Announcement

**Ronan Kelly** · May 15, 2013, 03:34 PM

Re: Brazil - Epidemiological Bulletins 2013

machine translated; http://portalsaude.saude.gov.br/port...ras-16-semanas

Influenza: Tracking the First 16 Weeks

Newsletter
Epidemiological

Secretariat of Health Surveillance - Ministry of Health

Influenza 2013: Monitoring of Epidemiological Week 16.

Updated on 22/04/2013
...
SUMMARY OF THE WEEK EPIDEMIOLOGIC

Brazil provided assistance percentage for Influenza-like illness syndrome (SG) below the upper limit in all geographic regions.

1,955 samples were collected from cases of SG to the epidemiological week (SE) in 16 sentinel. In the North, Northeast and Southeast predominated circulation of RSV, followed by influenza A and adenovirus in the northern region in the Northeast. In the South and Midwest, the number of positive samples does not permit describing predominant circulating respiratory viruses, but there is increasing trend in the number of cases.

Were reported 2,179 cases of Severe Acute Respiratory Syndrome (SARS). Of these, 7.3% (158/2.179) were classified by influenza. The median age was 10 (0-97) years and the regions with the highest number of cases of SARS were reported southeast and south

The number of deaths in reported cases of SARS was 185, with a median age of 39 (0-89) and mortality rate of SARS reported 0.10 / 100 000 inhabitants.
Epidemiology of influenza-like illness (SG)

The percentage of visits for SG between total attendances in 62 sentinel SG in Brazil remains below the upper limit of the control diagram for all regions, in the period 2004-2012 (Figure 1). To calculate the average, upper limit and lower limit were excluded from the years 2009 and 2010 due to the pandemic influenza A (H1N1) pdm09. Bacteriological samples collected in 2013, 17.3% (342/1.955) were positive for influenza or other respiratory viruses. In the North, Northeast and Southeast predominated circulation of RSV, followed by influenza A and adenovirus in the northern region in the Northeast. In the South and Midwest, the number of positive samples does not permit describing predominant circulating respiratory viruses (Figure 2.) The age group with the highest proportion of positive samples were children aged less than two years. In this age group were collected 500 samples, of which 34.2% (171/500) were positive for a respiratory virus. The VRS had a higher positivity rate in this age group, with 76.6% (131/171) of the positive samples. Among individuals 30-59 years old, approximately half of the samples were positive for influenza A (Figure 3).
...
EPIDEMIOLOGIC PROFILE OF SEVERE ACUTE RESPIRATORY SYNDROME (SARS)

SE 16 in 2013 were 38 reported cases of SARS, and the total caseload this year is 2,179 cases. Of these, 7.3% (158/2.179) were classified as SARS and influenza, at weeks 13, 14 and 15, there was a greater identification of influenza virus when compared to the previous week (Figure 4). The emergence of influenza cases among cases of SARS in the South, in the same period, suggesting increased circulation of influenza in the region.
...
Among the cases with samples positive for respiratory viruses, 59.0% (135/229) were due to influenza A virus, with 92 classified as influenza A (H1N1) pdm09, 36 as influenza A (H3) and seven samples of influenza The subtyping was not performed. The influenza B virus was detected in 7.9% (18/229) of specimens positive for respiratory viruses (Figure 5).
...
PROFILE OF DEATHS IN EPIDEMIOLOGIC SARS

In 2013, the total deaths from SARS to the epidemiological week 16, for the period from onset of 30/12/2012 to 20/04/2013, was 185. This year, the largest number of deaths from SARS in general was observed in week one and at weeks 12, 13 and 14, there was a higher incidence of subsequent deaths from influenza compared to previous weeks (Figure 7).
...
The Southeast and South were the ones that have accumulated the highest number of total deaths in SARS reported, 62.2% (115/185) and 22.7% (42/185), respectively (Table 2). In the country, until the epidemiological week 16/2013, the death rate from SARS was 0.10 / 100 000 inhabitants. Thirteen deaths were classified as caused by influenza A, ten influenza A (H1N1) pdm09, two influenza A (H3N2), an influenza A not subtyped (subtyping not performed) and influenza B.
...

**Ronan Kelly** · May 29, 2013, 05:36 AM

Re: Brazil - Epidemiological Bulletins 2013

machine translated;

Influenza 2013: Monitoring
Epidemiological Week 17
...

Epidemiological Syndrome Influenza-like illness (SG)

The proportion of visits in total SG of visits to the 62 sentinel
Brazil remains below the upper limit of control diagram for all regions (Figure
1). For the calculations of the average upper and lower limit of the control chart, were considered the years 2004 to 2012 and excluded
pandemic years of 2009 and 2010.
In 2013, 2,179 samples were collected cases of SG to the epidemiological week 17. Of these, 16.2% (354/2.179) tested positive for influenza or other viruses breathing. In the North, Northeast and Southeast predominated circulation VRS, followed by influenza A, in the North, and adenovirus in the Northeast and Southeast. at the South and Midwest the number of samples
positive does not permit describing predominance of circulation of respiratory viruses (Figure 2).
The age group with the highest proportion of samples positive was children under the age of two years. This age group were collected 536
samples, of which 64.0% (346/536) were positive for a respiratory virus. The VRS had greater proportion of this age group, with 76.7% (236/346) of the positive samples. between individuals 30-59 years old, approximately 50%
samples (47.1% to 50.0%) were positive for influenza A (Figure 3).

Epidemiological Profile of Severe Acute Respiratory Syndrome (SARS)
Were reported 3,244 cases of SARS to the SE 17, for the period from onset of
30/12/2012 to 27/04/2013. Of these, 9.1% (296/3.244) SARS were classified as influenza. in compared to previous weeks, the weeks 15, 16 and 17 were greater identifying viruses influenza (Figure 4).
Among the cases with positive samples respiratory viruses, 55.9% (259/463) were due the influenza A virus, with 175 classified as influenza A (H1N1) and 43 pdm09 as influenza A (H3), 38 influenza A subtyping not performed. Influenza B virus was identified in 6.9% (32/463) of samples positive for respiratory viruses (Figure 5).

The Southeast and South accumulated the highest number of cases of SARS in the period, with 54.3% (1.761/3.244) and 26.7% (866/3.244), respectively (Table 1).
The median age of cases of SARS was 11 (0-97) years. Cases of SARS positive for influenza were distributed in all age groups, and the band made up of people 25-59 years old had the highest percentage of cases of SARS from influenza, with 14.8% (Figure 6).

Epidemiological Profile of Deaths by SARS
The total deaths from SARS in the period from onset of 30/12/2012 to 27/04/2013 was 260. This year, many deaths occurred SARS for one week and in 14 to 16 weeks, we observed a peak identification influenza deaths, compared with the previous week (Figure 7).

The Southeast and South accumulated the highest number of deaths recorded in the period, with 62.3% (162/260) and 22.7% (59/260), respectively (Table 2). In the country, until the epidemiological week 17/2013, the mortality rate from SARS was 0.13 / 100 000 inhabitants. Thirty-seven deaths were classified as influenza, 25 influenza A (H1N1) pdm09, two influenza A (H3N2), three influenza A subtyping not performed, and three influenza B.
The median age of deaths from SARS was 39 (0-89) years. The age group with the highest proportion of influenza deaths was 25-59 years old, with 17.4% (Figure 8). According to the data recorded in SINAN, the total deaths from SARS 56.2% (146/260) had at least one comorbidity and 43.1% (112/260) were female. Among women, 40.2% (45/112) were of childbearing age, and of these 13.3% (6/45) were pregnant.

Final Thoughts
The period of seasonal influenza is approaching, and due to seasonal epidemic influenza A (H3N2) in North America is also possible that there is a period of seasonal influenza atypical countries in South America, Brazil and so on. The Ministry of Health has been developing activities to strengthen the surveillance of influenza, such as seminars, trainings and update / dissemination of the Protocol Treatment Influenza. Treatment with the antiviral Oseltamivir has been shown as a therapeutic resource for relevant impact in reducing the severity of influenza and deaths resulting therefrom.

Ministério da Saúde

http://portalsaude.saude.gov.br/portalsaude/arquivos/pdf/2013/Mai/28/2013_013_boletim_informativo_influenza_se_17.pdf

Influenza 2013: Monitoring
Epidemiological Week 18

National Context
? Brazil has assistance percentage by SG, the sentinel, below upper limit of the control diagram in all regions.
? 2,515 samples were collected from cases SG to the epidemiological week (SE) 18.
In the North, Northeast and Southeast were predominance of movement of RSV, followed by influenza A in the North and East and adenovirus in the Northeast. In the regions South and Midwest, the virus was prevalent
influenza A.
? There were 4,022 reported cases of SARS to SE 18. Of these, 10.0% (410/4.022) were sorted by influenza. The median age these patients was 12 (0-97) years.
? We recorded 322 deaths due to SARS SE 18, with a median age of 39 (0 - 89) and mortality rate of SARS 0.17 / 100 000 inhabitants.

Epidemiological Profile Influenza-like illness syndrome (GS)

The proportion of visits in SG relation to the total number of attendances in 72 units sentinels remained below the upper limit of control diagram (Figure 1). For the calculations and the average of the upper and lower
control diagram were considered years 2004 to 2012, excluding the years pandemic 2009 and 2010.
2,515 samples were collected from cases of SG to the epidemiological week 18. Of these, 15.9% (401/2.515) tested positive for influenza or other respiratory viruses. In the regions North, Northeast and Southeast predominated RSV circulation, followed by the influenza A North and South and adenovirus in the region Northeast. In the South and Midwest, the virus
Influenza A was the most prevalent (Figure 2).
The age group with the highest proportion of positive samples was children aged less than two years. This age group were 581 samples collected, of which 61.1% were a respiratory virus positive, and that these, 76.1% (270/355) for RSV. Between individuals 20-59 years, over 50% of
samples were positive for influenza A virus

Epidemiological Profile of Severe Acute Respiratory Syndrome (SARS)

Were reported 4,022 cases of SARS to SE 18, for the period from onset of 30/12/2012 to 04/05/2013. Of these, 10.0% (410/4.022) were classified as SARS influenza. At weeks 14, 15 and 16 there was a greater identification of influenza viruses compared to previous weeks (Figure 4).
Among the cases of SARS were predominant influenza virus, with 58.0% (340/586) of samples positive for influenza A and 6.5% (38/586) for influenza B (Figure 5). Among the cases classified as influenza A, 240 were influenza A (H1N1) pdm09, 51 influenza A (H3) and 49 influenza A not subtyped.
The Southeast and South accumulated the highest number of cases of SARS in the period, with 55.5% (2.234/4.022) and 26.0% (1.044/4.022), respectively (Table 1). The median age of patients was 12 (0-97) years and positive for influenza were distributed in all age groups, and the band made up of people 25-59 years old had the highest percentage of cases of SARS from influenza with 16.9% (201/1.192).

Epidemiological profile of deaths from SARS

We recorded 322 deaths from SARS to the epidemiological week 18, for the period from onset of 30/12/2012 to 04/05/2013. The largest number of deaths was observed at week 16 and from week 14, there was an increase identification of deaths from influenza, compared with the previous weeks (Figure 6).
The Southeast and South accumulated the highest number of deaths in the period, with 60.6% (195/322) and 21.7% (70/322), respectively (Table 1). In the country, until the epidemiological week 18/2013, the mortality rate from SARS was 0.17 / 100 000 inhabitants. As the etiologic agent, 54 resulted from influenza, three classified as unidentified influenza subtype, 38 as influenza A (H1N1) pdm09, two as influenza A (H3N2), for six cases of influenza A subtyping was not performed, and five were classified as influenza B.
The median age of cases of SARS who died was 39 (0-89) years. The age group with the highest proportion of influenza deaths was 25 and 59 years old, with 22.2% (34/153). According to the data recorded in SINAN, the total deaths from SARS, 55.9% (180/322) had at least one comorbidity and 45.3% (146/322) were female. Among women, 40.4% (59/146) were of childbearing age, of which 11.9% (7/59) were in the gestational period.

Ministério da Saúde

http://portalsaude.saude.gov.br/portalsaude/arquivos/pdf/2013/Mai/28/2013_014_boletim_influenza_se_18.pdf

**Ronan Kelly** · June 5, 2013, 03:41 PM

Re: Brazil - Epidemiological Bulletins 2013

Boletim
Epidemiológico
Secretaria de Vigilância em Saúde − Ministério da Saúde
Volume 44
N° 7 - 2013

Influenza 2013: Monitoring
Epidemiological Week 19

...
National Context
• The percentage of attendance by the SG sentinel in Brazil was below the
upper limit of the control chart in all geographic regions.
• 3,116 samples were collected from cases of SG to the epidemiological week 19. In the North, Northeast and Southeast predominated movement of RSV, followed by influenza A in the North and East, and adenovirus in Northeast. In the South and Midwest, influenza A virus was the most prevalent.
• There were 4,713 reported cases of SARS to the SE 19. Of these, 11.7% (553/4.713) were classified influenza. The median age of cases was 14 (0-97) years.
• We recorded 391 deaths from SARS to the SE 19, with a median age of 40 (0-89) and a mortality rate of 0.20 per SARS / 100 thousand inhabitants.

Epidemiology of Influenza-like illness syndrome (GS)
The proportion of visits by SG between total demand in 84 sentinel
in Brazil remained below the upper limit of diagram to control the country and all regions geographical (Figure 1). For the calculations of the average
upper and lower control chart were included the years 2004 to 2012, and excluded the years 2009 and 2010 pandemic.

3,116 samples were collected from cases of SG to the epidemiological week 19. Of these, 14.0% (437/3.116) tested positive for influenza or other respiratory viruses. There was predominance of RSV circulation in regions
North, Northeast and Southeast, followed by influenza The in the North and East and the adenovirus Northeast.
In the South and Midwest, the virus was the prevalent influenza A (Figure 2).
The age group with the highest proportion of positive samples was children aged less than two years. In this age group were 690 samples collected, of which 28.1% were positive for a respiratory virus. RSV showed a higher percentage of positivity in this age group, with 75.8% (147/194) of samples
positive. Among individuals aged 20 to 59 years the predominant influenza A, in this group, 51.4% (55/1.314) samples were positive for virus.
...
Epidemiology of Severe Acute Respiratory Syndrome
The Severe Acute Respiratory Syndrome (SARS) is characterized by cases of flu-like illness that evolve with impaired respiratory function, no other specific cause. May be caused by respiratory viruses, among which the predominant influenza, or by bacteria, fungi, and other agents.
The SARS from influenza includes cases of flu-like illness caused by influenza viruses A or B - no other specific cause - that evolve with compromised respiratory function.
Were reported 4,713 cases of SARS to SE 19, for the period from onset of 30/12/2012 to 11/05/2013. Of these, 11.7% (553/4.713) were classified as SARS influenza. In weeks 15, 16 and 17 were further identification of influenza viruses in comparison to the previous week (Figure 3).
Among the cases of SARS respiratory virus, influenza virus predominated, with 66.1% (504/763) of samples positive for influenza A and 6.2% (47/763) for influenza B (Figure 5). Among the cases classified as influenza A, 388 were influenza A (H1N1) pdm09, 65 influenza A (H3), and 51 cases of influenza A subtyping not performed.
Regarding the cases of SARS comparison between the years 2012 and 2013 for the same epidemiological week, note in Figure 4 (in which the dotted line represents the total number of SARS reported in 2012 and the histogram pertains to 2013) that there was an increase in the number of cases reported from SE 12 in 2013. Individual analysis by regions showed that the Southeast region increased by 97% (2.665/1.353) compared to 2012. It was found that 70% (1.863/2.665) of these cases were notifications of São Paulo, which showed an increase of notifications (1.863/402) compared to 2012.
There was a slight increase in deaths from SARS in the North and Midwest, and a significant increase in the Southeast. The percent increase in these three regions were 21% (23/19) 23% (32/26) and 87% (241/129), respectively. Of deaths in the Southeast, 76% (183/241) were from São Paulo. Until 19 SE, 2013, this state has notified 183 deaths from SARS, of which 55 were confirmed for influenza A (H1N1) pdm09. The same period in 2012, São Paulo was reported 69 deaths from SARS, seven by influenza A (H1N1) pdm09.
Geographic regions South and Southeast accumulated the highest number of cases of SARS in the period, with 56.5% (2.665/4.713) and 26.0% (1.227/4.4713), respectively (Table 1).
Among the cases of SARS, the median age was 14 (0-97) years. Cases of SARS positive for influenza were distributed in all age groups, and the band made up of people 25-59 years old had the highest percentage of cases of SARS from influenza, with 20.1% (286/1.425).
...
Epidemiological Profile of Deaths by SARS
We recorded 391 deaths from SARS to the epidemiological week 19, for the period from onset of 30/12/2012 to 11/05/2013. In 2013, the highest number of deaths from SARS was observed at week 16 and from week 12, there was an increase identification of deaths from influenza, compared with the previous weeks (Figure 6).
...
The Southeast and South were the ones that have accumulated the highest number of deaths recorded in the period, with 61.6% (241/391) and 19.4% (76/391), respectively (Table 1). In the country, until the epidemiological week 19/2013, the mortality rate from SARS was 0.20 / 100 000 inhabitants. Eighty-two deaths were classified as influenza, two classified as unidentified influenza subtype, and 61 influenza A (H1N1) pdm09, five as influenza A (H3) seasonal, eight cases of influenza A subtyping not performed, and six were rated and influenza B.
Among deaths from SARS, the median age was 40 (0-89) years. The age group with the highest percentage of deaths from influenza was 25-59 years old, with 25.3% (47/186).
According to the data recorded in SINAN, the total deaths from SARS, 55% (215/391) had at least one comorbidity and 46.5% (182/391) were female. Among women, 42.3% (77/182) were of childbearing age, of which 14.3% (11/77) were in the gestational period.
...
final Thoughts
The increase in the number of cases reported in the last three weeks this year indicates that, in some regions, seasonality has begun in Brazil. The Southeast region showed the most viral circulation and deaths, concentrating cases in the state of São Paulo. The Northern region had also increased circulation of influenza, especially in Pará, a fact demonstrated by the increase in the number of SARS cases and deaths in the same period in the Southeast.
It is essential that health services are prepared to meet the cases of SG and SARS and the dissemination of the Protocol Treatment Influenza, restated in 2013 (available at: and the flow distribution of Oseltamivir Phosphate arranged.

Ministério da Saúde

http://portalsaude.saude.gov.br/portalsaude/index.cfm?portal=pagina.visualizarTexto&codConteudo=11235&codModuloArea=783&chamada=influenza:-semana-epidemiologica-19-_-2013

**Ronan Kelly** · November 28, 2013, 07:25 AM

Re: Brazil - Epidemiological Bulletins 2013

Sorry - I haven't looked at the Brazilian MOH website in a month which makes my reporting their already tardy update even more out of date. - Ro

Volume 44 - No. 15-2013
Secretariat of Health Surveillance - Ministry of Health

Influenza: Epidemiological Monitoring until Week 29, 2013

Log in here the version of the Epidemiological Bulletin in PDF

Updated on 07/23/2013

National Context

? Earlier this year, the surveillance of influenza-like illness (SG) dominated the circulation of RSV as expected and, from SE 16, began to predominate influenza, especially the influenza A (H1N1) virus pdm09, persisting yet. It is noteworthy that in the South also cocirculam, more clearly, influenza viruses A (H3N2) and influenza B.

? The number of reported SARS cases and deaths continues to rise, especially in the South and Southeast regions, which is expected for this time of year, however, with a higher incidence than that observed in 2012. Of the reported cases, 17.8% were confirmed for influenza, among which predominated influenza A (H1N1) pdm09, with the proportion of 71.3% and increased circulation from SE 12. Of deaths from SARS, 28% were confirmed influenza, among which 86.1% were due to influenza A (H1N1) pdm09.

? Are Paulopermanece as the state with the largest number of cases and deaths from influenza, which initially concentrated in the capital and S?o Paulo and currently disperse by municipalities. Also continue increasing the number of cases and deaths in the states of Minas Gerais and in the Southern states, although the latter, the number of cases and deaths is lower than that recorded in 2012. In all regions the influenza A (H1N1) pdm09 predominant among influenza deaths.

Sentinel surveillance of influenza-like illness (SG)-Viral Movement

Sentinel surveillance of SG utilizes data from 120 sentinel units, distributed in all geographical regions: North (21) Northeast (27), South East (28) South (35) and Midwest (9). This sentinel surveillance is in the enlargement process and the next newsletter will be incorporated into the analysis of positivity for respiratory viruses registered new units gradually until the end of the expansion of these units.

Until 29 SE, 2013, 7,308 samples were collected. Of these, 1351 (18.5%) were positive for influenza and other respiratory viruses. Predominant circulation of RSV early in the year, and from SE 16, begins to dominate the influenza virus, with the highest frequency of the virus influenza A (H1N1) pdm09 (Figure 1). Noteworthy is the increase in circulating influenza B virus from SE 20, which becomes the second most common virus.
...
Universal Surveillance of Severe Acute Respiratory Syndrome *

Until SE 29 2013 21,307 cases of SARS, of which 17.8% (3,784) were confirmed influenza were reported. Among the cases of influenza, the predominant influenza A (H1N1) pdm09, with the proportion of 71.3% (2,698), which has remained as the predominant virus from SE 12 (Figure 2). Were also identified 619 cases due to influenza B infection, 323 cases of influenza A (H3N2) and other 145 were confirmed for influenza A, not subtyped (Annex - Table 2).

The state with the highest number of confirmed influenza cases was S?o Paulo, in the Southeast, representing 57.8% (2,186) of cases of SARS influenza in the country, with 1,687 cases of influenza A (H1N1) pdm09, 363 influenza B , 75 influenza A (H3N2), other 61 were confirmed for influenza A, without identification of the subtype (Annex - Table 2 and Figure 5). In S?o Paulo, the activity of SARS cases arising from the influenza A (H1N1) pdm09 became more important from SE 12.
...
Epidemiological profile of deaths from SARS

Until 29 SE, 2013, 2,128 deaths were reported by SARS, of which 28% (595) were confirmed for influenza. Among the influenza deaths, those predominated by influenza A (H1N1) pdm09, with the proportion of 86.1% (512) and a greater incidence from SE 12 (Figure 3). Besides the deaths from influenza A (H1N1) pdm09, deaths by 35 B, 27 influenza viruses have been confirmed influenza A (H3N2) and other 21 were confirmed for influenza A, without identification of the subtype (Annex - Table 2).

The mortality rate for influenza was 0.3 / 100 000 inhabitants. The state with the highest rate of mortality was S?o Paulo (0.9 / 100 000 inhabitants), representing 63.7% (379) of influenza deaths in the country: 339 influenza A (H1N1) pdm09, 21 influenza B, 12 influenza A (H3N2), the other seven were confirmed for influenza A, without identification of the subtype. The number of deaths from influenza reported also increased in the last SEs in the states of Minas Gerais (68), Paran? (39), Rio Grande do Sul (26) and Santa Catarina (11). In all states cited predominated deaths from influenza A (H1N1) pdm09 (Annex - Table 2 and Figure 5).

The median age of deaths confirmed influenza was 49 years (0-98). The age group with the highest percentage of deaths due to influenza was 40-59 years old. In this age group, 40.7% of total deaths from SARS (286/702) were confirmed for influenza, of which: 259 were influenza A (H1N1) pdm09, 11 influenza B, 8 influenza A (H3N2) and other 8 were confirmed for influenza A, without identification of the subtype.

Among the deaths from SARS influenza, 66.9% had at least one risk factor or condition, especially the deaths of adults aged 60 years or more (22.9%) and individuals with chronic diseases (20%) . The majority, 78.3%, made use of antiviral, but with median time of introduction of four (4) days after the first symptoms (Table 1) therapy. It is recommended to start treatment, preferably within 48 hours of onset of symptoms, although it is known that even after ten days there is still some benefit.
...

Ministério da Saúde

http://portalsaude.saude.gov.br/portalsaude/index.cfm?portal=pagina.visualizarTexto&codConteudo=14014&codModuloArea=783&chamada=boletim-epidemiologico-influenza-_-volume-44-no-15

Announcement

Brazil - Epidemiological Bulletins 2013

Brazil - Epidemiological Bulletins 2013

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