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Vigilancia Y Control De Las Arbovirosis En Barcelona

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Vigilancia Y Control De Las Arbovirosis En Barcelona Vigilancia y control de las arbovirosis en Barcelona X Jornada de Enfermedades Emergentes 10 de junio del 2020 Lilas Mercuriali [email protected] Enfermedades transmitidas por artrópodos Phlebotomus spp Leishmaniasis Virus Toscana Virus Nápoles Virus Sicilia Fuente: Modificado de AEP . https://upload.wikimedia.org/wikipedia/commons/3/36/Enfermedades_trasmitidas_por_artropodos-2.jpg Arbovirus causantes de infección humana Familia Género Especies (ejemplos) Flaviviridae Flavivirus Dengue virus, Zika virus, Yellow fever virus, Tick- borne encephalitis, West Nile virus, Japanese encephalitis virus, Usutu virus Togaviridae Alphavirus Chikungunya, Sindbis virus Nairoviridae Orthonairovirus Crimean-Congo haemorragic fever orthonairovirus Peribunyaviridae Orthobunyavirus California encephalitis orthobunyavirus, La Crosse orthobunyavirus Phenuiviridae Phlebovirus Toscana phlebovirus Reoviridae Coltivirus Colorado tick fever coltivirus Fuente: Elaboración propia, datos de la ICTV Ciclos de transmisión y métodos de vigilancia Fuente: Ramírez, Ana & van den Hurk, Andrew & Meyer Steiger, Dagmar & Ritchie, Scott. (2018). Searching for the proverbial needle in a haystack: Advances in mosquito-borne arbovirus surveillance. Parasites & Vectors. 11. 10.1186/s13071-018-2901-x. Guías y protocolos Nivel de riesgo Actuaciones sobre el individuo Control entomológico Vigilancia activa de nuevos casos (durante 45 días) Fuente: Modificado de CDC Patrones clínicos Font: Eckerle, Isabella, et al. "Emerging souvenirs—clinical presentation of the returning traveller with imported arbovirus infections in Europe." Clinical Microbiology and Infection 24.3 (2018): 240-245. Circuits Sospecha clínica chikungunya, dengue, Zika CASO IMPORTADO CASO VIRÉMICO Ha estado en zona endèmica los 15 días Ha estado en Barcelona los 10 días previos posteriores (para chikungunya y dengue) - Recomendaciones para evitar la transmisión - Encuesta epidemiológica SEPID - Gestión de muestras, si corresponde SISTEMA DE NOTIFICACIÓN LABORATORIOS MICROBIOLÓGICA DE CATALUNYA RT-PCR1 IgM positiva Todo negativo positiva: CASO CASO CASO PROBABLE2 DESCARTADO CONFIRMADO MEDIDAS DE CONTROL VECTORIAL 1: En el caso del dengue, también puede realizarse la derección de Ag NS1 2: Es necesaria una segunda muestra para confirmar seroconversión Notificación Professionals Laboratori sanitaris SEPID Vigilància de la malaltia ASPB ASPCAT RENAVE SVIPLA Vigilància del vector Notificaciones al SEPID durante el año 2019 • 287 sospechas de dengue (135 casos importados), • 16 sospechas de infección por virus chikungunya (12 casos importados) • 14 sospechas de infección por virus Zika (8 casos importados) Casos de infección por virus dengue, chikugunya o Zika. Barcelona, 2018-2019* 90 80 70 60 50 dengue 40 chikungunya núm casosnúm 30 zika 20 10 0 2015 2016 2017 2018 2019 año Font: Registre de MDO ASPB. *Dades provisionals no publicades. Casos de infección por virus dengue, chikugunya o Zika según mes de inicio de síntomas. Barcelona, 2019* 25 20 15 10 zika núm núm casos 5 chikungunya dengue 0 mes Fuente: Registro de MDO. *Datos provisionales. Mes de inicio de ´síntomas. Si este dato no estaba disponible, se tomó la fecha de la toma de la muestra. Infección por virus chikungunya • Total de casos incidentes = 7 • Mediana de edad 38 años (máximo 44, mínimo 26) • 71,4% hombres, ratio H:M 2,5 Fuente: Registro de MDO. *Datos provisionales Dengue • Total de casos incidentes = 85 • Mediana de edad 32 años (máximo 72, mínimo 14) • 62% hombres, ratio H:M 1,66 Fuente: Registro de MDO. *Datos provisionales Infección por virus Zika • Total de casos incidentes = 5 • Mediana de edad 46 años (máximo 50, mínimo 32) • 60% mujeres, ratio M:H 1,5 Fuente: Registro de MDO. *Datos provisionales ¡Muchas gracias! Rol del profesional sanitario INFORMACIÓN AL PACIENT 1. Explicar la llamada de SEPID i la visita de l’SVIPLA! 10 días 2. Evitar la propagación: eliminar recipients amb (5 días en el caso de Zika) aigua, roba llarga, ús de repel·lents i de mosquiteres a portes i finestres, quedar-se a casa. Fins descartar zika: ús de preservatiu. NOTIFICACIÓ (fer constar a la història clínica) Nom, cognoms, data de naixement (o CIP), telèfon i adreça real. Dates: d'arribada + Inici dels símptomes. Història de viatge! Dengue Definició de cas CAS SOSPITÓS CAS PROBABLE CAS CONFIRMAT Febre +(2 dels següents) • Cas sospitós + Criteri • Cas sospitós|probable epidemiològic • Anorèxia i nàusees, • Exantema, O + • Miàlgies i/o artràlgies, • Tècnica directa positiva • Leucopènia, • IgM positiva • x4 d’IgG a les 2-3 setmanes • Test del torniquet positiu, o * *SIGNES D’ALERTA • Dolor abdominal • Vòmits persistents • Acumulació de líquids • Hemorràgies a les mucoses (gingivitis, hematomes, equimosis, petèquies, sang a la femta) • Hipotèrmia amb sudoració profusa, letargia, intranquil·litat • Hepatomegàlia >2 cm (adults) • Dolor precordial • Augment de l’hematòcrit juntament amb una disminució ràpida del recompte de plaquetes Marcadors biològics: Dengue Chikungunya Definició de cas CAS SOSPITÓS CAS PROBABLE CAS CONFIRMAT • persona que presenta febre • Cas sospitós + Criteri • Cas sospitós|probable >38,5ºC d’inici sobtat epidemiològic + O + • artràlgia greu no vinculada a cap • Tècnica directa positiva altra patologia • IgM positiva • x4 d’IgG a les 2-3 setmanes Marcadors biològics: Chikungunya Font: Simon, F., et al. (2015). French guidelines for the management of chikungunya (acute and persistent presentations). November 2014. Médecine et Maladies Infectieuses. Zika Definició de cas CAS SOSPITÓS CAS PROBABLE CAS CONFIRMAT • Exantema maculopapular i febre • Cas sospitós +/- criteri • Cas sospitós moderada epidemiològic + + + • artràlgies o miàlgies • Criteris de laboratori per a cas • Criteris de laboratori per a cas confirmat • hiperèmia conjuntival probable • cefalea o malestar general Criteris de laboratori per a casos probables Criteris de laboratori per a casos confirmats –IgM, no confirmat per neutralització en una – Aïllament del virus en una mostra clínica. mostra de serum – Detecció d'àcid nucleic en la mostra clínica. – IgG i neutralització positives en una mostra – Detecció d'anticossos neutralitzants en de sèrum (en absència de IgM) sèrum, que es farà una vegada estiguin – Seroconversió d'IgG o increment x4 en fase disponibles resultats positius. aguda i fase convalescent, no confirmada per neutralització. Marcadors biològics: Zika (Fins a 20 dies) *símptomes neurològics: LCR i sèrum i orina. *nounats o si no és possible sèrum: saliva. Organización Panamericana de la Salud. Guía para la vigilancia de la enfermedad por el virus del Zika y sus complicaciones. Washington, D.C.: OPS; 2018. .
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