Análise epidemiológica do surto de Zika vírus no Brasil e no estado do Espírito Santo

Abstract

The Zika Virus epidemic in Brazil began in October 2015, in the Brazil-ian northeast, affected 27 units of the country and spread to more than 80 countries in the world, causing a pandemic. This epidemic was marked by symptoms never before described in the scientific literature, requiring numerous studies and studies to decipher the history of the disease and the teratogenic potential of the virus. Given this scenario, in 2015, the Ministry of Health declared Public Health Emergency of National Importance for changing the pattern of occurrence of microcephaly in Brazil and in 2016, WHO declared Public Health Emergency of International Importance. After research, it was discovered that the congenital syndrome associated with Zika virus infection comprises a set of signs and symptoms presented by children born to mothers infected by this virus during pregnancy such as microcephaly, a more prom-inent manifestation, as well as may include ocular alterations , craniofacial dispropor-tion and some joint and limb deformities, even in the absence of microcephaly. Dur-ing the period of discovery of the effects of the disease, different protocols on case definition were launched to instruct health professionals for notification. These fre-quent changes in the recommendations for the definition of fetal microcephaly by Zika Virus may have contributed to different estimates of the incidence of this syn-drome in Brazil, as well as may have affected clinical management and support for families and children directly affected. In addition, socioeconomic and environmental conditions also influence the outcome of this disease and can interfere with the care of these families. Objectives: The first objective of this dissertation is to describe how the protocol changes made in the epidemiological investigation process of cases of Congenital Syndrome of the Zika virus may have affected the estimates of this dis-ease. The second objective is to perform spatial distribution of Zika Virus and Con-genital Syndrome of the Zika Virus in the state of Espírito Santo by neighborhoods and to describe sociodemographic indicators and their implications in the health-disease process. Methodology: For the first objective, a study was carried out using data from reports of epidemiological records of children with Congenital Syndrome of the Zika Virus, in the period between January 1, 2015 and December 31, 2016. De-partment of Health of the State. These children were reclassified according to the first case definition protocol, launched in 2015, and by the current protocol, launched in 2016. For the second objective, a descriptive ecological study was conducted using data from the Aging Information System and Notification for the year 2016, data from epidemiological records of the State Secretariat of Health of the State of Espírito Santo for cases of Congenital Syndrome of the Zika Virus during the period from January 2015 to December 2016, as well as information from the neighborhoods of the families confirmed with Zika's Congenital Syndrome Virus from a field survey, of which this study is part. The disease was related to sociodemographic variables such as water supply, garbage collection, sanitary sewage, income and literacy. Results and Discussion: In relation to the first objective, it is noted that the first protocol, launched in 2015, is more sensitive and the current protocol, launched in 2016, is more specific. The change in the reporting protocol resulted in difficulties in reporting cases in the State of Espírito Santo, which initially reported a substantially larger number of closed cases (26 cases) compared to the period after a more specific re-porting protocol (8 cases) . Therefore, the child who is notified by the current protocol will have less chance of screening for disease follow-up. In relation to the second objective, in the year 2016, the State of Espírito Santo reported 2,774 cases of Zika Virus, of which 1939 (69.89%) women and 324 (16.70%) were notified with 193 (59.56%) confirmations according to the data of the Injury and Notification Infor-mation System. The majority 645 (57.33%) declared themselves non-white and 364 (41.69%) had complete secondary education. 49 (100%) children were notified with Zika Virus Congenital Syndrome by the State Department of Health of the State of Espírito Santo. Of these, 10 (20.40%) children died. The average sociodemographic indicators were analyzed in three distinct groups, respectively, total notifications by Zika Virus; Pregnant women notified with Zika virus; and cases of Congenital Syn-drome by Zika Virus visited. The average literacy rate was 71.13%, 70.95% and 68.34%, respectively. The average income per minimum wage was 1.41, 1.05 and 1.35. The average sewage coverage was 75.64%, 76.12% and 71.43%, garbage was 90.76%, 91.20% and 89.21%, and water was 93.83%. 94.14% and 93.82. Final Considerations: Early notification of affected newborns and colorectal diagnosis are fundamental conditions for comprehensive and necessary care for the well-being of the child and the family. Finally, given the current knowledge of the effects of the Zika virus on the development of children and noting the broader coverage of the first pro-tocol, the most prudent would be a review of the "discarded" cases of the onset of the epidemic, in order to confirmed by other specialties. In addition, it is necessary to evaluate if the current protocol is compatible with a health system with weaknesses and difficulties of standardization of behaviors as in Brazil. The sociodemographic profile and indicators of cases of Zika Virus and Congenital Syndrome of Zika Virus in the state revealed that the outbreak had different impacts on each class, social group or gender, reflecting the persistence and social geography of inequality in Brazil. The data in the present study can provide support for public policies that support the re-duction of social and gender inequalities, and that stress investment in healthy cities, urban planning and environmental sanitation, particularly with regard to access to treated water, garbage collection, and sanitary exhaustion.