Our proposal is to develop a sentinel syndromic surveillance strategy to identify encephalitis cases possibly related to emerging pathogens admitted to Intensive Care Units (ICUs) in Brazil. Sentinel to allow a diagnostic intensive approach on a smaller number of cases, syndromic to guarantee a sensitive criterion to include new or unexpected pathogens, and in ICUs to prioritize potentially severe threats. In a resource-limited setting it won't be possible to monitor and investigate all cases of encephalitis, so a cost-effective algorithm for early identification of the cases that are most likely to be caused by unusual, unexpected or emerging pathogens must be developed. As universal surveillance of encephalitis is not recommended in Brazil, data on incidence, causes and prognosis is not available, leaving a gap in the understanding of the epidemiology of this central nervous system disease in the country. This study will review cases of encephalitis admitted in the last five years to ICUs in a large metropolitan area. Its results will help understand the epidemiology of encephalitis in Brazil and will provide data to build a strategy for early identification of outbreaks and of emerging infectious diseases.~We will use data of a sentinel sample of 19 ICUs of nine of the largest hospitals in the metropolitan area of Rio de Janeiro - Brazil (12 million inhabitants in 2018), from 2015 to 2018, covered with the Epimed Monitor database, which routinely registers all admissions in ICUs. The Epimed Monitor system is present in more than 400 hospitals throughout Brazil, with 750 ICUs and 11,000 monitored beds, reaching over 1,000,000 patients within its base (http://www.utisbrasileiras.com.br/en/epimed/)(Zampieri et al. 2017). Based on previous studies (Boucher et al. 2017; Soares et al. 2011), we expect to identify between 100 and 250 cases of encephalitis.
Our proposal is to develop a sentinel syndromic surveillance strategy to identify encephalitis cases possibly related to emerging pathogens admitted to ICUs in Brazil. Sentinel to allow a diagnostic intensive approach on a smaller number of cases, syndromic to guarantee a sensitive criterion to include new or unexpected pathogens, and in ICUs to prioritize potentially severe threats. In a resource-limited setting it won't be possible to monitor and investigate all cases of encephalitis, so a cost-effective algorithm for early identification of the cases that are most likely to be caused by unusual, unexpected or emerging pathogens must be developed. As universal surveillance of encephalitis is not recommended in Brazil, data on incidence, causes and prognosis is not available, leaving a gap in the understanding of the epidemiology of this central nervous system disease in the country. This study will review cases of encephalitis admitted in the last five years to ICUs in a large metropolitan area. Its results will help understand the epidemiology of encephalitis in Brazil and will provide data to build a strategy for early identification of outbreaks and of emerging infectious diseases.