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Article ; Online: Addressing the COVID-19 transmission in inner Brazil by a mathematical model.

Almeida, G B / Vilches, T N / Ferreira, C P / Fortaleza, C M C B

2021 Volume 11, Issue 1, Page(s) 10760

Abstract: In 2020, the world experienced its very first pandemic of the globalized era. A novel coronavirus, SARS-CoV-2, is the causative agent of severe pneumonia and has rapidly spread through many nations, crashing health systems and leading a large number of ... ...

Abstract	In 2020, the world experienced its very first pandemic of the globalized era. A novel coronavirus, SARS-CoV-2, is the causative agent of severe pneumonia and has rapidly spread through many nations, crashing health systems and leading a large number of people to death. In Brazil, the emergence of local epidemics in major metropolitan areas has always been a concern. In a vast and heterogeneous country, with regional disparities and climate diversity, several factors can modulate the dynamics of COVID-19. What should be the scenario for inner Brazil, and what can we do to control infection transmission in each of these locations? Here, a mathematical model is proposed to simulate disease transmission among individuals in several scenarios, differing by abiotic factors, social-economic factors, and effectiveness of mitigation strategies. The disease control relies on keeping all individuals' social distancing and detecting, followed by isolating, infected ones. The model reinforces social distancing as the most efficient method to control disease transmission. Moreover, it also shows that improving the detection and isolation of infected individuals can loosen this mitigation strategy. Finally, the effectiveness of control may be different across the country, and understanding it can help set up public health strategies.
Language	English
Publishing date	2021-05-24
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-021-90118-5
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Taking the inner route: spatial and demographic factors affecting vulnerability to COVID-19 among 604 cities from inner São Paulo State, Brazil.

Fortaleza, C M C B / Guimarães, R B / de Almeida, G B / Pronunciate, M / Ferreira, C P

Epidemiology and infection

2020 Volume 148, Page(s) e118

Abstract: Even though the impact of COVID-19 in metropolitan areas has been extensively studied, the geographic spread to smaller cities is also of great concern. We conducted an ecological study aimed at identifying predictors of early introduction, incidence ... ...

Abstract	Even though the impact of COVID-19 in metropolitan areas has been extensively studied, the geographic spread to smaller cities is also of great concern. We conducted an ecological study aimed at identifying predictors of early introduction, incidence rates of COVID-19 and mortality (up to 8 May 2020) among 604 municipalities in inner São Paulo State, Brazil. Socio-demographic indexes, road distance to the state capital and a classification of regional relevance were included in predictive models for time to COVID-19 introduction (Cox regression), incidence and mortality rates (zero-inflated binomial negative regression). In multivariable analyses, greater demographic density and higher classification of regional relevance were associated with both early introduction and increased rates of COVID-19 incidence and mortality. Other predictive factors varied, but distance from the State Capital (São Paulo City) was negatively associated with time-to-introduction and with incidence rates of COVID-19. Our results reinforce the hypothesis of two patterns of geographical spread of SARS-Cov-2 infection: one that is spatial (from the metropolitan area into the inner state) and another which is hierarchical (from urban centres of regional relevance to smaller and less connected municipalities). Those findings may apply to other settings, especially in developing and highly heterogeneous countries, and point to a potential benefit from strengthening non-pharmaceutical control strategies in areas of greater risk.
MeSH term(s)	Brazil/epidemiology ; COVID-19 ; Cities/epidemiology ; Communicable Disease Control ; Coronavirus Infections/epidemiology ; Coronavirus Infections/mortality ; Coronavirus Infections/prevention & control ; Humans ; Incidence ; Pandemics/prevention & control ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/mortality ; Pneumonia, Viral/prevention & control ; Regression Analysis ; Urban Population ; Vulnerable Populations
Keywords	covid19
Language	English
Publishing date	2020-06-19
Publishing country	England
Document type	Journal Article
ZDB-ID	632982-2
ISSN	1469-4409 ; 0950-2688
ISSN (online)	1469-4409
ISSN	0950-2688
DOI	10.1017/S095026882000134X
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Article ; Online: Addressing the COVID-19 transmission in inner Brazil by a mathematical model

G. B. Almeida / T. N. Vilches / C. P. Ferreira / C. M. C. B. Fortaleza

Scientific Reports, Vol 11, Iss 1, Pp 1-

2021 Volume 14

Abstract: Abstract In 2020, the world experienced its very first pandemic of the globalized era. A novel coronavirus, SARS-CoV-2, is the causative agent of severe pneumonia and has rapidly spread through many nations, crashing health systems and leading a large ... ...

Abstract	Abstract In 2020, the world experienced its very first pandemic of the globalized era. A novel coronavirus, SARS-CoV-2, is the causative agent of severe pneumonia and has rapidly spread through many nations, crashing health systems and leading a large number of people to death. In Brazil, the emergence of local epidemics in major metropolitan areas has always been a concern. In a vast and heterogeneous country, with regional disparities and climate diversity, several factors can modulate the dynamics of COVID-19. What should be the scenario for inner Brazil, and what can we do to control infection transmission in each of these locations? Here, a mathematical model is proposed to simulate disease transmission among individuals in several scenarios, differing by abiotic factors, social-economic factors, and effectiveness of mitigation strategies. The disease control relies on keeping all individuals’ social distancing and detecting, followed by isolating, infected ones. The model reinforces social distancing as the most efficient method to control disease transmission. Moreover, it also shows that improving the detection and isolation of infected individuals can loosen this mitigation strategy. Finally, the effectiveness of control may be different across the country, and understanding it can help set up public health strategies.
Keywords	Medicine ; R ; Science ; Q
Language	English
Publishing date	2021-05-01T00:00:00Z
Publisher	Nature Portfolio
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Taking the inner route: spatial and demographic factors affecting vulnerability to COVID-19 among 604 cities from inner São Paulo State, Brazil

Fortaleza, C M C B / Guimarães, R B / de Almeida, G B / Pronunciate, M / Ferreira, C P

Epidemiol Infect

Abstract	Even though the impact of COVID-19 in metropolitan areas has been extensively studied, the geographic spread to smaller cities is also of great concern. We conducted an ecological study aimed at identifying predictors of early introduction, incidence rates of COVID-19 and mortality (up to 8 May 2020) among 604 municipalities in inner São Paulo State, Brazil. Socio-demographic indexes, road distance to the state capital and a classification of regional relevance were included in predictive models for time to COVID-19 introduction (Cox regression), incidence and mortality rates (zero-inflated binomial negative regression). In multivariable analyses, greater demographic density and higher classification of regional relevance were associated with both early introduction and increased rates of COVID-19 incidence and mortality. Other predictive factors varied, but distance from the State Capital (São Paulo City) was negatively associated with time-to-introduction and with incidence rates of COVID-19. Our results reinforce the hypothesis of two patterns of geographical spread of SARS-Cov-2 infection: one that is spatial (from the metropolitan area into the inner state) and another which is hierarchical (from urban centres of regional relevance to smaller and less connected municipalities). Those findings may apply to other settings, especially in developing and highly heterogeneous countries, and point to a potential benefit from strengthening non-pharmaceutical control strategies in areas of greater risk.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #606044
Database	COVID19

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Article ; Online: Taking the inner route

Fortaleza, C. M. C. B. / Guimarães, R. B. / de Almeida, G. B. / Pronunciate, M. / Ferreira, C. P.

Epidemiology and Infection

spatial and demographic factors affecting vulnerability to COVID-19 among 604 cities from inner São Paulo State, Brazil

2020 Volume 148

Abstract: Abstract Even though the impact of COVID-19 in metropolitan areas has been extensively studied, the geographic spread to smaller cities is also of great concern. We conducted an ecological study aimed at identifying predictors of early introduction, ... ...

Abstract	Abstract Even though the impact of COVID-19 in metropolitan areas has been extensively studied, the geographic spread to smaller cities is also of great concern. We conducted an ecological study aimed at identifying predictors of early introduction, incidence rates of COVID-19 and mortality (up to 8 May 2020) among 604 municipalities in inner São Paulo State, Brazil. Socio-demographic indexes, road distance to the state capital and a classification of regional relevance were included in predictive models for time to COVID-19 introduction (Cox regression), incidence and mortality rates (zero-inflated binomial negative regression). In multivariable analyses, greater demographic density and higher classification of regional relevance were associated with both early introduction and increased rates of COVID-19 incidence and mortality. Other predictive factors varied, but distance from the State Capital (São Paulo City) was negatively associated with time-to-introduction and with incidence rates of COVID-19. Our results reinforce the hypothesis of two patterns of geographical spread of SARS-Cov-2 infection: one that is spatial (from the metropolitan area into the inner state) and another which is hierarchical (from urban centres of regional relevance to smaller and less connected municipalities). Those findings may apply to other settings, especially in developing and highly heterogeneous countries, and point to a potential benefit from strengthening non-pharmaceutical control strategies in areas of greater risk.
Keywords	Epidemiology ; Infectious Diseases ; covid19
Language	English
Publisher	Cambridge University Press (CUP)
Publishing country	uk
Document type	Article ; Online
ZDB-ID	632982-2
ISSN	1469-4409 ; 0950-2688
ISSN (online)	1469-4409
ISSN	0950-2688
DOI	10.1017/s095026882000134x
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Trend analysis of carbapenem-resistant Gram-negative bacteria and antimicrobial consumption in the post-COVID-19 era: an extra challenge for healthcare institutions.

de Carvalho Hessel Dias, V M / Tuon, F / de Jesus Capelo, P / Telles, J P / Fortaleza, C M C B / Pellegrino Baena, C

The Journal of hospital infection

2021 Volume 120, Page(s) 43–47

Abstract: The incidence density trend of the carbapenem-resistant Gram-negative bacteria was analysed in device-associated infections and antimicrobial consumption in 99 critical care facilities in a low/middle-income country, between January 2019 and December ... ...

Abstract	The incidence density trend of the carbapenem-resistant Gram-negative bacteria was analysed in device-associated infections and antimicrobial consumption in 99 critical care facilities in a low/middle-income country, between January 2019 and December 2020. Carbapenem-resistant Acinetobacter baumannii (CRAB) per 1000 patient-days increased in 2020 and this finding had a strong positive correlation with the incidence density of COVID-19 by the Spearman test. Polymyxin consumption also increased in 2020 but without significant correlation with CRAB or COVID-19 incidence density, presumably due to empirical and untargeted prescribing as a consequence of concern about CRAB infections. These findings are a warning to infection control programmes and antimicrobial stewardship.
MeSH term(s)	Acinetobacter baumannii ; Anti-Bacterial Agents/pharmacology ; Anti-Bacterial Agents/therapeutic use ; Anti-Infective Agents ; COVID-19 ; Carbapenems ; Delivery of Health Care ; Drug Resistance, Bacterial ; Gram-Negative Bacteria ; Humans ; Microbial Sensitivity Tests ; SARS-CoV-2
Chemical Substances	Anti-Bacterial Agents ; Anti-Infective Agents ; Carbapenems
Language	English
Publishing date	2021-11-19
Publishing country	England
Document type	Journal Article
ZDB-ID	779366-2
ISSN	1532-2939 ; 0195-6701
ISSN (online)	1532-2939
ISSN	0195-6701
DOI	10.1016/j.jhin.2021.11.011
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Spatial and sociodemographic factors associated with surgical site infection rates in hospitals in inner São Paulo State, Brazil.

Carvalho, A G M L / Limaylla, D C / Vilches, T N / de Almeida, G B / Madalosso, G / de Assis, D B / Fortaleza, C M C B

The Journal of hospital infection

2020 Volume 108, Page(s) 181–184

Abstract: Low-to-middle-income countries often have high incidence of surgical site infection (SSI). To assess spatial and sociodemographic predictors of SSI rates, this study analysed and georeferenced governmental surveillance data from 385 hospitals located in ... ...

Abstract	Low-to-middle-income countries often have high incidence of surgical site infection (SSI). To assess spatial and sociodemographic predictors of SSI rates, this study analysed and georeferenced governmental surveillance data from 385 hospitals located in inner São Paulo State, Brazil. In multi-variate models, SSI rates were positively associated with distance from the state capital [incidence rate ratio (IRR) for each 100 km 1.19, 95% confidence interval (CI) 1.07-1.32], and were lower for non-profit (IRR 0.95, 95% CI 0.37-0.85) and private (IRR 0.47, 95% CI 0.31-0.71) facilities compared with public hospitals. Georeferencing results reinforced the need to direct SSI-prevention policies to hospitals located in areas distant from the state capital.
MeSH term(s)	Brazil/epidemiology ; Hospitals, Private ; Hospitals, Public ; Hospitals, Voluntary ; Humans ; Incidence ; Socioeconomic Factors ; Spatial Analysis ; Surgical Wound Infection/epidemiology
Language	English
Publishing date	2020-11-27
Publishing country	England
Document type	Journal Article
ZDB-ID	779366-2
ISSN	1532-2939 ; 0195-6701
ISSN (online)	1532-2939
ISSN	0195-6701
DOI	10.1016/j.jhin.2020.11.018
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Article ; Online: Elementary spatial structures and dispersion of COVID-19: health geography directing responses to public health emergency in Sao Paulo State, Brazil

Fortaleza, C. M. C. B. / Guimaraes, R. B. / Catao, R. d. C. / Ferreira, C. P. / de Almeida, G. B. / Pugliesi, E.

Abstract: Public health policies to contain the spread of COVID-19 rely mainly on non-pharmacological measures. Those measures, especially social distancing, are a challenge for developing countries, such as Brazil. In Sao Paulo, the most populous state in Brazil ( ...

Abstract	Public health policies to contain the spread of COVID-19 rely mainly on non-pharmacological measures. Those measures, especially social distancing, are a challenge for developing countries, such as Brazil. In Sao Paulo, the most populous state in Brazil (45 million inhabitants), most COVID-19 cases up to April 18th were reported in the Capital and metropolitan area. However, the inner municipalities, where 20 million people live, are also at risk. As governmental authorities discuss the loosening of measures for restricting population mobility, it is urgent to analyze the routes of dispersion of COVID-19 in those municipalities. In this ecological study, we use geographical models of population mobility as patterns for spread of SARS-Cov-2 infection. Based on surveillance data, we identify two patterns: one by contiguous diffusion from the capital metropolitan area and other that is hierarchical, with long-distance spread through major highways to cities of regional relevance. We also modelled the impact of social distancing strategies in the most relevant cities, and estimated a beneficial effect in each and every setting studied. This acknowledgement can provide real-time responses to support public health strategies.
Keywords	covid19
Publisher	MedRxiv; WHO
Document type	Article ; Online
DOI	10.1101/2020.04.26.20080895
Database	COVID19

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Article ; Online: The role of intra and inter-hospital patient transfer in the dissemination of heathcare-associated multidrug-resistant pathogens.

Vilches, T N / Bonesso, M F / Guerra, H M / Fortaleza, C M C B / Park, A W / Ferreira, C P

Epidemics

2018 Volume 26, Page(s) 104–115

Abstract: Healthcare-associated infections cause significant patient morbidity and mortality, and contribute to growing healthcare costs, whose effects may be felt most strongly in developing countries. Active surveillance systems, hospital staff compliance, ... ...

Abstract	Healthcare-associated infections cause significant patient morbidity and mortality, and contribute to growing healthcare costs, whose effects may be felt most strongly in developing countries. Active surveillance systems, hospital staff compliance, including hand hygiene, and a rational use of antimicrobials are among the important measures to mitigate the spread of healthcare-associated infection within and between hospitals. Klebsiella pneumoniae is an important human pathogen that can spread in hospital settings, with some forms exhibiting drug resistance, including resistance to the carbapenem class of antibiotics, the drugs of last resort for such infections. Focusing on the role of patient movement within and between hospitals on the transmission and incidence of enterobacteria producing the K. pneumoniae Carbapenemase (KPC, an enzyme that inactivates several antimicrobials), we developed a metapopulation model where the connections among hospitals are made using a theoretical hospital network based on Brazilian hospital sizes and locations. The pathogen reproductive number, R
MeSH term(s)	Brazil/epidemiology ; Cross Infection/epidemiology ; Drug Resistance, Multiple ; Hospitals/statistics & numerical data ; Humans ; Intensive Care Units ; Microbial Sensitivity Tests ; Patient Transfer/statistics & numerical data ; Prevalence
Language	English
Publishing date	2018-11-30
Publishing country	Netherlands
Document type	Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
ZDB-ID	2467993-8
ISSN	1878-0067 ; 1755-4365
ISSN (online)	1878-0067
ISSN	1755-4365
DOI	10.1016/j.epidem.2018.11.001
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Season, weather and predictors of healthcare-associated Gram-negative bloodstream infections: a case-only study.

Rodrigues, F S / Clemente de Luca, F A / Ribeiro da Cunha, A / Fortaleza, C M C B

The Journal of hospital infection

2018 Volume 101, Issue 2, Page(s) 134–141

Abstract: Background: Recent studies reported seasonality in healthcare-associated infections (HCAI). The association of this phenomenon with other risk factors for HCAI is not clear.: Aim: To analyse the interplay of season, weather and usual predictors of ... ...

Abstract	Background: Recent studies reported seasonality in healthcare-associated infections (HCAI). The association of this phenomenon with other risk factors for HCAI is not clear. Aim: To analyse the interplay of season, weather and usual predictors of healthcare-associated bloodstream infections caused by Gram-negative bacilli (GNB-BSI). Methods: A case-only study was conducted in a teaching hospital in Brazil. The study enrolled 446 subjects with GNB-BSI diagnosed from July 2012 to June 2016. Demographic data, comorbidities, invasive procedures and use of antimicrobials were reviewed in medical charts. The season in which GNB-BSI occurred, and weather parameters on the day of diagnosis were recorded. Factors associated with occurrence of GNB-BSI in different seasons (reference category: winter) and caused by different GNB (reference category: Escherichia coli) were analysed. Uni- and multi-variable models of multi-nomial logistic regression were used for analysis. Findings: GNB-BSI diagnosed in summer was more likely to be caused by Klebsiella spp. [odds ratio (OR) 5.33; 95% confidence interval (CI) 2.04-13.96] or Acinetobacter baumannii (OR 2.69; 95% CI 1.04-6.96), and there was an association between Klebsiella spp. and spring (OR 2.86; 95% CI 1.14-7.18). Average temperature on the day of diagnosis was associated with Klebsiella spp. (OR 1.19; 95% CI 1.07-1.33) and A. baumannii (OR 1.20; 95% CI 1.07-1.34). Conclusion: Warm seasons and daily temperature impact on the aetiology of GNB-BSI, even in models adjusted for usual risk factors. One possible explanation for these findings is that seasonality of healthcare-associated pathogens is intrinsic to micro-organisms, and not associated with comorbidities, procedures or use of antimicrobials.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Bacteremia/epidemiology ; Brazil/epidemiology ; Cross Infection/epidemiology ; Female ; Gram-Negative Bacterial Infections/epidemiology ; Hospitals, Teaching ; Humans ; Male ; Middle Aged ; Models, Statistical ; Risk Factors ; Seasons ; Weather ; Young Adult
Language	English
Publishing date	2018-06-22
Publishing country	England
Document type	Journal Article
ZDB-ID	779366-2
ISSN	1532-2939 ; 0195-6701
ISSN (online)	1532-2939
ISSN	0195-6701
DOI	10.1016/j.jhin.2018.06.015
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