SAÚDE DAS POPULAÇÕES

CURSO INTEGRADO DE MESTRADO EM MEDICINA

5ª Aula teórico prática – “Investigação de surtos”

A communicable (or infectious) disease is an illness due to the transmission of a specific

infectious agent (or its toxic products) from an infected person, animal or inanimate source to a
susceptible host, either directly or indirectly.
A commonly used definition of an epidemic is that of Abraham Benenson, who defined it as ‘the
occurrence in a community or region of cases of illness (or an outbreak) with a frequency clearly
in excess of normal expectancy’. The meaning of the term epidemic is broad. It encompasses
both communicable diseases, e.g. meningitis, and non-communicable diseases, e.g. obesity. (…)
The number of cases, geographic extent, and time period need to be specified to be able to
describe an epidemic.

O’Brien S (2013). Communicable disease epidemics. In: Guest C. et al, ed. Oxford Handbook of
Public Health Practice. Third edition. Oxford University Press, Oxford.

Outbreak investigations, an important and challenging component of epidemiology and public

health, can help identify the source of ongoing outbreaks and prevent additional cases. Even
when an outbreak is over, a thorough epidemiologic and environmental investigation often can
increase our knowledge of a given disease and prevent future outbreaks. Finally, outbreak
investigations provide epidemiologic training and foster cooperation between the clinical and
public health communities.
(…) Outbreak investigations are, in theory, indistinguishable from other epidemiologic
investigations; however, outbreak investigations encounter more constraints. 1) If the outbreak
is ongoing at the time of the investigation, there is great urgency to find the source and prevent
additional cases. 2) Because outbreak investigations frequently are public, there is substantial
pressure to conclude them rapidly, particularly if the outbreak is ongoing. 3) In many outbreaks,
the number of cases available for study is limited; therefore, the statistical power of the
investigation is limited. 4) Early media reports concerning the outbreak may bias the responses
of persons subsequently interviewed. 5) Because of legal liability and the financial interests of
persons and institutions involved, there is pressure to conclude the investigation quickly, which
may lead to hasty decisions regarding the source of the outbreak. 6) If detection of the outbreak
is delayed, useful clinical and environmental samples may be very difficult or impossible to
obtain.
Reingold AL. Outbreak investigations--a perspective. Emerg Infect Dis. 1998;4(1):21-7.
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Tendo como ponto de partida os textos acima descritos, pretende-se que seja dinamizada nesta
sessão uma discussão em grupo sobre a investigação epidemiológica de surtos, utilizando case-
studies específicos que serão propostos pelo docente. Apresentam-se algumas questões que
poderão orientar essa discussão (e que os estudantes devem preparar previamente).

1ª Questão: Qual a definição de surto? Que tipos de surtos existem?

2ª Questão: Que passos devem ser seguidos durante a investigação de um surto?

3ª Questão: Em que consiste a tríade epidémica? Quais os fatores que poderão levar a uma
epidemia?

4ª Questão: Qual a importância da curva epidémica para a investigação e controlo de um

surto?

5ª Questão: Como se calcula a “taxa” de ataque? Qual a utilidade deste indicador?

6ª Questão: O que são o período latente, o período de incubação, o período infecioso e o

período de geração?

7ª Questão: Em que tipo de infeções se calcula o número de reprodução básico e efetivo? Que
fatores aumentam (ou diminuem) o R0? E o Rt?

Bibliografia recomendada:
1. Centre for Diseases and Control (CDC). Principles of Epidemiology in Public Health
Practice, Third Edition. An Introduction to Applied Epidemiology and Biostatistics.
(2011).Atlanta: U.S. Department of Health and Human Services. Lesson 6: Investigating
an Outbreak, Section 1: Introduction to Investigating an Outbreak.
https://www.cdc.gov/csels/dsepd/ss1978/lesson6/section1.html
2. V Dato, MM Wagner, A Fapohunda. How outbreaks of infectious disease are detected: a
review of surveillance systems and outbreaks. Public Health Reports, 2004; 119(5):464-
71.
3. McLarty K, Paranthaman K, Jenkins C, Sedgwick J, Crawley-Boevey E. Lessons learned
from the investigation and management of an outbreak of Shigella flexneri associated
with a restaurant in London, 2019-2020. Public Health. 2022 Apr;205:130-132.
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