects of demographic and clinical characteristics with a multiple logistic regression model, it was observed that the factors associated with death were age >55 years (odds ratio [OR] 4.98), gastrointestinal bleeding (OR 10.26), hematuria (OR 5.07), and thrombocytopenia (OR 2.55). Gastrointestinal bleeding was the clinical sign most strongly associated with death, followed by hematuria and age >55 years. The study results showed that the best predictor of death from severe dengue is based on the characteristic of age >55 years, together with the clinical signs of gastrointestinal bleeding, hematuria, and low platelet count.

Database linkage for surveillance of the influenza A(H1N1)pdm09 pandemic in Brazil, 2009-2010

Based on database linkage, the objective of this study was to describe the epidemiological profile of notified cases and deaths from the new viral subtype of influenza during the influenza pandemic. Secondary data were used from the SINAN (Information System for Notifiable Diseases) and SIM (Mortality Information System) for the years 2009 and 2010. Linkage identified 5,973 deaths of cases notified as pandemic influenza. Of these, 2,170 (36.33%) had been classified in the SINAN as confirmed pandemic influenza, 215 (3.6%) as due to other infectious agents, and 3,340 (55.92%) as ruled out. After linkage, some cases in the SINAN database that were closed as death from influenza (n = 658) or death from other causes (n = 847) could not be located in the SIM database. Database linkage can improve the surveillance system and monitoring of morbidity and mortality. We recommend strengthening influenza surveillance in Brazil using linkage of Ministry of Health databases.

Global elimination of leprosy by 2020: are we on track?

BackgroundEvery year more than 200,000 new leprosy cases are registered globally. This number has been fairly stable over the past 8 years. WHO has set a target to interrupt the transmission of leprosy globally by 2020. The aim of this study is to investigate whether this target, interpreted as global elimination, is feasible given the current control strategy. We focus on the three most important endemic countries, India, Brazil and Indonesia, which together account for more than 80 % of all newly registered leprosy cases.MethodsWe used the existing individual-based model SIMCOLEP to predict future trends of leprosy incidence given the current control strategy in each country. SIMCOLEP simulates the spread of M. leprae in a population that is structured in households. Current control consists of passive and active case detection, and multidrug therapy (MDT). Predictions of leprosy incidence were made for each country as well as for one high-endemic region within each country: Chhattisgarh (India), Pará State (Brazil) and Madura (Indonesia). Data for model quantification came from: National Leprosy Elimination Program (India), SINAN database (Brazil), and Netherlands Leprosy Relief (Indonesia).ResultsOur projections of future leprosy incidence all show a downward trend. In 2020, the country-level leprosy incidence has decreased to 6.2, 6.1 and 3.3 per 100,000 in India, Brazil and Indonesia, respectively, meeting the elimination target of less than 10 per 100,000. However, elimination may not be achieved in time for the high-endemic regions. The leprosy incidence in 2020 is predicted to be 16.2, 21.1 and 19.3 per 100,000 in Chhattisgarh, Pará and Madura, respectively, and the target may only be achieved in another 5 to 10 years.ConclusionsOur predictions show that although country-level elimination is reached by 2020, leprosy is likely to remain a problem in the high-endemic regions (i.e. states, districts and provinces with multimillion populations), which account for most of the cases in a country.Electronic supplementary materialThe online version of this article (doi:10.1186/s13071-015-1143-4) contains supplementary material, which is available to authorized users.

Epidemiological Profile of Wild Rabies in Brazil (2002-2012).

Rabies is one of the most important zoonosis in the world with high impact on public health. Studies report the presence of Lyssavirus in reservoirs of the wild cycle, highlighting the role of wild canines, marmosets, and vampire and non-vampire bats as potential vectors of the disease to domestic animals and human beings. Therefore, the reintroduction of rabies in urban environments from reservoirs of the wild cycle is a matter of concern. This study describes the profile of rabies cases documented in Brazil from 2002 to 2012, with emphasis on the wild transmission cycle of the disease. We carried out a descriptive study using records with information on the time of infection, persons with infection and location of confirmed cases of rabies in humans and animals, as well as data on anti-rabies treatments obtained from the Information System of Notifiable Diseases (Sinan) database. Within the study period, 82 cases of rabies transmitted by wild animals to humans were reported, predominantly in rural areas of the northern and north-eastern regions. Of the cases in humans, 72% did not receive post-exposure prophylaxis. Among wild mammals, vampire bats were the most frequent vectors of the disease. In the north-east region, 460 terrestrial wild mammals were reported with confirmed rabies. Over the study period, 1703 bats were reported to carry the rabies virus. In the south-east region, the most frequently reported carriers of the virus were non-vampire bats. The midwest and northern regions presented a lower number of records of rabies cases among terrestrial wild mammals. However, the high number of rabies cases among bovines reflects the role of the vampire bat as a maintainer of the rabies virus in the rural cycle. The present results are key to adjust the planning of rabies control in Brazil to the current epidemiological trends.

Tuberculosis (TB) incidence in a cohort of individuals infected with human T-lymphotropic virus type 1 (HTLV-1) in Salvador, Brazil

Few reports evaluate the association between HTLV-1 and TB in countries where both infections are endemic. The incidence and relative risk of TB in a cohort of HTLV-1-infected individuals was estimated from 22 to 2012. Using records from the CHTLV database, the Information System on Diseases of Compulsory Declaration (Sinan) database was searched for TB cases matching each patients’ full name, date of birth and mother's full name. Structured Query Language for use in relational databases was used to cross match both registries by employing a “linkage” strategy. TB incidence density (ID) in both seropositive and seronegative HTLV-1 subjects was calculated as the number of new-TB-cases per 1,0 person-years of follow-up. From a cohort of 6,495 patients, 1,711 were infected with HTLV-1. 73 TB cases occurred during the 11-year study period: 33 in HTLV-1-infected patients and 40 in uninfected individuals. The ID for the HTLV-1/TB group was 3.3 per 1,0 person-years and 1.1 per 1,0 person-years in the non-infected individuals. The relative risk for TB in HTLV-1+ group was 2.3 (CI 95% 1.46 - 3.65). In addition, HTLV-1-infected individuals aged 31 to 50 presented the highest ID (3.4). In this group, the relative risk for TB was 2.6 (CI 95% 1.2-5.5). HTLV-1 patients with TB were older (p = 0. 5), had lower educational levels (p=0.02) and presented higher recurrence rates of TB (p=0.09) than non-HTLV-infected individuals with TB. HIV serology was positive for 6.0% of individuals infected with HTLV-1 versus 12.5% of individuals with isolated TB (p= 0.45). Patients infected with HTLV-1 are more susceptible to TB. The populations of HTLV/TB co-infected patients and HTLV-1-infected individuals share similar epidemiological features, highlighting the neglected nature of both diseases.

Uso do sistema de informação sobre mortalidade para identificar subnotificação de casos de tuberculose no Brasil

The aim of the study was to analyze the underreporting of deaths from tuberculosis (TB) in Brazil, as well as to assess the impact these cases would cause in the reporting rate and proportion of TB deaths in 2006. We analyzed the deaths recorded in the Mortality Information System (SIM) in 2006 and all reports of TB in Brazil during the 2001 to 2006 period. The variables used for the relationship were: report number, city and State of residence, patient name, date and year of birth, sex, mother's name and address. Six blocking steps were performed. Scores above 12.4 were considered pairs, and those below 9.7, doubtful pairs. After each step, we performed a manual review of doubtful pairs. The Reportable Disease Information System (Sinan) had 547,589 records. The SIM had 6,924 records, 39.3% (n = 2,727) of which were not found in Sinan during the period evaluated. We observed that 64.5% (2,707) of deaths were reported in 2006 and after analyzing the proportion of deaths underreported by region and federal units, we found that the highest percentage was in the Northern region, followed by the Southeast and Northeast. The addition of deaths that had not been reported to the Sinan database increased the reporting rate 3.7%. Regarding the proportion of deaths due to TB, such inclusion was responsible for a 60.7% increase in this indicator. The relationship between both databases seems to be an important strategy for improving the quality of the TB surveillance system.

Impacto da vacinação contra varicela na redução da incidência da doença em crianças e adolescentes de Florianópolis (SC)

OBJECTIVE: To evaluate the impact of universal early childhood vaccination against varicella on the reduction of its incidence in a state capital in southern Brazil. METHODS: Official epidemiologic surveillance data from the SINAN database for the 1997-2007 period were used to evaluate the impact of varicella vaccination targeting all children < 2 years of age in Florianopolis (the capital city of the state of Santa Catarina), Brazil, since 2002, thus comprising 5 years before and 6 years after the vaccination. Varicella incidence in Florianopolis was compared with the incidence in the rest of the state for four age groups (< 1, 1-4, 5-9, and 10-14 years). RESULTS: Among the 135,311 cases of varicella in the state of Santa Catarina during the 1997-2007 period, 70% were children under 10 years of age. The effectiveness of varicella vaccine ranged from 27 to 38% among the age groups but reached statistical significance only for children 1-4 years old. CONCLUSION: The vaccine was effective in reducing varicella incidence in Florianopolis for children 1-4 years old.

Impact of vaccination against varicella on the reduction of the disease incidence in children and adolescents from Florianópolis, Brazil

To evaluate the impact of universal early childhood vaccination against varicella on the reduction of its incidence in a state capital in southern Brazil. Official epidemiologic surveillance data from the SINAN database for the 1997-2007 period were used to evaluate the impact of varicella vaccination targeting all children < 2 years of age in Florianópolis (the capital city of the state of Santa Catarina), Brazil, since 2002, thus comprising 5 years before and 6 years after the vaccination. Varicella incidence in Florianópolis was compared with the incidence in the rest of the state for four age groups (< 1, 1-4, 5-9, and 10-14 years). Among the 135,311 cases of varicella in the state of Santa Catarina during the 1997-2007 period, 70% were children under 10 years of age. The effectiveness of varicella vaccine ranged from 27 to 38% among the age groups but reached statistical significance only for children 1-4 years old. The vaccine was effective in reducing varicella incidence in Florianópolis for children 1-4 years old.

ASPECTOS EPIDEMIOLÓGICOS DOS CASOS DE MENINGITE NOTIFICADOS NO MUNICÍPIO DE PONTA GROSSA – PR, 2001-2005

No Paraná são notificados anualmente cerca de 2.800 casos de meningite. Os objetivos deste estudo foram: descrever o perfil epidemiológico dos casos de meningite notificados e confirmados em Ponta Grossa - PR e analisar a letalidade deste agravo por ano, entre 2001 e 2005. Os dados epidemiológicos foram levantados a partir do banco de dados Sistema de Informação de Agravos de Notificação - SINAN, junto à 3ª Regional de Saúde do Estado do Paraná. As variáveis selecionadas foram gênero, idade, raça/cor, doenças pré-existentes, tipo de meningite, evolução do caso e seqüelas. Dentre os 401 casos notificados predominou o gênero masculino, a faixa etária foi de crianças menores de 9 anos, a raça branca, ausência de doença pré-existente e seqüelas. A etiologia viral foi a que apresentou maior freqüência, tendo a letalidade variado entre 5,39% a 17,24%. O monitoramento das meningites é indispensável, para subsidiar a adoção de medidas de controle, diagnóstico rápido e tratamento precoce.

The use of Geographical Information System (GIS) to improve active leprosy case finding campaigns in the Municipality of Mossoró, Rio Grande do Norte State, Brazil

There is a high incidence of leprosy in the municipality of Mossor6, Rio Grande do Norte state, where the detection coefficient has risen from 2.78/10,000 population in 1998 to 5.14 in 2004. While cases have been registered throughout the urban area, the disease is concentrated in select neighbourhoods. This study was undertaken using Geographical Information System (GIS) with the objective of defining low-cost, effective strategies to control leprosy. The land registry map of the city, Ikonos satellite images and the SINAN (National Morbidity Notification Information System) database were used as the cartographical basis for the study. The sample for the leprosy mapping was drawn from the 358 new cases of the disease diagnosed in the municipality between 1998 and 2002. The houses of 281 patients were located (78.5% of the total) and their addresses geo-referenced using a GPS handheld device. Subsequently, geographical analysis was carried out using ArcView 9.0 software showing predominant concentration of cases in the neighbourhoods of Barrocas, Santo Antônio, Bom Jardim and Paredões. This mapping served as the basis for four active case finding campaigns conducted in the most highly concentrated areas between March and September of 2005. Campaigns guided by spatial analysis led to the diagnosis of 104 new cases of the disease (50% of the total number of new cases detected in the municipality in 2005). The use of GIS in leprosy diagnosis has shown to be extremely effective, providing a clear visual understanding of the distribution of the disease in the municipality, which results in targeted interventions and important cost reductions in leprosy control activities.