Complete your personal information for a more tailored experience for the best life sciences journalism in the industry Brazil — His nicotine-yellow eyes and haunted stare gave José de Moraes the look of a man who had been to the brink of death and back again A 54-year-old city council employee, de Moraes caught yellow fever two months ago the same strain that has killed nearly 200 people in Brazil since January and infected at least three times more Today he is still too weak to climb the steps to his first-floor apartment on the edge of this quiet country town And he is still spooked by the force of the disease describing how the virus attacked his kidneys The pain started in his back and took over his whole frame and delirium that he no longer recognized anyone The virus that de Moraes caught is part of a broader outbreak that has taken authorities here by surprise Although Brazil experiences what is known as a “sylvatic” cycle of yellow fever — in which the virus is spread between mosquitoes and monkeys in the jungle — the current outbreak has fanned far beyond the Amazon jungle and out to the coast and raised fears of an epidemic in Brazil’s urban areas that could be devastating if not quickly contained It is the worst outbreak of yellow fever in this country in recent memory Although Brazil appears to be moving quickly to administer vaccines and take other steps to stop the spread of the virus it is still struggling to get the outbreak under control And while the outbreak is still in the “syvlatic” cycle a rash of monkey deaths in big cities has raised fears the situation could still get much worse before it gets better the World Health Organization added parts of São Paulo and Rio de Janeiro states to a list of areas at risk “Yellow fever virus transmission continues to expand towards the Atlantic coast of Brazil,” the WHO said in a statement The vaccine against yellow fever is highly effective, but at times has been in short supply the WHO dispatched 3.5 million additional doses of its vaccine to Brazil from an international emergency stockpile Brazil’s Ministry of Health has also adopted the WHO recommendation that one dose of the vaccine is sufficient, not two as previously advised, and said it is preparing contingency plans to recommend one-fifth of the normal dose, a strategy that proved effective recently in the Democratic Republic of Congo The last urban epidemic of yellow fever in Brazil But the disease is still spread by Haemagogus and Sabethes forest mosquitoes A roundup of STAT's top stories of the day An hour’s drive down dirt roads from Ipanema is the tiny hamlet of Santa Constância where Leonel Ferreira Neto grew coffee and sugar cane possibly while clearing forest on the steep hills beside his neat farmhouse remembered he had seen a dead monkey — a sign the family now know means yellow fever could be present her father trusted vaccines as little as he trusted school which he only let his six children attend for a year each “He did not believe in these things,” she said after running up a vertiginous slope in flip-flops to herd a couple of cows His widow said he spent weeks in the hospital before dying taking on the jaundiced color for which the disease is known The family had never seen yellow fever in the town rural state have seen outbreaks before — 16 people in Minas Gerais died of yellow fever in 2001 Adults were advised to get vaccinations every 10 years by the state and federal government Yet just 30 percent of the population of Ipanema was vaccinated The widespread deaths of monkeys can be a signal that the disease is spreading a professor of zoology and primate specialist at the Federal University of Espírito Santo who has documented the deaths of over 1,200 since January monkeys were found to have died from yellow fever in towns in Minas and São Paulo states But “authorities were slow to perceive the problem,” Lucena said city health director Weverton Rodrigues said adults don’t bother keeping their vaccinations up to date “Unfortunately I see the culture of our country as very short-sighted “A problem comes up and let’s deal with it.” Some specialists said Minas Gerais should have worked harder to vaccinate its population “The human cases in Minas Gerais are the result of a failure in vaccination cover,” said Jessé Alves an infectious diseases specialist at the Emilio Ribas hospital in São Paulo a spokeswoman for the Minas Gerais health secretariat said the population’s demand for the vaccine had always been low and that 77 percent of the state was now vaccinated.) Yellow fever vaccinations were not recommended in Espírito Santo state which borders Minas Gerais on Brazil’s eastern coast Since January it has confirmed 148 cases and 44 deaths from the disease where residents can schedule vaccinations online the coverage is even higher: 92 percent of its 333,000 people according to the municipal health secretary the director of health vigilance in Espírito Santo She had been told by specialists that Vitória’s metropolitan area was basically free of yellow fever Then laboratory results confirmed yellow fever in 22 monkeys that died there Other towns near Vitória have been slow to vaccinate residents only 49 percent of the population were vaccinated In February its police force went on strike leading to a crime wave and hundreds of deaths Rodrigues said Brazil’s Ministry of Health did not always supply the quantity of vaccines they needed She was forced to prioritize rural areas where cases had been found over those that had yet to report them a rural municipality surrounded by impacted areas that did not immediately report cases She had to argue to get the ministry to send her enough doses of vaccine for Muniz Freire too Six deaths have since been confirmed there “It makes you want to cry,” Rodrigues said “You are facing a situation that you know what the solution is but the decision to put the vaccine there is not in your power.” Recently another 200,000 doses of the vaccine were held up for a week In March cases appeared in Casimiro de Abreu Now the state is working to vaccinate its entire 16 million-plus population concerned yellow fever could spread to Aedes aegypti mosquitos in cities like Rio where almost a quarter of its 6.5 million people live in the densely packed When one clinic outside the Complexo do Alemão favela opened on a recent morning many forming a line for yellow fever vaccines “I tried last week and there was none here,” said Viviane Duarte some waited three hours in a line that stretched a block Staff at both centers said they were vaccinating around 500 people a day said she was getting vaccinated because “where I live To submit a correction request, please visit our Contact Us page Reporting from the frontiers of health and medicine Metrics details The 69th World Health Assembly approved the Global Health Sector Strategy to eliminate hepatitis C virus (HCV) infection by 2030 efforts have been undertaken to achieve this goal; there are It is important to understand the disease profile in different regions of the country in order to design strategies to fight the disease nationwide The objective of this study was to analyse the time trend of the incidence and mortality of hepatitis C in Brazil during the period from 2008 to 2018 according to sociodemographic and clinical characteristics All newly diagnosed cases of hepatitis C reported between 2008 and 2018 The indicators were obtained from the databases of the Brazilian Ministry of Health 136,759 newly diagnosed cases of hepatitis C were reported considering anti-HCV and HCV RNA positivity and 271,624 newly diagnosed cases were reported considering one or another positive test The majority of the records were concentrated in the Southeast (61%) and South (26.2%) Regions The joinpoint regression model indicated an increasing trend in the detection rate of hepatitis C in Brazil but there was a decreasing trend in the mortality rate during the period analysed Differences were observed in the time trend of hepatitis C and in the sociodemographic and clinical characteristics in different regions of Brazil These data can provide support to design strategies for the elimination of hepatitis C in Brazil and regional inequalities lead to differences in diagnosis and access to treatments of fundamental importance to conduct epidemiological studies that contribute to characterization of the disease in different regions of the country in order to contribute to the design of strategies for combating and eliminating hepatitis C throughout Brazil There are no recent studies in Brazil on the trend behavior of the disease in its different regions the objective of this study is to analyse the time trend of the incidence and mortality of hepatitis C in Brazil during the period from 2008 to 2018 according to sociodemographic and clinical characteristics the Brazilian Ministry of Health database provides data on both confirmation criteria for the entire study period in the present study we present data for both criteria from 2008 to 2018 Hepatitis C by spatial units (two indicators): Number and detection rate per 100,000 inhabitants of individuals who were anti-HCV positive and HCV RNA positive; Number and detection rate per 100,000 inhabitants of individuals who were anti-HCV positive or HCV RNA positive; Hepatitis C by sociodemographic and clinical characteristics (seven indicators): Number and detection rate of hepatitis C per 100,000 inhabitants by sex (male and female) and sex ratio; Number and proportion of confirmed cases of hepatitis C by race/colour (White; Black; Asian; Mixed Number and detection rate per 100,000 inhabitants by age group and year of notification (< 5 years; 5–9 years; 10–14 years; 15–19 years; 20–24 years; 25–29 years; 30–34 years; 35–39 years; 40–44 years; 45–49 years; 50–54 years; 55–59 years; 60 years or more); Number and percentage of hepatitis C by level of education and year of notification (Illiterate; first to fourth grade incomplete; completed fourth grade; fifth to eighth grade incomplete; completed elementary school; secondary school incomplete; completed secondary school; tertiary school incomplete; completed tertiary school; unknown; not applicable); Number and proportion of confirmed cases of hepatitis C by likely source/mechanism of infection (Sexual; transfusion; drug use; vertical transmission; work accident; haemodialysis; household; others; unknown/left blank); Number and proportion of confirmed cases of hepatitis C by association with HIV/AIDS (yes; no; unknown); Number and proportion of confirmed cases of hepatitis C coinfected with HIV by macro-region (North; Northeast; Southeast; South; Central-West); Number of deaths due to hepatitis C and mortality rate (per 100,000 inhabitants) as underlying cause Number of deaths due to hepatitis C and mortality rate (per 100,000 inhabitants) as the underlying cause by place of residence and year of occurrence descriptive analysis of the variables was conducted indicators were described as absolute and relative frequencies and measures of central tendency (mean and standard deviation) Scatter plots with smoothed regression lines were generated to evaluate the relationship between the Brazilian and regional rates For comparison of detection rates before and after the change in the notification process for confirmed cases of hepatitis C descriptive exploratory spatial analysis was conducted significance level of 5% and confidence interval of 5% (95% CI) were considered The results of the analysis are displayed in graphs Netherlands) and QGIS (2.14.11 Open Source Geospatial Foundation As this study used data from the public domain evaluation by the Research Ethics Committee was waived Hepatitis C detection rate considering A anti-HCV and HCV-RNA positivity and B considering anti-HCV or HCV-RNA positivity, by region of residence and year of notification. Brazil, 2008–2018 Distribution of hepatitis C detection rate* in the analysed period considering A anti-HCV and HCV-RNA positivity and B considering anti-HCV or HCV-RNA positivity *Each data point represents incidence rate of one year Relation between regional and national hepatitis C detection rate considering A anti-HCV and HCV-RNA positivity and B considering anti-HCV or HCV-RNA positivity Spatial distribution of the hepatitis C detection rate in Brazil considering A anti-HCV and HCV-RNA positivity and B considering anti-HCV or HCV-RNA positivity This study has presented important data regarding the detection and mortality rate of hepatitis C in Brazil in recent years as well as differences in the epidemiological profile of the disease in different regions of the country The main explanation for the increased incidence of HCV in these age groups involves changes in the mechanisms of disease transmission over the years have led to changes in the disease profile in Brazil This finding is corroborated by the data on level of education where an increase was observed in the proportion of individuals who were illiterate and those who had not completed secondary or tertiary education the decreasing trend in HCV-HIV coinfection in the country may reflect increased access to diagnostic tests over the years as the prevalence of HCV-HIV coinfection could have been overestimated in previous years due to a greater demand for test orders in individuals who were previously infected with HIV The worldwide impacts of the COVID-19 pandemic have jeopardized all the advances observed in recent years not only due to the evident impact on the entire health system but also due to the lack of investigations that evaluate the relationship between the two viruses the notification system does not allow for separate analysis according to the diagnostic method (anti-HCV or HCV-RNA) so we were unable to differentiate between active and past infection in our analyses the increasing trends observed for some indicators when the confirmation criteria was changed in Brazil This study provides important data regarding the behaviour of hepatitis C in Brazil over a 10-year period A change was observed in the epidemiological profile of the disease caused mainly by changes in diagnostic confirmation criteria and the introduction of new medications that have contributed to reduced mortality in recent years Also evident are the differences in the disease profile in different regions of Brazil as a result of regional differences related to the sociodemographic profile and health and social infrastructure conditions with strategies developed according to the population profile of each region of Brazil with expanded diagnosis for all risk groups in addition to the development of prevention strategies through health education which will make it possible to slow contagion and promote awareness so that the population will seek testing centres and the industry is also needed to guarantee access to treatment for all individuals who are infected Only then will it be possible to eliminate hepatitis C in Brazil World Health Organization. Global hepatitis report 2017. 2017. https://apps.who.int/iris/bitstream/handle/10665/255016/9789?sequence=1 Prevalence and risk factors of Hepatitis C virus infection in Brazil 2005 through 2009: a cross-sectional study World Health Organization. Global health sector strategy on viral hepatitis 2016–2021. Towards ending viral hepatitis. 2016. https://apps.who.int/iris/bitstream/handle/10665/246177/WHO?sequence=1 Impact of the COVID-19 pandemic on hepatitis C diagnosis in Brazil: is the global hepatitis C elimination strategy at risk Instituto Brasileiro de Geografia e Estatística. Portal do IBGE. https://www.ibge.gov.br/ Transição epidemiológica e o estudo de carga de doença no Brasil Brasil. Atlas de Vulnerabilidade Social. http://ivs.ipea.gov.br/index.php/pt/ Brasil. Ministério da Saúde. Departamento de Doenças de Condições Crônicas e Infecções Sexualmente Transmissíveis. Indicadores e Dados Básicos das Hepatites nos Municípios Brasileiros. http://indicadoreshepatites.aids.gov.br/ Permutation tests for joinpoint regression with applications to cancer rates Hepatitis C worldwide and in Brazil: silent epidemic–data on disease including incidence Health conditions and health-policy innovations in Brazil: the way forward Hepatites B e C em usuários de drogas injetáveis vivendo com HIV em São Paulo Brasil [Hepatitis B and C among injecting drug users living with HIV in São Paulo Co-infection by hepatitis C virus in HIV-infected patients in southern Brazil: genotype distribution and clinical correlates Hepatitis C disease burden and strategies for elimination by 2030 in Brazil Exposure source prevalence is associated with gender in hepatitis C virus patients from Rio de Janeiro Gender differences in sexual and injection risk behavior among active young injection drug users in San Francisco (the UFO Study) Higher risk of incident hepatitis C virus among young women who inject drugs compared with young men in association with sexual relationships: a prospective analysis from the UFO Study cohort Higher incidence of HCV in females compared to males who inject drugs: a systematic review and meta-analysis Evaluation of a strategy for identification of hepatitis C virus carriers in outpatient and emergency units: contribution to the microelimination of hepatitis C in Brazil Seroprevalence of hepatitis B and C in Brazilian army conscripts in 2002: a cross-sectional study Likely transmission of hepatitis C virus through sharing of cutting and perforating instruments in blood donors in the State of Pará Transmission of hepatitis C virus by blood transfusions and other medical procedures: a global review Global prevalence of hepatitis C virus in children in 2018: a modelling study Hepatitis C virus infection status and associated factors among a multi-site sample of people who used illicit drugs in the Amazon region Perfil clínico-epidemiológico da hepatite C na região norte do Brasil entre 2012 e 2015 Hepatitis C: evaluation of outcomes and georeferencing of cases in Santa Cruz do Sul HCV genotype profile in Brazil of mono-infected and HIV co-infected individuals: A survey representative of an entire country Changes in liver-related mortality by etiology and sequelae: underlying versus multiple causes of death Hepatitis C virus infection mortality trends according to three definitions with special concern for the baby boomer birth cohort Impact of COVID-19 on TB diagnosis in Northeastern Brazil Impact of the COVID-19 pandemic on the diagnosis of new leprosy cases in Northeastern Brazil and disorders attributed to alcohol use: global Burden of Disease in Brazil Download references Rodrigo José Videres Cordeiro de Brito & Patrícia Muniz Mendes Freire de Moura Universidade Federal Do Vale Do São Francisco (UNIVASF) Leonardo Feitosa da Silva & Carlos Dornels Freire de Souza The authors declare that they have no competing interests Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations unless otherwise stated in a credit line to the data Download citation DOI: https://doi.org/10.1186/s12879-022-07063-5 Anyone you share the following link with will be able to read this content: a shareable link is not currently available for this article Samarco Mineracão's Alegria iron ore mine is in Brazil's Iron Quadrangle Samarco Minerac&atilde;o (50% BHP Billiton Samarco Mineracão’s Alegria iron ore mine is in Brazil’s Iron Quadrangle about 4.5km north of the depleted Germano deposit within the districts of Mariana and Ouro Preto in the state of Minas Gerais The process plant pumps concentrate via a slurry pipeline to facilities at Ponta Ubu on the Atlantic coast that include two pelletising plants and a shipping quay BHP Billiton and CVRD (Vale) each has a 50% holding in Samarco The operation employed 1,336 people directly and more than 2,000 via contractors in 2005 The company implemented an optimisation project to increase concentrator and pelletisation capacity in the short term It also invested in a new concentrator and pelletisation plant port improvement and a second slurry pipeline that began operations in 2008 Samarco produced 8.5Mt of iron ore in 2008 the second and third pellet plants were temporarily suspended While the two pellets have subsequently been restarted they will continue operations based on the demand globally The deposit consists of low-grade itabiritic ore Alegria’s certified mineral reserves totalled 769MT by 30 June 2009 graded at 44.3% Fe Probable resources stood at 821Mt at 41.5% Fe Measured resources totalled 1238Mt at 42.2% Fe while indicated resources were 682Mt at 38.1% Fe loaded by front-end loaders into 177t-capacity trucks and taken to a crushing and screening plant in the blending yard The ore is blended and stored before transport by belt conveyors to the surge pile An overland conveyor system transports the ore over a distance of 4km to the beneficiation plant at Germano At the Germano beneficiation plant the ore is screened crushed and classified to feed the primary mills This circuit assures sufficient reduction of the iron ore particles with the ultrafine material being removed in cluster cyclones before conventional flotation where waste material such as silica is separated from the iron particles The ore is reground and enters a column flotation circuit.The addition of a roller press in 2004 improved productivity by 7% The resulting concentrate is slurried with water for pipeline transport The concentrator is capable of an annual production of 24Mt of iron-ore concentrates a year Its output in the 2008 financial year was 8.5Mt The slurry pipeline takes ore from the Germano plant to the Point Ubu pellet plant and shipping facility at Espírito Santo on the Atlantic coast this iron ore slurry pipeline is the world’s longest and offers environmental safety and 99% average availability The new slurry pipeline built in 2008 also measures 396km Two pump stations and two valve stations regulate internal pressures and maintain flows at an average speed of 6km/h with a flow rate of 1,200m³/h is now operating at over 15Mt/y owing to advances in pumping and monitoring technology A new pipeline will be built in conjunction with the new concentrator and pellet plant incoming slurry is thickened and then stored in tanks that feed vacuum filters These remove the remaining water from the slurry The concentrate’s moisture content is adjusted and limestone It is then conveyed to the balling discs for pelletising The pellets are screened and classified by size before being fired in the induration furnace Oversize and undersize materials return to the balling discs Fired pellets are conveyed to the port stockpile area The final product is direct reduction and blast furnace pellets for steelmaking The plant has an annual production capacity of 13Mt of pellets Surplus concentrates are sold as pellet plant and sinter feed The pelletising facility on the coast enables Samarco to operate its own port facility at Point Ubu which can accommodate two vessels of up to 170,000t The 313m-long by 22m-wide shiploading pier also receives carriers and tankers bringing coal and fuel oil for the pelletising plant The third pellet-plant project was approved in October 2005 The new concentrator has a capacity of 7.5Mt/y Outotec supplied the pellet indurating furnace for the third plant in 2007 under a $200m contract The pellet plant increased yield capacity by 7.6Mt/y and altered the blast furnace:direct-reduction pellet output split to 50:50 The installation of the third pellet plant enabled Samarco to process nearly 24Mt/y of ore concentrate It allowed Samarco to produce approximately 21.6Mt of pellets every year the fourth pellet plant project with capacity of 8.3Mt/y was approved A third slurry pipeline running parallel to the two existing pipeline will be installed as part of the project The new pipeline that will link the mine with the fourth pellet plant and is designed to carry 20Mt/y An estimated $3bn will be invested in the fourth pellet plant project The plant is anticipated to go operational by the first half of 2014 The key to Samarco’s expansion has been the Guilman-Amorin hydro-electric plant Samarco has a 49% interest in this project in partnership with Companhia Siderúrgica Belgo-Mineira The power plant has a capacity of 140MW from four 35MW turbines Give your business an edge with our leading industry insights View all newsletters from across the GlobalData Media network