RESUMEN Objetivo: identificar la ocurrencia del brote compatible con escorbuto y los factores de exposición asociados con signos/síntomas típicos de hipovitaminosis que ocurrieron en una penitenciaría masculina en Ceará, Brasil entre 2019-2020. Métodos: estudio poblacional de casos y controles; se utilizaron historias clínicas y entrevistas con casos compatibles, con inicio de signos/síntomas durante el período de estudio, y controles; se realizó análisis multivariable. Resultados: de los 62 casos, edad media fue 40,6 años (DE = 10,8); principales signos/síntomas fueron edema y dolor en miembros inferiores (100,0%), dificultad para caminar (91,9%), hematoma/equimosis en miembros inferiores (90,3%) y fiebre (88,7%); la edad mayor de 40 años se identificó como factor asociado (ORa = 1,10; IC95% 1,05;1,17; p-valor = 0,001); y como factores protectores: trabajo (ORa = 0,11; IC95% 0,03;0,36; p-valor < 0,001) y participación en clases (ORa = 0,21; IC95% 0,08;0,59; p-valor = 0,003) dentro del centro penitenciario. Conclusión: el brote en centro penitenciario fue considerado compatible con escorbuto debido a los signos/síntomas característicos, asociados a los factores identificados; se recomendó oferta regular de dieta rica en vitamina C a todos los internos y seguimiento clínico de los casos. Objetivo signossíntomas signos síntomas Ceará 20192020. 20192020 2019 2020. 2020 2019-2020 Métodos controles compatibles multivariable Resultados 6 406 40, DE 10,8 108 10 8 10,8) 100,0%, 1000 100,0% , 100 0 (100,0%) 91,9%, 919 91,9% 91 9 (91,9%) hematomaequimosis hematoma equimosis 90,3% 903 90 3 (90,3% 88,7% 887 88 7 (88,7%) 4 ORa 1,10 110 1 IC95 IC 1,051,17 105117 1,05 1,17 05 17 1,05;1,17 pvalor p valor 0,001 0001 001 protectores 0,11 011 11 0,030,36 003036 0,03 0,36 03 36 0,03;0,36 0,21 021 21 0,080,59 008059 0,08 0,59 08 59 0,08;0,59 0,003 0003 003 Conclusión característicos identificados 2019202 201 202 2019-202 10, 100,0 (100,0% 91,9 (91,9% 90,3 (90,3 88,7 (88,7% 1,1 IC9 051 1,051,1 10511 105 1,0 117 1,05;1,1 0,00 000 00 0,1 01 030 0,030,3 00303 0,0 036 0,3 0,03;0,3 0,2 02 2 080 0,080,5 00805 008 059 0,5 5 0,08;0,5 201920 20 2019-20 100, (100,0 91, (91,9 90, (90, 88, (88,7 1, 1,051, 1051 1,05;1, 0, 0,030, 0030 0,03;0, 0,080, 0080 0,08;0, 20192 2019-2 (100, (91, (90 (88, 1,051 1,05;1 0,030 0,03;0 0,080 0,08;0 2019- (100 (91 (9 (88 1,05; 0,03; 0,08; (10 ( (8 (1

ABSTRACT Objective: to identify the occurrence of an outbreak compatible with scurvy and exposure factors associated with typical signs/symptoms of hypovitaminosis that occurred in a male penitentiary in Ceará, Brazil between 2019-2020. Methods: this was a population-based case-control study; we used clinical records and interviews with compatible cases - based on sign/symptom onset during the study period - and with controls; we carried out multivariate analysis. Results: out of 62 cases, mean age was 40.6 years (SD = 10.8); main signs/symptoms were edema and pain in the lower limbs (100.0%), difficulty in walking (91.9%), hematoma/ecchymosis in the lower limbs (90.3%) and fever (88.7%); we identified being over 40 years old as an associated factor (aOR = 1.10; 95%CI 1.05;1.17; p-value = 0.001); and as protective factors: working (aOR = 0.11; 95%CI 0.03;0.36; p-value < 0.001) and taking part in classes (aOR = 0.21; 95%CI 0.08;0.59; p-value = 0.003) in the prison. Conclusion: we considered the penitentiary outbreak to be compatible with scurvy due to characteristic signs/symptoms, associated with the identified factors; we recommended regular provision of a diet rich in vitamin C to all male inmates and clinical follow-up of cases. Objective signssymptoms signs symptoms Ceará 20192020. 20192020 2019 2020. 2020 2019-2020 Methods populationbased population casecontrol case control signsymptom sign symptom controls analysis Results 6 406 40. SD 10.8 108 10 8 10.8) 100.0%, 1000 100.0% , 100 0 (100.0%) 91.9%, 919 91.9% 91 9 (91.9%) hematomaecchymosis hematoma ecchymosis 90.3% 903 90 3 (90.3% 88.7% 887 88 7 (88.7%) 4 aOR 1.10 110 1 95CI CI 95 1.051.17 105117 1.05 1.17 05 17 1.05;1.17 pvalue p value 0.001 0001 001 0.11 011 11 0.030.36 003036 0.03 0.36 03 36 0.03;0.36 0.21 021 21 0.080.59 008059 0.08 0.59 08 59 0.08;0.59 0.003 0003 003 prison Conclusion followup follow up 2019202 201 202 2019-202 10. 100.0 (100.0% 91.9 (91.9% 90.3 (90.3 88.7 (88.7% 1.1 051 1.051.1 10511 105 1.0 117 1.05;1.1 0.00 000 00 0.1 01 030 0.030.3 00303 0.0 036 0.3 0.03;0.3 0.2 02 2 080 0.080.5 00805 008 059 0.5 5 0.08;0.5 201920 20 2019-20 100. (100.0 91. (91.9 90. (90. 88. (88.7 1. 1.051. 1051 1.05;1. 0. 0.030. 0030 0.03;0. 0.080. 0080 0.08;0. 20192 2019-2 (100. (91. (90 (88. 1.051 1.05;1 0.030 0.03;0 0.080 0.08;0 2019- (100 (91 (9 (88 1.05; 0.03; 0.08; (10 ( (8 (1

RESUMO Objetivo: identificar ocorrência de surto compatível com escorbuto e fatores de exposição associados aos sinais/sintomas típicos de hipovitaminose, em penitenciária masculina, Ceará, Brasil, 2019-2020. Métodos: estudo de caso-controle populacional; foram utilizados registros clínicos e entrevistas com casos compatíveis - sinais/sintomas iniciados no período - e com controles; realizou-se análise multivariável. Resultados: 62 casos; idade média de 40,6 anos (DP = 10,8); principais sinais/sintomas foram edema e dor em membros inferiores (100,0%), dificuldade para deambular (91,9%), hematoma/equimose em membros inferiores (90,3%), febre (88,7%); identificou-se, como fator de exposição, média de idade > 40 anos (ORa = 1,10; IC95% 1,05;1,17; p-valor = 0,001); e como fatores protetores, trabalho (ORa = 0,11; IC95% 0,03;0,36; p-valor < 0,001) e participação em aulas (ORa = 0,21; IC95% 0,08;0,59; p-valor = 0,003) dentro da penitenciária. Conclusão: surto da penitenciária compatível com escorbuto pelos sinais/sintomas característicos, associados aos fatores identificados; recomendou-se oferta regular de dieta rica em vitamina C para todos os internos e acompanhamento clínico dos casos. Objetivo sinaissintomas sinais sintomas hipovitaminose masculina Ceará Brasil 20192020. 20192020 2019 2020. 2020 2019-2020 Métodos casocontrole caso controle populacional controles realizouse realizou se multivariável Resultados 6 406 40, DP 10,8 108 10 8 10,8) 100,0%, 1000 100,0% , 100 0 (100,0%) 91,9%, 919 91,9% 91 9 (91,9%) hematomaequimose hematoma equimose 90,3%, 903 90,3% 90 3 (90,3%) 88,7% 887 88 7 (88,7%) identificouse, identificouse identificou se, identificou-se 4 ORa 1,10 110 1 IC95 IC 1,051,17 105117 1,05 1,17 05 17 1,05;1,17 pvalor p valor 0,001 0001 001 protetores 0,11 011 11 0,030,36 003036 0,03 0,36 03 36 0,03;0,36 0,21 021 21 0,080,59 008059 0,08 0,59 08 59 0,08;0,59 0,003 0003 003 Conclusão característicos identificados recomendouse recomendou 2019202 201 202 2019-202 10, 100,0 (100,0% 91,9 (91,9% 90,3 (90,3% 88,7 (88,7% 1,1 IC9 051 1,051,1 10511 105 1,0 117 1,05;1,1 0,00 000 00 0,1 01 030 0,030,3 00303 0,0 036 0,3 0,03;0,3 0,2 02 2 080 0,080,5 00805 008 059 0,5 5 0,08;0,5 201920 20 2019-20 100, (100,0 91, (91,9 90, (90,3 88, (88,7 1, 1,051, 1051 1,05;1, 0, 0,030, 0030 0,03;0, 0,080, 0080 0,08;0, 20192 2019-2 (100, (91, (90, (88, 1,051 1,05;1 0,030 0,03;0 0,080 0,08;0 2019- (100 (91 (90 (88 1,05; 0,03; 0,08; (10 (9 (8 (1 (

RESUMO Objetivo: identificar ocorrência de surto compatível com escorbuto e fatores de exposição associados aos sinais/sintomas típicos de hipovitaminose, em penitenciária masculina, Ceará, Brasil, 2019-2020. Métodos: estudo de caso-controle populacional; foram utilizados registros clínicos e entrevistas com casos compatíveis - sinais/sintomas iniciados no período - e com controles; realizou-se análise multivariável. Resultados: 62 casos; idade média de 40,6 anos (DP = 10,8); principais sinais/sintomas foram edema e dor em membros inferiores (100,0%), dificuldade para deambular (91,9%), hematoma/equimose em membros inferiores (90,3%), febre (88,7%); identificou-se, como fator de exposição, média de idade > 40 anos (ORa = 1,10; IC95% 1,05;1,17; p-valor = 0,001); e como fatores protetores, trabalho (ORa = 0,11; IC95% 0,03;0,36; p-valor < 0,001) e participação em aulas (ORa = 0,21; IC95% 0,08;0,59; p-valor = 0,003) dentro da penitenciária. Conclusão: surto da penitenciária compatível com escorbuto pelos sinais/sintomas característicos, associados aos fatores identificados; recomendou-se oferta regular de dieta rica em vitamina C para todos os internos e acompanhamento clínico dos casos.

RESUMEN Objetivo: identificar la ocurrencia del brote compatible con escorbuto y los factores de exposición asociados con signos/síntomas típicos de hipovitaminosis que ocurrieron en una penitenciaría masculina en Ceará, Brasil entre 2019-2020. Métodos: estudio poblacional de casos y controles; se utilizaron historias clínicas y entrevistas con casos compatibles, con inicio de signos/síntomas durante el período de estudio, y controles; se realizó análisis multivariable. Resultados: de los 62 casos, edad media fue 40,6 años (DE = 10,8); principales signos/síntomas fueron edema y dolor en miembros inferiores (100,0%), dificultad para caminar (91,9%), hematoma/equimosis en miembros inferiores (90,3%) y fiebre (88,7%); la edad mayor de 40 años se identificó como factor asociado (ORa = 1,10; IC95% 1,05;1,17; p-valor = 0,001); y como factores protectores: trabajo (ORa = 0,11; IC95% 0,03;0,36; p-valor < 0,001) y participación en clases (ORa = 0,21; IC95% 0,08;0,59; p-valor = 0,003) dentro del centro penitenciario. Conclusión: el brote en centro penitenciario fue considerado compatible con escorbuto debido a los signos/síntomas característicos, asociados a los factores identificados; se recomendó oferta regular de dieta rica en vitamina C a todos los internos y seguimiento clínico de los casos.

ABSTRACT Objective: to identify the occurrence of an outbreak compatible with scurvy and exposure factors associated with typical signs/symptoms of hypovitaminosis that occurred in a male penitentiary in Ceará, Brazil between 2019-2020. Methods: this was a population-based case-control study; we used clinical records and interviews with compatible cases - based on sign/symptom onset during the study period - and with controls; we carried out multivariate analysis. Results: out of 62 cases, mean age was 40.6 years (SD = 10.8); main signs/symptoms were edema and pain in the lower limbs (100.0%), difficulty in walking (91.9%), hematoma/ecchymosis in the lower limbs (90.3%) and fever (88.7%); we identified being over 40 years old as an associated factor (aOR = 1.10; 95%CI 1.05;1.17; p-value = 0.001); and as protective factors: working (aOR = 0.11; 95%CI 0.03;0.36; p-value < 0.001) and taking part in classes (aOR = 0.21; 95%CI 0.08;0.59; p-value = 0.003) in the prison. Conclusion: we considered the penitentiary outbreak to be compatible with scurvy due to characteristic signs/symptoms, associated with the identified factors; we recommended regular provision of a diet rich in vitamin C to all male inmates and clinical follow-up of cases.

Abstract INTRODUCTION: COVID-19 emerged in late 2019 and quickly became a serious public health problem worldwide. This study aim to describe the epidemiological course of cases and deaths due to COVID-19 and their impact on hospital bed occupancy rates in the first 45 days of the epidemic in the state of Ceará, Northeastern Brazil. METHODS: The study used an ecological design with data gathered from multiple government and health care sources. Data were analyzed using Epi Info software. RESULTS: The first cases were confirmed on March 15, 2020. After 45 days, 37,268 cases reported in 85.9% of Ceará’s municipalities, with 1,019 deaths. Laboratory test positivity reached 84.8% at the end of April, a period in which more than 700 daily tests were processed. The average age of cases was 67 (<1 - 101) years, most occurred in a hospital environment (91.9%), and 58% required hospitalization in an ICU bed. The average time between the onset of symptoms and death was 18 (1 - 56) days. Patients who died in the hospital had spent an average of six (0 - 40) days hospitalized. Across Ceará, the bed occupancy rate reached 71.3% in the wards and 80.5% in the ICU. CONCLUSIONS: The first 45 days of the COVID-19 epidemic in Ceará revealed a large number of cases and deaths, spreading initially among the population with a high socioeconomic status. Despite the efforts by the health services and social isolation measures the health system still collapsed.

The organophosphate temephos has been the main insecticide used against larvae of the dengue and yellow fever mosquito (Aedes aegypti) in Brazil since the mid-1980s. Reports of resistance date back to 1995; however, no systematic reports of widespread temephos resistance have occurred to date. As resistance investigation is paramount for strategic decision-making by health officials, our objective here was to investigate the spatial and temporal spread of temephos resistance in Ae. aegypti in Brazil for the last 12 years using discriminating temephos concentrations and the bioassay protocols of the World Health Organization. The mortality results obtained were subjected to spatial analysis for distance interpolation using semi-variance models to generate maps that depict the spread of temephos resistance in Brazil since 1999. The problem has been expanding. Since 2002-2003, approximately half the country has exhibited mosquito populations resistant to temephos. The frequency of temephos resistance and, likely, control failures, which start when the insecticide mortality level drops below 80%, has increased even further since 2004. Few parts of Brazil are able to achieve the target 80% efficacy threshold by 2010/2011, resulting in a significant risk of control failure by temephos in most of the country. The widespread resistance to temephos in Brazilian Ae. aegypti populations greatly compromise effective mosquito control efforts using this insecticide and indicates the urgent need to identify alternative insecticides aided by the preventive elimination of potential mosquito breeding sites.