Alinha-se assim ao espírito da Declaração de Alma-Ata, de 1978, sobre atenção primária à saúde (APS) que convocou os governos a formular políticas nacionais, estratégias e planos de ação para implementar a APS como parte de um sistema nacional de saúde integral e em coordenação com outros setores para enfrentar os determinantes sociais e ambientais da saúde, mobilizando vontade política e recursos.

Globally, millions of lives are impacted every year by infectious diseases outbreaks. Comprehensive and innovative surveillance strategies aiming at early alert and timely containment of emerging and reemerging pathogens are a pressing priority. Shortcomings and delays in current pathogen surveillance practices further disturbed informing responses, interventions, and mitigation of recent pandemics, including H1N1 influenza and SARS-CoV-2. We present the design principles of the architecture for an early-alert surveillance system that leverages the vast available data landscape, including syndromic data from primary health care, drug sales, and rumors from the lay media and social media to identify areas with an increased number of cases of respiratory disease. In these potentially affected areas, an intensive and fast sample collection and advanced high-throughput genome sequencing analyses would inform on circulating known or novel pathogens by metagenomics-enabled pathogen characterization. Concurrently, the integration of bioclimatic and socioeconomic data, as well as transportation and mobility network data, into a data analytics platform, coupled with advanced mathematical modeling using artificial intelligence or machine learning, will enable more accurate estimation of outbreak spread risk. Such an approach aims to readily identify and characterize regions in the early stages of an outbreak development, as well as model risk and patterns of spread, informing targeted mitigation and control measures. A fully operational system must integrate diverse and robust data streams to translate data into actionable intelligence and actions, ultimately paving the way toward constructing next-generation surveillance systems.

Until recently, Zika virus (ZIKV) infections were considered mild and self-limiting. Since 2015, they have been associated with an increase in microcephaly and other birth defects in newborns. While this association has been observed in case reports and epidemiological studies, the nature and extent of the relationship between ZIKV and adverse pregnancy and pediatric health outcomes is not well understood. With the unique opportunity to prospectively explore the full spectrum of issues related to ZIKV exposure during pregnancy, we undertook a multi-country, prospective cohort study to evaluate the association between ZIKV and pregnancy, neonatal, and infant outcomes. At research sites in ZIKV endemic regions of Brazil (4 sites), Colombia, Guatemala, Nicaragua, Puerto Rico (2 sites), and Peru, up to 10,000 pregnant women will be recruited and consented in the first and early second trimesters of pregnancy and then followed through delivery up to 6 weeks post-partum; their infants will be followed until at least 1 year of age. Pregnant women with symptomatic ZIKV infection confirmed by presence of ZIKV RNA and/or IgM for ZIKV will also be enrolled, regardless of gestational age. Participants will be tested monthly for ZIKV infection; additional demographic, physical, laboratory and environmental data will be collected to assess the potential interaction of these variables with ZIKV infection. Delivery outcomes and detailed infant assessments, including physical and neurological outcomes, will be obtained. With the emergence of ZIKV in the Americas and its association with adverse pregnancy outcomes in this region, a much better understanding of the spectrum of clinical outcomes associated with exposure to ZIKV during pregnancy is needed. This cohort study will provide information about maternal, fetal, and infant outcomes related to ZIKV infection, including congenital ZIKV syndrome, and manifestations that are not detectable at birth but may appear during the first year of life. In addition, the flexibility of the study design has provided an opportunity to modify study parameters in real time to provide rigorous research data to answer the most critical questions about the impact of congenital ZIKV exposure. NCT02856984. Registered August 5, 2016. Retrospectively registered.

RESUMO O presente artigo analisa, de forma preliminar, as principais posições e respostas de instituições-chave do sistema multilateral das Nações Unidas, como a Assembleia Geral (AGNU) e a Secretaria Geral, e sua agência especializada em saúde, a Organização Mundial da Saúde (OMS), quanto à pandemia pela Covid-19, no período compreendido entre janeiro e maio de 2020. Usando como metodologia a análise de conteúdo dos principais documentos produzidos no âmbito do referido sistema multilateral, identifica a amplitude dessa abordagem, mas também seus limites, assim como os conflitos inerentes a um mundo dividido, que traduzem as disputas de atores políticos relevantes da cena mundial, transferidas também para o campo da saúde global. Ao final, aponta questões fundamentais a serem resolvidas no âmbito de um multilateralismo fraturado e enfraquecido.

Research on ambient temperature effects on mortality leveraging cohort data remains scarce. This study estimates the association between ambient temperature and non-accidental mortality and investigates potential effect modification of the temperature-mortality relationship by a wide range of individual and household-level characteristics in a nationwide cohort. We designed a space-time-stratified case-crossover study within the 100 Million Brazilian Cohort, comprising low-income families enrolled in Brazil's Unified Registry for Social Programs (CadÚnico), including all deaths from 2000 to 2018. Daily mean temperatures were obtained from Brazilian Daily Weather Gridded Data based on 1,252 meteorological stations. The outcome was defined as daily counts of non-accidental deaths aggregated at the municipality level. The effect of ambient temperature on non-accidental mortality was estimated using conditional quasi-Poisson regression combined with distributed lag non-linear models. The study population included 3,554,422 deaths. Cold temperatures were associated with a 38 % increase in non-accidental mortality risk (RR = 1.38, 95 % CI: 1.34-1.43) nationally, with high regional variability. In contrast, heat was associated with a 4 % increase in mortality risk nationally, primarily driven by increased risk in the Southeast and Central-West regions. Across population subgroups, cold-related mortality risk was higher among older (≥60 years) adults (RR = 1.47, 95 % CI: 1.42-1.53) and Black individuals (RR = 1.56, 95 % CI: 1.49-1.64). Higher vulnerability to heat-related mortality was found among urban residents (RR = 1.07, 95 % CI: 1.05-1.10). However, we found no consistent evidence of effect modification of cold- and heat-related mortality by sex, income or access to key utilities (water, waste, and electricity). Our findings indicate significant regional differences, highlighting population strata particularly vulnerable to temperature-related mortality. This evidence informs the targeting of interventions for protecting vulnerable populations from extreme temperatures.