Surveillance of Zika virus in Brazil -...

Surveillance of Zika virus in Brazil

Ministry of HealthSecretariat of Health SurveillanceDepartment of Communicable Disease SurveillanceGeneral Coordination of National Programs for Control and Prevention of Malaria and Diseases transmitted by Aedes

December 11, 2016

Cases of dengue, Zika and chikungunya, Brazil, EW 1 to 46, 2016

Source: Sinan Net and Sinan Online, 11/28/2016

Background – Zika virus transmission

Clusters of acute

exanthematousdisease, NE

casos

SGB/BA

2015 2016

* Information note nº 7/2015 – CIEVS/DEVIT/SVS/MS**Information note nº 1/2015 – COES Microcephaly


Clusters of acute


casos

SGB/BA

Identification zika virus for the first time

in Brazil*2015 2016



Clusters of acute


casos

SGB/BA


in Brazil*2015 2016

Increase in GBS and other

MN in NE



Clusters of acute


casos

SGB/BA


in Brazil*2015 2016


MN in NE

Declaration of emergency

in public health**

Microcefalia - PESGB



Clusters of acute


casos

SGB/BA

Case-control study GBS

SGB


in Brazil*2015 2016


MN in NE


in public health**




Clusters of acute


casos

SGB/BA

Case-control study GBS

SGB


in Brazil*2015 2016


MN in NE


in public health**


Investigations - EpiSUS• 03 – Zika virus fever• 03 – neurological syndromes• 10 – microcephaly


Surveillance Zika virus

The needs of Brazil at that moment:

• Information on cases to trigger intervention activities

• Occurrence of reports of suspected cases in all regions of the national territory

• Need to confirm viral circulation of an emerging etiologic agent

• Know the behavior of the disease

Surveillance Zika virus

The needs of Brazil at that moment:

• Information on cases to trigger intervention activities

• Occurrence of reports of suspected cases in all regions of the national territory

• Need to confirm viral circulation of an emerging etiologic agent

• Know the behavior of the disease

ZIKA Sentinel Surveillance Implemented

in Brazil

Choice of Sentinel UnitsCommon agreement between states and municipalities

Criteria:

• Capitals and Federal District: Select at least 1 and at most 3 health services

• Interior: At least 1 health service by regional or municipality polo (at the discretion of SES)

• Representativeness of the population

• Service with prompt service and good articulation with surveillance

• Ability to collect, process, store and forward laboratory samples

Eligible patients

Initially, differential diagnoses should be investigated:

Dengue

Chikungunya

Measles and rubella

Other exanthematous diseases: parvovirus, cytomegalovirus, mononucleosis,

enterovirus, among others

Case records - FormSUS

Communication and information flow

* Annex II of the Ordinance MS/GM nº1.271/2014;

Immediate communication of laboratory confirmed cases *


* Annex II of the Ordinance MS/GM nº1.271/2014;


If SMS or SES does not have the structure to receive the immediate notifications (night time, weekends or holidays)


* Annex II of the Ordinance MS/GM nº1.271/2014; **Center for Strategic Health Surveillance Information


If SMS or SES does not have the structure to receive the immediate notifications (night time, weekends or holidays)

Dial notify (24/7): 0800 – 644 – 6645

Email notifies (CIEVS**-national): [email protected]

mailto:[email protected]

Surveillance of the Zika virus

1Portaria MS/GM nº1.271/2014

Zika virus sentinel

surveillance1

June, 14

2014 2015 2016


1Portaria MS/GM nº1.271/20142Portaria 204 de 18/02/2016; 3Sistema Nacional de Agravos de Notificação

Zika virus sentinel

surveillance1

June, 14

Sentinel surveillance of

arbovirus neurological

manifestations

December, 16

2014 2015 2016


1Portaria MS/GM nº1.271/20142Portaria 204 de 18/02/2016; 3Sistema Nacional de Agravos de Notificação

Zika virus sentinel

surveillance1

June, 14

Universal surveillance of the Zika virus2

February, 16

Sentinel surveillance of

arbovirus neurological

manifestations

December, 16

Specific profile Sinan3 online

2014 2015 2016

Zika Virus Surveillance - Case Definition

Suspected case - Patients with pruritouc maculopapular rash accompanied by two or more of the following signs and symptoms:

Fever, conjunctival hyperemia without secretion and pruritus, polyarthralgia, periarticular edema

Case confirmed- a suspected case with one of the following specific positive/ diagnostic reagents for Zika: viral isolation; detection of viral RNA by reverse transcriptase reaction (RT-PCR); IgM serology

Zika Virus Surveillance - Case Definition

Suspected case - Patients with pruritouc maculopapular rash accompanied by two or more of the following signs and symptoms:

Fever, conjunctival hyperemia without secretion and pruritus, polyarthralgia, periarticular edema

Case confirmed- a suspected case with one of the following specific positive/ diagnostic reagents for Zika: viral isolation; detection of viral RNA by reverse transcriptase reaction (RT-PCR); IgM serology

After confirmation of autochthonous circulation, the other acute cases of Zikashould be confirmed by clinical-epidemiological criteria, except for pregnant women, neurological manifestations and deaths

Guillain-Barré syndrome and otherneurological manifestations

Guillain-Barré Syndrome (GBS) admissions, by year of hospitalization. Brazil, 2014 and 2015

0

50

100

150

200

250

300

350

AL BA CE MA PB PE PI RN SE AC AP AM PA RO RR TO DF GO MT MS ES MG RJ SP PR RS SC

Nu

mb

er

of

SGB

cas

es

2014 2015

Internships for SGB, Brazil2014: 1,4552015: 1,953 ( 34.2%)

Source: SIH / SUS - Datasus, updated on 12/08/2016

Source: SIH / SUS - Datasus, updated on 12/08/2016

0

50

100

150

200

250

300

350

AL BA CE MA PB PE PI RN SE AC AP AM PA RO RR TO DF GO MT MS ES MG RJ SP PR RS SC

Nu

mb

er

of

SGB

cas

es

2014 2015 2016

Internships for SGB, Brazil2014: 1,4552015: 1,953 ( 34.2%)2016: 1,603

Guillain-Barré Syndrome (GBS) admissions, by year of hospitalization. Brazil, 2014, 2015, and 2016*

Protocol - Surveillance of Neurological Manifestations

Circular Letter No. 94/2015 - Implementation of the Protocol of Neurological

Manifestations

• Office and Protocol of Surveillance of Neurological Manifestations forwarded tothe State Surveillance

• Material available on Zika virus and neurological manifestations on the SVSwebsite

Protocol - Surveillance of Neurological Manifestations

Investigations

Surto SGB, Bahia-Brasil, 2016

Distribution of the cases of Guillain-Barré syndrome, by date of onset of neurological symptoms

Results

N=50

0

1

2

3

4

5

6

7

8

9

10

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34

Jan Fev Mar Abr Mai Jun Jul Ago

Nu

mb

ero

fca

ses

Epidemiological week / month

*46 cases = 50 - 4 outbreak period

Incidence n=46*5.3 casos/100,000


Distribution of the cases of Guillain-Barré syndrome, by date of onset of neurological symptoms

Results

N=50

0

1

2

3

4

5

6

7

8

9

10

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34

Jan Fev Mar Abr Mai Jun Jul Ago

Nu

mb

ero

fca

ses

Epidemiological week / month

Incidence n=46*5.3 casos/100,000

0

5

10

15

20

25

30

35

Início infecção viral x Início MN

Dia

s

*46 cases = 50 - 4 outbreak period


Distribution of cases of Guillain-Barré syndrome by age group, according to incidence during the period of the outbreak

Results

45 cases = 50 - 4 outbreak period -1 in Maragogipe

0

2

4

6

8

10

12

14

16

18

0

2

4

6

8

10

12

12-19 20-29 30-39 40-49 50-59 60-69 70+

Inci

de

nce

SG

B /

10

0,0

00

Nu

mb

er o

f ca

ses

Age group


Distribution of cases of Guillain-Barré syndrome and incidence of Zika virus

Results

0,0

5,0

10,0

15,0

20,0

25,0

30,0

35,0

40,0

45,0

0

1

2

3

4

5

6

7

8

9

10

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39

Jan Fev Mar Abr Mai Jun Jul Ago Set

Inci

de

nce

fev

er o

f Zi

ka/

10

0,0

00

Nu

mb

er o

f SG

B c

ase

s

casos SGB Incidência


Distribution of cases and controls according to habits and exposures that mayfavor infection by A. aegypti

Results

Exhibitions in 2015Cases (N=41) Controls (N=85)

P valuen (%) n (%)

Mosquito bite 22 (53.7) 55 (64.7) 0.20

Use of repellent 5 (12.2) 9 (10.6) 0.80

Leaves the windows open from the residence 41 (100.0) 82 (96.5) 0.55

Presence of screens on windows or doors 2 (4.9) 3 (3.5) 0.72

Temperature control in residence

Air conditioning 7 (17.1) 6 (7.1) -

Fan 40 (97.6) 76 (89.4) -

None 1 (2.4) 6 (7.1) -

Presence of still water in the residence 20 (48.8) 47 (55.3) 0.52


Characterization of cases and controls according to signs and symptoms of previous disease

Results

Signals and symptonsCases (N=41) Controls (N=85)

P value* OR (IC95%)n (%) n (%)

Previous viral infection 34 (82.9) 18 (21.4) 0.01 17.8 (6.7-46.7)

Exanthema 24 (58.5) 7 (8.2) 0.01 15.7 (5.8-42.4)

Headache 23 (56.1) 14 (16.5) 0.01 6.8 (2.7-15.0)

Fever 21 (51.2) 13 (15.3) 0.01 5.8 (2.4-13.6)

Myalgia 20 (48.8) 11 (12.9) 0.01 6.4 (2.6-15.4)

Polyarthralgia 18 (43.9) 12 (14.1) 0.01 4.7 (1.9-11.3)

Itching 17 (41.5) 8 (9.4) 0.01 6.8 (2.6-17.7)

Retroorbital Pain 15 (36.6) 7 (8.2) 0.01 6.4 (2.3-17.4)

Chill 15 (36.6) 11 (12.9) 0.01 3.8 (1.5-9.5)

Conjunctival hyperemia 11 (26.8) 4 (4.7) 0.01 7.4 (2.1-25.1)

Nausea / vomiting 11 (26.8) 4 (4.7) 0.01 7.4 (2.1-25.1)

Calf pain 6 (14.6) 7 (8.2) 0.26 1.9 (0.5-6.09)

Incidence rate Zika and SGB. UF, 2015 to 2016

Incidence rate Zika and SGB. UF of the North region, 2015 to 2016

Incidence rate Zika and SGB. UF of the Northeast region, 2015 to 2016

Incidence rate Zika and SGB. UF of the Southeast region, 2015 to 2016

Incidence rate Zika and SGB. UF of the South region, 2015 to 2016

Incidence rate Zika and SGB. UF of the Midwest region, 2015 to 2016

• Implementation of universal surveillance

• Epidemiological bulletins: dengue, Zika and chikungunya

• Instrument of investigation for death by dengue, Zika and chikungunya

• Distance education - Zika course: clinical approach in basic care; Update inthe Vector Combat to Aedes aegypti; Review of the dengue course at adistance

• GT participating in Renezika

• Partnership with CDC in improving laboratory issues and research

Zika Virus Surveillance - ACTIONS ACHIEVED

• Elaborated integrated notification / investigation form for dengue, Zika and chikungunya


• Monitoring of Zika virus research and new vector control technologies

Reunião internacional para implementação de novas alternativas para o controle do Aedes aegypti. Brasil, Fevereiro, 2015


• Elaborate and implement an integrated

surveillance proposal for dengue,

chikungunya and Zika

• Follow the states with face-to-face advice

• To train multipliers in the management of

dengue, chikungunya and Zika:

partnership with PAHO

Zika virus surveillance - CHALLENGES

• Restructuring of surveillance of neurological manifestations with a previoushistory of viral infection by arbovirus dengue / chikungunya / Zika

Proposed elaboration Financial cost incentive order for implementationand maintenance of sentinel surveillance actions

• Update and revision of the current surveillance protocol carried out jointlywith CGDT

Vigilância do vírus Zika e manifestações neurológicas – DESAFIOS

www.saude.gov.br/svsDisque Saúde - 136

Disque Notifica

0800-644-6645

[email protected]

www.saude.gov.br/combateaedes

Thank you!

Casos com manifestações neurológicas confirmados para vírus Zika

Dados Gerais

Paciente Caso 1 Caso 2 Caso 3 Caso 4*

Idade 48 32 26 35

Sexo F M M M

Residência Recife Goiana Recife Recife

Infecção Viral Prévia

Sinais e sintomas

Exantema, prurido, artralgia, edema articular, sem febre

Exantema, prurido, anorexia, cefaleia, febre

Cefaléia, dor retrorbitaria, mialgia, diarreia, náuseas, febre

Exantema, prurido, artralgia, edema articular, conjuntivite, febre

Manifestação neurológica

Quadro clínico SGB SGB Meningoencefalite SGB

Dados Laboratoriais

Amostra Soro Soro Soro LCR

Tempo IS infecção e coleta

6 8 19 23

Tempo IS neurológicos e coleta

2 5 14 4

Laboratório Fiocruz/PE Fiocruz/PE Fiocruz/PE Fiocruz/PE

Resultado Zika+ Zika+ Zika+ Zika+

*Paciente com confirmação por meio de análise de LCR

Surveillance of Zika virus in Brazil -...

Documents

Transcript of Surveillance of Zika virus in Brazil -...