Brazilian Surveillance Research Articles

Influenza in Brazil: surveillance pathways.

Influenza is a viral disease of global concern that has demanded the attention of health authorities. Since 1947, as a preventive measure, the World Health Organization monitors viral circulation to define the annual vaccine through a worldwide network of laboratories. This article presents the structuring of influenza surveillance in Brazil and highlights virological surveillance and the role of diagnostic laboratories as well as the expansion of actions to improve detection and expedite responses. The model set corresponds to sentinel surveillance complemented by the universal notification of severe acute respiratory syndrome investigating outbreaks, deaths, and unusual events and monitoring hospitalization and mortality in an expanded surveillance. In this review, we address aspects of influenza surveillance in animals, the need for interagency integration, and the sharing of information in many surveillance systems.

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.

Planejamento de Recursos Humanos de Saúde e Ambiente - aspectos históricos, teóricos e reflexões para políticas públicas em Vigilância em Saúde Ambiental no Brasil.

As relações entre a saúde e o ambiente no âmbito das atribuições do Sistema Único de Saúde é um desafio no cuidado coletivo na perspectiva da identificação, prevenção, controle e das recomendações de processos envolvidos na exposição humana às situações ambientais que possam gerar impacto e consequências negativas para a saúde humana. As reflexões sobre os caminhos da vigilância em saúde ambiental (VSA), seu histórico, conceito, teoria e alternativas metodológicas, que geram informação para tomada de decisão e inclui possibilidades de interpretação e transformação da realidade são os objetivos abordados neste ensaio. A partir de uma pesquisa exploratória sobre a Vigilância em Saúde Ambiental no Brasil, suas práticas e teorias, foi realizada uma revisão sobre a vigilância em saúde ambiental no Brasil, e seu contexto teórico e histórico. O objeto da Vigilância em Saúde Ambiental é a relação sócio ecológica do ambiente, da saúde e da sustentabilidade, e há que se avançar e pensar na análise de situação de saúde ambiental como eixo da discussão do seu objeto produzindo informação qualificada para a intervenção solidária e democrática tendo a saúde como valor que traz a discussão da sustentabilidade, da equidade, com a incorporação de uma política social que interaja condicionando o desenvolvimento econômico e social.

PP10.12 – 2525: Neurological adverse events following immunization (AEFI): Brazilian data

Objective Despite the benefits of vaccines, it is well recognized that some cases of AEFI occur; among them, adverse events that affect the nervous system are that cause more concern. The nervous system can be affected directly by vaccines' antigens, or by inflammatory processes triggered by them. Herein we describe all the neurological AEFI reported to the Ministry of Health (MoH) surveillance system in the period from 2008 to 2013 in Brazil. Methods A retrospective study based on the AEFI data from 2008 to 2013. AEFI seriousness, demographic data, frequency and vaccine data were analysed. Results 3,200 neurological events were reported to the MoH during the period and 2,885 were consistent with AEFI (52.1% male). Three deaths were reported and 1.32% presented some sequel. Among all the vaccines that are part of the Brazilian calendar, the most frequent neurological AEFI reported were febrile and afebrile seizures (67.83% and 21.21%, respectively) and the highest rates were observed after the Diphtheria, Tetanus, Pertussis, and Haemophilus influenzae type b combined vaccine (50.36%). Guillain Barre syndrome also was reported (1.4%). The Influenza vaccine was the most related with this AEFI (0.7 cases per 1,000,000 doses). Conclusion Brazil's National Immunization Program (NIP) is one of the most extensive (27 vaccines, 4 immunoglobulins and 13 sera), offered with no cost to all its population. In this period more than 550 million of vaccines' doses were administered. Although the Brazilian AEFI surveillance system is mostly passive (based in the received reports), and on the fact that AEFI data can be underestimated, this large series shows that the majority of the AEFI are not serious and rates are within the expected from the literature. It is necessary to stimulate reporting, adequate investigation and causality assessment for keeping the population's confidence in NIP.

Trends in animal rabies surveillance in the endemic state of Minas Gerais, Brazil.

Rabies is a viral zoonosis affecting mammal species and causes large economic losses. Included among the neglected diseases, it is still insufficiently addressed by governments and the international community, despite formal surveillance and control programs. This study used a dataset of 10,112 rabies diagnoses in animals provided by the Brazilian passive surveillance system from 2001 to 2012. The positivity rate of the tested samples was 26.4%, and a reduction in the total samples sent during the last six years was observed. The kernel density map indicated case concentration in the south region and a decrease in density of rabies cases in the second period studied (2007 to 2012). The directional trend of positive rabies diagnoses remained in the south region, as shown by the standard deviational ellipse. The spatial scan statistic identified three large clusters of positive diagnoses, one in the first period (2001-2006) and two in the second period (2007-2012), indicating an expansion of risk areas. The decrease in rabies cases from 2006 to 2012 does not necessarily reflect lower viral circulation or improvement in actions by epidemiological surveillance; this decrease could indicate a deficiency in epidemiological surveillance during the observation period due to the increase in the silent areas. Surveillance should maintain an increasing or constant number of tests during the years in addition to a reduction in the number of outbreaks of rabies, which would indicate a lower positivity rate. The findings in this study indicate deterioration in the effectiveness of the passive surveillance for rabies. The number of rabies cases, total number of tests performed and positivity rate are good indicators for evaluating passive surveillance. This paper can function as a guide for the assessment and improvement of the actions in passive surveillance of rabies.

Whole-genome sequences of influenza A(H3N2) viruses isolated from Brazilian patients with mild illness during the 2014 season.

The influenza A(H3N2) virus has circulated worldwide for almost five decades and is the dominant subtype in most seasonal influenza epidemics, as occurred in the 2014 season in South America. In this study we evaluate five whole genome sequences of influenza A(H3N2) viruses detected in patients with mild illness collected from January-March 2014. To sequence the genomes, a new generation sequencing (NGS) protocol was performed using the Ion Torrent PGM platform. In addition to analysing the common genes, haemagglutinin, neuraminidase and matrix, our work also comprised internal genes. This was the first report of a whole genome analysis with Brazilian influenza A(H3N2) samples. Considerable amino acid variability was encountered in all gene segments, demonstrating the importance of studying the internal genes. NGS of whole genomes in this study will facilitate deeper virus characterisation, contributing to the improvement of influenza strain surveillance in Brazil.

Twenty Years of Listeria in Brazil: Occurrence of Listeria Species and Listeria monocytogenes Serovars in Food Samples in Brazil between 1990 and 2012.

Listeria spp. isolated from different food products and collected from 12 Brazilian states were sent to the Laboratory of Bacterial Zoonoses (Oswaldo Cruz Institute, Brazil) for identification. The aims of this study were to characterize these isolates, from 1990 to 2012, by using biochemical, morphological, and serotyping tests, and to analyze the distribution of L. monocytogenes serotypes on different food products and geographical locations. Serotyping was performed using polyclonal somatic and flagellar antisera. Of 5953 isolates, 5770 were identified as Listeria spp., from which 3429 (59.4%) were L. innocua, 2248 (38.9%) were L. monocytogenes, and 93 (1.6%) were other Listeria spp. L. innocua was predominantly isolated from 1990 to 2000, while L. monocytogenes was from 2001 to 2012. Regarding the serotype distribution in the foods, serotypes 1/2a and 4b were most common in processed meat and ready-to-eat products, respectively; serotypes 1/2a, 1/2b, and 4b were the most common in nonprocessed meat. The results above confirm the presence of the main serotypes of L. monocytogenes in different parts of the food chain from three regions of the country and emphasize the importance of improving the control measures, as tolerance zero policy and microbiological surveillance in Brazil.

Phylogenetic analysis of human group C rotavirus circulating in Brazil reveals a potential unique NSP4 genetic variant and high similarity with Asian strains.

Group C rotaviruses (RVC) cause gastroenteritis in humans and animals worldwide, and the evidence for a possible zoonotic role has been recently provided. To gain information on the genetic diversity and relationships between human and animal RVC, we sequenced the VP4, VP7, and NSP4 genes of 12, 19, and 15 human strains, respectively, detected in São Paulo state during historical (1988 and 1993) and recent (2007 and 2008) Brazilian rotavirus surveillance. All RVC strains analyzed in the present study grouped into human genotype (G4-P[2]-E2), and did not show any evidence of animal ancestry. Phylogenetic analysis showed that RVC samples detected in 1988 and 1993 clustered together with strains from distinct continents, indicating that historical RVC strains circulating in São Paulo were closely related to those strains circulating worldwide. All three genes (VP7, VP4 and NSP4) of São Paulo RVC strains isolated in 2007-2008 exhibited close phylogenetic relationship with human RVC strains isolated in China and Japan, suggesting that they are genetically linked, and that a gene flow could be occurring between this Asian countries and Brazil. We identified two distinct clusters in the NSP4 phylogenetic tree. One cluster formed exclusively by human Brazilian strains detected in 1997 and 2003-2004 in Rio de Janeiro, Bahia, and Rio Grande do Sul states (Subgroup II) previously described in a different study, that displayed low sequence identities to other human strains formerly published, and to the Brazilian RVC strains (Subgroup I) characterized in the present study. These data suggests the circulation of two genetic profiles of the NSP4 gene in Brazil. High sequence diversity in NSP4 gene was previously reported in Asia, and additional diversity in NSP4 RVC strains spreading in the world should be expected. More in-depth molecular and epidemiological analysis of human RVC throughout the world will be needed to understand their diversity and clarify their evolution, as well as to develop classifications schemes.

Factors associated with tuberculosis by HIV status in the Brazilian national surveillance system: a cross sectional study.

BackgroundOver the last decade tuberculosis (TB) incidence and mortality in Brazil have been steadily declining. However, this downward trend has not been observed among HIV-infected patients. We describe the epidemiological and clinical profile of TB patients by HIV status using the Brazilian National Surveillance System.MethodsAll TB diagnoses with HIV status information between January 1, 2007 and December 31, 2011 were categorized as either HIV or non-HIV at time of TB diagnosis. Co-infected patients (TB-HIV) were compared to TB patients with no HIV-infection using a hierarchical logistic regression model using Stata 13.0.ResultsThe prevalence of TB-HIV co-infection was 19% among adults ≥ 15 years of age. We analyzed data from 243,676 individuals, of whom 46,466 were TB-HIV and 197,210 were only TB cases. The following factors increased risk of co-infection: male sex (OR: 1.06, 95% CI 1.03-1.10), 20 to 39 years of age (OR = 4.82, 95% CI 4.34-5.36), black (OR = 1.08, 95% CI 1.04-1.13), 4–7 years of education (OR = 1.13, 95% CI 1.19-1.28), diagnosed following default (OR = 2.65, 95% CI 1.13-6.25), presenting with pulmonary and extra-pulmonary forms of TB simultaneously (OR = 2.80, 95% CI 1.56-5.02), presenting with histopathologic examination suggestive of TB (OR = 2.15, 95% CI 1.13-4.07). Co-infected patients were less likely to live in rural areas (OR = 0.45, 95% CI 0.42-0.48), have diabetes (OR = 0.45, 95% CI 0.40-0.50) and be smear positive (OR = 0.55, 95% CI 0.32-0.95), and co-infected patients had higher risk of default (OR = 2.96, 95% CI 2.36-3.71) and death from TB (OR = 5.16, 95% CI 43.04-5.77).ConclusionsThe prevalence of co-infection with HIV among TB patients is 19% in Brazil. By identifying predictors of co-infection targeted interventions can be developed to prevent both TB and HIV, and to diagnose each disease earlier and ultimately decrease poor treatment outcomes and death.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-415) contains supplementary material, which is available to authorized users.

Frequency, distribution and time trends of types of leisure-time physical activity in Brazil, 2006-2012.

To describe the frequency and the distribution of the main types of leisure time physical activity (LTPA) practiced by Brazilian adults in 2012 and to observe their time trends from 2006 to 2012. Cross-sectional data from the Brazilian surveillance system of risk and protective factors for non-transmissible chronic diseases from 2006 to 2012 (around 54,000 adults aged 18 years or older in all Brazilian State capitals interviewed yearly). Participants were asked whether they had practiced any type of exercise or sport in the last 3 months, and if so which type. Linear regression was used to identify trends of the five most cited LTPA. In 2012, walking was reported as the main LTPA (18.1 %), followed by strength training/gymnastics (11.2 %) and football (7.2 %). Time-trend analysis showed reduction in football (9.1-7.2 %; p = 0.004, β = -0.25, R(2) = 0.79) and increase in strength training/gymnastics (7.9-11.2 %; p = 0.02, β = 0.50, R(2) = 0.62) and running (1.7-3.1 %; p < 0.001, β = 0.22, R(2) = 0.93). Walking was the main type of LTPA. Patterns of LTPA types remained relatively stable over the last 7 years.

Treatment outcomes in tuberculosis patients with diabetes: a polytomous analysis using Brazilian surveillance system.

BackgroundThe impact of non-communicable diseases on tuberculosis incidence has received significant attention. It has been suggested that the risk of tuberculosis is higher among subjects with diabetes and these subjects also has poor TB treatment outcomes.This study was aimed at assessing the socio-demographic and clinical factors that may influence different outcome of TB in patients with DM (TB-DM) identified in the Brazilian national database from 2001 to 2011.MethodsTB-DM cases reported in the Brazilian information system were identified and compared.Covariates associated with the outcomes of interest (cure, default, deaths, and development of TB MDR) were included in a hierarchical regression model.ResultsTB-DM cases increased from 380/100,000/year in 2001 to 6,150/100,000/year in 2011. Some of the main associations found are pointed. The odds of default was higher among those in the age group 20–39 years (OR = 2.07, 95%CI 1.32–3.24); alcoholics (OR = 2.17, 95%CI 1.86–2.54), and HIV/AIDS (OR = 2.16, 95%CI 1.70–2.74);positive monitoring smear (OR = 1.94, 95%CI 1.55–2.43); prior default (OR = 5.41, 95%CI 4.47–6.54), and unknown type of treatment (OR = 3.33, 95%CI 1.54–7.22). The odds of death was greater for subjects ≥60 years old (OR = 2.74, 95%CI 1.74–4.29); institutionalized in shelter (OR = 2.69, 95%CI 1.07–6.77); alcoholics (OR = 2.70, 95%CI 2.27–3.22); HIV/AIDS (OR = 2.87, 95%CI 2.13–3.86); pulmonary+extrapulmonary TB (OR = 2.49, 95%CI 1.79–3.46); with unknown type of treatment (OR = 14.12, 95%CI 7.04–28.32).Development of MDR TB was more related to relapse (OR = 9.60, 95%CI 6.07–15.14);previous default (OR = 17.13, 95%CI 9.58–30.63); and transfer of treatment center (OR = 7.87, 95%CI 4.74–13.07).ConclusionsOlder subjects and those with comorbidities and with a previous treatment of TB had poorest outcomes. TB control program in Brazil will need to expand efforts to focus on treatment of TB-DM patients to improve their cure rates in order to achieve the goals of tuberculosis elimination.

0227 Benzene occupational exposure estimates in Brazil using a job-exposure matrix

ObjectivesTo estimate the number and prevalence of occupational exposure to benzene in Brazil.MethodThis study was carried out with the economic active population of Brazil, using 2010 Census data. Benzene data...

Participação social no planejamento das ações e serviços de vigilância sanitária: uma análise crítica

Prompted by the data presented in the ANVISA’S preliminary report “Profile of Municipal Sanitary Surveillance in Brazil”, this article aims to make a critical analysis of the “debate”. About the planning of actions and Health Surveillance - VISA services . To achieve these objectives, it uses a case study conducted at the City Health Council of Belo Horizonte — CMSBH. Thirty five of the thirty six sitting members of CMSBH were interviewed, with the following results: 45.71% of the board members are unaware of the Plan of Action; 17:14% of them did not fully know the Plan of Action; 17:14% did not know the Plan of Action, but would like to know; 5.71% know of the existence of the Plan of Action and 14.29% know the Plan of Action. After three years of the completion of the case study, this paper resorted to documentary research to revisit the planning process of VISA, analyzing ANVISA’s documents, minutes of meetings and resolutions of CMSBH and Municipal Health Plan 2010-2013. From the recommendations of the study this paper seeks to find the progress and challenges of the process. It becomes clear the necessity of promoting a constant debate between the VISA and the society. This debate can occur through the exercise of social participation and control of the process of the formulation of Municipal Sanitary Surveillance’ policies.

Assessing the vulnerability of Brazilian municipalities to the vectorial transmission of Trypanosoma cruzi using multi-criteria decision analysis

Despite the dramatic reduction in Trypanosoma cruzi vectorial transmission in Brazil, acute cases of Chagas disease (CD) continue to be recorded. The identification of areas with greater vulnerability to the occurrence of vector-borne CD is essential to prevention, control, and surveillance activities. In the current study, data on the occurrence of domiciliated triatomines in Brazil (non-Amazonian regions) between 2007 and 2011 were analyzed. Municipalities’ vulnerability was assessed based on socioeconomic, demographic, entomological, and environmental indicators using multi-criteria decision analysis (MCDA). Overall, 2275 municipalities were positive for at least one of the six triatomine species analyzed (Panstrongylus megistus, Triatoma infestans, Triatoma brasiliensis, Triatoma pseudomaculata, Triatoma rubrovaria, and Triatoma sordida). The municipalities that were most vulnerable to vector-borne CD were mainly in the northeast region and exhibited a higher occurrence of domiciliated triatomines, lower socioeconomic levels, and more extensive anthropized areas. Most of the 39 new vector-borne CD cases confirmed between 2001 and 2012 in non-Amazonian regions occurred within the more vulnerable municipalities. Thus, MCDA can help to identify the states and municipalities that are most vulnerable to the transmission of T. cruzi by domiciliated triatomines, which is critical for directing adequate surveillance, prevention, and control activities. The methodological approach and results presented here can be used to enhance CD surveillance in Brazil.

HIV/AIDS coinfection with the hepatitis B and C viruses in Brazil

The aim of this study is to estimate the prevalence of HIV/HBV and HIV/HCV coinfections among AIDS cases reported in Brazil, and to describe the epidemiological profile of these cases. Coinfection was identified through probabilistic record linkage of the data of all patients carrying the HIV virus recorded as AIDS patients and of those patients reported as carriers of hepatitis B or C virus in various databases from the Brazilian Ministry of Health from 1999 to 2010. In this period 370,672 AIDS cases were reported, of which 3,724 were HIV/HBV coinfections. Women are less likely to become coinfected than men and the chance of coinfection increases with age. This study allowed an important evaluation of HBV/HIV and HCV/HIV coinfections in Brazil using information obtained via merging secondary databases from the Ministry of Health, without conducting seroprevalence research. The findings of this study might be important for planning activities of the Brazilian epidemiologic surveillance agencies.

Maternal near miss and death among women with severe hypertensive disorders: a Brazilian multicenter surveillance study

BackgroundHypertensive disorders represent the major cause of maternal morbidity in middle income countries. The main objective of this study was to identify the prevalence and factors associated with severe maternal outcomes in women with severe hypertensive disorders.MethodsThis was a cross-sectional, multicenter study, including 6706 women with severe hypertensive disorder from 27 maternity hospitals in Brazil. A prospective surveillance of severe maternal morbidity with data collected from medical charts and entered into OpenClinica®, an online system, over a one-year period (2009 to 2010). Women with severe preeclampsia, severe hypertension, eclampsia and HELLP syndrome were included in the study. They were grouped according to outcome in near miss, maternal death and potentially life-threatening condition. Prevalence ratios and 95% confidence intervals adjusted for cluster effect for maternal and perinatal variables and delays in receiving obstetric care were calculated as risk estimates of maternal complications having a severe maternal outcome (near miss or death). Poisson multiple regression analysis was also performed.ResultsSevere hypertensive disorders were the main cause of severe maternal morbidity (6706/9555); the prevalence of near miss was 4.2 cases per 1000 live births, there were 8.3 cases of Near Miss to 1 Maternal Death and the mortality index was 10.7% (case fatality). Early onset of the disease and postpartum hemorrhage were independent variables associated with severe maternal outcomes, in addition to acute pulmonary edema, previous heart disease and delays in receiving secondary and tertiary care.ConclusionsIn women with severe hypertensive disorders, the current study identified situations independently associated with a severe maternal outcome, which could be modified by interventions in obstetric care and in the healthcare system. Furthermore, the study showed the feasibility of a hospital system for surveillance of severe maternal morbidity.

Detection of Oseltamivir-Resistant Pandemic Influenza A(H1N1)pdm2009 in Brazil: Can Community Transmission Be Ruled Out?

Although surveillance efforts that monitor the emergence of drug-resistant strains of influenza are critical, systematic analysis is overlooked in most developing countries. We report on the occurrence of strains of pandemic influenza A(H1N1)pdm09 with resistance and decreased susceptibility to oseltamivir (OST) in Brazil in 2009, 2011 and 2012. We found 7 mutant viruses, 2 with the mutation S247N and other 5 with the mutation H275Y. Most of these viruses were from samples concentrated in the southern region of Brazil. Some of these resistant viruses were detected prior to the initiation of OST treatment, suggesting that community transmission of mutant viruses may exist. Moreover, we show that one of these OST-resistant (H275Y) strains of A(H1N1)pdm09 was discovered in the tri-border region between Brazil, Argentina and Paraguay, highlighting that this strain could also be found in other Latin American countries. Our findings reinforce the importance of enhanced antiviral resistance surveillance in Brazil and in other Latin American countries to confirm or rule out the community transmission of OST-resistant strains of A(H1N1)pdm09.

Rotavirus in adults, Brazil, 2004–2011: G2P[4] dominance and potential impact on vaccination

ObjectivesThe aim of this study was to monitor rotavirus (RV) infections in adults >18 years with acute gastroenteritis during 2004–2011 national Brazilian RV surveillance. In addition, to characterize the RV group A (RVA) strains in order to gain insight into the supposed vaccine selective pressure imposed to Brazilian children population. MethodsA total of 2102 convenient fecal specimens were investigated by ELISA, PAGE, and RT-PCR. ResultsRV was detected in 203 (9.6%) of 2102 specimens, and showed a marked peak of detection in September. RVA infection was detected in 9.4% (197/2102) and RV group C (RVC) in 0.3% (6/2102). The most frequent genotypes detected in 2004 and 2005 were G9P[8] (38.5%; 5/13) and G1P[8] (54.5%; 6/11), respectively. The dominant genotype identified from 2006 to 2011 was G2P[4] (64.4%; 116/180). Detection rate varied during the 8-year period of the study from 0.7% to 12.9%. ConclusionThe high detection rate of G2P[4] in adults provides further evidence that its dominance reflects the seasonality of RVA strains instead of the supposed selective advantage created by vaccination program. It also can be suggested that adult infections may serve as a reservoir to maintain RVA strains in childhood gastroenteritis. Considering the detection rate, the evident reduction of RVA frequency observed in children after vaccine introduction was not present in adults.

Nosocomial Bloodstream Infections in Brazilian Pediatric Patients: Microbiology, Epidemiology, and Clinical Features

BackgroundNosocomial bloodstream infections (nBSIs) are an important cause of morbidity and mortality and are the most frequent type of nosocomial infection in pediatric patients.MethodsWe identified the predominant pathogens and antimicrobial susceptibilities of nosocomial bloodstream isolates in pediatric patients (≤16 years of age) in the Brazilian Prospective Surveillance for nBSIs at 16 hospitals from 12 June 2007 to 31 March 2010 (Br SCOPE project).ResultsIn our study a total of 2,563 cases of nBSI were reported by hospitals participating in the Br SCOPE project. Among these, 342 clinically significant episodes of BSI were identified in pediatric patients (≤16 years of age). Ninety-six percent of BSIs were monomicrobial. Gram-negative organisms caused 49.0% of these BSIs, Gram-positive organisms caused 42.6%, and fungi caused 8.4%. The most common pathogens were Coagulase-negative staphylococci (CoNS) (21.3%), Klebsiella spp. (15.7%), Staphylococcus aureus (10.6%), and Acinetobacter spp. (9.2%). The crude mortality was 21.6% (74 of 342). Forty-five percent of nBSIs occurred in a pediatric or neonatal intensive-care unit (ICU). The most frequent underlying conditions were malignancy, in 95 patients (27.8%). Among the potential factors predisposing patients to BSI, central venous catheters were the most frequent (66.4%). Methicillin resistance was detected in 37 S. aureus isolates (27.1%). Of the Klebsiella spp. isolates, 43.2% were resistant to ceftriaxone. Of the Acinetobacter spp. and Pseudomonas aeruginosa isolates, 42.9% and 21.4%, respectively, were resistant to imipenem.ConclusionsIn our multicenter study, we found a high mortality and a large proportion of gram-negative bacilli with elevated levels of resistance in pediatric patients.

Fear, Security, and the Spread of CCTV in Brazilian Cities: Legislation, Debate, and the Market

Latin America has shown itself to be a fertile ground for the proliferation of surveillance cameras, especially in retail and in small-scale private security (homes, condominiums, shopping malls, etc.). In Brazil, this proliferation has occurred for three main reasons: the absence of specific legislation regulating how these systems are used; the limited scope of the debate about the deployment of surveillance technology and the implications of its widespread use; and a growing atmosphere of urban fear that affects the way people live in and move around large and medium-sized cities. In a study carried out in Brazil and Mexico and funded by the International Development Research Centre (IDRC), various aspects of the use of surveillance technologies were mapped and described, focusing on existing legislation, related studies, research centers, current technologies and the market. In this article we present some of the results of this research as they relate to the proliferation of video surveillance in Brazil. The Brazilian market for video surveillance, which has grown steadily since the 1980s, is now booming, reflecting the growing interest this technology holds for the (property and personal) security market as well as the real estate market. Over the past 30 years, this interest centered on public areas with large numbers of people, such as parks, squares, and major commercial streets, or private spaces such as shopping malls, sports centers, and event centers. However, in recent years there has been an expansion in the security market as a result of the gentrification of large residential areas in medium-sized cities and metropolitan regions in Brazil. A consequence of these developments in the real estate market has been, indirectly, a growth in the use of CCTV systems as crime- and violence-prevention tools by small, medium-sized, and large private security companies targeting all social classes. In this study, we highlight the following aspects of video surveillance in Brazil: regulation of the use and proliferation of CCTV; involvement of the scientific community through debate and academic training; and the technologies used in electronic surveillance as a response to a growing demand by the urban security and real estate markets.