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Mandatory reporting of infectious diseases (MRID) is an essential practice to prevent disease outbreaks. Disease notification is a mandatory procedure for most infectious diseases, even during non-pandemic periods in healthcare. The main rationale behind MRID is the protection of public health. The information and data provided by infectious disease reports are used for many purposes, such as preventing the spread and potential negative impact of infectious diseases, assessing the national and global situation regarding reported diseases, conducting scientific research and planning health policy. In this context, the relevant information benefits public health, health systems and scientific work. Additionally, the follow up and treatment of individuals with infectious diseases is a necessity in certain cases to protect those who cohabit with them. However, these benefits cannot be accepted as unrestricted justifications for MRID, since it is evident that reporting should be conducted within ethical and legal boundaries. MRID should only be devised and implemented with due regard to balancing potential benefits between all individuals, as well as between the individual and the rest of society. Disease notification systems that are not designed with a balancing and harm-reductionist approach may lead to stigmatisation and discrimination. This study aims to investigate the legal framework and ethical issues regarding the reporting of individuals diagnosed with COVID-19 in Turkey—which is a primary example of a developing country.

Problem/condition Gastrointestinal illness is common worldwide and can be transmitted by an infected person or contaminated food, water, or environmental surfaces. Outbreaks of gastrointestinal illness commonly occur in crowded living accommodations or communities where persons are physically close. Pathogens that cause gastrointestinal illness outbreaks can spread quickly in closed and semienclosed environments, such as cruise ships. CDC's Vessel Sanitation Program (VSP) is responsible for conducting public health inspections and monitoring acute gastroenteritis (AGE) illness on cruise ships entering the United States after visiting a foreign port. Period covered 2006-2019. Description of system VSP maintains the Maritime Illness Database and Reporting System (MIDRS) for monitoring cases of AGE illness among passengers and crew sailing on cruise ships carrying ≥13 passengers and within 15 days of arrival at U.S. ports from foreign ports of call. Cruise ships under VSP jurisdiction are required to submit a standardized report (24-hour report) of AGE case counts for passengers and crew 24-36 hours before arrival at the first U.S. port after traveling internationally. If the cumulative number of AGE cases increases after submission of the 24-hour report, an updated report must be submitted no less than 4 hours before the ship arrives at the U.S. port. A special report is submitted to MIDRS when vessels are within 15 days of arrival at a U.S. port and cumulative case counts reach 2% of the passenger or crew population during a voyage. VSP declares an outbreak when 3% or more of the passengers or crew on a voyage report AGE symptom to the ship's medical staff. Results During 2006-2019, a total of 37,276 voyage reports from 252 cruise ships were submitted to MIDRS. Of the 252 cruise ships, 80.6% were extra large in size (60,001-120,000 gross registered tons [GRT]), 37.0% and 32.9% had voyages lasting 3-5 days and 8-10 days, respectively, and 53.2% were traveling to a port in the Southeast region of the United States at the time the final MIDRS report was submitted. During 2006-2019, VSP received 18,040 (48.4%) 24-hour routine reports, 18,606 (49.9%) 4-hour update reports, and 612 (1.6%) special reports (2% and 3% AGE reports). Incidence rates decreased from 32.5 cases per 100,000 travel days to 16.9 for passengers and from 13.5 to 5.2 for crew. Among passengers, AGE incidence rates increased with increasing ship size and voyage length. For crew members, rates were significantly higher on extra-large ships (19.8 per 100,000 travel-days) compared with small and large ships and on voyages lasting 6-7 days. Geographically, passenger incidence rates were highest among ships underway to ports in California, Alaska, Texas, New York, Florida, and Louisiana. Among passengers, AGE incidence rates were significantly higher on ships anchoring in California (32.1 per 100,000 travel-days [95% confidence interval (CI) = 31.7-32.4]); among crew, they were significantly higher in the South region of the United States (25.9 [CI = 25.1-26.7]). Interpretation This report is the first detailed summary of surveillance data from MIDRS during 2006-2019. AGE incidence rates decreased during this time. Incidence rates among passengers were higher on mega and super-mega ships and voyages lasting >7 days. AGE incidence among crew was higher on extra-large ships and voyages lasting 6-7 days. Ship size and voyage length are associated with AGE incidence rates, and more targeted effort is needed to prevent disproportionate AGE incidence rates among passengers and crew sailing in high-risk situations. Public health actions Maritime AGE surveillance provides important information about the epidemiology of gastrointestinal illness among cruise ship populations traveling in U.S. jurisdictions. AGE illness is highly contagious and can be transmitted quickly within vessels. State and local public health departments in the United States can use data in this report to better inform the traveling public about the risk for AGE and the importance of their role in minimizing the risk for illness while traveling onboard cruise ships. Key elements for reducing exposure to AGE illness, limiting the spread of illness, and preventing AGE outbreaks are proper hand hygiene practices and prompt isolation of symptomatic persons. Passengers can work in collaboration with cruise lines to promote onboard public health by frequently washing their hands, promptly reporting AGE illness symptoms, and isolating themselves from other persons immediately after illness onset. Access to and proper use of handwashing stations can reduce the risk for illness transmission aboard cruise ships.

We assessed the overseas gonorrhea results reported in the CDC’s Electronic Disease Notification (EDN) system among refugees ≥ 15 years old who arrived in the United States during 2018. Of 18,720 refugees, 57 (0.4%) tested positive. Among those with a positive test, 31 (54.5%) were born in the Democratic Republic of the Congo, followed by 12 (21.1%) from Afghanistan. Thirty-three (57.9%) cases were female. Fifty-one cases (89.4%) were between 15 and 44 years of age; 25 (43.9%) were ages 15–24 and 26 (45.6%) were ages 25–44. Among the cases, 56 (98.2%) were treated overseas with the recommended therapy of ceftriaxone and azithromycin. Our findings suggest that the risk of gonorrhea in refugees is similar to that in the U.S. Given recent worldwide increases in gonorrhea, additional monitoring among refugees are necessary to assess the appropriateness of the gonorrhea screening requirement in the overseas medical examination.

Objective: To analyze the factors associated with the confirmation determinants of notified Coronavirus Disease-2019 (COVID-19) cases. Method: A cross-sectional study using two accompanying data for notifications in the state of Pernambuco, Brazil, between February and August 2020. Descriptive statistics and binary logistic regression were performed with odds ratios as the association measure. Results: A total of 38,178 cases were reported, of which 59.9% were confirmed. Factors associated with confirmation determinants included: male (OR: 1.08; 95% CI=1.02-1.14), older adults (OR 1.15; 95% CI=1.09-1.22) and race/white (OR:1.10; CI95%=1.03-1.17). Change in smell/taste isolated or associated with symptomatology (OR 2.41; 95% CI=2.13-2.72) and unreported deaths (OR: 2.74; 95% CI=2.57-2.92) have more chance of confirmation for COVID-19. Conclusion: The confirmation determinants for the notified cases demonstrate the importance of clinical symptoms such as loss of smell and taste, as well as evolution to death as an outcome. Objetivo: Analizar los factores asociados a los determinantes para la confirmación de casos notificados por Coronavirus Disease-2019 (COVID-19). Método: Estudio transversal con datos del seguimiento de notificaciones en el estado de Pernambuco, Brasil, entre febrero y agosto de 2020. Se realizó estadística descriptiva y regresión logística binaria con razones de probabilidad como medida de asociación. Resultados: Se notificaron 38.178 casos, de los cuales se confirmó el 59,9%. Factores asociados a determinantes de confirmación: hombres (OR: 1,08; IC95%=1,02-1,14), adultos mayores (OR 1,15; IC95%=1,09-1,22) y raza blanca/color (OR:1,10; IC95%=1,03-1.17). La alteración aislada o asociada del olfato/gusto en los síntomas (OR 2,41; IC95%=2,13-2,72) y las muertes no declaradas (OR: 2,74; IC95%=2,57-2,92) tenían más probabilidades de confirmación por COVID-19. Conclusión: Los determinantes para la confirmación de los casos notificados demostraron la importancia de los síntomas clínicos como la pérdida del olfato y del gusto, así como la evolución a la muerte como resultado. Objetivo: analisar os fatores associados aos determinantes para a confirmação dos casos notificados pela Corona virus Disease-2019 (COVID-19). Método: estudo transversal com a utilização dos dados de acompanhamento das notificações no estado de Pernambuco, entre fevereiro e agosto de 2020. Realizou-se estatística descritiva e regressão logística binária com razões de chance como medida de associação. Resultados: foram notificados 38.178 casos, sendo 59,9% confirmados. Fatores associados aos determinantes da confirmação: homens (OR:1,08; IC95%=1,02-1,14), idosos (OR 1,15; IC95%=1,09-1,22) e raça/cor branca (OR:1,10; IC95%=1,03-1,17). Alteração de olfato/paladar isolado ou associado na sintomatologia (OR 2,41; IC95%=2,13-2,72) e os óbitos no desfecho (OR:2,74; IC95%=2,57-2,92) tiveram mais chance de terem a confirmação para a COVID-19. Conclusão: os determinantes para a confirmação dos casos notificados demonstraram a importância de sintomas clínicos como a perda de olfato e paladar, assim como evolução para óbito como desfecho.

Objectives: Toward common methods for system monitoring and evaluation, we proposed a key performance indicator framework and discussed lessons learned while implementing a statewide exposure notification (EN) system in California during the COVID-19 epidemic. Materials and Methods: California deployed the Google Apple Exposure Notification framework, branded CA Notify, on December 10, 2020, to supplement traditional COVID-19 contact tracing programs. For system evaluation, we defined 6 key performance indicators: adoption, retention, sharing of unique codes, identification of potential contacts, behavior change, and impact. We aggregated and analyzed data from December 10, 2020, to July 1, 2021, in compliance with the CA Notify privacy policy. Results: We estimated CA Notify adoption at nearly 11 million smartphone activations during the study period. Among 1 654 201 CA Notify users who received a positive test result for SARS-CoV-2, 446 634 (27%) shared their unique code, leading to ENs for other CA Notify users who were in close proximity to the SARS-CoV-2–positive individual. We identified at least 122 970 CA Notify users as contacts through this process. Contact identification occurred a median of 4 days after symptom onset or specimen collection date of the user who received a positive test result for SARS-CoV-2. Practice Implications: Smartphone-based EN systems are promising new tools to supplement traditional contact tracing and public health interventions, particularly when efficient scaling is not feasible for other approaches. Methods to collect and interpret appropriate measures of system performance must be refined while maintaining trust and privacy.

Objectives: We conducted a survey to understand how people’s willingness to share information with contact tracers, quarantine after a COVID-19 exposure, or activate and use a smartphone exposure notification (EN) application (app) differed by the person or organization making the request or recommendation. Methods: We analyzed data from a nationally representative survey with hypothetical scenarios asking participants (N = 2157) to engage in a public health action by health care providers, public health departments, employers, and others. We used Likert scales and ordered logistic regression to compare willingness to take action based on which person or organization made the request, and we summarized findings by race and ethnicity. Results: The highest levels of willingness to engage in contact tracing (adjusted odds ratio [aOR] = 1.74; 95% CI, 1.55-1.96), quarantine (aOR = 1.91; 95% CI, 1.69-2.15), download/activate an EN app (aOR = 1.30; 95% CI, 1.16-1.46), and notify other EN users (aOR = 1.43; 95% CI, 1.27-1.60) were reported when the request came from the participant’s personal health care provider rather than from federal public health authorities. When compared with non-Hispanic White participants, non-Hispanic Black participants reported significantly higher levels of willingness to engage in contact tracing (aOR = 1.32; 95% CI, 1.18-1.48), quarantine (aOR = 1.49; 95% CI, 1.37-1.63), download/activate an EN app (aOR = 2.19; 95% CI, 2.01-2.38), and notify other EN users (aOR = 1.63; 95% CI, 1.49-1.79). Conclusions: Partnering with individuals and organizations perceived as trustworthy may help influence people expressing a lower level of willingness to engage in each activity, while those expressing a higher level of willingness to engage in each activity may benefit from targeted communications.

The objective of this research was to characterize work-related cancers reported by health units in the area covered by the Centro de Referência em Saúde do Trabalhador - CEREST Registro/SP, from 2015 to 2021. This is an epidemiological and descriptive study. cross-sectional study performed with secondary cancer data related to the work of the Information System on Notifiable Diseases of the CEREST Registro/SP. The prevalence and association of sociodemographic and occupational variables were evaluated, identifying the epidemiological link between occupational activity and the type of cancer diagnosed. Pearson's chi-square test (χ2) was used considering categorical data to assess the sociodemographic variables associated with the ICD-10. Results: The most prevalent diseases were cancers occurring in the oral cavity and digestive tract (71.43%) in workers in the "agricultural, forestry and fishing" group, especially in males, which denotes 6.8 times more chances of getting cancer in this region (OR 6.8, 95% CI: 2.1-21.6), and 73.33% of this group was exposed to substances used in pest control. “production of industrial goods and services”the greatest exposure factors were asbestos, silica and dust (83.33%) affected by 12 different types of cancer. Conclusion: Evidence was recorded on exposure to risk factors with pesticides and the agricultural, forestry and fishing workers, with tumors in the oropharyngeal cavity and digestive tract predominating, suggesting an epidemiological link with work. El objetivo de esta investigación fue caracterizar los cánceres relacionados con el trabajo notificados por las unidades de salud del área de cobertura del Centro de Referencia en Salud del Trabajador - CEREST Registro/SP, de 2015 a 2021. Se trata de un estudio epidemiológico y descriptivo transversal. realizado con datos de cáncer secundario relacionados con el trabajo del Sistema de Información de Enfermedades de Declaración Obligatoria del CEREST Registro/SP. Se evaluó la prevalencia y asociación de variables sociodemográficas y ocupacionales, identificando el vínculo epidemiológico entre la actividad ocupacional y el tipo de cáncer diagnosticado. Se utilizó la prueba de chi-cuadrado de Pearson (χ2) considerando datos categóricos para evaluar las variables sociodemográficas asociadas a la CIE-10. Resultados: Las enfermedades más prevalentes fueron los cánceres que se presentan en la cavidad oral y en el aparato digestivo (71,43%) en los trabajadores del grupo "agricultura, silvicultura y pesca", especialmente en el sexo masculino, lo que denota 6,8 veces más posibilidades de contraer cáncer en esta región ( OR 6.8, IC 95%: 2.1-21.6), y el 73.33% de este grupo estuvo expuesto a sustancias utilizadas en el control de plagas. “producción de bienes y servicios industriales” los mayores factores de exposición fueron asbesto, sílice y polvo (83.33%) afectados por 12 tipos diferentes de cáncer Conclusión: Se registró evidencia sobre la exposición a factores de riesgo con plaguicidas en los trabajadores agrícolas, forestales y pesqueros, predominando los tumores en la cavidad orofaríngea y tracto digestivo, lo que sugiere un vínculo epidemiológico con el trabajo. O objetivo desta pesquisa foi caracterizar os cânceres relacionados ao trabalho notificados pelas unidades de saúde da área de abrangência do Centro de Referência em Saúde do Trabalhador – CEREST Registro/SP, no período de 2015 a 2021. Trata-se de um estudo epidemiológico e descritivo de corte transversal realizado com dados secundários, de câncer relacionados ao trabalho do Sistema de Informação de Agravos de Notificação do CEREST Registro. Foram avaliados a prevalência e associação de variáveis sociodemográficas e ocupacionais, identificando-se o nexo epidemiológico entre a atividade ocupacional e o tipo de câncer diagnosticado. Foi utilizado o teste qui-quadrado (χ2) de Pearson considerando dados categóricos para avaliar as variáveis sociodemográficas associadas ao CID-10. Resultados: Os agravos mais prevalentes foram os cânceres incidentes na cavidade oral e aparelho digestivo (71,43%) em trabalhadores(as) do grupo "agro pecuários, florestais e da pesca”, especialmente no sexo masculino que denota 6,8 vezes mais chances de apresentar câncer nessa região (OR 6,8 IC95%: 2,1-21,6), sendo que deste grupo 73,33% foi exposto a substâncias utilizadas no controle de pragas. Já dentre os trabalhadores(as) do grupo “produção de bens e serviços industriais” os maiores fatores de exposição foram o amianto, sílica e poeira (83,33%) acometidos por 12 diferentes tipos de câncer. Conclusão: Foi registrado evidência sobre a exposição a fatores de risco com agrotóxicos e os trabalhadores do grupo agropecuários, florestais e da pesca predominando tumores na cavidade orofaríngea e tubo digestivo, sugerindo nexo epidemiológico com o trabalho.

Self-inflicted violence refers to acts of self-mutilation and suicide attempts in individuals with intense psychological distress. This study is based on the hypothesis that living in the COVID-19 pandemic, by triggering and/or aggravating psychological suffering/illness, predisposes to acts of self-inflicted violence. To test this hypothesis, 493 Compulsory Notification Forms referring to cases of self-inflicted violence in one of the ten health districts in the city of Curitiba were analyzed between the years 2018 to 2020. The data was analyzed based on the evaluation of the association between categorical variables, using the chi-square test or Fisher's exact test (p

The objective was to describe and analyze the epidemiological profile of cases of compulsory notification of exogenous intoxication in the municipality of Jaguaribe Ceará from 2017 to 2021. This is a cross-sectional, descriptive and quantitative study, carried out through the collection of secondary data of cases of exogenous intoxication reported in the Notifiable Diseases Information System (SINAN) from 2017 to 2021 in the municipality of Jaguaribe, Ceará. Data collection was carried out in the period of July 2022, through access to the portal of the Department of Informatics of the Unified Health System (DATASUS). The data were organized and tabulated with the help of Microsoft Excel (2019) software, and were later analyzed using descriptive statistics and discussed in the literature. From the collection and analysis of data, it was possible to identify 215 cases of reports of exogenous intoxication in the municipality under study. Of these, notifications related to females (60.5%), of mixed race (95%), aged between 20 and 39 years (44.65%), with unknown/white education (61.7%), with medications as the main toxic agent (72.7%), the predominant circumstance being the suicide attempt (44%), single-acute exposure (58.6%) and evolution with cure without sequelae (93.4%). Therefore, it appears that the description of the epidemiological profile of a disease is of paramount importance to support the actions of prevention, promotion and recovery of the health of populations, as well as the formulation of public health policies aiming to reduce the occurrence of cases of intoxication exogenous. El objetivo fue describir y analizar el perfil epidemiológico de los casos de notificación obligatoria de intoxicación exógena en el municipio de Jaguaribe Ceará de 2017 a 2021. Se trata de un estudio transversal, descriptivo y cuantitativo, realizado a través de la recolección de datos secundarios de casos de intoxicación exógena notificados en el Sistema de Información de Enfermedades de Declaración Obligatoria (SINAN) de 2017 a 2021 en el municipio de Jaguaribe, Ceará. La recolección de datos se realizó en el período de julio de 2022, a través del acceso al Portal del Departamento de Informática del Sistema Único de Salud (DATASUS). Los datos fueron organizados y tabulados con la ayuda del software Microsoft Excel (2019), y posteriormente analizados mediante estadística descriptiva y discutidos en la literatura. A partir de la recolección y análisis de datos, fue posible identificar 215 casos de informes de intoxicación exógena en el municipio de estudio. De estos, las notificaciones se relacionaron con mujeres (60,5%), mestizos (95%), con edades entre 20 y 39 años (44,65%), con educación desconocida/blanca (61,7%), con medicamentos como principal agente tóxico (72,7%). %), siendo la circunstancia predominante el intento de suicidio (44 %), la exposición aguda única (58,6 %) y la evolución con curación sin secuelas (93,4 %). Por lo tanto, parece que la descripción del perfil epidemiológico de una enfermedad es de suma importancia para apoyar las acciones de prevención, promoción y recuperación de la salud de las poblaciones, así como la formulación de políticas de salud pública con el objetivo de reducir la ocurrencia de casos. de intoxicación exógena. Objetivou-se descrever e analisar o perfil epidemiológico dos casos de notificação compulsória de intoxicação exógena no município de Jaguaribe Ceará no período de 2017 a 2021. Trata-se de um estudo transversal, descritivo e de cunho quantitativo, realizado através do levantamento de dados secundários dos casos de intoxicação exógena notificados no Sistema de Informação de Agravos de Notificação (SINAN) no período de 2017 a 2021 no município de Jaguaribe, Ceará. A coleta de dados foi realizada no período de julho de 2022, através do acesso ao site do Portal do Departamento de Informática do Sistema Único de Saúde (DATASUS). Os dados foram organizados e tabulados com o auxílio do software Microsoft Excel (2019), e posteriormente, foram analisados por meio de estatística descritiva e discutidos frente à literatura. A partir da coleta e análise dos dados foi possível identificar 215 casos de notificações de intoxicação exógena no município em estudo. Destes, predominaram notificações relativas a indivíduos do sexo feminino (60,5%), de raça parda (95%), na faixa-etária entre 20 e 39 anos (44.65%), com a escolaridade ignorada/branca (61,7%), apresentando como principal agente tóxico os medicamentos (72,7%), circunstância predominante a tentativa de suicídio (44%), exposição do tipo aguda-única (58,6%) e evolução com cura sem sequela (93,4%). Portanto, verifica-se que a descrição do perfil epidemiológico de um agravo é de suma importância para subsidiar as ações de prevenção, promoção e recuperação da saúde das populações, bem como a formulação de políticas públicas de saúde objetivando diminuir a ocorrência de casos de intoxicação exógena.

Introduction: COVID-19 is a severe respiratory syndrome caused by the SARS-CoV-2 virus. In Brazil the highest infection rates are associated with socially vulnerable populations. This study therefore sought to analyze the spatial distribution of the disease and its relation with geographic, socioeconomic and public health policy characteristics associated with quilombola communities in Salvaterra municipality, state of Pará, for the period of March to September, 2020. Methodology: This cross-sectional and ecological study used data from the Disease Notification System and the National Registry of Health Establishments of the Ministry of Health, the Income Transfer Registry of the Ministry of Citizenship and the 2010 census of the Brazilian Institute of Geography and Statistics. Statistical and spatial analysis of the data was done through percentages of cases and Flow and Kernel map techniques. Results: Seventy-five notified cases of COVID-19 distributed among 7 quilombola communities in the municipality were analyzed. The epidemiological profile followed a national trend, with a higher percentage of cases among persons who were female, adults with low schooling levels, working as family farmers and with an outcome ending in recovery. The spatial distribution of the disease was not homogenous and showed clusters of cases and high incidence rates, especially in communities close to the municipal seat or to highways. Conclusions: The use of data analysis techniques was satisfactory for providing an understanding of the socioeconomic production of the disease in the areas studied. Accordingly, the need for intensifying epidemiological survey actions in the quilombola communities of the municipality is emphasized.

Arthropod-borne viruses (arboviruses) are transmitted to humans primarily through the bites of infected mosquitoes and ticks. West Nile virus (WNV) is the leading cause of domestically acquired arboviral disease in the United States (1). Other arboviruses, including La Crosse, Jamestown Canyon, Powassan, eastern equine encephalitis, and St. Louis encephalitis viruses, cause sporadic disease and occasional outbreaks. This report summarizes surveillance data for nationally notifiable domestic arboviruses reported to CDC for 2019. For 2019, 47 states and the District of Columbia (DC) reported 1,173 cases of domestic arboviral disease, including 971 (83%) WNV disease cases. Among the WNV disease cases, 633 (65%) were classified as neuroinvasive disease, for a national incidence of 0.19 cases per 100,000 population, 53% lower than the median annual incidence during 2009-2018. More Powassan and eastern equine encephalitis virus disease cases were reported in 2019 than in any previous year. Health care providers should consider arboviral infections in patients with aseptic meningitis or encephalitis, perform recommended diagnostic testing, and promptly report cases to public health authorities. Because arboviral diseases continue to cause serious illness, and annual incidence of individual viruses continues to vary with sporadic outbreaks, maintaining surveillance is important in directing prevention activities. Prevention depends on community and household efforts to reduce vector populations and personal protective measures to prevent mosquito and tick bites such as use of Environmental Protection Agency-registered insect repellent and wearing protective clothing.*,†.

OBJECTIVE. The purpose of this study was to quantify improved rates of follow-up and additional important diagnoses made after notification for overdue workups recommended by radiologists. MATERIALS AND METHODS. Standard reports from imaging studies performed at our institution from October through November 2016 were searched for the words "recommend" or "advised," yielding 9784 studies. Of these, 5245 were excluded, yielding 4539 studies; reports for 1599 of these 4539 consecutive studies were reviewed to identify firm or soft recommendations or findings requiring immediate management. If recommended follow-ups were incomplete within 1 month of the advised time, providers were notified. Compliance was calculated before and after notification and was compared using a one-sample test of proportion. RESULTS. Of 1599 patients, 92 were excluded because they had findings requiring immediate management, and 684 were excluded because of soft recommendations, yielding 823 patients. Of these patients, 125 were not yet overdue for follow-up and were excluded, and 18 were excluded because of death or transfer to another institution. Of the remaining 680 patients, follow-up was completed for 503 (74.0%). A total of 177 (26.0%) of the 680 patients were overdue for follow-up, and providers were notified. Of these 177 patients, 36 (20.3%) completed their follow-ups after notification, 34 (19.2%) had follow-up designated by the provider as nonindicated, and 107 (60.5%) were lost to follow-up, yielding four clinically important diagnoses: one biopsy-proven malignancy, one growing mass, and two thyroid nodules requiring biopsy. The rate of incomplete follow-ups after communication decreased from 26.0% (177/680) to 20.7% (141/680) (95% CI, 17.7-23.9%; p = .002), with a 20.4% reduction in relative risk of noncompliance, and 39.5% (70/177) of overdue cases were resolved when nonindicated studies were included. CONCLUSION. Notification of overdue imaging recommendations reduces incomplete follow-ups and yields clinically important diagnoses.

Objetivo: Refletir sobre a correlação entre os dados dos sistemas de informação em saúde e o processo de tomada de decisão; Compreender os conceitos de gerência e gerenciamento aplicados à enfermagem; Discutir possíveis implicações para a tomada de decisão na vigilância epidemiológica do HIV/AIDS e as ações de saúde implementadas. Método: Revisão Integrativa de Literatura, realizada entre setembro de 2019 e setembro de 2020 nas bases LILACS, BDENF, MEDLINE/PubMed, Scopus e SciELO. Resultados principais: Identificou-se diferentes percepções quanto aos conceitos de gerência e gerenciamento, notando-se uma influência de concepções pessoais dos autores. O SINAN mostrou que deve ser um dos principais meios para subsidiar o planejamento de ações relacionadas ao HIV/AIDS. Em relação ao agravo, notou-se uma mudança de paradigma acerca das características populacionais na década de 80 e na atual, refletindo uma necessidade de reformulação das políticas de saúde, para que sejam, verdadeiramente, efetivas. Conclusão geral: A tomada de decisão oportuna e com embasamento é primordial na transcendência das barreiras que interferem no planejamento das ações referentes ao agravo apresentado. Necessidade de análise e avaliação rotineira da população, a fim de, além de formular políticas e ações de saúde específicas para cada realidade local, seja também possível conscientizar a sociedade da constante transição populacional da epidemia. Fortalecendo assim, a autonomia, corresponsabilidade e protagonismo dos sujeitos e coletivos, na manutenção da sua saúde. Descritores (indicando identificador único): Enfermagem; HIV; Síndrome da Imunodeficiência Adquirida; Tomada de Decisão; Gerência; Sistemas de Informação em Saúde; Doenças de Notificação Compulsória.

Background Bluetooth-based exposure notification apps can supplement manual contact tracing to reduce SARS-CoV-2 transmission. Their speed, scalability, and privacy preservation are generally acknowledged, but less exploited are smartphones’ accurate measurement of duration, and ability to automatically calculate risk from multiple inputs. Methods We model uncertainty in the shape of an exhaled virus-containing plume, inhalation parameters, and distance as a function of Bluetooth attenuation. We assume relative rates of viral shedding depend on the timing of exposure relative to symptom onset. We calibrate an exponential dose-response curve on the basis of the infection probabilities of household contacts. The conditional probability of current or future infectiousness, conditioned on how long post-exposure an exposed individual has been free of symptoms, decreases during quarantine, with shape determined by the distribution of incubation periods, proportion of asymptomatic cases, and distribution of asymptomatic shedding durations. It can be adjusted for negative test results using Bayes Theorem. Findings As an example of our calculations, fifteen minutes of close contact with a high-shedding individual, given a 15% asymptomatic infection rate and no testing, would require 5- and 14-day quarantine for their risk of current or future infectiousness to fall below 0.84% and 0.14% risk, respectively. Interpretation The Covid-Watch app is currently programmed either to use a threshold on initial infection risk to determine 14-day quarantine onset, or on the conditional probability of current and future infectiousness conditions to determine both quarantine and duration. Either threshold can be set by public health authorities. Funding University of Arizona

Australia monitors its polio-free status by conducting surveillance for cases of acute flaccid paralysis (AFP) in children less than 15 years of age, as recommended by the World Health Organization (WHO). Cases of AFP in children are notified to the Australian Paediatric Surveillance Unit or the Paediatric Active Enhanced Disease Surveillance System, and faecal specimens are referred for virological investigation to the National Enterovirus Reference Laboratory. In 2021, no cases of poliomyelitis were reported from clinical surveillance and Australia reported 1.31 non-polio AFP cases per 100,000 children, thereby meeting the WHO’s performance criterion for a sensitive surveillance system. The non-polio enteroviruses coxsackievirus A4, coxsackievirus A10, coxsackievirus A13 and enterovirus A71 were identified from clinical specimens collected from AFP cases. Australia also performs enterovirus and environmental surveillance to complement the clinical system focussed on children. In 2021, there were five cases of wild poliovirus reported from the two remaining endemic countries: Afghanistan and Pakistan. Including Afghanistan and Pakistan, 22 countries also reported cases of AFP due to circulating vaccine-derived poliovirus.

Nationwide surveillance of Creutzfeldt-Jakob disease (CJD) and other human prion diseases is performed by the Australian National Creutzfeldt-Jakob Disease Registry (ANCJDR). National surveillance encompasses the period since 1 January 1970, with prospective surveillance occurring from 1 October 1993. Over this prospective surveillance period, considerable developments have occurred in pre-mortem diagnostics; in the delineation of new disease subtypes; and in a heightened awareness of prion diseases in healthcare settings. Surveillance practices of the ANCJDR have evolved and adapted accordingly. This report summarises the activities of the ANCJDR during 2021. Since the ANCJDR began offering diagnostic cerebrospinal fluid (CSF) 14-3-3 protein testing in Australia in September 1997, the annual number of referrals has steadily increased. In 2021, a total of 548 domestic CSF specimens were referred for 14-3-3 protein testing; 73 persons with suspected human prion disease were formally added to the national register. As of 31 December 2021, just over half of the 73 suspect case notifications (37/73) remain classified as ‘incomplete’; 17 cases were classified as ‘definite’ and 13 as ‘probable’ prion disease; six cases were excluded through either detailed clinical follow-up (two cases) or neuropathological examination (four cases). For 2021, sixty-four percent of all suspected human-prion-disease-related deaths in Australia underwent neuropathological examination. No cases of variant or iatrogenic CJD were identified. The SARS-CoV-2 pandemic did not affect prion disease surveillance outcomes in Australia.

The aim of study was to evaluate completeness and estimate sensitivity of the measles surveillance using the new electronic version of the national notification system of infectious diseases (ISIN) in order to assess its performance.The completeness of measles reporting in the ISIN for demographic characteristics (week and region of reporting, age and gender), date of onset, complications, hospitalisations, vaccination status, used laboratory methods and country of import from January 2018 to June 2019 was assessed. The register from National Reference Laboratory (NRL) and the ISIN were compared using the capture-recapture method (CRM). Cases were matched using unique personal identifier. The total number of measles cases in the population was assessed using the Chapmans formula. Sensitivity of reporting was calculated by dividing the number of reported cases by the CRM estimated true number of cases.In the ISIN, 765 measles cases were registered within specified time period. For many variables 100% completeness was found. The data were missing mainly for vaccination status (20%), serology results (55%) and used laboratory methods (8%). The NRL confirmed 653 patient samples in respected period. Within both registries (ISIN and NRL) the total 612 cases were matched. Estimated real number of measles cases using the CRM was 816 (95% CI: 809-823) compared to 806 reported cases. The estimated surveillance system sensitivity was 98.8%. Five percent (n = 41) of cases tested positively in the NRL were not reported to the ISIN.We found high level of reported measles data completeness in the ISIN for most variables. Estimated real and reported number of cases was in a good correlation and calculated sensitivity of the ISIN was on very high level. Though, the data sources used in the study were not independent on each other, therefore results may not be fully accurate. The technical changes (more mandatory fields and more logical syntax to check data) in the ISIN to improve data completeness are being recommended. Data providers should report all measles cases to the ISIN with maximum precision in entering individual variables and investigating laboratories should send samples for confirmation to the NRL in required cases.

FluTracking experienced major growth in 2018, with participation numbers increasing 34.1% from 2017. The addition of 16,881 new participants brought the total number of participants for 2018 to 45,532. A majority of participants continued to complete their survey within 24 hours of the email being sent (mean 74.3% responses received in 24 hours). The rate of influenza-like illness (ILI) in 2018 was the lowest since FluTracking commenced in 2007 and was consistently low across all ages. The peak weekly ILI rate was consistent with previous years, occurring during the week ending 19 August. This preceded the peak in laboratory-confirmed influenza notifications by three weeks. During the peak week of FluTracking, 2.1% of unvaccinated, and 1.9% of vaccinated participants reported fever and cough. By the final survey of 2018, 65.6% of participants had received the annual influenza vaccine, compared with 60.2% in 2017. Vaccination rates in participants under five years of age doubled from 23.7% in 2017, to 55.6% in 2018. During the peak four weeks of reported ILI, a lower percentage of participants sought medical care in 2018 compared to 2017 (36.7% and 42.3% respectively), and fewer participants reported a positive laboratory test for influenza (0.8% and 4.8%). Overall the severity of the 2018 season was one of the lowest FluTracking has recorded. Rates of both influenza laboratory notifications and general practitioner (GP) ILI consultations were lower in 2018 than most prior years. We found a reduction in the percentage of FluTracking participants with ILI who were tested for influenza (3.2% compared with 5.0% in 2017), and who visited a medical practitioner (36.7% compared with 42.3% in 2017). The drop in laboratory-confirmed cases and Australian Sentinel Practices Research Network (ASPREN) reported GP consultations concurs with our survey results that 2018 was a milder influenza season than many previous.

The swift global spread of COVID-19 prompted public health authorities to explore digital technologies to aid in contact tracing for infection control. Exposure notification, a mobile device–based technology that notifies individuals of potential exposure to COVID-19 without requiring personally identifiable information, has been broadly favored because of its relative ease of use, scalability, and protection of personal privacy. Although several exposure notification protocols were developed, a partnership between Google and Apple led to the development of the most widely implemented exposure notification protocol in the world, including in the United States. In this article, we first describe the development of the Google Apple Exposure Notification (GAEN) protocol, noting the value of the discourse among software developers and public health authorities concerning the protocol’s design and features. We track states’ deployment of GAEN mobile applications (apps) and population-level adoption rates, finding the nationwide rollout of GAEN apps to be more fragmented than anticipated. We then discuss how the limited data collected from these apps make assessments of their effectiveness challenging. Finally, we consider the importance of the federal government playing a greater role in GAEN’s early development, emphasize the power of public–private partnerships, and highlight the overriding importance of public messaging over technological details.

Laboratory information systems need to adapt to new demands created by the COVID-19 pandemic, which has set up new normals like containment measures and social distancing. Some of these have negatively impacted the pre- and postanalytical phases of laboratory testing. Here, we present an intriguing finding related to the generation of the accession number/specimen number on the investigation module of a hospital management information system and its impact on the dissemination of reports resulting in the wrong release of reports on a female patient amidst the background of COVID-19 containment measures. We analyze the situation that led to this false reporting and the importance of the proper customization of information software in laboratories along with a robust postanalytical framework of laboratory work culture to avert such untoward incidents. This introspection has made us realize that COVID-19 has been a scientific, medical, and social challenge. We need to redefine our priorities in the days to come because SARS-CoV-2 is here to stay.

Objectives The objective of this study was to characterize the changes in timeliness and completeness of disease case reporting in Texas in response to an increasing number of foodborne illnesses and high-consequence infectious disease investigations and the Texas Department of State Health Services’ new state-funded epidemiologist (SFE) program. Methods We extracted electronic disease case reporting data on 42 conditions from 2012 through 2016 in all local health department (LHD) jurisdictions. We analyzed data on median time for processing reports and percentage of complete reports across time and between SFE and non-SFE jurisdictions using Mann–Whitney t tests and z scores. Results The median time of processing improved from 13 days to 10 days from 2012 to 2016, and the percentage of disease case reports that were complete improved from 19.6% to 27.7%. Most reports were for foodborne illnesses; both timeliness (11 to 7 days) and completeness (20.9% to 23.5%) improved for these reports. Conclusions Disease reporting improvements in timeliness and completeness were associated with the SFE program and its enhancement of epidemiologic capacity. SFEs were shown to improve surveillance metrics in LHDs, even in jurisdictions with a high volume of case reports. Adding epidemiologist positions in LHDs produces a tangible outcome of improved disease surveillance.

A violência contra a mulher é reflexo das relações de poder que estruturam a sociedade moderna, na qual as desigualdades existentes entre homens e mulheres, forçam-nas a assumir posições de subordinação. Na pandemia do Covid-19, os protocolos de saúde recomendaram o isolamento social, que repercutiu em problemas sociais e deixaram a mulher exposta à violência doméstica. Assim questionou-se: qual a relação das ocorrências da violência doméstica contra a mulher no antes e durante a pandemia no Planalto Norte Catarinense? O objetivo geral foi conhecer a relação das ocorrências da violência antes e durante a pandemia. Realizou-se um estudo documental, descritivo, quantitativo, baseado no Sistema de Notificação de Agravos oficial acessados no site da Diretoria de Vigilância Epidemiológica estadual, na qual levantou-se as notificações dos 13 municípios da 25ª Agência de Desenvolvimento Regional de março a junho de 2019 e o mesmo período de 2020. Os resultados apontam para uma redução 46,4% de casos (153 para 82), o problema atinge mais as mulheres entre 20 a 60 anos, com ensino médio, prevalece a agressão física. Destaca-se a violência autoprovocada, na qual a mulher convive com uma situação extremamente desgastante tanto física quanto psicologicamente, buscando acabar com seu sofrimento. Conclui-se houve diminuição da notificação de casos, que sugere dificuldade da vítima em buscar ajuda. Por isso há necessidade de um olhar diferenciado para o problema, com estratégias inovadoras e profissionais capacitados para o enfrentamento do problema. Palavras Chave: Violência contra a mulher. COVID-19. Enfermagem.

本研究の目的は、小児がんの病名を告知されていない場合と告知されている場合の患児・親・医療者の気持ちや体験を明らかにすること、今後の小児がん看護におけるケアについての示唆を得ることである。「医学中央雑誌」WEB 版より、「小児がん」「看護」「病名告知」をキーワードにして検索した1991年から2018年までの21編を分析した。分析の結果、患児には病名を知る機会が多くみられ、告知されている患児と比較すると未告知の患児は不安に陥りやすいことが分かった。また、親は告知の有無にかかわらず患児が不安をもつことを心配していた。一方、医療者は未告知の患児への対応に困難さを感じていた。看護師は、患児や家族の些細な変化にも気づく感性、告知の有無によって起こりうる今後の展開をアセスメントする能力や患児と家族間の意見調整が必要だということが示唆された。, This study aimed to clarify the feelings and experiences of pediatric patients, parents, and health care providers in cases where the pediatric patient was and was not notified of having pediatric cancer, and to obtain suggestions for childhood cancer nursing care.We utilized Ichushi -Web to search for the keywords “pediatric cancer,” “nursing,” and “disease notification,” and subsequently analyzed 21 papers from 1991 to 2018. The results of the analysis revealed that in comparison with pediatric patients who had received a notification, pediatric patients who had not received it tended to feel anxious. Moreover, there were many opportunities for pediatric patients to learn the name of the disease from the people in their network. Parents reported being worried that their children would be anxious, regardless of notification. Moreover, health care practitioners felt it was difficult to deal with pediatric patients who had not received a notification.It was suggested that nurses need to be capable of noticing even the slightest changes in the child and family, the ability to assess future prospects based on the presence or absence of notification and the coordination of opinions between the child and family.

Background Zhejiang is a southeastern province of China with middle level notification rates of tuberculosis in China, but more than 27,000 pulmonary tuberculosis (PTB) cases are still reported annually in this province. We aimed to analyze the time trends of PTB cases and bacteriologically confirmed cases notification rates at the province and city levels of Zhejiang during 2005–2018. Methods Data from the web-based TB Information Management System of Zhejiang Province were used to calculate annual notification rates per 100,000 population of PTB cases and bacteriologically confirmed cases for Zhejiang Province and its 11 cities. The joinpoint regression method was used to analyze the time trends and calculate the annual percentage change of notification rates. Results There were 480,668 notified PTB cases in Zhejiang Province during 2005–2018, 38.78% of which were bacteriologically confirmed cases. Both the PTB cases and bacteriologically confirmed cases notification rates of Zhejiang Province have declined since 2007. Most of the cities’ time trends were the same as Zhejiang Province. The PTB cases and bacteriologically confirmed cases notification rates of males and elderly people are the highest in both sexes and among the four age groups, but the decline speeds of the two groups were slowest. Conclusions With the effective implementation of TB control measures and projects, the PTB cases notification rates of Zhejiang Province have declined. In order to reach the target in 2035 of the End TB Strategy, additional efforts should be made in the diagnosis and treatment of TB patients, particularly with regard to males and older adult people.

Background Ross River virus (RRV) disease is Australia's most widespread vector-borne disease causing significant public health concern. The aim of this study was to identify the ecological covariates of RRV risk and to develop epidemic forecasting models in a disease hotspot region of South Australia. Methods Seasonal autoregressive integrated moving average models were used to predict the incidence of RRV disease in the Riverland region of South Australia, an area known to have a high incidence of the disease. The model was developed using data from January 2000 to December 2012 then validated using disease notification data on reported cases for the following year. Results Monthly numbers of the mosquito Culex annulirostris (β=0.033, p Conclusions A predictive model has been shown to be useful in forecasting the occurrence of RRV disease, with increased vector populations and rainfall being important factors associated with transmission. This approach may be useful in a public health context by providing early warning of vector-borne diseases in other settings.

Seasonal trends in tuberculosis (TB) notifications have been observed in several countries but are poorly understood. Explanatory factors may include weather, indoor crowding, seasonal respiratory infections and migration. Using enhanced citywide TB surveillance data collected over nine years in Blantyre, Malawi, we set out to investigate how weather and seasonality affect temporal trends in TB case notification rates (CNRs) across different demographic groups. We used data from prospective enhanced surveillance between April 2011 and December 2018, which systematically collected age, HIV status, sex and case notification dates for all registering TB cases in Blantyre. We retrieved temperature and rainfall data from the Global Surface Summary of the Day weather station database. We calculated weekly trends in TB CNRs, rainfall and temperature, and calculated 10-week moving averages. To investigate the associations between rainfall, temperature and TB CNRs, we fitted generalized linear models using a distributed lag nonlinear framework. The estimated Blantyre population increased from 1,068,151 in April 2011 to 1,264,304 in December 2018, with 15,908 TB cases recorded. Overall annual TB CNRs declined from 222 to 145 per 100,000 between 2012 and 2018, with the largest declines seen in HIV-positive people and adults aged over 20 years old. TB CNRs peaks occurred with increasing temperature in September and October before the onset of increased rainfall, and later in the rainy season during January-March, after sustained rainfall. When lag between a change in weather and TB case notifications was accounted for, higher average rainfall was associated with an equivalent six weeks of relatively lower TB notification rates, whereas there were no changes in TB CNR associated with change in average temperatures. TB CNRs in Blantyre have a seasonal pattern of two cyclical peaks per year, coinciding with the start and end of the rainy season. These trends may be explained by increased transmission at certain times of the year, by limited healthcare access, by patterns of seasonal respiratory infections precipitating cough and care-seeking, or by migratory patterns related to planting and harvesting during the rainy season.

Aim: Research concerning COVID-19 among immigrants is limited. We present epidemiological data for all notified cases of COVID-19 among the 17 largest immigrant groups in Norway, and related hospitalizations and mortality. Methods: We used data on all notified COVID-19 cases in Norway up to 18 October 2020, and associated hospitalizations and mortality, from the emergency preparedness register (including Norwegian Surveillance System for Communicable Diseases) set up by The Norwegian Institute of Public Health to handle the pandemic. We report numbers and rates per 100,000 people for notified COVID-19 cases, and related hospitalizations and mortality in the 17 largest immigrant groups in Norway, crude and with age adjustment. Results: The notification, hospitalization and mortality rates per 100,000 were 251, 21 and five, respectively, for non-immigrants; 567, 62 and four among immigrants; 408, 27 and two, respectively, for immigrants from Europe, North-America and Oceania; and 773, 106 and six, respectively for immigrants from Africa, Asia and South America. The notification rate was highest among immigrants from Somalia (2057), Pakistan (1868) and Iraq (1616). Differences between immigrants and non-immigrants increased when adjusting for age, especially for mortality. Immigrants had a high number of hospitalizations relative to notified cases compared to non-immigrants. Although the overall COVID-19 notification rate was higher in Oslo than outside of Oslo, the notification rate among immigrants compared to non-immigrants was not higher in Oslo than outside. Conclusions: We observed a higher COVID-19 notification rate in immigrants compared to non-immigrants and much higher hospitalization rate, with major differences between different immigrant groups. Somali-, Pakistani- and Iraqi-born immigrants had especially high rates.

RESUMO Objetivo: Descrever os casos autoprovocados de violência e de intoxicação exógena aguda ocorridos no Rio Grande do Sul (RS) entre os anos de 2013 e 2017. Métodos: Estudo transversal incluindo todos os casos notificados no Sistema de Agravos de Notificação (Sinan) entre 2013 e 2017, selecionados por meio das fichas de violência interpessoal/autoprovocada, por meio da variável lesão provocada, e de investigação de intoxicação exógena, pela variável circunstância da exposição/contaminação. A análise compreendeu a estatística descritiva, o cálculo das prevalências por 100.000 habitantes e a estratificação por sexo conforme características sociodemográficas e clínicas. Resultados: No perío-do proposto, foram notificados 18.544 casos autoprovocados de violência e 5.624 de intoxicação exógena, com predomínio de mulheres (67% e 75,3%), entre 30 e 59 anos (46,4% e 49%), brancas (86% e 86%), com ensino fundamental completo/incompleto (58,3% e 47,3%), residentes em zona urbana/periurbana (89,2% e 89,6%) e com episódios ocorridos na própria residência (88,8% e 96,6%). Quanto aos métodos de violência empregados, destacaram-se os envenenamentos/intoxicações (39,7%), enforcamentos (13,8%), agentes perfurocortantes (13,6%) e armas de fogo (2,0%). Verificou-se diferença conforme o sexo nas variáveis sociodemográficas e clínicas referentes a ambos os agravos, bem como um aumento de 169% e 381,1%, respectivamente, nas prevalências de violência e intoxicação entre os anos de 2013 e 2017. Conclusões: Evidenciou-se um expressivo e crescente número de casos no estado, com maiores implicações no gênero feminino, importantes diferenças de acordo com sexo e populações mais acometidas, fomentando a necessidade da implementação de medidas preventivas específicas nos grupos vulneráveis. ABSTRACT Objective: To describe the self-inflicted cases of violence and acute exogenous intoxication occurred in the state of Rio Grande do Sul (RS) between 2013 and 2017. Methods: Cross-sectional study including all cases reported in the Notifiable Diseases System between 2013 and 2017, selected through the forms of interpersonal/self-infliged, through the variable caused injury, and through the investigation of exogenous intoxication, due to the variable circumstances of exposure/contamination. The analysis included descriptive statistics, calculation of prevalences per 100.000 and stratification by sex according to sociodemographic and clinical characteristics. Results: In the proposed period, 18.544 cases of violence and 5.624 cases of exogenous intoxication self-infliged were reported, with a predominance of women (67% and 75,3%), between 30 and 59 years old (46,4% and 49%), white (86% and 86%), with complete/incomplete elementary education (58,3% and 47,3%), living in urban/periurban areas (89,2% and 89,6%) and with episodes occurring at their own residence (88,8% and 96,6%). About the methods of violence used, poisonings/intoxications (39,7%), hangings (13,8%), sharp objects (13,6%) and firearms (2%) stood out. There was a difference according to sex in the sociodemographic and clinical variables referring to both diseases, as well as an increase of 169% and 381,1% in prevalences of violence and intoxication, between 2013 and 2017. Conclusions: An expressive and growing number of cases in the state, with greater implications for females, important differences according to sex and most affected populations, encourages the need to implement specific preventive measures in vulnerable groups.

Resumo O estudo teve por objetivo analisar a tendência temporal dos coeficientes de incidência da infecção por HIV-aids por meio de estudo ecológico retrospectivo e regressão segmentada em maiores de 13 anos notificados no SINAN entre os anos de 1980 e 2016. Dos 14.204 casos notificados, 70,9% eram do sexo masculino e 39,5% brancos. Nota-se aumento da incidência do critério aids de 1986 a 1996 com variação anual percentual (APC) de 108,5% ao ano entre 1983 a 1989 (IC: 90,3 - 128,4), entre os anos de 1989 e 1998 a APC foi de 13,2% (IC: 8,2 - 18,3) e redução da APC no período de 1998 a 2016, -6,2% (IC: -7,4 - -4,9). Altos coeficientes do critério óbito entre os anos 1988 a 2002 (4,7/100.00 hab.) com queda acentuada após 1995. Observa-se crescimento do critério HIV+ a partir do ano 2000, chegando a 30,2 por 100 mil habitantes em 2016. Embora as taxas de incidência ainda permaneçam altas no município, estas tendências são compatíveis com o impacto positivo das políticas de detecção precoce e acesso ao seguimento clínico e terapêutico dos indivíduos com HIV e aids na cidade. Abstract The objective of this study was to analyze the temporal trend of the incidence coefficients of HIV-AIDS infection via a retrospective ecological study and segmented regression in individuals older than 13 year reported at SINAN between 1980 and 2016. Of the 14,204 reported cases, 70.9% were male and 39.5% were white. The AIDS criterion presented growing incidence from 1986 to 1996 with Annual Percentual Change (APC) of 108.5% per year between 1983 and 1989 (CI: 90.3 - 128.4), between 1989 and 1998 the APC was 13.2% (CI: 8.2 - 18.3) and APC reduction in the period from 1998 to 2016, -6.2% (CI: -7.4 - -4.9). High coefficients of the death criteria between 1988 and 2002 (4.7/100,000 inhabitants), with a noticeable decrease after 1995. The growth of the HIV+ criteria from 2000 onward was observed, reaching 30.2 cases per 100,000 inhabitants in 2016. Although incidence rates still remain high in the municipality, these trends are consistent with the positive impact of early detection policies and access to clinical and therapeutic follow-up of individuals with HIV and AIDS in Campinas.

Background Informed decision making is underlined by all tiers in the health system. Poor data record system coupled with under- (over)-reporting of malaria cases affects the country’s malaria elimination activities. Thus, malaria data at health facilities and health offices are important particularly to monitor and evaluate the elimination progresses. This study was intended to assess overall reported malaria cases, reporting quality, spatiotemporal trends and factors associated in Gedeo zone, South Ethiopia. Methods Past 8 years retrospective data stored in 17 health centers and 5 district health offices in Gedeo Zone, South Ethiopia were extracted. Malaria cases data at each health center with sociodemographic information, between January 2012 and December 2019, were included. Meteorological data were obtained from the national meteorology agency of Ethiopia. The data were analyzed using Stata 13. Results A total of 485,414 suspected cases were examined for malaria during the previous 8 years at health centers. Of these suspects, 57,228 (11.79%) were confirmed malaria cases with an overall decline during the 8-year period. We noted that 3758 suspected cases and 467 confirmed malaria cases were not captured at the health offices. Based on the health centers records, the proportions of Plasmodium falciparum (49.74%) and P. vivax (47.59%) infection were nearly equivalent (p = 0.795). The former was higher at low altitudes while the latter was higher at higher altitudes. The over 15 years of age group accounted for 11.47% of confirmed malaria cases (p Belg (12.52%) and in Dilla town (18,150, 13.17%, p Conclusion A notable overall decline in malaria cases was observed during the eight-year period. Both P. falciparum and P. vivax were found at equivalent endemicity level; hence control measures should continue targeting both species. The noticed under reporting, the high malaria burden in urban settings, low altitudes and Belg season need spatiotemporal consideration by the elimination program.

Resumen: Los informes sobre la COVID-19 del Ministerio de Sanidad en España son valiosos, pero incompletos, con el efecto perverso de que la susceptibilidad al virus según el sexo está poco clara. La prevalencia de COVID-19 por sexo difiere entre países. España muestra un patrón desigual: inicialmente más frecuente en los hombres, las mujeres los superaron a partir del 31 de marzo, tras 2 semanas de confinamiento, con contagios más frecuentes en las mujeres en contacto con casos de COVID-19. Concordando con los fallecimientos, los hombres son hospitalizados con mayor frecuencia. Las diferencias significativas por sexo en signos/síntomas pueden conducir a este patrón, observado también en otras enfermedades. A finales de abril, el exceso de mortalidad es el mismo en las mujeres (67%) que en los hombres (66%). No obstante, la falta de información exhaustiva sobre las muertes por COVID-19 en no hospitalizados/as puede contribuir a la menor notificación de fallecimientos en las mujeres. La invisibilidad de los datos por sexo y de género probablemente está afectando de manera negativa más a las mujeres que a los hombres. Abstract: Reports on COVID-19 from the Spanish Health Ministry are valuable, but incomplete, with the perverse effect that the susceptibility to COVID-19 by sex is unclear. Prevalence of COVID-19 by sexes differs between countries. The trend in Spain shows an unequal pattern, initially more frequent in men, but women outnumbered them from March 31, after two weeks lockdown. Infections are more frequent in women than in men in close contact with probable/confirmed COVID-19 cases. Consistent with deaths in men, they are hospitalized more frequently than women: Significant gender differences in signs/symptoms can drive this pattern, already observed in other pathologies. In late April, excess mortality is the same in women (67%) than in men (66%). But, lack of exhaustive information on deaths from COVID-19 in non-hospitalized patients may contribute to lower notification of deaths in women. Invisibility of data by sex and gender is probably affecting negatively women with COVID -19 more than men.

Background: Diagnosis, notification and timely initiation of treatment is an important cornerstone for the elimination of tuberculosis (TB). The referral and feedback mechanism under National Tuberculosis Programme of India has been changed from paper-based to web-based electronic system (Nikshay) since 2018. The current study was carried out to assess the effect of Nikshay in referral and receipt of feedback on treatment initiation and to understand the early implementation challenges. Methods: A mixed-methods study was conducted in a medical college referral unit (MCRU) of Delhi, India. The electronic TB notification data for July 2018–March 2019 were abstracted from Nikshay portal and analysed. Unadjusted and adjusted relative risk (aRR) was calculated to assess the factors associated with the receipt of feedback. Themes and subthemes were generated from qualitative data obtained through key-informant interviews of healthcare providers. Results: Of the total 4395 patients handled by MCRU during the study period, 3315 (75.4%) were referred out within and outside Delhi for treatment. Feedback was received among 797 (24.0%) of the patients who were referred out. Patients with extrapulmonary TB (aRR: 1.3, confidence interval (CI): 1.1–1.8), previously treated (aRR: 1.2, CI: 1.2–1.3) and registered for drug-resistant TB care (aRR: 1.4, CI: 1.1–1.8), had high chance of receiving feedback. Four broad themes emerged, namely, (a) awareness of programme and Nikshay; (b) tracking of patients; (c) user-friendly portal and (d) workload. Conclusion: The low feedback on treatment initiation of patients with TB needs further research after health system-level quality improvement interventions. Real-time tracking of patients is the need of the hour towards the path for TB elimination.

OBJECTIVE In developed countries prolonged symptoms due to, or following, Giardia intestinalis infection can have a significant impact on the quality of life. In this research, we investigate the presence of a socioeconomic status (SES) gradient in the reporting of giardiasis in South West Sydney Local Health District (SWSLHD), New South Wales (NSW), Australia, across geographic scales. METHODS We used a large database, spatial-cluster analysis and a linear model. RESULTS Firstly, we found one spatial cluster of giardiasis in one of the most advantaged neighbourhoods of SWSLHD. Secondly, rates of giardiasis notifications were significantly and consistently lower in SWSLHD compared to an unnamed advantaged Local Health District and NSW over multiple years. Finally, we found an overall significant positive dose-response relationship between counts of giardiasis and area-level SES. CONCLUSIONS Lower reporting in disadvantaged areas may represent true differences in incidence across SES groups or may result from differential use of health services and reporting. Implications for public health: If the disparities result from differential use of health services, research should be directed toward identifying barriers and facilitators of use. If disparities result from a true difference in incidence, then the behavioural mediators between SES and giardiasis should be identified and addressed.