Epidemiologia

Population ageing is driving a growing demand for orthopedic surgical procedures. The rise in chronic conditions such as osteoarthritis significantly contributes to disability among older adults, particularly women, and primarily affects the hip and knee joints, thereby increasing the need for arthroplasties. Objective: To determine the future demand for lower limb arthroplasty procedures among individuals aged 60 and over in Colombia up to 2050, using official public health records and national demographic projections. Methods: This study used an observational longitudinal retrospective design, using a Poisson regression model with official records from the Integrated Social Protection Information System—which consolidates procedures reported by both public and private healthcare service providers—to identify lower limb arthroplasties performed between 2015 and 2023. Population projections from the National Department of Statistics were incorporated to model future demand, accounting for demographic ageing and mortality trends. An additional analysis was conducted by sex and the most prevalent types of arthroplasties. Results: A total of 62,728 procedures took place from 2015 to 2023, with women undergoing approximately twice as many as men. The highest intervention rates occurred in the 65–69 and ≥80 age groups. By 2050, projections indicate the number of procedures will reach 39,270, with 52.7% projected among women. Conclusions: This study reports demographic trends in arthroplasties between 2015 and 2023 and offers insights into the anticipated future burden of lower limb arthroplasties among Colombia’s older population. Full article

Vegetarianism, as a dietary pattern, is characterized by animal product avoidance and increased consumption of fruits, vegetables, whole grains, and legumes. It has been associated with health benefits, both physical and psychological, and has raised interest as a potential strategy for cancer prevention and treatment, which remains one of the leading causes of morbidity and mortality worldwide, demanding continual exploration of novel approaches. Background/Objectives: This study aims to describe trends in scientific publications about the relationship between vegetarianism and cancer and to highlight research gaps using bibliometric analysis. Methods: The methodology includes comprehensive research of three literature databases. After combining and cleaning these data, a final sample of 3427 studies was obtained that was analyzed using the Bibliometrix-R package. Results: The results indicate a continuously growing production of scientific publications. The most impactful sources, authors and their collaborations were identified. Author keywords, their co-occurrence network, and thematic trends were studied. Conclusions: Through synthesizing and critically evaluating insights from the scientific literature, we aim to contribute to the understanding of the potential benefits of vegetarianism in cancer prevention and management. However, due to the complexity of the topic, the results are often contradictory and could be used as a starting point for further research. Full article

Congenital syphilis (CS) is an important infectious cause of miscarriage, stillbirth, and neonatal morbidity and mortality. Despite the advances in diagnosis and treatment, CS continues to challenge health systems with increasing incidence and mortality rates in recent years worldwide. Given this, the present study aims to comparatively analyze the temporal trends in CS incidence and mortality in Brazil’s Southeast Region from 2008 to 2022. This is an ecological time-series study using secondary data on congenital syphilis from the states of Espírito Santo, Minas Gerais, Rio de Janeiro, and São Paulo. The data was extracted from the Brazilian Health System Informatics Department. Incidence and mortality rates were calculated per 100,000 live births. Joinpoint regression models were employed to identify trends in annual percentage change and average annual percentage change with 95% confidence intervals. The temporal trend of CS incidence in Brazil’s Southeast Region increased 12.8% between 2008 and 2022. Minas Gerais, São Paulo, Espírito Santo, and Rio de Janeiro showed increasing temporal trends of 21.4%, 14.1%, 14.0%, and 10.9%, respectively. The temporal trend of CS mortality in Brazil’s Southeast Region rose 11.9% between 2008 and 2022. Minas Gerais, São Paulo, and Rio de Janeiro exhibited increasing mortality temporal trends of 21.9%, 20.8%, and 10.1%, respectively. In contrast, Espírito Santo showed reduced mortality, with no deaths in 2021 and 2022. The temporal trend of CS incidence increased in all states of Brazil’s Southeast Region between 2008 and 2022, highlighting the need to reassess control measures. The temporal trend of CS mortality also increased during the same period, except in Espírito Santo. Considering that CS is preventable with adequate prenatal care and low-cost measures, these findings can serve as instruments to support strengthening public health policies. Full article

Background/Objectives: This narrative review provided a broad synthesis of recent epidemiological trends, priority resistance mechanisms, and public health implications of multidrug-resistant (MDR) bacteria. We focused on the most clinically significant MDR pathogens, regional differences in resistance, and the effectiveness of containment strategies. Our goal was to synthesize current knowledge and propose research directions. Methods: Through comprehensive analysis of epidemiological studies, surveillance reports, clinical trials, and meta-analyses, we present a detailed assessment of the evolving landscape of antimicrobial resistance across both developed and developing nations. The review encompasses data from 187 countries, analyzing over 2500 published studies and reports from major health organizations. Results: Our findings reveal a concerning 43% increase in multidrug-resistant infections globally, with particularly sharp rises in healthcare-associated infections (67% increase) and community-acquired infections (38% increase) in regions with high antibiotic misuse. The analysis specifically focuses on critical pathogens, including methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL), and carbapenem-resistant Enterobacteriaceae (CRE), documenting their prevalence, transmission patterns, and treatment outcomes. Economic impact assessments indicate annual global healthcare costs exceeding USD 100 billion due to resistant infections. The review identifies significant gaps in current surveillance systems, particularly in low- and middle-income countries, and proposes standardized approaches for monitoring and containment strategies. We evaluate the effectiveness of various antimicrobial stewardship programs, documenting success rates and implementation challenges across different healthcare settings. Conclusions: The analysis concludes with evidence-based recommendations for policy reforms, research priorities, and international collaboration frameworks necessary to address this growing global health crisis. Our findings highlighted the importance of strengthening stewardship efforts, proposing novel diagnostics and therapeutic interventions, and addressing inequities in access to care and data across different countries. Full article

Background/Objectives: Significant disparities in access to diabetes screening persist, particularly among populations with limited healthcare access. We aimed to estimate the proportion of overweight-obese Peruvian adults who underwent blood glucose testing (BGT) in the past year and to analyse the socioeconomic and geographic inequalities associated with access to this preventive intervention. Methods: We conducted a cross-sectional study using data from the Demographic and Family Health Survey 2023. We included adults aged 35–70 years diagnosed with overweight or obesity, according to the United States Preventive Services Task Force screening recommendation. We used concentration curves (CC) and concentration indices (CI) to assess socioeconomic inequalities in BGT. BGT was ascertained using a self-reported question, while the wealth index was used as the variable to measure inequality. We also conducted a decomposition analysis to determine the relative contributions of covariates to socioeconomic inequalities in BGT. Results: A total of 9499 individuals were included in the analysis. A pro-rich concentration of BGT uptake was observed in CC and CI (0.2090; p < 0.001). Notably, a 27-point prevalence difference was reported between the lowest and highest wealth index. The decomposition analysis showed that higher education (+64%) and rural areas (+10.6%) were the main contributors to this pro-rich concentration. In contrast, secondary education (−4.7%) and female gender (−3.4%) reduced this pro-rich concentration. Conclusions: The results underscore the need for targeted strategies, such as enhancing healthcare infrastructure and implementing localized screening initiatives, to close the gap and address the burden of undiagnosed diabetes in high-risk populations. Full article

Background/Objectives: The aim of this study was to quantify and analyze the incidence and epidemiology of kidney infarctions between 2012 and 2022 in Germany. Methods: We analyzed and extracted data from the national database of federal health reporting. Incidence rates were calculated and stratified by gender and age. Statistical analysis involved linear regression to assess correlations between incidence, age, and reporting year, with significance determined using F-tests and Student’s t-tests. Results: From 2012 to 2022, 7983 cases of kidney infarction (4769 male, 3214 female) were identified. The mean incidence was 8.81 per million per year, higher in males (10.7) than females (6.99). Incidence peaked among individuals aged 50–59 years. A significant decrease in incidence over the study period was observed, particularly among males (−2.49 per million per year) compared to females (−0.87 per million per year). Linear regression showed a significant correlation between incidence and age (F(1,6) = 131, p < 0.001) and a significant overall incidence decrease over time (F(1,9) = 40.5, p < 0.001). Conclusions: This study provides the first nationwide epidemiological data on kidney infarction in a Western country. The downward trend, especially among males, may be due to the improved management of risk factors like atherosclerosis and atrial fibrillation, e.g., through an increase in the prescription of direct anticoagulatory agents. Despite the decrease, kidney infarction remain a significant cause of acute kidney injury. Further research is needed to understand these trends and improve preventive strategies. Full article

Background/Objectives: Sparse data exist identifying racial/ethnic outcome disparities among patients with lung cancer, specifically regarding healthcare utilization patterns, such as emergency department visits and outpatient follow-ups. We aimed to utilize our large, multicenter, and ethnically diverse integrated health system to assess for such disparities among patients undergoing pulmonary resections for lung cancer. Methods: The cohort comprised all patients undergoing pulmonary resections for lung cancer at our integrated health system from 1 January 2016 to 31 December 2020. Outcomes including the length of stay (LOS), 30-day return to the emergency department (30d-ED), 30-day readmission, 30- and 90-day outpatient appointments, and 30- and 90-day overall mortality were compared by race/ethnicity. Multivariable logistic and linear models adjusted for age, sex, body mass index (BMI), Charlson Comorbidity Index scores, procedure approach, neighborhood deprivation index (NDI), cancer stage, receipt of adjuvant chemotherapy, and insurance. Results: Of the 645 included patients, non-Hispanic White patients tended to be older and live in the least deprived neighborhoods. Among each race/ethnicity, the percentage of patients insured by Medicaid was highest among Asian patients. On bivariate analysis, only the outcome of surgical outpatient appointments within 30 days had differing distributions by race/ethnicity with no other significant associations between race/ethnicity and other outcomes; however, multivariable analysis showed Asian patients having lower odds of 30d-ED (adjusted odds ratio 0.51; 95% CI 0.27–0.98) while those with Medicaid insurance had higher odds of 30d-ED (adjusted odds ratio 3.29; 95% CI 1.26–8.59). Conclusions: Despite parity across clinical outcomes, some patient encounter-related differences still exist within our system. To better understand racial/ethnic disparities in care, systems must track such disparities in addition to clinical outcomes. Full article

Objectives: This study aimed to evaluate the prognostic impact of coinfections and other clinical factors on mortality in melioidosis patients, providing a comprehensive analysis through systematic review and meta-analysis. Methods: A systematic search was conducted in PubMed, Embase, Scopus, and other sources for studies published from their inception to August 2023. Studies reporting mortality outcomes in melioidosis patients with and without coinfections were included. Mixed-effects logistic regression models were used to estimate the causal association of each prognostic factor on the outcome. Directed acyclic graphs (DAGs) were used to guide confounding adjustment, and missing data were handled using multiple imputations. Results: A total of 346 studies involving 509 patients were analyzed. Coinfections were observed in 10.8% of patients with tuberculosis and Leptospira spp. being the most common. Disseminated disease significantly increased the odds of death (OR 4.93, 95% CI: 2.14–11.37, p < 0.001). Coinfections were associated with a higher mortality rate, but the association was not statistically significant (OR 2.70, 95% CI: 0.53–13.90, p = 0.172). Sensitivity analyses confirmed the robustness of the findings. Other factors, including diabetes mellitus and agricultural occupation, were evaluated for their associations with mortality. Conclusions: Disseminated melioidosis remains a significant factor influencing prognosis. Although less common, coinfections may contribute to worsen patient outcomes, emphasizing the importance of immediate and accurate diagnosis and comprehensive management. Full article

Background: Respiratory syncytial virus (RSV) is a common respiratory virus that can cause serious illness in infants and the elderly. Vaccines for RSV have recently been introduced and have been shown to reduce the severity of the disease. However, there has been limited examination of how viral dynamics differ between vaccinated and unvaccinated individuals. Methods: Here, we use data from the MVA-BN-RSV Phase II vaccine study to quantify the dynamical differences between vaccinated and unvaccinated patients challenged with RSV. We use an ordinary differential equation model of within host viral dynamics to fit viral load data. Results: We find statistically significant differences in viral clearance rate and basic reproduction number. We also find that vaccinated patients experience a higher response variance than the placebo group. Conclusions: While the differences in viral clearance and basic reproduction number are promising, the high variability in response to the vaccine could leave many vaccinated patients without adequate protection. Full article

Background/Objectives: Sedentary behavior (SB) and physical activity (PA) are key determinants of health in occupational settings. This study aimed to analyze the levels of SB, PA, and their associations with health outcomes among Chilean workers using data from the National Health Survey-2017. Methods: A secondary analysis of 2042 workers aged ≥18 years was conducted. Occupations were classified using ISCO-08, and SB/PA were assessed using the Global Physical Activity Questionnaire (GPAQ). Health outcomes included musculoskeletal symptoms, hypertension, diabetes mellitus, metabolic syndrome, and cardiovascular risk. Results: Of the participants, 49.8% were women, and the mean age was 45 years (±13.7). The median SB was 120 min/day, with 32.6% accumulating ≥4 h/day. “Managers” exhibited the highest SB (median: 270 min/day). The median total PA was 123 min/day, and “Skilled agricultural, forestry, and fishery workers” reported the highest PA (median: 330 min/day). The SB (≥4 h/day) was significantly associated with musculoskeletal symptoms (OR: 1.61, 95% CI: 1.21–2.14) and hypertension (OR: 1.53, 95% CI: 1.07–2.18). PA showed no significant protective effect. Conclusions: SB and PA vary significantly across occupational groups. SB is associated with musculoskeletal symptoms. Health promotion programs should be tailored to specific occupational groups. Full article

The objective of this study was to examine the impact of varying levels of non-pharmaceutical interventions (NPIs) on COVID-19 transmission in nursing homes during the first wave of the pandemic. Background/Objectives: The primary aim involved exploring qualitative insights from staff and management regarding the implementation of NPIs. The secondary aim was to determine the cumulative incidence of PCR-confirmed COVID-19 cases among residents. Incident rate ratios (IRRs) were the calculated levels of NPI restrictiveness. Methods: We used a mixed methodology to identify factors that might have affected COVID-19 expansion in nursing homes in the canton of Geneva, Switzerland. For the qualitative component, we interviewed the Attending Physicians and/or Director of each nursing home. In the quantitative component, we calculated incident rate ratios (IRRs) for infection between the three levels of COVID-19-related measures taken in these nursing homes, and the cumulative incidence of PCR-confirmed COVID-19 cases in their resident population. This study was conducted in 12 nursing homes located in the canton of Geneva, Switzerland, between 1 March 2020, and 1 June 2020. Results: Most nursing homes mandated NPIs for their staff and residents during the first wave of COVID-19. We found an equal distribution of maximally (n = 4), moderately (n = 4), and minimally (n = 4) restrictive NPIs for nursing home workers and residents. The extent of NPIs implemented was not shown to be significantly associated with the cumulative incidence of COVID-19 cases among residents (maximally restrictive IRR = 3.90, 95%CI 0.82–45.54, p = 0.184; moderately restrictive IRR = 3.55, 95%CI 0.75–41.42, p = 0.212; minimally restrictive IRR = reference). Conclusions: Nursing homes in our study showed high variability in which NPIs, and to what extent, they implemented, with no significant relationship between the restrictiveness of NPIs and COVID-19 incidence among nursing home residents. This suggests that other factors influence the transmission of COVID-19 in these settings. Future research should explore additional determinants and the balance between strict NPIs and the overall well-being of residents. Full article

Introduction: The COVID-19 pandemic caused significant disruptions to medical training worldwide, particularly for junior doctors, as in-person clinical training was replaced by online education. This study aims to assess the impact of the pandemic on medical training in Greece, focusing on the perceptions of junior doctors across various specialties and exploring the implications for future clinical practice. Methods: We conducted a cross-sectional online survey of 465 junior doctors, all of whom were members of the Athens Medical Association, from 14 September to 14 October 2022. Participants completed a questionnaire assessing the perceived impact of the pandemic on their training, the effectiveness of online education, and potential consequences for clinical preparedness. Factor analysis was conducted to identify underlying patterns related to perceptions for the impact on medical training. Multiple linear regression models were used to assess potential associations among the extracted factors and participants’ sociodemographic characteristics. Results: Among the 465 participants, the mean age was 32.1 (SD = 7.0) years and 300 (64.5%) were female. Among the responders, the majority (n = 241, 51.8%) conducted training in Internal Medicine, 155 (33.3%) in a surgical specialty and 69 (14.8%) in other specialties, including Psychiatry, Radiology and Laboratory Medicine. Two out of five medical students reported that their medical training was mostly affected during the first wave of the pandemic, from March to June 2020 (n = 201, 43.2%). Factor analysis revealed the existence of two factors with high reliability and acceptable validity, interpreted as “perceptions towards online training” and “perceptions for the consequences of the pandemic on medical training”. Age and medical specialty were found to be significantly associated with both factors. Conclusion: Training was severely disrupted, with potential long-term implications for clinical competence; therefore Government and Universities should consider the lessons learned from the pandemic and compensate for the time and opportunities lost. Measures must be taken to safeguard medical education and training in the event of such outbreaks in the future. Full article

Background/Objectives: In recent years, non-contact room disinfection devices using ultraviolet light and hydrogen peroxide have emerged as disinfection methods. However, data on their usefulness in neonatal intensive care units (NICUs) are limited. Therefore, the aim of the present study was to evaluate the effectiveness of environmental disinfection in controlling methicillin-resistant Staphylococcus aureus (MRSA) outbreaks in a NICU/growing care unit (GCU). Methods: Daily cleaning/disinfection of the patient environment was changed from using a cloth containing quaternary ammonium salts to an agent containing ethanol and surfactant, and terminal cleaning with a pulsed xenon ultraviolet light (PX-UV) non-contact disinfection device was added for patients with confirmed MRSA and those on contact precautions. MRSA incidence and environmental culture results were then compared before and after the method change. Results: The MRSA infection rate was 2.81/1000 patient days before the method change and 0.90/1000 patient days after the change (p = 0.008). Environmental cultures were positive in 12/137 (8.8%) before the change and 0 after the change. There were no adverse events in the neonates due to PX-UV irradiation of the environment. Conclusions: Daily cleaning and disinfection with ethanol and surfactant-containing cleaning disinfectants and a final cleaning with a PX-UV non-contact disinfection device reduced environmental MRSA contamination. In addition to adherence to hand hygiene and contact precautions, reducing MRSA present in the environment may contribute to MRSA control in NICUs and GCUs. Full article

Background/Objectives: The 1742–1743 plague epidemic had a profound impact on populations along the Royal Road (Camino Real), the principal trade route connecting Buenos Aires and Lima. This study aimed to quantify the demographic and socioeconomic consequences of the epidemic in Cordova and Santa Fe, with a focus on excess mortality and its broader implications for marginalized groups. Methods: This research utilized parish death records and complementary historical sources to calculate excess mortality in Cordova and Santa Fe during the epidemic. Mortality rates were compared across pre-epidemic (1740–1741), epidemic (1742–1743), and post-epidemic (1744–1745) periods. Additional data on demographic variables such as age, gender, marital status, and ethnicity were analyzed to identify patterns of vulnerability and resilience. Results: Excess mortality during the epidemic was significant, with death rates in Cordova peaking at 12 times the pre-epidemic average in May 1743, while Santa Fe experienced a 45% increase in mortality, peaking in December 1743. Marginalized groups, including enslaved and Indigenous populations, were disproportionately affected, exacerbating existing social inequalities. The epidemic also disrupted socioeconomic structures and highlighted systemic vulnerabilities in both urban centers. Conclusions: This study demonstrates the critical role of excess mortality as a metric for understanding the demographic and socioeconomic impacts of historical epidemics. By integrating quantitative and qualitative analyses, it underscores the intersection of public health crises with social structures in colonial Latin America. The findings offer insights into resilience and recovery mechanisms relevant to both historical and contemporary public health strategies. Full article

Background/Objectives: Emergency department (ED) crowding has become a pressing global concern exacerbated by the COVID-19 pandemic. No studies have addressed this issue in Europe during the post-pandemic period so far. This study examined ED visit volumes, patient acuity, hospital admission rates, emergency vehicle arrivals, and crowding metrics before, during, and after the pandemic. Methods: We conducted a retrospective descriptive study including data on all ED visits in the Lombardy Region of Italy from January 2019 to December 2023. Furthermore, an inferential statistical analysis was performed to compare ED trends between 2019 and 2023. Results: During the analyzed period, there were 15,515,128 visits across all Lombardy EDs. ED visits dropped from 3,514,426 in 2019 to 2,380,005 in 2020, then rebounded to 3,464,756 in 2023. In 2019, triage code distribution was 9.9% white, 68.7% green, 19.0% yellow, and 1.9% red. During the pandemic, the proportion of white and green codes decreased. By 2023, these comprised 80.7% of the total. The percentage of admitted patients was 11.9% in 2019, rose to 16.2% in 2020, and returned to 11.4% in 2023. The median ED length of stay (EDLOS) for admitted patients in 2023 was 5.2 h (IQR [2.1–17.4]), compared to 3.8 h (IQR [1.6–8.6]) in 2019 (p-value < 0.01). The median EDLOS for discharged patients in 2023 was 2.7 h (IQR [1.4–4.9]), compared to 2.4 h (IQR [1.3–4.4]) in 2019 (p-value < 0.01). The rate of patients leaving before completing treatment was 5.0% in 2019 and peaked at 6.8% in 2023 (p-value < 0.01). Conclusions: In 2023, ED visits in Lombardy increased, compared to the pandemic period, but remained below 2019 levels. The proportion of high-acuity codes and hospital admissions was slightly lower than in 2019. However, ED crowding metrics worsened. The high levels of lower-acuity visits and the deterioration in crowding metrics highlight systemic challenges within the healthcare system. Full article

Background and Objectives: Inadequate pain treatment in pediatric patients can cause long-term physical and psychological issues. Accurate detection of pain presence and intensity is crucial, especially in Neonatal and Pediatric Sub-Intensive Care Units. Due to uncertainties about the best pain assessment tool in these settings, it is necessary to review the literature to identify the available evidence. Methods: A scoping review was performed to address the question: What tools are available for pain assessment in non-sedated, non-intubated pediatric patients in sub-intensive care? Searches were conducted in databases including PubMed, Scopus, Embase, CINAHL, Cochrane Library, Web of Science, Open Dissertation, as well as CENTRAL and ClinicalTrials.gov registries. Results: The review included 27 studies, revealing various tools for pain assessment in pediatric sub-intensive settings. All studies favored the use of multidimensional scales, combining physiological and behavioral indicators. Conclusions: This review offers a comprehensive overview of the tools for pain assessment in pediatric patients in sub-intensive care settings but does not determine a single best tool. Most studies focused on the validation, translation, and adaptation of these tools. Further research is needed on the practical application of these tools and the perceptions of those administering them. Full article

Background: HIV-related opportunistic infections like Pneumocystis jirovecii Pneumonia (PCP) remain a major contributor to child morbidity and mortality globally. PCP accounts for over 60% of AIDS in the first year of life and is responsible for a third of AIDS in children globally. Cotrimoxazole prophylaxis, which is an intervention directed towards tackling this burden, has not attained remarkable coverage despite advocacy towards scale-up. This work was therefore aimed at evaluating the efficacy of cotrimoxazole in the prevention of PCP among children exposed to and infected with HIV by carrying out a systematic review. Methods: Key scientific databases were searched for primary studies not older than 15 years old without language restrictions. Randomized Control Trials (RCTs) and Cohorts comparing the effectiveness of cotrimoxazole versus placebo in the prevention of PCP among children (<17 years) exposed to and infected with HIV were selected. Studies with a duration of follow-up not less than 3 months long were included. A meta-analysis was conducted on RevMan 5.3 statistical application software following data extraction, and the data quality and risk of bias were also assessed. Exactly Ten (10) studies were selected and analyzed. Findings: It was observed that cotrimoxazole had beneficial effects in terms of a reduction in mortality among HIV-exposed and infected children, as 72 fewer children in 1000 (based on an absolute 95% CI) will die as a result of cotrimoxazole compared to a placebo. Cotrimoxazole also significantly reduces hospital admissions (p-value of 0.008). The adverse events associated with cotrimoxazole are comparable to a placebo when co-administered with ARTS (p = 0.90), which did not impact adherence. Conclusion: The benefits of cotrimoxazole prophylaxis far outweigh its risks. Therefore, scaling up the intervention is recommended as a prophylactic for wider coverage, especially in resource-limited settings. Full article

Background: This article examines the infectious disease surveillance system in the Lombardy region of Italy, with a focus on its response mechanisms to respiratory syndromes. This study aims to describe the alert system and the organizational procedures in place, assessing their effectiveness in managing health crises. Methods: This study is based on the analysis of Lombardy’s regional resolution No. 1125, developed by regional public health experts. Surveillance levels were categorized based on incidence thresholds and healthcare system impacts, establishing specific indicators and activation protocols. Information flows are managed through real-time data portals, enabling the real-time monitoring of COVID-19, influenza, and other infectious respiratory diseases. Results: A multi-level response system was established, with levels ranging from ordinary regimes to critical epidemic activation. Each level includes specific actions, such as resource reallocation, emergency department support, and the suspension of elective procedures. The use of technological tools, such as electronic health records, streamlined reporting processes, and real-time data flow management, has strengthened the region’s response capabilities. Conclusions: This study underscores the value of a structured, multi-level response system for infectious disease management, showing that a unified regional approach improves crisis response efficiency. It suggests that sharing activation indicators and protocols within the scientific community can help harmonize national and international responses to future pandemics. The system, while effective in its current context, may require adaptation for future health challenges. Full article

Introduction: COVID-19 is a respiratory disease caused by the SARS-CoV-2 virus, which belongs to the coronavirus family. SARS-CoV-2 is related to other viruses that cause severe acute respiratory syndrome. The emergence of cases of pneumonia of unknown origin triggered the largest viral pandemic in modern times, presenting major challenges to global public health. Objective: To analyze the evolution of the COVID-19 pandemic in the state of São Paulo from 2020 to 2023, focusing on trends in incidence, mortality, and lethality. Methods: Ecological study of time series of incidence, mortality and lethality by COVID-19 in the state of São Paulo using Prais-Winsten regression considering the Weekly Percentage Change (WPC) and probability values (p), considering a significance level of 95% (95% CI). To ensure the reliability of the entered data, double-blind typing was performed by different researchers in the same database extracted from the 2024 Ministry of Health Coronavirus dashboard. Results: From February 2020 and the end of December 2023, 6,763,310 accumulated cases and 182,254 deaths were recorded. Stationary trends were observed for the year 2022, with a reduction in incidence and mortality in the year 2023. However, the epidemiological variable lethality showed a stationary trend. Conclusion: The analysis of the trends in incidence, mortality, and lethality revealed variable dynamics over time, with emphasis on the significant reduction of these indicators in 2023. Full article