SÔBRE ALGUNS EPIDEMIOLóGICA QUE SE REFERE ELEMENTOS DA ESTRUTURA DA CIDADE DE SÃO PAULO NO A DOENÇAS CUJOS AGENTES ETIOLóGICOS SE ELIMINAM PELOS EXCRETA

Abstract

1. The infectious diseases, whose causative agents are excreted in the feces, are a serious problem of Public Health in São Paulo. Among them Typhoid and Paratyphoid fevers are the ones that render easiest for epidemiological studies based on data obtained from death register and notification of cases. 2.The very great decline of incidence and mortality of such fevers has not reached a satisfactory levei yet. For this reason these diseases are problem of public health of importance although not so outstanding as in past years. 3. The mortality rates have not been altered in the last three years( 1951-1953) and the morbidity ones h ave increased showing that the transmission of this group of diseases has not decreased, ali suggesting, on the contrary, that it has increased. 4. The data on typhoid and paratyphoid give us an indication on what occurs with the transmission of other diseases that are transmitted through excreta, such as shighellosis, amebiasis and dysenteries of various causes. Very suggestive of this is the fact of the mortality rate of such diseases having increased in São Paulo, during the last five years. 5. The fact of poorer districts having a higher morbidity rate suggests that prophylactic measures that must follow a certain priority be brought into force there in first place. 6. The global morbidity rate for the lot of poor districts that are situated on low and levei land being higher than in the ones of same economical levei, but situated on high and mountainous land, suggest that measures that must follow certain priority be brought into force there first. 7. The districts provided with public water supply in 100% of their area, both poor and rich present morbidity rates that are still considered high, although lower than districts not provided with it. This indicates that once eliminated this factor there will be a demainder of cases that will appear in consequence of other transmission factors. These questions must by cleared up by field-work, outstanding among others, the ones relative to proportion of carriers, the role of food handlers, production of flies and frequence of pollution of vacant lots by teces. 8. Lack o f notification o f cases o f thyphoid fever, now increased with the advent of chloranphenicol, and difficulties to study other diseases transmitted through excreta epidemiologically, through data obtained from register, sugest that these preliminary studies be amplified by epidemiological investigation, conducted with representative samples of the general population, so that the results may guide authorities in applying adequate measures of prophylaxis of such diseases. 9. The preliminary study o f data on hand about sanitation o f the districts of São Paulo unprovided of public watzr supply and the ones obtained by us show that conditions in these districts continue favourable to transmission of diszases transmitted by excreta and suggest more detailed studies of each one of the factors of epidemiological importance, such as water supply, disposal of excreta and refuse, production of flies, pollution of vacant lots, kitchen gardens and farms.1O. Considering that the extension o f public water supply in the city of São Paulo can not exceed a certain yearly rate of construction based on our preliminary conclusions and those of other authors, we suggest provisional measures be taken in those districts that can not be served by public water supply within a certain time. Nature of such measures, should be based on local epidemiological studies carried out by teams of the tchnicians of different formations, so that the measures be adequate to local reality. 11 . The zones that will only be able to receive benefits of water supply remotely, and in the rural zone, convenient measures should be advised and facillities offered to population for individual water supply, building of pits in tolerable conditions, and other measures of the same nature. 12. This study is a preliminary epidemiological study o f the situation of São Paulo concerning potential transmission of infectious diseases transmitted through excreta, first step given to offer data to our authorities in order to act against them. A deaper knowledge of this situation, that may furnish more useful information to administrators that must apply provisional measures above suggested, or to the authorities responsible for plans of more general action, must be done by a team of doctors sanitary engineers, bacteriologists and parasitologists so that a complete picture of the situation can be made.