Do nicho ao bicho: fermentas de predição pra a vigilância da Febre Maculosa no Brasil

Abstract

Introduction: Spotted fever (FM) is an infectious disease caused by bacteria of the genus Rickettsia sp. served in Brazil mainly by ticks of the genus Amblyomma sp., known to be common to pasture areas, forest edges and river banks. It is almost recognized that there is an absolute prevalence of cases and, consequently, of hospitalizations and deaths in the Southeast region, when analyzing the epidemiological situation of the disease in other regions of the country. Following the assumptions of One Health, we believe that the growing human activity impacts natural ecosystems, disrupting their structures and functions, which leads to the loss and alteration of biodiversity. Thus, when transferred to the FM perspective, these effects lead to changes in the well-being and health of human collectives, since both rickettsial agents, as well as their vectors and hosts, contribute to the spread of the disease in areas of recent process urbanization. Objective: To discuss the use of prediction tools for FM surveillance, in the light of the concepts of One Health, in the Brazilian territory. Methodology: Review of the specialized literature on ecological and epidemiological aspects of FM in the country; narrative review about the perspectives of One Health, in a critical analysis in relation to the related movements of Medical Ecology and Ecohealth, regarding the aspects involved in the reemergence of zoonoses in recent years; epidemiological study on FM cases between the years 2007 and 2016 in the three states with the highest incidence of the disease in Brazil; development of a climate suitability model for four tick species of importance for FM transmission in the country; and production of a hazard map for FM transmission in the state of Rio de Janeiro. Results: Among others, the highlight is the spatialization and specialization of health care and the increase in urban and household cases of FM in the states of São Paulo, Minas Gerais and Rio de Janeiro; validation by experts of climatic suitability for four tick species of epidemiological importance for FM in the national territory; and production of a hazard map for different scenarios of FM transmissibility in the state of Rio de Janeiro. Conclusion: It is essential to encourage predictive mechanisms for FM surveillance that observe the ecological relationships between vectors and hosts, especially in areas said to be in epidemiological silence or that haveundergone an accelerated process of environmental degradation. Thus, the prediction models developed in the thesis, when associated with epidemiological situation analysis methodologies, may be useful in planning surveillance actions and in the management of health care.