Resumo O presente estudo tem como objetivo estimar o impacto da COVID-19 na mortalidade de idosos institucionalizados no Brasil. Foram estimados números de óbitos pela doença para o País, Unidades da Federação e Regiões, com base nas estimativas calculadas e efetuadas neste trabalho do percentual de óbitos de idosos que ocorreriam em instituições de longa permanência de acordo com os totais. Essa estimativa foi baseada em informações disponíveis para uma série de países. O percentual ponderado foi de 44,7%. Estimaram-se 107.538 óbitos de idosos nestas instituições no Brasil em 2020, por COVID-19. São previstos maiores números de óbitos na Região Sudeste (48.779 óbitos), seguida da Região Nordeste (28.451 óbitos); São Paulo é a Unidade da Federação que na estimativa será mais afetada (24.500 óbitos). Fica claro o forte impacto da COVID-19 na população idosa residente em instituições de longa permanência para idosos. As estimativas ultrapassam para o país 100 mil idosos, potencialmente os mais frágeis e vulneráveis, e são baseadas em número de óbitos totais conservador, tendo em vista outras estimativas e a situação alarmante de crescimento dos números de óbitos no Brasil.

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IntroductionHealthcare workers (HCWs) have a higher risks of contracting tuberculosis (TB) than general population. International and national policies recommend routine screening of latent tuberculosis infection (LTBI) as an essential component in the control and prevention of TB in healthcare facilities.MethodsFrom January 2008 to December 2016, 1759 hospital employees were screened for LTBI. Symptom assessment and chest X-ray were conducted to exclude active TB, and tuberculin skin test (TST) and/or QuantiFERON-TB Gold test (QFT) were performed to diagnose LTBI.ResultsAt the end of 2016, 1054 active workers were screened one or more times, totalizing 1810 screenings; 81.5% were female and 18.5% were male; mean age was 42 years. None were found to have active TB. LTBI prevalence in the screened population was 17.7% (n=187): 101 individuals had a QTF positive test and 86 didn’t perform QTF test but had a TST ≥15 mm. The majority were positive for LTBI at the first screening (n=110; 58.8%). Among the screened HCWs, medical aid assistants had the highest prevalence of LTBI (21.7%), followed by nurses (19.4%), administrative and supportive staff (14.4%), while physicians had the lowest prevalence (12.4%) of LTBI. QFT was negative in 47.3% of the individuals with TST ≥15 mm (n=61, which 41 submitted to repetitive TST testing), and in 76.5% of the cases with TST ≥10 mm but <15 mm (n=65, which 37 submitted to repetitive TST testing).DiscussionSince 2015, Portugal has been a low-incidence country regarding TB. The prevalence of LTBI in HCWs is relatively high as far as 17,7%. As a result, active screening for TB and LTBI is needed for these workers. Screening with TST and QTF is a cost-effective approach as high numbers of discordant TST positive/QTF negative results are probably caused by BCG vaccination or boosting due to repetitive TST testing.

Introduction Tuberculosis (TB) is an occupational hazard for healthcare workers. National and internationals policies establish occupational TB risk assessment through the number of patients with TB per year for the whole facility. However, in an hospital setting with different workplaces, it's important to independently classify TB risk in every work environment in order to implement cost-effective preventive measures. Methods We establish a TB risk matrix for our 500-beds hospital and we applied it retrospectively to each department from 2014 to 2016. We studied the following variables: frequency (number of inpatients with infectious TB per service per year), exposure (period of time without isolation measures per patient or, in case of outpatient setting, performance of high-risk procedures for transmission) and severity of the occupational disease.Results The highest risk of occupational TB was found through the studied years in Emergency, Pneumology and Infectiology Departments. However, there was a decrease in the last year due to better isolation measures. Internal Medicine and Otorhinolaryngology wards were considered very high-risk departments due to prolonged exposure to TB patients without any control procedures. Imageology and Primary Care ward were consistently classified as high-risk as result of the high number of TB patients assisted. Exceptionally, in 2015, Intensive Care and Stroke units as well as Psychiatry department were found to have very high-risk TB infection due to a prolonged admission of one patient without isolation procedures. The other departments were classified as moderate or low risk. Discussion All healthcare institutions should conduct TB risk assessment periodically as risk classification may change. These results allow to identify which departments have high-risk of occupational TB infection, in order to undertake specific preventive strategies and TB screening accordingl.