Monitoramento das Produções

Title: Brasil já perdeu mais profissionais de enfermagem para o coronavírus do que Itália e Espanha juntas
Authors: Informe ENSP
Abstract: De acordo com o Conselho Federal de Enfermagem (Cofen), até o dia 6 de maio foram identificados 73 óbitos de profissionais pela covid-19 no país. São vítimas jovens: a maior parte (41) tinha menos de 60 anos, sendo uma delas de apenas 29 anos. A cidade de São Paulo, maior epicentro da crise sanitária no país, lidera o ranking com 18 mortos, seguida por Rio de Janeiro, com 14 casos. O Cofen laçou uma plataforma para monitorar as mortes na enfermagem em todo o Brasil, com o auxílio dos Conselhos Regionais. Além destas vítimas, outros 16 óbitos envolvendo trabalhadores da área ainda estão sob análise, aguardando resultado de testes. Para efeito de comparação, os Estados Unidos, país com maior número vítimas da pandemia (mais de 71.000), perdeu 46 profissionais de enfermagem, segundo entidades de classe. A Itália, segunda nação mais afetada pela doença com mais de 29.000 vítimas, teve 35 óbitos, de acordo com informações da Federazione Nazionale degli Ordini delle Professioni Infermieristiche, entidade equivalente ao Cofen no país europeu. A Espanha, que vem logo atrás com mais de 25.000 mortos, teve apenas quatro óbitos entre profissionais da área, segundo o Consejo General de Enfermería. Os dois países europeus tiveram o início da crise antes que o Brasil e já passaram do pico de casos. “Um dos fatores [para a alta mortalidade] é que boa parte dos serviços de Saúde não afastou profissionais com idade avançada, acima de 60 anos, e com comorbidades. Eles continuam atuando na linha de frente da pandemia quando deveriam estar em serviços de retaguarda ou afastados”, afirma Manoel Neri, presidente do Cofen. Foi este o caso da enfermeira Maria Aparecida Duarte, 63, conhecida pelos colegas como Cidinha. Ela continuou trabalhando praticamente na porta de um pronto-socorro em Carapicuiba, na Região Metropolitana de São Paulo, apesar de ser parte do grupo de risco. Contraiu a doença e morreu em 3 de abril.

by Vivek Verma, Ramesh K. Vishwakarma, Anita Verma, Dilip C. Nath, Hafiz T. A. Khan
Background The outbreak of coronavirus disease, 2019 (COVID-19), which started from Wuhan, China, in late 2019, have spread worldwide. A total of 5,91,971 cases and 2,70,90 deaths were registered till 28th March, 2020. We aimed to predict the impact of duration of exposure to COVID-19 on the mortality rates increment. Methods In the present study, data on COVID-19 infected top seven countries viz., Germany, China, France, United Kingdom, Iran, Italy and Spain, and World as a whole, were used for modeling. The analytical procedure of generalized linear model followed by Gompertz link function was used to predict the impact lethal duration of exposure on the mortality rates. Findings Of the selected countries and World as whole, the projection based on 21st March, 2020 cases, suggest that a total (95% Cl) of 76 (65–151) days of exposure in Germany, mortality rate will increase by 5 times to 1%. In countries like France and United Kingdom, our projection suggests that additional exposure of 48 days and 7 days, respectively, will raise the mortality rates to10%. Regarding Iran, Italy and Spain, mortality rate will rise to 10% with an additional 3–10 days of exposure. World’s mortality rates will continue increase by 1% in every three weeks. The predicted interval of lethal duration corresponding to each country has found to be consistent with the mortality rates observed on 28th March, 2020. Conclusion The prediction of lethal duration was found to have apparently effective in predicting mortality, and shows concordance with prevailing rates. In absence of any vaccine against COVID-19 infection, the present study adds information about the quantum of the severity and time elapsed to death will help the Government to take necessary and appropriate steps to control this pandemic.

by Frédéric Jourdain, David Roiz, Henriette de Valk, Harold Noël, Grégory L’Ambert, Florian Franke, Marie-Claire Paty, Anne Guinard, Jean-Claude Desenclos, Benjamin Roche
Background The global spread of Aedes albopictus has exposed new geographical areas to the risk of dengue and chikungunya virus transmission. Several autochthonous transmission events have occurred in recent decades in Southern Europe and many indicators suggest that it will become more frequent in this region in the future. Environmental, socioeconomic and climatic factors are generally considered to trigger the emergence of these viruses. Accordingly, a greater knowledge of the determinants of this emergence in a European context is necessary to develop adapted surveillance and control strategies, and public health interventions. Methodology/Principal findings Using French surveillance data collected from between 2010 and 2018 in areas of Southern France where Ae. albopictus is already established, we assessed factors associated with the autochthonous transmission of dengue and chikungunya. Cases leading to autochthonous transmission were compared with those without subsequent transmission using binomial regression. We identified a long reporting delay (≥ 21 days) of imported cases to local health authorities as the main driver for autochthonous transmission of dengue and chikungunya in Southern France. The presence of wooded areas around the cases’ place of residence and the accumulation of heat during the season also increased the risk of autochthonous arbovirus transmission. Conclusions Our findings could inform policy-makers when developing strategies to the emerging threats of dengue and chikungunya in Southern Europe and can be extrapolated in this area to other viruses such as Zika and yellow fever, which share the same vector. Furthermore, our results allow a more accurate characterization of the environments most at risk, and highlight the importance of implementing surveillance systems which ensure the timely reporting and of imported cases and swift interventions.

by Nabeel Abdur Rehman, Henrik Salje, Moritz U G Kraemer, Lakshminarayanan Subramanian, Umar Saif, Rumi Chunara

Increasing urbanization is having a profound effect on infectious disease risk, posing significant challenges for governments to allocate limited resources for their optimal control at a sub-city scale. With recent advances in data collection practices, empirical evidence about the efficacy of highly localized containment and intervention activities, which can lead to optimal deployment of resources, is possible. However, there are several challenges in analyzing data from such real-world observational settings. Using data on 3.9 million instances of seven dengue vector containment activities collected between 2012 and 2017, here we develop and assess two frameworks for understanding how the generation of new dengue cases changes in space and time with respect to application of different types of containment activities. Accounting for the non-random deployment of each containment activity in relation to dengue cases and other types of containment activities, as well as deployment of activities in different epidemiological contexts, results from both frameworks reinforce existing knowledge about the efficacy of containment activities aimed at the adult phase of the mosquito lifecycle. Results show a 10% (95% CI: 1–19%) and 20% reduction (95% CI: 4–34%) reduction in probability of a case occurring in 50 meters and 30 days of cases which had Indoor Residual Spraying (IRS) and fogging performed in the immediate vicinity, respectively, compared to cases of similar epidemiological context and which had no containment in their vicinity. Simultaneously, limitations due to the real-world nature of activity deployment are used to guide recommendations for future deployment of resources during outbreaks as well as data collection practices. Conclusions from this study will enable more robust and comprehensive analyses of localized containment activities in resource-scarce urban settings and lead to improved allocation of resources of government in an outbreak setting.

by Amanda Murphy, Giri Shan Rajahram, Jenarun Jilip, Marilyn Maluda, Timothy William, Wenbiao Hu, Simon Reid, Gregor J. Devine, Francesca D. Frentiu

In South East Asia, dengue epidemics have increased in size and geographical distribution in recent years. We examined the spatiotemporal distribution and epidemiological characteristics of reported dengue cases in the predominantly rural state of Sabah, in Malaysian Borneo–an area where sylvatic and urban circulation of pathogens are known to intersect. Using a public health data set of routinely notified dengue cases in Sabah between 2010 and 2016, we described demographic and entomological risk factors, both before and after a 2014 change in the clinical case definition for the disease. Annual dengue incidence rates were spatially variable over the 7-year study period from 2010–2016 (state-wide mean annual incidence of 21 cases/100,000 people; range 5-42/100,000), but were highest in rural localities in the western districts of the state (Kuala Penyu, Nabawan, Tenom and Kota Marudu). Eastern districts exhibited lower overall dengue rates, although a high proportion of severe (haemorrhagic) dengue cases (44%) were focused in Sandakan and Tawau. Dengue incidence was highest for those aged between 10 and 29 years (24/100,000), and was slightly higher for males compared to females. Available vector surveillance data indicated that during large outbreaks in 2015 and 2016 the mosquito Aedes albopictus was more prevalent in both urban and rural households (House Index of 64%) than Ae. aegypti (15%). Demographic patterns remained unchanged both before and after the dengue case definition was changed; however, in the years following the change, reported case numbers increased substantially. Overall, these findings suggest that dengue outbreaks in Sabah are increasing in both urban and rural settings. Future studies to better understand the drivers of risk in specific age groups, genders and geographic locations, and to test the potential role of Ae. albopictus in transmission, may help target dengue prevention and control efforts.

by Jaber S. Alqahtani, Tope Oyelade, Abdulelah M. Aldhahir, Saeed M. Alghamdi, Mater Almehmadi, Abdullah S. Alqahtani, Shumonta Quaderi, Swapna Mandal, John R. Hurst
Background Coronavirus disease 2019 (COVID-19) is an evolving infectious disease that dramatically spread all over the world in the early part of 2020. No studies have yet summarized the potential severity and mortality risks caused by COVID-19 in patients with chronic obstructive pulmonary disease (COPD), and we update information in smokers. Methods We systematically searched electronic databases from inception to March 24, 2020. Data were extracted by two independent authors in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Study quality was assessed using a modified version of the Newcastle-Ottawa Scale. We synthesized a narrative from eligible studies and conducted a meta-analysis using a random-effects model to calculate pooled prevalence rates and 95% confidence intervals (95%CI). Results In total, 123 abstracts were screened and 61 full-text manuscripts were reviewed. A total of 15 studies met the inclusion criteria, which included a total of 2473 confirmed COVID-19 patients. All studies were included in the meta-analysis. The crude case fatality rate of COVID-19 was 7.4%. The pooled prevalence rates of COPD patients and smokers in COVID-19 cases were 2% (95% CI, 1%–3%) and 9% (95% CI, 4%–14%) respectively. COPD patients were at a higher risk of more severe disease (risk of severity = 63%, (22/35) compared to patients without COPD 33.4% (409/1224) [calculated RR, 1.88 (95% CI, 1.4–2.4)]. This was associated with higher mortality (60%). Our results showed that 22% (31/139) of current smokers and 46% (13/28) of ex-smokers had severe complications. The calculated RR showed that current smokers were 1.45 times more likely [95% CI: 1.03–2.04] to have severe complications compared to former and never smokers. Current smokers also had a higher mortality rate of 38.5%. Conclusion Although COPD prevalence in COVID-19 cases was low in current reports, COVID-19 infection was associated with substantial severity and mortality rates in COPD. Compared to former and never smokers, current smokers were at greater risk of severe complications and higher mortality rate. Effective preventive measures are required to reduce COVID-19 risk in COPD patients and current smokers.

Title: Violence against women, children, and adolescents during the COVID-19 pandemic: overview, contributing factors, and mitigating measures
Authors: Marques, Emanuele Souza; Moraes, Claudia Leite de; Hasselmann, Maria Helena; Deslandes, Suely Ferreira; Reichenheim, Michael Eduardo

Title: Posicionamento da Fundação Oswaldo Cruz (Fiocruz) – 06/05/2020: a evolução da Covid-19 no Estado do Rio de Janeiro: desafios no enfrentamento da crise sanitária e humanitária relacionada à pandemia

by Jang-Hoon Choi, Hye-Min Woo, Tae-young Lee, So-young Lee, Sang-Mu Shim, Woo-Jung Park, Jeong-Sun Yang, Joo Ae Kim, Mi-Ran Yun, Dae-Won Kim, Sung Soon Kim, Yi Zhang, Wei Shi, Lingshu Wang, Barney S. Graham, John R. Mascola, Nanshuang Wang, Jason S. McLellan, Joo-Yeon Lee, Hansaem Lee

Middle East respiratory syndrome coronavirus (MERS-CoV) causes severe respiratory infection and continues to infect humans, thereby contributing to a high mortality rate (34.3% in 2019). In the absence of an available licensed vaccine and antiviral agent, therapeutic human antibodies have been suggested as candidates for treatment. In this study, human monoclonal antibodies were isolated by sorting B cells from patient’s PBMC cells with prefusion stabilized spike (S) probes and a direct immunoglobulin cloning strategy. We identified six receptor-binding domain (RBD)-specific and five S1 (non-RBD)-specific antibodies, among which, only the RBD-specific antibodies showed high neutralizing potency (IC50 0.006–1.787 μg/ml) as well as high affinity to RBD. Notably, passive immunization using a highly potent antibody (KNIH90-F1) at a relatively low dose (2 mg/kg) completely protected transgenic mice expressing human DPP4 against MERS-CoV lethal challenge. These results suggested that human monoclonal antibodies isolated by using the rationally designed prefusion MERS-CoV S probe could be considered potential candidates for the development of therapeutic and/or prophylactic antiviral agents for MERS-CoV human infection.

by Rui Huang, Li Zhu, Leyang Xue, Longgen Liu, Xuebing Yan, Jian Wang, Biao Zhang, Tianmin Xu, Fang Ji, Yun Zhao, Juan Cheng, Yinling Wang, Huaping Shao, Shuqin Hong, Qi Cao, Chunyang Li, Xiang-an Zhao, Lei Zou, Dawen Sang, Haiyan Zhao, Xinying Guan, Xiaobing Chen, Chun Shan, Juan Xia, Yuxin Chen, Xiaomin Yan, Jie Wei, Chuanwu Zhu, Chao Wu

Limited data are available for clinical characteristics of patients with coronavirus disease 2019 (COVID-19) outside Wuhan. This study aimed to describe the clinical characteristics of COVID-19 and identify the risk factors for severe illness of COVID-19 in Jiangsu province, China. Clinical data of hospitalized COVID-19 patients were retrospectively collected in 8 hospitals from 8 cities of Jiangsu province, China. Clinical findings of COVID-19 patients were described and risk factors for severe illness of COVID-19 were analyzed. By Feb 10, 2020, 202 hospitalized patients with COVID-19 were enrolled. The median age of patients was 44.0 years (interquartile range, 33.0–54.0). 55 (27.2%) patients had comorbidities. At the onset of illness, the common symptoms were fever (156 [77.2%]) and cough (120 [59.4%]). 66 (32.7%) patients had lymphopenia. 193 (95.5%) patients had abnormal radiological findings. 11 (5.4%) patients were admitted to the intensive care unit and none of the patients died. 23 (11.4%) patients had severe illness. Severe illness of COVID-19 was independently associated with body mass index (BMI) ≥ 28 kg/m2 (odds ratio [OR], 9.219; 95% confidence interval [CI], 2.731 to 31.126; P

by Constância F. J. Ayres, Gonçalo Seixas, Sílvia Borrego, Cátia Marques, Inilça Monteiro, Camila S. Marques, Bruna Gouveia, Silvania Leal, Arlete D. Troco, Filomeno Fortes, Ricardo Parreira, João Pinto, Carla A. Sousa

The extensive use of insecticides for vector control has led to the development of insecticide resistance in Aedes aegypti populations on a global scale, which has significantly compromised control actions. Insecticide resistance, and its underlying mechanisms, has been investigated in several countries, mostly in South American and Asian countries. In Africa, however, studies reporting insecticide resistance are rare and data on resistance mechanisms, notably knockdown resistance (kdr) mutations, is scarce. In this study, the recently described V410L kdr mutation is reported for the first time in old world Ae. aegypti populations, namely from Angola and Madeira island. Two additional kdr mutations, V1016I and F1534C, are also reported for the first time in populations from Angola and Cape Verde. Significant associations with the resistance phenotype were found for both V410L and V1016I individually as well as for tri-locus genotypes in the Angolan population. However, no association was found in Madeira island, probably due to the presence of a complex pattern of multiple insecticide resistance mechanisms in the local Ae. aegypti population. These results suggest that populations carrying the same kdr mutations may respond differently to the same insecticide, stressing the need for complementary studies when assessing the impact of kdr resistance mechanisms in the outcome of insecticide-based control strategies.

Title: Coronavírus faz educação à distância esbarrar no desafio do acesso à internet e da inexperiência dos alunos
Authors: Informe ENSP
Abstract: O aumento no número de casos de coronavírus no Brasil levou à suspensão de aulas da rede pública e privada em todo o país. A medida serve para evitar aglomerações e deslocamentos. Segundo autoridades de Saúde, uma das melhores formas de parar a transmissão de casos é ficar em isolamento social. Sem aulas, estabelecimentos de ensino têm adotado a educação à distância (EAD), com uso de computadores e atividades complementares, para dar continuidade à aprendizagem das crianças. No entanto, nem todos os estudantes do país têm acesso a computadores e à internet de qualidade. Outro problema é manter a concentração de crianças mais novas, enquanto os pais também trabalham em casa. Segundo a Unicef, 154 milhões de estudantes estão sem aulas na América Latina e Caribe. A entidade alerta que a situação poderá se estender, e há risco de abandono escolar definitivo.

by Kévin Jean, Arran Hamlet, Justus Benzler, Laurence Cibrelus, Katy A. M. Gaythorpe, Amadou Sall, Neil M. Ferguson, Tini Garske
Background To counter the increasing global risk of Yellow fever (YF), the World Health Organisation initiated the Eliminate Yellow fever Epidemics (EYE) strategy. Estimating YF burden, as well as vaccine impact, while accounting for the features of urban YF transmission such as indirect benefits of vaccination, is key to informing this strategy. Methods and findings We developed two model variants to estimate YF burden in sub-Saharan Africa, assuming all infections stem from either the sylvatic or the urban cycle of the disease. Both relied on an ecological niche model fitted to the local presence of any YF reported event in 34 African countries. We calibrated under-reporting using independent estimates of transmission intensity provided by 12 serological surveys performed in 11 countries. We calculated local numbers of YF infections, deaths and disability-adjusted life years (DALYs) lost based on estimated transmission intensity while accounting for time-varying vaccination coverage. We estimated vaccine demand and impact of future preventive mass vaccination campaigns (PMVCs) according to various vaccination scenarios.Vaccination activities conducted in Africa between 2005 and 2017 were estimated to prevent from 3.3 (95% CI 1.2–7.7) to 6.1 (95% CI 2.4–13.2) millions of deaths over the lifetime of vaccinees, representing extreme scenarios of none or maximal herd effects, respectively. By prioritizing provinces based on the risk of urban YF transmission in future PMVCs, an average of 37.7 million annual doses for PMVCs over eight years would avert an estimated 9,900,000 (95% CI 7,000,000–13,400,000) infections and 480,000 (180,000–1,140,000) deaths over the lifetime of vaccinees, corresponding to 1.7 (0.7–4.1) deaths averted per 1,000 vaccine doses. Conclusions By estimating YF burden and vaccine impact over a range of spatial and temporal scales, while accounting for the specificity of urban transmission, our model can be used to inform the current EYE strategy.

by Matthew J. Miller, Jose R. Loaiza, Anshule Takyar, Robert H. Gilman

Title: Perguntas e respostas sobre COVID-19 e Doença de Chagas
Authors: Ferreira, Roberto Rodrigues; Araujo-Jorge, Tania Cremonini
Abstract: Diante da pandemia do coronavírus (COVID-19), apresentamos algumas
recomendações gerais para pessoas afetadas pela doença de Chagas. É importante considerar que cada uma das situações particulares pode diferir bastante. Portanto, é aconselhável seguir as recomendações das autoridades de saúde nos níveis local e nacional. O COVID-19 é um desafio relativamente novo à saúde e ainda não temos evidências suficientes para saber como ele interage com outras infecções. No entanto,
existem medidas que podem nos dar uma boa proteção contra o vírus.

Title: Protective immunity after COVID-19 has been questioned: what can we do without SARS-CoV-2-IgG detection?
Authors: Melgaço, Juliana Gil; Azamor, Tamiris; Bom, Ana Paula Dinis Ano

Title: Structural characterization and polymorphism analysis of the NS2B-NS3 protease from the 2017 Brazilian circulating strain of Yellow Fever virus
Authors: Noske, Gabriela Dias; Gawriljuk, Victor Oliveira; Fernandes, Rafaela Sachetto; Furtado, Nathalia Dias; Bonaldo, Myrna Cristina; Oliva, Glaucius; Godoy, Andre Schutzer

by Thaddeus M. Carvajal, Kohei Ogishi, Sakiko Yaegeshi, Lara Fides T. Hernandez, Katherine M. Viacrusis, Howell T. Ho, Divina M. Amalin, Kozo Watanabe

Dengue is a highly endemic disease in Southeast Asia and is transmitted primarily by the mosquito, Aedes aegypti. The National Capital Region (NCR) of the Philippines, or Metropolitan Manila, is a highly urbanized area that is greatly affected by this arboviral disease. Urbanization has been shown to increase the dispersal of this mosquito vector. For this reason, we conducted a fine-scale population genetic study of Ae. aegypti in this region. We collected adult Ae. aegypti mosquitoes (n = 526 individuals) within the region (n = 21 study areas) and characterized the present population structure and the genetic relatedness among mosquito populations. We genotyped 11 microsatellite loci from all sampled mosquito individuals and analyzed their genetic diversity, differentiation and structure. The results revealed low genetic differentiation across mosquito populations which suggest high gene flow and/or weak genetic drift among mosquito populations. Bayesian analysis indicated multiple genetic structures (K = 3–6), with no clear genetically distinct population structures. This result implies the passive or long-distance dispersal capability nature Ae. aegypti possibly through human-mediated transportation. The constructed dendrogram in this study describes the potential passive dispersal patterns across Metropolitan Manila. Furthermore, spatial autocorrelation analysis showed the limited and active dispersal capability (

Title: COVID-19 faecal-oral transmission: Are we asking the right questions?
Authors: Heller, Léo; Mota, César R.; Greco, Dirceu B.
Description: Documento disponível em acesso aberto pela Editora, devido a pandemia da COVID-19.

by Daihai He, Shi Zhao, Qianying Lin, Salihu S. Musa, Lewi Stone
Background Between January 2015 and August 2016, two epidemic waves of Zika virus (ZIKV) disease swept the Northeastern (NE) region of Brazil. As a result, two waves of Guillain-Barré Syndrome (GBS) were observed concurrently. The mandatory reporting of ZIKV disease began region-wide in February 2016, and it is believed that ZIKV cases were significantly under-reported before that. The changing reporting rate has made it difficult to estimate the ZIKV infection attack rate, and studies in the literature vary widely from 17% to > 50%. The same applies to other key epidemiological parameters. In contrast, the diagnosis and reporting of GBS cases were reasonably reliable given the severity and easy recognition of the disease symptoms. In this paper, we aim to estimate the real number of ZIKV cases (i.e., the infection attack rate) and their dynamics in time, by scaling up from GBS surveillance data in NE Brazil. Methodology A mathematical compartmental model is constructed that makes it possible to infer the true epidemic dynamics of ZIKV cases based on surveillance data of excess GBS cases. The model includes the possibility that asymptomatic ZIKV cases are infectious. The model is fitted to the GBS surveillance data and the key epidemiological parameters are inferred by using a plug-and-play likelihood-based estimation. We make use of regional weather data to determine possible climate-driven impacts on the reproductive number R 0, and to infer the true ZIKV epidemic dynamics. Findings and conclusions The GBS surveillance data can be used to study ZIKV epidemics and may be appropriate when ZIKV reporting rates are not well understood. The overall infection attack rate (IAR) of ZIKV is estimated to be 24.1% (95% confidence interval: 17.1%—29.3%) of the population. By examining various asymptomatic scenarios, the IAR is likely to be lower than 33% over the two ZIKV waves. The risk rate from symptomatic ZIKV infection to develop GBS was estimated as ρ = 0.0061% (95% CI: 0.0050%—0.0086%) which is significantly less than current estimates. We found a positive association between local temperature and the basic reproduction number, R 0. Our analysis revealed that asymptomatic infections affect the estimation of ZIKV epidemics and need to also be carefully considered in related modelling studies. According to the estimated effective reproduction number and population wide susceptibility, we comment that a ZIKV outbreak would be unlikely in NE Brazil in the near future.

Title: Webinar: Vulnerabilidades, impactos e o enfrentamento à COVID-19 no contexto dos povos indígenas: reflexões para ação
Abstract: Evento virtual que aconteceu na terça-feira (28/04/2020) às 11h, com o objetivo de gerar reflexões para ação sobre os impactos sociais da pandemia. Transmissão ao vivo no Portal Fiocruz e no canal da Fiocruz no Youtube.
Description: Disponível também no canal da Fiocruz no Youtube.

by Marissa G. Baker, Trevor K. Peckham, Noah S. Seixas
Introduction With the global spread of COVID-19, there is a compelling public health interest in quantifying who is at increased risk of contracting disease. Occupational characteristics, such as interfacing with the public and being in close quarters with other workers, not only put workers at high risk for disease, but also make them a nexus of disease transmission to the community. This can further be exacerbated through presenteeism, the term used to describe the act of coming to work despite being symptomatic for disease. Quantifying the number of workers who are frequently exposed to infection and disease in the workplace, and understanding which occupational groups they represent, can help to prompt public health risk response and management for COVID-19 in the workplace, and subsequent infectious disease outbreaks. Methods To estimate the number of United States workers frequently exposed to infection and disease in the workplace, national employment data (by Standard Occupational Classification) maintained by the Bureau of Labor Statistics (BLS) was merged with a BLS O*NET survey measure reporting how frequently workers in each occupation are exposed to infection or disease at work. This allowed us to estimate the number of United States workers, across all occupations, exposed to disease or infection at work more than once a month. Results Based on our analyses, approximately 10% (14.4 M) of United States workers are employed in occupations where exposure to disease or infection occurs at least once per week. Approximately 18.4% (26.7 M) of all United States workers are employed in occupations where exposure to disease or infection occurs at least once per month. While the majority of exposed workers are employed in healthcare sectors, other occupational sectors also have high proportions of exposed workers. These include protective service occupations (e.g. police officers, correctional officers, firefighters), office and administrative support occupations (e.g. couriers and messengers, patient service representatives), education occupations (e.g. preschool and daycare teachers), community and social services occupations (community health workers, social workers, counselors), and even construction and extraction occupations (e.g. plumbers, septic tank installers, elevator repair). Conclusions The large number of persons employed in occupations with frequent exposure to infection and disease underscore the importance of all workplaces developing risk response plans for COVID-19. Given the proportion of the United States workforce exposed to disease or infection at work, this analysis also serves as an important reminder that the workplace is a key locus for public health interventions, which could protect both workers and the communities they serve.

by Kentaro Itokawa, Jinping Hu, Nayu Sukehiro, Yoshio Tsuda, Osamu Komagata, Shinji Kasai, Takashi Tomita, Noboru Minakawa, Kyoko Sawabe

The introduction of exotic disease vectors into a new habitat can drastically change the local epidemiological situation. During 2012–2015, larvae and an adult of the yellow-fever mosquito, Aedes aegypti, were captured alive at two international airports serving the Greater Tokyo Area, Japan. Because this species does not naturally distribute in this country, those mosquitoes were considered to be introduced from overseas via air-transportation. To infer the places of origin of those mosquitoes, we genotyped the 12 microsatellite loci for which the most comprehensive population genetic reference is currently available. Although clustering by Bayesian and multivariate methods both suggested that all those mosquitoes captured at the airports in Japan belonged to the Asia/Pacific populations, they were not clustered into a single cluster. Moreover, there was variation in mitochondrial cytochrome oxidase I gene (CoxI) haplotypes among mosquitoes collected in different incidents of discovery which indicated the existence of multiple maternal origins. We conclude there is little evidence to support the overwintering of Ae. aegypti at the airports; nevertheless, special attention is still needed to prevent the invasion of this prominent arbovirus vector.

Title: Mulheres, violência e pandemia de novo coronavírus
Authors: Bevilacqua, Paula Dias
Description: Texto publicado originalmente no site Pensar a Educação, Pensar o Brasil.

by Sonja E. Leonhard, Cristiane C. Bresani-Salvi, Joanna D. Lyra Batista, Sergio Cunha, Bart C. Jacobs, Maria Lucia Brito Ferreira, Maria de Fatima P. Militão de Albuquerque
Background The Zika virus (ZIKV) has been associated with Guillain-Barré syndrome (GBS) in epidemiological studies. Whether ZIKV-associated GBS is related to a specific clinical or electrophysiological phenotype has not been established. To this end, we performed a systematic review and meta-analysis of all published studies on ZIKV-related GBS. Methods We searched Pubmed, EMBASE and LILACS, and included all papers, reports or bulletins with full text in English, Spanish or Portuguese, reporting original data of patients with GBS and a suspected, probable or confirmed recent ZIKV infection. Data were extracted according to a predefined protocol, and pooled proportions were calculated. Results Thirty-five studies were included (13 single case reports and 22 case series, case-control or cohort studies), reporting on a total of 601 GBS patients with a suspected, probable or confirmed ZIKV infection. Data from 21 studies and 587 cases were available to be summarized. ZIKV infection was confirmed in 21%, probable in 22% and suspected in 57% of cases. ZIKV PCR was positive in 30% (95%CI 15–47) of tested patients. The most common clinical features were: limb weakness 97% (95%CI 93–99), diminished/absent reflexes 96% (95%CI 88–100), sensory symptoms 82% (95%CI 76–88), and facial palsy 51% (95%CI 44–58). Median time between infectious and neurological symptoms was 5–12 days. Most cases had a demyelinating electrophysiological subtype and half of cases were admitted to the Intensive Care Unit (ICU). Heterogeneity between studies was moderate to substantial for most variables. Conclusions The clinical phenotype of GBS associated with ZIKV infection reported in literature is generally a sensorimotor demyelinating GBS with frequent facial palsy and a severe disease course often necessitating ICU admittance. Time between infectious and neurological symptoms and negative PCR in most cases suggests a post-infectious disease mechanism. Heterogeneity between studies was considerable and results may be subject to reporting bias. This study was registered on the international Prospective Register of Systematic Reviews (CRD42018081959).

Title: Effect of High vs Low Doses of Chloroquine Diphosphate as Adjunctive Therapy for Patients Hospitalized With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection A Randomized Clinical Trial
Authors: Borba, Mayla Gabriela Silva; Val, Fernando Fonseca Almeida; Sampaio, Vanderson Souza; Alexandre, Marcia Almeida Araújo; Melo, Gisely Cardoso; Brito, Marcelo; Mourão, Maria Paula Gomes; Sousa, José Diego Brito; Silva, Djane Baia da; Guerra, Marcus Vinitius Farias; Hajjar, Ludhmila Abrahão; Pinto, Rosemary Costa; Balieiro, Antonio Alcirley Silva; Pacheco, Antônio Guilherme Fonseca; Santos Jr., James Dean Oliveira; Naveca, Felipe Gomes; Xavier, Mariana Simão; Siqueira, André Machado; Schwarzbold, Alexandre; Croda, Júlio; Nogueira, Maurício Lacerda; Romero, Gustavo Adolfo Sierra; Bassat, Quique; Fontes, Cor Jesus; Albuquerque, Bernardino Cláudio; Daniel-Ribeiro, Cláudio Tadeu; Monteiro, Wuelton Marcelo; Lacerda, Marcus Vinícius Guimarães; CloroCovid-19 Team

Title: COVID-19: a meta-analysis of diagnostic test accuracy of commercial assays registered in Brazil
Authors: Castro, Rodolfo; Luz, Paula M.; Wakimoto, Mayumi D.; Veloso, Valdilea G.; Grinsztejn, Beatriz; Perazzo, Hugo
Description: The authors declare no conflict of interest.

Title: Existe o dever de falar a verdade no contexto da Covid-19?, questiona artigo
Authors: Informe ENSP
Abstract: O artigo Existe o dever de falar a verdade no contexto da Covid-19?, publicado pelo GT de Bioética da Associação Brasileira de Saúde Coletiva (Abrasco), aborda a questão imperativa de ser verdadeiro em um cenário de emergência em Saúde Pública. No texto, os pesquisadores alertaram para o fato de que “vivemos mais um momento em que as verdades científicas são questionadas por dúvidas razoáveis que movimentam o método científico, como seria natural, mas não por opiniões, que são determinadas por visões ideológicas que desprezam argumentos científicos, ideias fantasiosas ou ficcionais tomam o lugar do respeito às verdades científicas”. No artigo, os pesquisadores ressaltam que “o Brasil é um país com uma história notadamente autoritária. A baixa consciência política da população em geral é reforçada por uma história de ações violentas do Estado contra aqueles que se envolvem na organização popular, independente dos governos”. Os autores apontaram que, tradicionalmente, os governos são pouco transparentes ao lidarem com questões que afligem a população, e os meios de comunicação tradicionais, muitas vezes, apresentam apenas uma versão dos fatos. “Mais do que nunca, cabe afirmar o direito de as populações serem adequadamente informadas e esclarecidas sobre assuntos que são de seu interesse direto. De acordo com essa lógica, as informações sobre a pandemia deveriam ser baseadas em evidências e submetidas à permanente avaliação de especialistas e autoridades, sejam políticas ou técnicas”, defendem os autores no texto.

Title: Relatório avalia disseminação da Covid-19 entre indígenas
Authors: Informe ENSP
Abstract: Um grupo de pesquisadores da Fiocruz e da Fundação Getulio Vargas (FGV) acaba de produzir um relatório sobre o risco de disseminação da Covid-19 entre populações indígenas a partir da vulnerabilidade geográfica e sociodemográfica desse segmento. De acordo com o estudo, a chegada da Covid-19 impõe grandes desafios às comunidades indígenas, às autoridades de saúde e a toda a sociedade para promover a proteção dessa população contra a nova doença, que pode causar grandes impactos sociais de saúde. Com a interiorização da epidemia, o que é esperado para as próximas semanas, deverá ocorrer um expressivo aumento do montante da população indígena em alto risco. Os pesquisadores anexaram ao relatório uma carta dirigida ao Conselho Deliberativo (CD) da Fiocruz. Em um trecho da carta, os pesquisadores afirmam que “o crescimento exponencial de casos confirmados de Covid-19 na população brasileira e a clara interiorização da circulação viral, com destaque para os estados do Amazonas e Amapá, nos alertam para os impactos dessa pandemia nos povos indígenas”. O relatório é o primeiro de uma série que acompanhará a disseminação da epidemia na população indígena. O documento foi produzido por pesquisadores do Núcleo de Métodos Analíticos para Vigilância em Epidemiologia do Programa de Computação Científica da Fiocruz e da FGV, em parceria com Grupo de Trabalho sobre Vulnerabilidade Sociodemográfica e Epidemiológica dos Povos Indígenas no Brasil à Pandemia de Covid-19, da Escola Nacional de Saúde Pública (Ensp/Fiocruz). Acesse o relatório no campo “Documento relacionado”, abaixo.

Title: Microcefalia pelo Zika Vírus: as ações do poder legislativo e executivo brasileiro no combate à epidemia
Authors: Barbosa, Larissa Arruda; Bem, Ivan Pricken de
Abstract: Objetivo: O artigo aborda o tema da microcefalia pelo Zika Vírus e as ações que foram realizadas pelo Poder Legislativo e Executivo. Metodologia: Foi feito um estudo exploratório no Observatório da Saúde e suas diferentes categorias. Utilizou-se buscas em banco de dados do Senado federal e da Câmara dos Deputados Resultados: Foram encontrados 27 projetos de lei e uma medida provisória que foi transformada na Lei nº 13.301 de 2016. As categorias que ganharam destaque estão relacionadas a indenizações e benefícios, medicamentos e produtos para a saúde, exames de detecção e tratamento, vigilância em saúde, isenção de impostos, aborto e pesquisa. Destaca-se também as ações que foram efetuadas para o combate da emergência em saúde pública que se relacionam com a microcefalia pelo Zika, tais como a elaboração de portarias, guias, protocolos, ações de combate ao mosquito, entre outros. Conclusão: O estudo expõe que o Poder Legislativo por intermédio da apresentação de Projetos de Lei tem demonstrado preocupação especialmente com os surtos mais frequentes de Zika Vírus e enfermidades relacionadas. Há um trabalho de cooperação entre os poderes Legislativo e Executivo.