Surveillance Actions Research Articles

Trends in prevalence and correlates of tobacco use among school-going adolescents in Bhutan: A secondary data analysis of the 2004-2019 Global Youth Tobacco Survey.

Tobacco use remains a major public health challenge globally. In Bhutan, despite the implementation of strict tobacco control measures, the tobacco uses among the students continue to be alarmingly high compared to neighboring countries. This study aims to analyze the trends and correlates of tobacco use among students in Bhutan, utilizing the nationally representative Global Youth Tobacco Survey (GYTS) data from multiple survey years. Secondary analyses of GYTS data collected during 2004-2019 with 12,594 students aged 11-18 years were employed. Use of tobacco was defined as either smoked or smokeless tobacco use in last 30 days of the survey. Prevalence was estimated over time and multivariable log-binomial regression was used to determine the correlates of current tobacco use. Overall tobacco use prevalence increased from 18.5% in 2004 to 27.3% in 2019. Males had higher prevalence (20.4% in 2019) than females (7.0% in 2019). Smokeless tobacco use increased substantially from 8.2% to 19.4% over the study period. Earlier age of initiation had adjusted odds ratio (aOR) of 9.2 for <11 years and 12.8 for 13-16 years vs. never smoking), betel quid use (aOR 3.3), peer pressure (aOR 3.6), and lower cost were significant correlates of adolescent tobacco use. Despite tobacco control policies, tobacco use among Bhutanese students is high and has been increasing over time, especially smokeless forms. Tobacco uses regulation, targeted interventions for high-risk junior high school students, and addressing social influences are urgently needed to curb this epidemic. Sustained tobacco use surveillance and public health action is imperative to protect students in Bhutan from this harmful habit.

Entomological indicators and food sources of triatomines in the Brazilian semi-arid region.

Triatomines are biological vectors of Trypanosoma cruzi, the etiological agent of Chagas Disease (CD) and have various mammalian hosts. This study evaluated the entomological indicators and food sources of triatomines in Petrolina in the semi-arid region of Brazil, where CD is endemic. Triatomines were captured indoors and outdoors through an active search and entomological indices (household and natural infections) were calculated. Parasitological analyses were performed through microscopic visualization using Giemsa-stained insect feces, and DNA sequencing was employed to identify food sources from the gut contents of 82 insects (9.05%) that were better preserved. We captured triatomines (906) in peridomicile (807) and intradomicile (99): Triatoma brasiliensis (84.7%, 767 specimens), Triatoma spp. (8.2%, 74 specimens), T. pseudomaculata (6.5%, 59 specimens), Rhodnius spp. (0.4%, four specimens), R. nasutus (0.1%, one specimen), and T. sordida (0.1%, one specimen). The household infestation index is 11.8%. Thirty-five triatomines were infected (33 T. brasiliensis and two T. pseudomaculata), corresponding to a natural infection index of 3.8%. The identified food sources were human T. pseudomaculata and T. brasiliensis, dogs for T. brasiliensis and rodents (Mus musculus) for T. brasiliensis. The results reinforce the need to intensify CD diagnosis, surveillance, and control actions, as an increase in entomological indices was recorded. Blood from humans and domestic and synanthropic animals was detected in the infected triatomines, suggesting a risk of CD vector transmission in Petrolina. As CD is a zoonosis, multidisciplinary and intersectoral CD surveillance must be conducted in the context of the One Health.

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

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

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

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

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

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

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

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

Food and nutrition surveillance actions in Brazil and Portugal: a comparative documentary analysis

Food and nutrition surveillance is fundamental to the formulation, implementation, monitoring, and evaluation of public policies on food and nutrition. The comparative analysis of the evolution of food and nutrition surveillance actions between countries makes it possible to learn about advances, challenges and innovations for the planning of interventions. This study aimed to describe and compare food and nutrition surveillance actions in Brazil and Portugal, countries with different geographical dimensions and socio-economic profiles, but with the common characteristic of having a universal healthcare system. We manually searched for documents describing food and nutrition surveillance actions and for potential data sources on the institutional websites of the Brazilian and Portuguese governments. The recommendations of the READ approach were used (59 documents were identified for Brazil and 29 for Portugal). In Brazil, food and nutrition surveillance actions are included in health policies and in the constraints of conditional cash transfer programs. The Brazilian Households Budget Surveys and health surveys are used simultaneously with the Brazilian National Food and Nutrition Surveillance System (SISVAN). In Portugal, food and nutrition surveillance actions are part of health policies, via the National Program and the Integrated Strategy for the Promotion of Healthy Eating. Among the data sources identified are the Portuguese Food Balance Sheet and household budget, health and food surveys, as well as initiatives to monitor the nutritional status of children and adolescents. In both countries, strategies need to be improved in terms of the regularity of data recording, the harmonization of food consumption indicators and the dissemination of information.

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

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

Leishmania infantum surveillence on dogs from Primavera do Leste, Mato Grosso state, Brazil.

The objective of this research was to determine the seroprevalence of Leishmania infantum in dogs in the city of Primavera do Leste, Mato Grosso, Brazil. A total of 109 serological samples from dogs were analyzed, collected between August 2021 to March 2022, using rapid immunochromatographic test, TR DPP® (LVC BioManguinhos), and Immunoenzymatic Assay (ELISA), EIE-Canine Visceral Leishmaniasis (Bio-Manguinhos®, Fiocruz). IgG anti-Leishmania infantum antibodieswere detected 4.6% (5/109) by DPP test. Regardless of results, all samples were submitted to ELISA test, of those 0.9% (1/109) was positive, the same having also been positive for the DPP, from asymptomatic, adult dog living in the urban area. This is the first autochthonous report of CVL in the municipality. Since Visceral leishmaniasis caused by L. infantum is a disease of One Health concern, the results obtained are essential to fill the epidemiological gap of in the region. Furthermore, the health authorities should implement surveillance actions in order to monitoring of dogs, as well as survey of sand flies, and health education programs to stimulate the prevention of the disease.

Epidemiological profile of human toxocariasis in patients examined at Evandro Chagas Institute (IEC/SVSA/MS) between 2014 and 2019

IntroductionToxocariasis is caused by nematodes of Toxocara genus, which infest dogs and cats, with humans serving as paratenic hosts. MethodsThe epidemiological profile of patients examined for toxocariasis between October 2014 and October 2019 at Evandro Chagas Institute (IEC) was outlined. The frequency of anti-T. canis IgG antibodies were evaluated using the Enzyme Linked Immunosorbent Assay (ELISA) method. ResultsFrom a total of 734 samples, 56% were from male (p < 0.05). Regarding age, the group with the most solicitations were from ≤11 years old individuals (p < 0.05). Pará state had the highest number of exams requested (92%), with the majority from residents of urban areas, accounting for 81.5% of samples (p < 0.05). The overall toxocariasis seroprevalence was 41.8%, the male sex being the most frequent with 60.9% (p < 0.05). The most affected age group was ≤11 years old, with a total of 67.8% of positive samples (p < 0.05). ConclusionThe high rates obtained emphasize the need for complementary studies on toxocariasis in Brazil, especially in Pará state, contributing to epidemiological surveillance actions in the control of this infection. Besides, health campaigns for domestic and stray animals, also can contribute to a more effective surveillance in controlling parasitic infections and encourages the One Health approach.

A Proposed Two-stage Bayesian Modeling for Calibration of Epidemiological Forecasts with Applications on Dengue Cases in Butuan City

This paper presents a comparative analysis of modeling approaches for a high-frequency time series. The moving average of 567 morbidity weeks of dengue cases in Butuan City, a Highly Urbanized City (HUC), was used as the response variable, with the aggregated rainfall, mean maximum temperature, mean minimum temperature, and mean relative humidity as the set of regressors. The last 24 morbidity weeks were set to be used for validation of predictive accuracy. Some pieces of literature support the robustness of the use of Bayesian methods in drawing inferences, modeling, and predicting epidemiological data. Hence, candidate Bayesian Econometric models were applied following appropriate assumptions. The applicability of Bayesian Vector Autoregression (BVAR) for variable selection and lag inclusion purposes was empirically supported. The BVAR results show that the dependent variable was mostly sensitive only to the variabilities in both the (a) direct effects and (b) lags of the cases themselves, and rainfall. The generated lags as included regressors were used in a separate model using the Bayesian Metropolis-Hastings (BMH) Algorithm. For comparison, a Frequentist Vector Autoregression (FVAR) Model as the baseline model, and BMH Algorithm were applied, too. Predictions comparison shows that the variable and lag selection process of BVAR combined with the BMH Algorithm (BVAR-BMH) simulation resulted in promising gains in predictive accuracy against straightforwardly using FVAR, BVAR, or BMH algorithm for the original set of variables. The promising gains in predictive accuracy may be used in anticipatory actions for dengue epidemiological surveillance for the specified HUC, or other locations.

Serological and Molecular Survey of Brucella Species in Owners and Their Dogs Living on Island and Mainland Seashore Areas of Brazil.

Background: Although Brucella abortus, Brucella suis, and Brucella canis may infect humans and dogs worldwide, no study to date has assessed and compared owners and their dogs between island and mainland seashore areas. Materials and Methods: Accordingly, the study herein has applied serological tests, including Microplate Agglutination Test with 2-Mercaptoethanol, immunochromatographic assay, and Rose Bengal Test, and a Brucella genus-specific PCR assay to 195 owners and their 148 dogs living on 1 mainland seashore area and three nearby oceanic islands of southern Brazil. Results: No seropositivity to B. abortus and B. suis was detected in owner or dog sera. Anti-B. canis seropositivity was observed in 3/148 (2.0%) dogs, but no owner sample was seropositive to B. canis. In addition, all blood samples from both owners and dogs were negative on Brucella genus-specific PCR assay. Conclusions: The seropositive dogs were not related and lived on the seashore mainland area of Guaraqueçaba city. The absence of seropositivity on the islands and the low seropositivity on the seashore mainland could be attributed to geographic isolation, and suggest the low impact of the disease in the region. Despite being a zoonotic disease, brucellosis by B. canis is not included in the National Program for Control and Eradication of Brucellosis, and its diagnosis and notification are not mandatory. The presence of seropositive dogs highlights the risk to human health and the importance of epidemiological surveillance actions in the region, as well as the need for the implantation of preventive measures to avoid the transmission of the pathogen.

Congenital syphilis: performance of primary care services in São Paulo, 2017.

To evaluate congenital syphilis prevention actions in primary health care services in the state of São Paulo. Cross-sectional evaluative research that used indicators extracted from the Survey of Evaluation and Monitoring of Primary Care Services ( Avaliação e Monitoramento de Serviços da Atenção Básica - QualiAB) in the state of São Paulo in 2017. An evaluative matrix composed of 31 indicators of prevention of congenital syphilis, categorized into four domains of analysis: diagnosis and treatment of acquired syphilis (10); basic infrastructure and resources (7); prevention of congenital syphilis during prenatal care (7); and educational actions and prevention of sexually transmitted infections (7). The frequency of services with positive responses for each indicator and the percentage of service performance were calculated based on the proportion of indicators reported per service and the overall average observed. Subsequently, services were classified into four quality groups, and associations between groups and each indicator, type of organizational arrangement and location were estimated. 2,565 services participated, located in 503 municipalities, with an overall average performance of 74.9%. The domain "diagnosis and treatment of acquired syphilis" had the highest performance (89.8%), followed by "infrastructure and basic resources" (79.5%), "prevention of congenital syphilis in prenatal care" (73.3%) and "educational actions and prevention of sexually transmitted infections" (56.8%). There was a significant difference between quality groups and all indicators and types of organizational arrangements. The evaluated services have limitations in the development of actions to prevent congenital syphilis, mainly related to health education and actions included in prenatal care, such as screening and adequate treatment of pregnant women and their partners. Changes are needed in the work process, with the expansion of educational and surveillance actions, as well as the qualification of the teams to effectively comply with the protocols.

Existing workloads among managers and healthcare workers during the COVID-19 pandemic: Meanings in the Amazon context.

The global COVID-19 pandemic has increased the concern and risks of health professionals exposed by acting on the front lines in combating and controlling the spread of the virus. This study aims at analyzing the workloads and their implications for the activities carried out by managers and health workers in the face of the COVID-19 pandemic in Manaus, Amazonas, Brazil. This is a qualitative study, of the case study type, that integrates a macro research that deals with the experiences built during the confrontation of the pandemic of COVID-19 in the capital of the state of Amazonas, Brazil, the epicenter of the pandemic in the country. Data production resorted to documentary analysis and semi-structured interviews with 56 managers or professionals from the Manaus Health Care Network. The analytical process was supported by the resources of the Atlas.ti 8.0 software and the precepts of Thematic Networks analysis. The thematic network "workloads" brought together three topics related to the experience of psychological, physiological and biological loads. Psychological workloads were strongly present in the work routine, being referred to in a more significant way. The sources that increase them are strongly related to work stress, dealing with suffering and death and excess demand on the service. Physiological loads were related to excessive working hours, staff shortages and activity overload. "Biological burdens" include exposure to the SARS-CoV-2 virus, constant contact with infected individuals, and individual protection as key elements of this set. The study showed that both managers and workers have work processes and environments with conditions that tend to generate workloads that harm their health and safety, as well as institutions and patient care. Therefore, there is a need for more effective organizational actions in workers' health surveillance, disease prevention, adequate working conditions, reducing workloads and promoting more resolute and less stressful work environments.

Sugar-sweetened beverage intakes among adults between 1990 and 2018 in 185 countries

Sugar-sweetened beverages (SSBs) are associated with cardiometabolic diseases and social inequities. For most nations, recent estimates and trends of intake are not available; nor variation by education or urbanicity. We investigated SSB intakes among adults between 1990 and 2018 in 185 countries, stratified subnationally by age, sex, education, and rural/urban residence, using data from the Global Dietary Database. In 2018, mean global SSB intake was 2.7 (8 oz = 248 grams) servings/week (95% UI 2.5-2.9) (range: 0.7 (0.5-1.1) in South Asia to 7.8 (7.1-8.6) in Latin America/Caribbean). Intakes were higher in male vs. female, younger vs. older, more vs. less educated, and urban vs. rural adults. Variations by education and urbanicity were largest in Sub-Saharan Africa. Between 1990 and 2018, SSB intakes increased by +0.37 (+0.29, +0.47), with the largest increase in Sub-Saharan Africa. These findings inform intervention, surveillance, and policy actions worldwide, highlighting the growing problem of SSBs for public health in Sub-Saharan Africa.

A-304 A RT-PCR Assay for Detection and Quantification of Hepatitis D Virus (HDV)

Abstract Background Hepatitis D virus (HDV), also called Delta Hepatitis, is associated with the presence of the Hepatitis B virus (HBV) and is responsible for the infection and inflammation of liver cells. It is estimated that 15–20 million people worldwide are affected by HDV. In Brazil, Hepatitis D has high prevalence rates in the Amazon Basin. HDV is an enveloped virus with a 36 nm average diameter. The HDV virion involves a negative-sense, single-stranded circular RNA molecule associated with an inner-core delta antigen surrounded by envelope glycoproteins. HDV-infected individuals may not show signs or symptoms of the disease. When present, the most common are: tiredness, dizziness, nausea and/or vomiting, fever, abdominal pain, and yellow skin/eyes. Chronic Hepatitis D is considered the most severe form of chronic viral hepatitis, with more rapid progression to cirrhosis and an increased risk for decompensation, hepatocellular carcinoma (HCC), and death. Molecularly, determining the concentration of virus circulating in the blood of HDV patients is extremely important for diagnosis. The Quantitative Polymerase Chain Reaction (qPCR) is a molecular technique capable of detecting the viral genome with high sensitivity and specificity, ensuring the safety of the result. Therefore, this study aims to describe the analytical validation of a one-step RT-qPCR assay for HDV detection. Methods Assay performance was evaluated using commercial quantified positive control to HDV (1000, 100, 10, 1, and 0.5 IU/µL), and the parameters of analysis included: standardization assays, efficiency, and detection limit. For specificity evaluation, positive samples for Epstein-Barr Virus (EBV), Herpes Simplex Virus (HSV), Cytomegalovirus (CMV), Hepatitis B Virus (HBV), and Hepatitis C Virus (HCV) were used. RNA isolation was performed with the MagNA Pure 24 Total NA Isolation Kit at the automated platform MagNA Pure 24 System (Roche Diagnostics, Basel, Switzerland), according to the manufacturer's instructions. Altona RealStar HDV RT-PCR Kit 1.0 (Altona Diagnostics, Hamburg, Germany) was used to directly amplify RNA samples on the qPCR instrument, according to the manufacturer's instructions. Results The standardization assays indicated good qPCR amplification curves and high fluorescence levels between the controls evaluated. The assay demonstrated an average efficiency of 95%, with a coefficient of determination (r2) of 0.99. The detection limit of the test was 1 IU/µL for the HDV target (95% confidence interval). No cross-reactions with closely related viruses were observed (15 HDV-negative human plasma samples), indicating 100% specificity. The experiments performed to evaluate the precision demonstrated optimal repeatability and reproducibility. Conclusion The HDV diagnostic is required to ensure sensitive, specific and accurate identification of the viral agent and thus prompt surveillance actions such as epidemiological monitoring and control measures of infection. The RT-qPCR assay described here provides a reliable, highly specific, and sensitive method for the detection and quantification of HDV. Nevertheless, the assay needs to be evaluated in conjunction with a clinical and epidemiological context.

A-301 Analytical and Clinical Performance of the Molecular Method for Monkeypox Virus Detection

Abstract Background Monkeypox (MPX) is a zoonose caused by the Monkeypox virus (MPXV) belonging to the Orthopoxvirus genus of the Poxviridae family. Currently, MPXV is responsible for more than 84 000 infections worldwide, resulting in major social impacts. Although the reservoir is unknown, the main hosts are small rodents, typical of the tropical forests of West and Central Africa. The transmission occurs by interactions of infected animal-to-person (direct contact with the blood, bodily fluids, or cutaneous/mucosal lesions) and person-to-person (close contact with respiratory secretions, skin lesions, or recently contaminated objects). After infection, there is an incubation period of approximately 1–2 weeks (asymptomatic and non-transmissible), followed by the development of skin rashes over the body, lymphadenopathy, and systemic symptoms (fever, malaise, headache, myalgia, and fatigue). The rapid and accurate diagnosis of MPX is extremely important for combating the virus and also for epidemiological tracking. In this sense, molecular methods have been shown essential for the accurate detection and characterization of MPXV. Therefore, this study aims to describe the analytical and clinical validation of real-time polymerase chain reaction (qPCR) assay for MPXV detection. Methods The qPCR assay used in this validation was based on recommendations published by the Center for Disease Control and Prevention (CDC). The primer/probe sequence was commercially acquired and included the analysis of a MPXV-specific genomic region (CADT ID APNKYAD; Thermo Fisher, USA). Assay performance was evaluated using inactivated viral isolates and positive samples with known MPXV positive results. The analysis parameters included: (i) assay verification (performance evaluation of probes and reagents); (ii) Analytical sensitivity; (iii) Limit of detection (LOD); (iv) Analytical specificity (interference study with Herpes simplex virus and Varicella-Zoster virus); and (v) clinical validation (10 positive skin rashes samples for the MPXV). Results The assay demonstrated good performance visualized by the qPCR amplification curves (low cycle threshold (Ct) value and high fluorescence level) with an efficiency &amp;gt;92%. Analytical sensitivity and LOD tests were 100% and 50 copies/µL, respectively, considering a 95% confidence interval. The regression equations obtained show satisfactory reaction conditions with a positive correlation between the variables (coefficient of determination (r2) = 0.99). The assays indicated no cross-reactions with closely related viruses, demonstrating 100% of specificity. Finally, clinical validation showed 100% agreement with the expected results for all samples evaluated. Conclusion qPCR can play an important role in the rapid and accurate diagnosis of several viruses. The analytical and clinical validation provided data indicating high sensitivity and specificity for MPX detection. This study allowed the implementation of a sensitive, specific, and accurate molecular test for viral agent identification and allow prompt surveillance action by health such as epidemiological monitoring and control measures of these infections.

Iodized Salt May Not Be Sufficient to Guarantee an Adequate Iodine Intake in Pregnant Women.

Adequate iodine intake is of crucial importance in pregnancy to meet the thyroid hormone needs of both mother and fetus. In the present study, undertaken as a part of the surveillance actions following the introduction in Italy of a national salt iodination program in 2005, the iodine intake was investigated in 123 pregnant women and 49 control women living in the same area of central Italy. All the participants were screened for urinary iodine concentration (UIC), serum level of thyrotropin, free-thyroxine, free-triiodothyronine, and thyroid volume. Moreover, they were provided with a questionnaire on the use of iodine-containing salt or supplements. Control women had a median UIC of 102 µg/L, consistent with an iodine sufficiency, while in pregnant women the median UIC value was 108 µg/L, lower than the endorsed UIC of 150 µg/L. In addition, pregnant women showed a significantly increased median thyroid volume compared to controls. Interestingly, the median UIC did not differ between pregnant women not using iodine-containing salt or supplements and those regularly consuming iodized salt alone, while pregnant women with a daily intake of iodine-containing supplements had an adequate median UIC (168 µg/L). In conclusion, the data reported here showed that pregnant women and their fetuses are still exposed to the detrimental effects of iodine deficiency and that the consumption of iodine-containing supplements should be recommended in pregnancy.

Individual, socioeconomic and healthcare access factors influencing the delays in leprosy presentation, diagnosis and treatment: a qualitative study.

This study investigated the factors influencing the presentation, diagnosis and treatment of leprosy in primary healthcare. Qualitative research was conducted on patients undergoing treatment in a priority hyperendemic region for leprosy control in northeastern Brazil. Interviews were conducted between September and December 2020 at primary healthcare centers. Data were analysed based on the basic interpretive qualitative structure according to Andersen and Newman's model of healthcare utilisation. Knowledge of leprosy symptoms influenced patients' search for a diagnosis. Unfavorable socioeconomic conditions experienced by patients made diagnosis and treatment difficult. Incorrect evaluations by health professionals caused difficulties and delays in obtaining a diagnosis of leprosy. Perceptions about the disease, such as non-acceptance of the disease and the adverse effects of the medications, affected treatment seeking and treatment continuity. Patients with leprosy faced delays and healthcare access barriers related to knowledge of the disease, socioeconomic conditions and the structure of healthcare services, which must be considered when creating care plans, surveillance and control actions against leprosy. Appropriate interventions are necessary to reduce delays and better control the disease.

Analyzing a national health surveillance strategy to reduce mother-to-child transmission of syphilis: The case of Brazilian investigation committees

ObjectivesThis study aimed to analyze the relevance of investigation committees in eliminating mother-to-child transmission of syphilis in Brazil. MethodsQuestionnaires and interviews were conducted with health managers of 25 Brazilian Federative Units and Brazil's Federal District. Data were analyzed using Bardin's content analysis technique and subsequently compared with the global prescriptions for syphilis response of the Pan American Health Organization, World Health Organization, and recent research publications examining the course of syphilis in Brazil, in Brazilian regions, and globally. ResultsWhile the investigation committees drew on the successful experience of those in reducing maternal mortality, which helped the country achieve the Millennium Development Goals, they are not demonstrated to be sufficient for preventing mother-to-child transmission of syphilis. The committees’ systematic and bureaucratic agenda has not been efficient in managing avoidable factors for syphilis, nor do they operate in the scope of the integration of surveillance and care actions, as recommended by the health policy. ConclusionThe committees’ model needs to be reviewed in the context of Brazil's National Health System. The research process should be rescaled in order to remain a cornerstone for the induction of health policy that integrates surveillance and healthcare across Brazilian Federative Units. The advancement toward an automated case management model becomes relevant for the country to meet global commitments to eliminate congenital syphilis transmission and achieve the goals outlined in the 2030 Agenda.