Background: The introduction of the bacterium Wolbachia (wMel strain) into Aedes aegypti mosquitoes reduces their capacity to transmit dengue and other arboviruses. Evidence of a reduction in dengue case incidence following field releases of wMel-infected Ae. aegypti has been reported previously from a cluster randomised controlled trial in Indonesia, and quasi-experimental studies in Indonesia and northern Australia. Methodology/Principal findings: Following pilot releases in 2015–2016 and a period of intensive community engagement, deployments of adult wMel-infected Ae. aegypti mosquitoes were conducted in Niterói, Brazil during 2017–2019. Deployments were phased across four release zones, with a total area of 83 km² and a residential population of approximately 373,000. A quasi-experimental design was used to evaluate the effectiveness of wMel deployments in reducing dengue, chikungunya and Zika incidence. An untreated control zone was pre-defined, which was comparable to the intervention area in historical dengue trends. The wMel intervention effect was estimated by controlled interrupted time series analysis of monthly dengue, chikungunya and Zika case notifications to the public health surveillance system before, during and after releases, from release zones and the control zone. Three years after commencement of releases, wMel introgression into local Ae. aegypti populations was heterogeneous throughout Niterói, reaching a high prevalence (>80%) in the earliest release zone, and more moderate levels (prevalence 40–70%) elsewhere. Despite this spatial heterogeneity in entomological outcomes, the wMel intervention was associated with a 69% reduction in dengue incidence (95% confidence interval 54%, 79%), a 56% reduction in chikungunya incidence (95%CI 16%, 77%) and a 37% reduction in Zika incidence (95%CI 1%, 60%), in the aggregate release area compared with the pre-defined control area. This significant intervention effect on dengue was replicated across all four release zones, and in three of four zones for chikungunya, though not in individual release zones for Zika. Conclusions/Significance: We demonstrate that wMel Wolbachia can be successfully introgressed into Ae. aegypti populations in a large and complex urban setting, and that a significant public health benefit from reduced incidence of Aedes-borne disease accrues even where the prevalence of wMel in local mosquito populations is moderate and spatially heterogeneous. These findings are consistent with the results of randomised and non-randomised field trials in Indonesia and northern Australia, and are supportive of the Wolbachia biocontrol method as a multivalent intervention against dengue, chikungunya and Zika.

Segundo a Organização Mundial da Saúde cerca de 55 milhões de abortos ocorreram no mundo, entre 2010 e 2014, e 45% destes foram inseguros. No Brasil, dados sobre aborto e suas complicações são incompletos. Dados assistenciais estão somente disponíveis para o setor público e dados de mortalidade dependem de investigação do óbito. O objetivo do estudo foi descrever o cenário do aborto no país, utilizando dados públicos disponíveis para acesso nos diversos Sistemas de Informação - SIM (mortalidade), SINASC (nascidos vivos) e SIH (internação hospitalar). No período entre 2008 e 2015, ocorreram cerca de 200.000 internações/ano por procedimentos relacionados ao aborto, sendo cerca de 1.600 por razões médicas e legais. De 2006 a 2015, foram encontrados 770 óbitos maternos com causa básica aborto no SIM. Houve discreta redução dos óbitos por aborto ao longo do período, com variações regionais. Esse número poderia ter um incremento de cerca de 29% por ano se os óbitos com menção de aborto e declarados com outra causa básica fossem considerados. Entre os óbitos declarados como aborto, 1% foi por razões médicas e legais e 56,5% como aborto não especificado. A proporção de óbitos por aborto identificados no SIH, em relação ao total de óbitos por aborto identificados no SIM, variou de 47,4% em 2008 para 72,2% em 2015. Embora os dados oficiais de saúde não permitam uma estimativa do número de abortos no país, foi possível traçar um perfil de mulheres em maior risco de óbito por aborto: as de cor preta e as indígenas, de baixa escolaridade, com menos de 14 e mais de 40 anos, vivendo nas regiões Norte, Nordeste e Centro-oeste, e sem companheiro.

Expanding delivery of primary healthcare to urban poor populations is a priority in many low- and middle-income countries. This remains a key challenge in Brazil despite expansion of the country’s internationally recognized Family Health Strategy (FHS) over the past two decades. This study evaluates the impact of an ambitious program to rapidly expand FHS coverage in the city of Rio de Janeiro, Brazil, since 2008. A cohort of 1,241,351 low-income adults (observed January 2010–December 2016; total person-years 6,498,607) with linked FHS utilization and mortality records was analyzed using flexible parametric survival models. Time-to-death from all-causes and selected causes were estimated for FHS users and nonusers. Models employed inverse probability treatment weighting and regression adjustment (IPTW-RA). The cohort was 61% female (751,895) and had a mean age of 36 years (standard deviation 16.4). Only 18,721 individuals (1.5%) had higher education, whereas 102,899 (8%) had no formal education. Two thirds of individuals (827,250; 67%) were in receipt of conditional cash transfers (Bolsa Família). A total of 34,091 deaths were analyzed, of which 8,765 (26%) were due to cardiovascular disease; 5,777 (17%) were due to neoplasms; 5,683 (17%) were due to external causes; 3,152 (9%) were due to respiratory diseases; and 3,115 (9%) were due to infectious and parasitic diseases. One third of the cohort (467,155; 37.6%) used FHS services. In IPTW-RA survival analysis, an average FHS user had a 44% lower hazard of all-cause mortality (HR: 0.56, 95% CI 0.54–0.59, p < 0.001) and a 5-year risk reduction of 8.3 per 1,000 (95% CI 7.8–8.9, p < 0.001) compared with a non-FHS user. There were greater reductions in the risk of death for FHS users who were black (HR 0.50, 95% CI 0.46–0.54, p < 0.001) or pardo (HR 0.57, 95% CI 0.54–0.60, p < 0.001) compared with white (HR 0.59, 95% CI 0.56–0.63, p < 0.001); had lower educational attainment (HR 0.50, 95% CI 0.46–0.55, p < 0.001) for those with no education compared to no significant association for those with higher education (p = 0.758); or were in receipt of conditional cash transfers (Bolsa Família) (HR 0.51, 95% CI 0.49–0.54, p < 0.001) compared with nonrecipients (HR 0.63, 95% CI 0.60–0.67, p < 0.001). Key limitations in this study are potential unobserved confounding through selection into the program and linkage errors, although analytical approaches have minimized the potential for bias. FHS utilization in urban poor populations in Brazil was associated with a lower risk of death, with greater reductions among more deprived race/ethnic and socioeconomic groups. Increased investment in primary healthcare is likely to improve health and reduce health inequalities in urban poor populations globally.

To assess the adequacy of prenatal care offered in the Brazilian capital cities and the diagnosis of gestational syphilis through public data from health information systems. The modified Kotelchuck index for adequacy of prenatal care was built using Brazilian Information System on Live Births (SINASC) data. Data on gestational syphilis, congenital syphilis, estimated population coverage by the Family Health Strategy (FHS), the Municipal Human Development Index (MHDI) and data from National Program for Access and Quality Improvement in Primary Care (PMAQ-AB) were accessed in public sites. The profile of pregnant women associated with inadequate care was assessed by logistic regression. In total, 685,286 births were analyzed. Only 2.3% of women did not attend prenatal appointments. The mean adequacy was 79.7%. No correlation was found between adequacy of prenatal care and FHS coverage (p = 0.172), but a positive correlation was found with the MHDI (p < 0.001). Inadequacy of prenatal care was associated with age below 20 years old, schooling less than 4 years, non-white skin color and not having a partner. Among the congenital syphilis cases, 17.2% of mothers did not attend prenatal care. Gestational syphilis more often affected vulnerable women, including a higher proportion of adolescents, women with low schooling, and women of non-white color. The PMAQ-AB showed a median availability of 27.3% for syphilis rapid tests, 67.7% for benzathine penicillin, and 86.7% for benzathine penicillin administration by health teams. The use of public data showed a low adequacy of prenatal care in Brazilian capitals, denoting insufficient quality for the diagnosis and treatment of gestational syphilis, despite the availability of supplies. Continuous monitoring can be carried out using public data, indicating to local strategies to eliminate congenital syphilis.

Objetivo. Descrever o perfil epidemiológico dos casos notificados de sífilis em gestantes e sífilis congênita nos estados brasileiros do Amazonas, Ceará, Espírito Santo, Rio de Janeiro e Rio Grande do Sul e no Distrito Federal a partir de dados do Sistema Nacional de Agravos de Notificação (SINAN). Métodos. Estudo descritivo incluindo avaliação ecológica e transversal. Foram utilizados dados do SINAN Net. Foram calculadas a taxa de detecção de sífilis em gestantes e a taxa de incidência de sífilis congênita por 1 000 nascidos vivos. Para identificar as gestantes notificadas com sífilis com desfecho de sífilis congênita, as duas bases do SINAN foram relacionadas por meio do software RecLink. Como os dados eram de representatividade regional, as comparações foram feitas entre as unidades da federação, e não com a soma dos casos. Resultados A taxa de detecção de sífilis em gestantes cresceu entre 21% (Amazonas) e 75% (Rio de Janeiro). A incidência de sífilis congênita seguiu o mesmo perfil de incremento, variando de 35,6% no Distrito Federal a 639,9% no Rio Grande do Sul, com redução de 0,7% no Amazonas. A realização de pré-natal nas mulheres com desfecho de sífilis congênita variou de 67,3% no Amazonas a 83,3% no Distrito Federal. Das gestantes com sífilis, 43% tiveram desfecho notificado de sífilis congênita. Nas gestantes com sífilis e desfecho de sífilis congênita, o diagnóstico materno ocorreu durante o pré-natal em 74% e no parto em 18%. Em 8% das mulheres ignorava-se o momento do diagnóstico. Conclusão. O incremento nas taxas de detecção de sífilis pode ter resultado do aumento na notificação. O monitoramento constante em gestantes é essencial para a eliminação desses agravos.

Este estudo procurou correlacionar as informações disponíveis em sistemas nacionais de informação em saúde sobre notificações de sífilis em gestante, sífilis congênita e cobertura populacional da Estratégia Saúde da Família (FHS). As estimativas de notificação foram calculadas de acordo com o Estudo Sentinela Parturiente de 2004 do Ministério da Saúde e os dados observados foram obtidos na Internet, nas páginas da Secretaria de Vigilância em Saúde e da Secretaria de Atenção em Saúde, para o ano de 2008. As razões observadas sobre estimadas para sífilis em gestante e sífilis congênita e a cobertura populacional da FHS por macrorregião brasileira não apresentaram correlação (r = -0,28 e r = -0,40, respectivamente). A FHS se apresenta como local privilegiado para realização do pré-natal e, logicamente, fonte da notificação compulsória de sífilis em gestante. Acoplando diagnóstico com o tratamento adequado da sífilis na gestante e no parceiro, a FHS é instrumento primordial para a eliminação da sífilis congênita no Brasil. Expansão da cobertura e cuidado de qualidade são essenciais para o alcance da meta.