Rio Grande do Sul wants to prevent diseases from spreading after floods

Rio Grande do Sul, hit by floods over the last 45 days, has been working to prevent diseases such as tuberculosis from spreading and affecting the population that spent several weeks living with the cold and flooding.

The Paternon sanatorium hospital, part of the state health network, is a reference in the treatment of the disease. The coordinator of the State Department of Health’s State Tuberculosis Control Program, Carla Jarczewski, took measures with shelters to control the disease.

“We know that the crowded situation favors contagion. Since the beginning of the flood, we have greatly increased the search for those who have respiratory symptoms, cough, night sweats, lack of appetite and weight loss, which are characteristics of our respiratory symptoms, mainly cough, with or without phlegm. These people, when identified as having the diagnosis made, and while waiting, they must wear a regular mask so as not to contaminate other people,” he explained.

He added that “many people who were taking the medication [contra tuberculose] at home they ended up losing the medicine. Just as they lost their house, they were left without their documents and medicines. Therefore, it was requested to reinstitute the medication, in the shortest possible time”, he explained”.

“Agglomeration favors contagion. We, since the beginning of the floods, have [priorizado] There is a lot of demand for those who have respiratory symptoms, cough, expectoration, night sweats, lack of appetite, weight loss, which are characteristics of our respiratory symptoms, especially cough, with or without phlegm. These people, when identified with their diagnosis, must wear a regular mask to avoid contaminating other people”, stressed Carla.

For her, it is still too early to identify whether the flood situation in Rio Grande do Sul may have increased tuberculosis cases in the state. She clarified that tuberculosis is a notifiable disease, but as it is not an acute disease that is notifiable online, the diagnosis is often made and it takes a while for this data to migrate to the Notifiable Diseases Information System (Sinan) .

“It’s still very early. We have had 45 days since the start of the floods and we still cannot work with this type of indicator. We will probably have the numbers at the end of the year, when we start to close the cases in the system” said Clara Jarczewski, technical director of the Paternon Sanatorium Hospital.

Homeless population

Cases of homeless people diagnosed with tuberculosis in Rio Grande do Sul have grown since 2017, when there were 188 cases of the disease. This number has gradually increased until 2022 when 250 victims were recorded, a percentage just over 5%.

The victims live away from home and “we have a lot of difficulty because it is a treatment that lasts at least six months. So, it is a section of our population most exposed to the bacillus”.

This homeless person is 56 times more likely to contract tuberculosis than the general population. The Paternon sanatorium hospital is the assistance support of the Tuberculosis Control Program in Rio Grande do Sul.

“These patients never follow through with the treatment. In recent years, indicators have become more complicated. We have cases with worse outcomes, however, those occurrences in which we managed to achieve success [envolvem] those addressed by multidisciplinary teams”, he emphasized.

Medicines

Carla also said that the floods did not reach the Department of Health’s medicine warehouse. Porto Alegre lost many medicines for various diseases as a result of the floods. The coordinator also stated that the state replenished the stock for cities affected by river floods.

“We had the support of the federal sphere, which sent us a larger amount [de remédios] because all these medications for tuberculosis are only found in the SUS [Sistema Único de Saúde] and we received reinforcement from the Ministry of Health. We then passed it on to the municipalities according to the number of cases reported”, he highlighted.

Tuberculosis control

In Rio Grande do Sul, the epidemiological situation of tuberculosis remains under control. Since the beginning of the 2000s, the state has had more or less five thousand new cases per year, which gives an incidence rate of around 42 cases per 100 thousand inhabitants.

“Our problem here is that we are unable to complete the treatment, and our cure rate, in the general population, is still low, at 58%. The Ministry of Health and international organizations recommend that, for the disease to be under control, we should cure 85% of the population. We have an unfavorable number here in terms of cure rate, it would have to be better”, said Carla.

For professor, researcher at Fiocruz and head of the National Academy of Medicine, Margareth Dalcolmo, tuberculosis is a disease that historically has a higher incidence in homeless people due to adherence.

“The treatment is long, it has to last at least six months, and these people migrate from one place to another. They tend to abandon treatment very frequently. Therefore, treating homeless people requires very complex logistics and not all health departments are able to do so. That is, taking medicine to people daily, especially because they are not in the same places every day. This is the first problem. The incidence is higher because homeless people tend to have other associated comorbidities. This is very common,” she noted.

For the tuberculosis scholar, what happened in Rio Grande do Sul was not a specific issue just for the homeless, because the state has a lot of people who are in shelters and who will stay in shelters for a prolonged period.

Thus, the state’s tuberculosis program “is traditionally very efficient, that is, it has qualified people, the Department of Health usually works adequately, however, the logistics at this moment became very complex with people who probably could have interrupted treatment because the medicine is not given all at once, it is given daily, weekly and sometimes monthly, depending on each patient’s situation. So, our concern is great regarding these people who are in shelters,” he said.

Respiratory transmission

For the researcher, in the same way that victims can become infected with other respiratory-transmitted diseases, such as respiratory syncytial virus, for example, diseases such as leptospirosis can affect those exposed to contaminated water or mud. This is very common in places where there are floods. Leptospirosis caused some deaths in Rio Grande do Sul, said Margareth Dalcolmo.

She also stated that in pulmonary tuberculosis the most common symptoms are fever, cough, fever that usually occurs at night, night sweats, weight loss, tiredness and weight loss. If there are, for example, any respiratory symptoms, coughing due to secretions for more than a week, you should seek a health service.

If there are “any respiratory symptoms such as coughing for more than a week [as pessoas] should seek a health service. Of course, it could be other things too, it could be many diseases. They have to go to a health service to take the rapid molecular test. The diagnosis is made within 24 hours”, he concluded.

Information from Agência Brasil