Revista Panamericana de Salud Pública/Pan American Journal of Public Health

English

Substance use, risk situations, and HIV seroprevalence among individuals seeking free HIV testing in Porto Alegre, Brazil

Objective. To describe substance use, HIV seroprevalence, and risk of exposure to HIV infection in individuals seeking HIV testing in two screening centers (a municipal one and a state one) in the city of Porto Alegre, Rio Grande do Sul, Brazil.
Methods. Using a cross-sectional design, we enrolled a convenience sample of 1 026 men and women between 15 and 60 years of age. We included all the subjects who, after an initial triage, reported any drug use or any behavior or situation with risk of HIV transmission. A Brazilian-Portuguese version of the Risk Assessment Battery was used to assess exposure to risk situations. Blood samples were tested for anti-HIV antibodies, using enzyme-linked immunosorbent assay. Before the blood test, individuals participated in a group counseling session (with a maximum of 20 participants) on HIV and AIDS, in line with the criteria of the Ministry of Health of Brazil.
Results. Among the sample, a high overall HIV seroprevalence was found, 15.1%. Drug use did not explain all of the risk exposure. In comparison to those who reported no injecting drug use, the odds ratio (OR) for being HIV-positive for those who reported injecting drug use at some point in their life was 7.6 (95% confidence interval (CI) = 4.4 to 13.0). However, only 10.3% of the sample reported any injecting drug use.The variables that were associated with HIV seropositivity were: male gender (OR =1.8; 95% CI = 1.1 to 2.8), monthly family income below three times the minimum-salary amount (OR = 2.1; 95% CI = 1.3 to 3.5), age over 25 (OR = 1.7; 95% CI = 1.1 to 2.7), and having had sexual relations with a partner who was possibly HIV-positive (OR = 1.8; 95% CI = 1.1 to 3.2).
Conclusions. Even irregular or occasional drug use increases the odds of seropositivity, particularly if intravenous drugs are used. Sexual transmission played an important role in seropositivity in this sample, indicating that drug use can affect thejudgment of risk and thus contribute to HIV transmission.

Key words

Substance use, risk situations, and HIV seroprevalence among individuals seeking free HIV testing in Porto Alegre, Brazil

Português

Objetivo. Descrever o uso de substâncias, a soroprevalência e a presença de situações de risco para infecção por HIV em indivíduos que buscaram testagem sorológica em um centro municipal e em um centro estadual de testagem e aconselhamento na Cidade de Porto Alegre (RS), Brasil.
Método. Através de um delineamento transversal, foi obtida uma amostra de conveniência de 1 026 homens e mulheres com idade entre 15 e 60 anos. Foram incluídos todos os indivíduos que, após uma triagem inicial, descreviam qualquer uso de droga ou qualquer comportamento ou situação de risco para a transmissão do HIV. Para avaliar a exposição a situações de risco, utilizou-se o questionário de comportamento de risco para AIDS, uma versão do risk assessment battery (RAB) traduzida para o português brasileiro. As amostras de sangue foram testadas para anticorpos anti-HIV usando o método imunoenzimático (ELISA). Antes do exame, cada indivíduo participava de uma sessão de aconselhamento em grupo (máximo de 20 participantes) sobre HIV e AIDS, de acordo com os critérios do Ministério da Saúde do Brasil.
Resultados. A taxa de soropositividade para a amostra em geral foi alta, de 15,1%. O uso de substâncias não explicou toda a exposição ao risco; o uso de drogas injetáveis ao longo da vida, apesar de apresentar uma razão de chances (OR) de 7,6 (IC95% = 4,4 a 13,0) para soropositividade, esteve presente em apenas 10,3% das respostas. Gênero masculino (OR = 1,8; IC95% = 1,1 a 2,8), renda familiar inferior a 3 salários mínimos por mês (OR = 2,1; IC95% = 1,3 a 3,5), idade acima de 25 anos (OR = 1,7; IC95% = 1,1 a 2,7) e ter tido relação sexual com possível indivíduo soropositivo (OR = 1,8; IC95% = 1,1 a 3,2) estiveram associados com soropositividade.
Conclusões. Mesmo o uso não regular ou sistemático de substâncias, em especial sob forma endovenosa, aumenta as chances de soropositividade. A transmissão sexual teve um papel importante na soropositividade nesta amostra, indicando que a diminuição do senso crítico pelo uso de drogas pode comprometer a avaliação de situações de risco e contribuir para a transmissão do HIV.

English

OBJECTIVE: To determine the most rational strategy of vaccination with Candid 1 vaccine in order to prevent Argentine hemorrhagic fever among children under 15 years old living an endemic area.
METHODS: To analyze the estimated effectiveness, a decision tree model was designed, with two possible options: vaccinate all the children under age 15 in the endemic area ("expanded vaccination") or vaccinate only the children at greater risk ("selective vaccination"). These two options were compared with the alternative of not vaccinating. The evaluation was complemented with a sensitivity analysis to identify the threshold values of the critical variables that could change the decision. The probabilities that were used were taken from earlier clinical and epidemiological trials.
RESULTS: According to the model that we used, the expanded vaccination strategy was the best option, with a total expected utility of 9.99998 (out of a maximum possible 10.0). The sensitivity analysis showed that selective vaccination would be the best strategy if the incidence in the population with low risk drops to less than 3 per 1 000 000 population or if the rate of serious adverse reactions to the vaccine reaches more than 9 per 100 000 inhabitants. No variation in the parameters used in the model supported the option of not vaccinating.
CONCLUSIONS: Given the risk and benefit parameters that we used, we recommend vaccinating with Candid 1 all the children under age 15 who live in the area endemic for Argentine hemorrhagic fever. The proposed model can be fitted to future needs, and it can help in decision-making by incorporating prospective disease surveillance data. These results can be used as a basis for cost and efficacy studies and for other quantitative analyses.

Keywords: Junin virus; hemorrhagic fever, American; decision support techniques; viral vaccines.

Español

OBJETIVO: Determinar la estrategia más racional de vacunación con Candid 1 para prevenir la fiebre hemorrágica argentina (FHA) en los menores de 15 años que viven en el área endémica.
MÉTODOS: Para el análisis de la efectividad estimada se diseñó un modelo de árbol de decisión, con dos posibles opciones: vacunar a todos los menores del área endémica (vacunación ampliada) o vacunar solamente a los menores de 15 años con mayor riesgo (vacunación selectiva). Estas opciones se compararon con la alternativa de no vacunar. La evaluación se complementó con un análisis de sensibilidad para identificar los valores umbral de las variables críticas que podrían modificar la decisión tomada. Las probabilidades empleadas se tomaron de estudios clínicos y epidemiológicos previos.
RESULTADOS: Según el modelo empleado, la estrategia de vacunación ampliada fue la mejor opción, con una utilidad total esperada de 9,99998 (siendo 10 el valor máximo posible). El análisis de sensibilidad demostró que la vacunación selectiva sería la estrategia de mayor utilidad si la incidencia en la población de bajo riesgo se reduce a menos de 3 por 1 000 000 habitantes o si la tasa de reacciones adversas graves a la vacuna asciende a más de 9 por 100 000 habitantes. Ninguna variación de los parámetros empleados en el modelo respaldó la opción de no vacunar.
CONCLUSIONES: Con los parámetros de riesgo y de beneficio empleados, se recomienda vacunar con Candid 1 a todos los menores de 15 años que viven en el área endémica de FHA. El modelo propuesto puede adaptarse a las necesidades futuras y ayudar a tomar decisiones mediante la incorporación de los datos prospectivos de la vigilancia de la enfermedad. Estos resultados pueden usarse como base para estudios de costo y eficacia y para otros análisis cuantitativos.

Español

Response capacity for epidemic emergencies: recommendations for country self-evaluation

Communicable diseases that have appeared or reappeared in recent years have demonstrated their great potential for spreading and their capacity to overwhelm a country's resources, causing major emergencies. The recent SARS epidemic showed that only health systems that have been strengthened and that have the response capacity for events of this kind will be able to handle future contingencies. Governments have recognized the need to support initiatives to strengthen their countries' capacities in surveillance, prevention, and the control of emergencies caused by epidemics. This piece identifies essential components that will make it possible to guide the efforts of governments, with the support of the Pan American Health Organization and other international organizations, toward achieving a common goal: establishing for countries warning and epidemic-emergency response systems that are appropriate and effective.

Key words: epidemiology, disease outbreaks, communicable diseases, epidemiologic surveillance, disease notification.

English

Dengue, a viral disease transmitted by mosquitoes, is endemic and frequently epidemic in many tropical countries. Because low-incidence periods vary in length, it is difficult to know in advance when an epidemic will occur. Response efforts, despite being logical, have been counter-productive at times. Furthermore, experience has demonstrated that dengue epidemics last a long time, making it important that government control efforts be sustainable while they last.
This article describes priority activities requiring attention in order to minimize the impact of dengue epidemics. Such activities, which in many cases can be adapted to combat other types of epidemics as well, are as follows: (1) establishment of an inter-sectoral action committee, (2) formalization of an emergency action plan, (3) epidemiologic surveillance, (4) diagnostic laboratory testing, (5) mosquito control, (6) protection of sources of employment and special populations, (7) patient care, (8) education of medical personnel, (9) research, and (10) transparency before the mass media.
The best way to reduce the ravaging effects of dengue epidemics is to anticipate their emergence so that infection can be prevented and steps can be taken to protect the ill. Relying on improvisation to solve all the problems that arise in moments of crisis is inefficient and reckless.

English

Adolescent pregnancy and social exclusion: analysis of intra-urban disparities

Objective. To compare adolescent mothers living in four areas with different degrees of social exclusion in the city of Santo André, São Paulo, Brazil, in terms of the mothers’ schooling, the birth weight and gestational age of their babies, and the specific fertility rate of each of the four areas in 1998.
Method. An ecological cross-sectional study was carried out with 1 314 adolescent girls. The four areas analyzed had earlier been defined in the City of Santo André Social Exclusion/Inclusion Map. Area 1 had the highest exclusion index (worst socioeconomic conditions), and Area 4 the lowest exclusion index (best socioeconomic conditions). The data relating to the adolescent mothers and their children were collected from the National Live Birth Information System, and the socioeconomic data for Santo André were obtained from the State Data Analysis System Foundation, the Brazilian Institute of Geography and Statistics, and the city’s Social Exclusion/ Inclusion Map.
Results. Having little formal education was statistically associated with the poorest areas. Of the infants with a birthweight < 2 500 g, 76.8% of them were born in the two poorest areas of the city. The highest fertility rate (35.7 per 1 000 adolescents) was found in Area 1, the area with the worst socioeconomic conditions; the lowest fertility rate (12.1 per 1 000) was found in Area 4, the area with the best socioeconomic conditions. The proportion of births that were premature did not differ among the four areas (P = 0.81).
Conclusions. The results showed that adolescent girls with little schooling and a lower socioeconomic level were more likely to give birth. Specific actions should be promoted to prevent pregnancy in this group and to foster the social inclusion of these adolescents and their children, providing them with opportunities to improve their socioeconomic situation.

Português

Objetivo. Comparar as adolescentes que residiam em quatro áreas com diferentes graus de exclusão social no Município de Santo André, Estado de São Paulo, em relação ao nível de escolaridade, o peso ao nascer e a idade gestacional dos bebês e as taxas de fecundidade específicas de cada área no ano de 1998.
Método. Foi realizado um estudo transversal ecológico com 1 314 adolescentes. As quatro áreas utilizadas foram as previamente identificadas no Mapa da exclusão/inclusão social da cidade de Santo André, sendo a área 1 a de exclusão social mais pronunciada e a 4 a de menor exclusão social. Os dados das adolescentes e de seus recém-nascidos foram coletados através do Sistema de Informação sobre Nascidos Vivos (SINASC), e as informações socioeconômicas do Município de Santo André foram obtidas da Fundação Sistema Estadual de Análise de Dados (SEADE), do Instituto Brasileiro de Geografia e Estatística (IBGE) e do Mapa da exclusão/ inclusão social da cidade de Santo André.
Resultados. O nível de escolaridade mostrou uma relação estatisticamente significativa com as áreas mais pobres, que concentravam o maior número de adolescentes com menos escolaridade. Quanto à distribuição do baixo peso ao nascer, 76,8% dos bebês nascidos com < 2 500 g encontravam-se nas áreas mais pobres da cidade. A maior taxa de fecundidade (35,7 em 1 000 adolescentes) também esteve associada às piores condições socioeconômicas, enquanto que a menor taxa (12,1 em 1 000) foi observada na área mais favorecida. A freqüência de bebês prematuros não foi diferente entre as quatro áreas (P = 0,81). Conclusões. Os resultados mostram que mais adolescentes de baixa escolaridade e menor nível socioeconômico tiveram mais filhos. É necessário promover ações específicas para evitar a gravidez nesse grupo e para incentivar a inclusão social dessas adolescentes e de seus filhos, abrindo a eles perspectivas de modificar a sua condição.

English

OBJECTIVE: To estimate the prevalence of anemia and to determine associated risk factors among infants receiving routine health care in public clinics in Brazil.
METHOD: This cross-sectional study included 2 715 infants between 6 and 12 months old in 12 cities, in all five of the geographic regions of Brazil. Information regarding the child and its feeding habits was obtained from the mother or other caregiver, using a questionnaire. Nutritional status was determined based on height and weight measurements. The hemoglobin concentration was measured using the HemoCue portable hemoglobinometer. Anemia was defined as hemoglobin < 11 g/dL. The infants’ eating habits were assessed based on what they were eating around the time of the questionnaire interviews. The association between anemia and the different variables was evaluated through bivariate analysis, followed by multiple logistic regression using a hierarchical selection model.
RESULTS: The prevalence of anemia for the entire group was 65.4%. Multiple regression analysis identified the following risk factors for anemia: living in the Southeastern Region of Brazil (odds ratio (OR) = 1.57, 95% confidence interval (95% CI) = 1.25– 1.99), maternal age < 20 years (OR = 1.58, 95% CI = 1.21–2.07), birthweight < 2 500 g (OR = 2.09, 95% CI = 1.48–2.95), not being breast-fed (OR = 1.28, 95% CI = 1.02–1.61), receiving both breast milk and other foods (OR = 1.40, 95% CI = 1.10–1.78), and male gender (OR = 1.24, 95% CI = 1.06–1.46).
CONCLUSIONS: The high proportion of anemic children indicates the need to emphasize, in prenatal and infant health programs, intervention measures for anemia control. Our results could guide these measures, focusing on the groups at greatest risk, such as low birthweight babies and the children of adolescent mothers.

Keywords: Anemia, iron-deficiency; infant nutrition; child nutrition; risk factors; epidemiologic studies.

Português

OBJETIVO: Estimar a prevalência de anemia e investigar os fatores de risco a ela associados em lactentes brasileiros que recebem atendimento na rede básica de saúde.
MÉTODO: Estudo transversal com 2 715 crianças entre 6 e 12 meses de idade, residentes em 12 municípios das cinco regiões do Brasil. As mães ou responsáveis responderam a um questionário para coleta de informações sobre a criança e sua alimentação. Foram medidos o peso e a altura para determinação do estado nutricional. Também foi feita a dosagem da concentração de hemoglobina com fotômetro portátil HemoCue, considerando-se como anemia o nível < 11 g/dL. A prática alimentar considerou a situação das crianças no momento do estudo (current status). A associação entre as variáveis e a anemia foi verificada inicialmente por análise bivariada e posteriormente por regressão logística múltipla segundo modelo hierarquizado.
RESULTADO: A prevalência média de anemia para todo o grupo foi de 65,4%. A análise múltipla identificou os seguintes fatores de risco para anemia: morar na Região Sudeste [razão de produtos cruzados, ou OR, de 1,57 (1,25 a 1,99)], idade materna inferior a 20 anos [OR = 1,58 (1,21 a 2,07)], peso ao nascer < 2 500 g [OR = 2,09 (1,48 a 2,95)], não receber leite materno [OR = 1,28 (1,02 a 1,61)] ou estar em aleitamento misto [OR = 1,40 (1,10 a 1,78)] e sexo masculino [OR = 1,24 (1,06 a 1,46)].
CONCLUSÕES: A alta proporção de crianças anêmicas indica a necessidade de enfatizar, nos programas de pré-natal e puericultura do país, medidas de intervenção e controle desse distúrbio nutricional. Os presentes resultados podem orientar tais ações, que devem privilegiar os grupos de maior risco, como os bebês de baixo peso e os filhos de mães adolescentes.

English

Epidemiologic surveillance of measles and rubella in Campinas (SP), Brazil: the reliability of the data

Objective. To evaluate and validate the information concerning measles and rubella from the Brazilian National Disease Notification System (BNDNS) (Sistema Nacional de Informação de Agravos de Notificação, or SINAN) for Campinas, a large city in the state of São Paulo, Brazil, using as a reference the data from a control system, the Syndromic Surveillance System for Fever and Exanthem (SSSFE) (Sistema de Vigilância Sindrômica de Febre e Exantema, or VigiFEx), which operated from May 2003 through June 2004.
Method. In our study we compared: (1) annual data from BNDNS for the years 1999 through 2003 and (2) data from BNDNS and data from SSSFE for the period of June 2003 through May 2004. We analyzed the rate of completion for key fields (record number, date of notification, and city of notification) as well as for name of disease, date of first symptoms, name of patient, birth date and age, sex, city of residence, date of investigation, immunization history, presence of exanthem, date at start of exanthem, presence of fever, suspected cases among pregnant women, signs and symptoms, date of collection of first sample, results with the sample, virus isolation, final classification, criteria for confirmation/exclusion of cases, diagnosis of excluded patients, development of the case, and date of closure. The level of agreement between the recorded cases in the two data banks was also analyzed.
Results. From June 2003 through May 2004, 211 suspected cases of measles or rubella were identified in SSSFE and 275 in BNDNS. All the records had complete information concerning the three key fields. The rate of completion was also 100% for patient name, disease, and city of residence. The completion rate was higher than 95% for date of investigation, measles vaccine, measles and rubella vaccine, and rubella vaccine. A lower completion rate was found for other vaccination variables (number of doses and date of last dose) and for exanthem, fever, and date of start of exanthem. The two information systems were not completely consistent, particularly in terms of variables related to epidemiologic background, clinical data, and case closure. The quality of the SSSFE data was higher.
Conclusions. Epidemiologic surveillance, immunization, and laboratory information systems need to undergo routine evaluation to ensure that the data are reliable and can support the planning of public health efforts.

Português

Objetivo. Avaliar e validar as informações sobre o sarampo e a rubéola existentes no Sis-tema Nacional de Informação de Agravos de Notificação (SINAN) em Campinas, tomando como referência os dados do Sistema de Vigilância Sindrômica de Febre e Exantema (VigiFEx), que funcionou paralelamente ao SINAN no período de maio de 2003 a junho de 2004.
Método. Foram comparados os dados anuais do SINAN de 1999 a 2003 e os dados do SINAN e do VigiFEx para o período de junho de 2003 a maio de 2004. Analisou-se o preenchimento dos campos número, data e município da notificação (variáveis chaves), nome da doença, data dos primeiros sintomas, nome do paciente, data de nascimento e idade, sexo e município de residência, data da investigação, antecedentes vacinais, presença de exantema, data de início do exantema e presença de febre; e casos suspeitos em gestantes, sinais e sintomas, data da coleta da primeira amostra, resultados, coleta de isolamento viral, classificação final, critério de confirmação/descarte, diagnóstico do caso descartado, evolução do caso e data de encerramento. Também foi analisada a concordância dos casos registrados entre as bases de dados.
Resultados. Foram identificadas 211 suspeitas de sarampo ou rubéola na base VigiFEx e 275 na base SINAN 12 meses. Todos os casos registrados apresentaram dados completos em relação às variáveis chaves. Os campos nome do paciente, agravo ou doença e município de residência também tiveram 100% de preenchimento. Mais de 95% de preenchimento foi observado para data de investigação, vacina contra o sarampo, vacina contra o sarampo e a rubéola e vacina contra a rubéola. As demais variáveis vacinais (número de doses e data da última dose) apresentaram elevados percentuais de não-preenchimento, assim como as variáveis exantema, febre e data de início do exantema. Houve inconsistência entre os sistemas, principalmente em relação às variáveis sobre antecedentes epidemiológicos, dados clínicos e conclusão do caso. Os dados do VigiFEx apresentaram melhor qualidade.
Conclusões. É preciso avaliar rotineiramente os sistemas de informação de vigilância, imunização e laboratório para garantir a confiabilidade dos dados, de forma que possam embasar o planejamento de ações em saúde.

English

Violence and social representation in teenagers in Brazil

OBJECTIVE: To investigate the association between the self-representation of teenagers and the severe physical, psychological, and sexual violence inflicted on them by close family relations, especially their parents, and to analyze the association between victimization in the family and victimization in other social spaces.
METHOD: An epidemiological survey was carried out in 2002 with 1 685 adolescents chosen at random from public and private schools in the municipality of S�o Gon�alo, which is in the state of Rio de Janeiro, Brazil. To measure each form of violence, we used scales of tactics for dealing with conflict, of child abuse and trauma, and of psychological violence.
RESULTS: We found that 14.6% of the students had been physically abused by the father or the mother and that 11.8% had witnessed sexual abuse of another family member or they themselves had been sexually abused. In addition, 48.0% of the students reported having been psychologically abused by a close relation. In comparison to students who had not been abused, the victims of family abuse were more often also victims of community and school violence, and they also more frequently reported having broken the law. Overall, the adolescents surveyed had a positive self-representation, but the adolescents who had been abused mentioned negative self-attributes more frequently than did the teenagers who had not been abused.
CONCLUSIONS: The predominantly positive social representation of teenagers must be supported by health promotion initiatives. The finding of an association between indices of violence and the teenager's various spheres of action indicates that resolving this problem will require strategies that target all these spheres.

Português

OBJETIVO: Investigar a associação entre a representação que os adolescentes têm de si e a violência física severa, psicológica e sexual que sofrem de pessoas que lhes são importantes, sobretudo os pais; e analisar a associação entre a vitimização na família e em outros espaços sociais.
MÉTODO: Inquérito epidemiológico com 1 685 estudantes selecionados aleatoriamente nas escolas públicas e particulares do Município de São Gonçalo (RJ), Brasil, em 2002. Para aferir cada uma das formas de violência foram usadas escalas de avaliação de táticas para lidar com conflito, de abuso e trauma infantil e de violência psicológica.
RESULTADOS: Constatou-se que 14,6% dos estudantes sofriam violência física severa de pai ou mãe; 11,8% testemunharam ou vivenciaram violência sexual na família; 48,0% relataram sofrer violência psicológica de pessoas significativas. Os adolescentes que sofrem essas formas de violência são mais freqüentemente vítimas de violência na comunidade e na escola, relatando-se também mais transgressores da lei. Em geral, possuem uma representação positiva de si próprios, embora mencionem atributos negativos com maior freqüência.
CONCLUSÃO: A representação social predominantemente positiva entre jovens necessita ser estimulada nas atividades de promoção à saúde. A constatação de que os índices de violência estão associados às várias esferas de atuação dos adolescentes indica que a resolução do problema depende de estratégias que englobem todas essas esferas.

English

Final characterization of and lessons learned from the dengue 3 epidemic in Cuba, 2001–2002

Over the past 10 years, the American Region has witnessed the reintroduction and dissemination of dengue virus serotype 3. In this paper we describe the main clinical and epidemiologic features of the dengue 3 epidemic that broke out in Cuba between June 2001 and March 2002, as well as the measures that were undertaken to eliminate it. A total of 14 524 confirmed cases were reported, 12 889 (88,7%) of them in the City of Havana. Eighty one cases of dengue hemorrhagic fever were confirmed, three of which died. Secondary infection, white skin color, sickle cell anemia, and bronchial asthma were risk factors for dengue hemorrhagic fever. Active clinical and epidemiologic surveillance and laboratory support were critical to the early detection of transmission and to the monitoring of the epidemic. Widespread involvement of the community and its different sectors, participation of the mass media with a single leadership in command, and strong political will were the key factors that made it possible to eliminate transmission. This epidemic was one more example of the risk of dengue epidemics faced by countries in the area, including those that have strong surveillance and control programs. It also served to show that by applying the principles established by the Pan American Health Organization and the World Health Organization for dengue control, transmission can be stopped.

English

Economic impact of dengue and dengue hemorrhagic fever in the State of Zulia, Venezuela, 1997–2003

Objectives. To determine the direct and indirect costs of medical care provided to cases of dengue and dengue hemorrhagic fever/dengue shock syndrome (DHF/DSS) between 1997 and 2003 in Zulia State, Venezuela.
Methods. The total number of patients with dengue and DHF/DSS was obtained from records belonging to the Regional Epidemiology Office of the state of Zulia and from reports of cases that were confirmed in the Virology Section of Dr. Americo Negrette’s Clinical Research Institute, Zulia University, Maracaibo, Venezuela, between 1 January 1997 and 31 December 2003. Direct costs included the cost of emergency medical care for all cases and hospital costs for cases with DHF/DSS (cost per bedday and laboratory expenses). The costs connected to absence from work among patients over 15 years of age and mothers who accompanied their children under 15 years of age comprised the indirect costs, which were adjusted for the proportion of men and women in the labor force. Calculations were based on the minimum yearly wage, and results were given in United States dollars, converted according to each year’s average exchange rate.
Results. During the study period, 33 857 cases of dengue and DHF/DSS were seen. Of them, 30 251 (89.35%) were cases of dengue, and 3 606 (10.65%) were cases of DHF/DSS. Six cases of DHF/DSS died (lethality rate: 0.2 per 100 cases of DHF/DSS). Direct costs were US$ 474 251.70; of these costs, US$ 132 042.30 were spent on emergency medical care and US$ 342 209.40 on the hospital costs of DHF/DSS cases. Indirect costs were US$ 873 825.84 and comprised 64.8% of overall expenditures (US$ 1 348 077.54) connected to this disease during the study years.
Conclusions. This is the first study on the economic impact of dengue in the state of Zulia and in Venezuela. In spite of some limitations, results show that dengue is an important public health problem that causes great expense because of temporary absenteeism from work and that undermines regional and national economic development.

Español

Objetivos. Determinar los costos directos e indirectos asociados con la atención de los casos de dengue y de dengue hemorrágico o síndrome de choque por dengue (DH/SCD) entre los años 1997 y 2003 en el Estado de Zulia, Venezuela.
Métodos. El número total de pacientes con dengue y DH/SCD se obtuvo de los registros de la Dirección Regional de Epidemiología del Estado de Zulia y de los informes de casos confirmados en la Sección de Virología del Instituto de Investigaciones Clínicas Dr. Américo Negrette, de la Facultad de Medicina, Universidad del Zulia, Maracaibo, entre el 1.° de enero de 1997 y el 31 de diciembre de 2003. Como costos directos se consideraron el costo de la atención médica de urgencia de todos los casos y los costos de hospitalización de los casos con DH/SCD (costo por día-cama y costos de laboratorio). Los costos asociados con la ausencia laboral de los enfermos mayores de 15 años y de las madres acompañantes de los enfermos menores de 15 años conformaron los costos indirectos, ajustados según la proporción de hombres y mujeres en la fuerza laboral activa del país. Para el cálculo se utilizó el salario mínimo anual y los resultados se expresaron en dólares estadounidenses, según la tasa de cambio promedio de cada año.
Resultados. En el período estudiado se atendieron 33 857 casos de dengue y de DH/SCD; de ellos, 30 251 (89,35%) fueron de dengue y 3 606 (10,65%) de DH/SCD. Seis de estos fallecieron (letalidad 0,2 por 100 casos de DH/SCD). Los costos directos fueron US$ 474 251,70; de esa suma, US$ 132 042,30 correspondieron a la atención en los servicios de urgencia y US$ 342 209,40 a los gastos de hospitalización de los casos con DH/SCD. Los costos indirectos ascendieron a US$ 873 825,84 y representaron 64,8% del gasto total (US$ 1 348 077,54) relacionado con esta enfermedad en los años estudiados.
Conclusiones. Este es el primer estudio acerca del impacto económico del dengue en el Estado de Zulia y en Venezuela. A pesar de que el estudio tuvo algunas limitaciones, los resultados demuestran que el dengue constituye un importante problema de salud pública que ocasiona grandes gastos por ausentismo laboral temporal y que afecta considerablemente al desarrollo de la economía regional y nacional.