L’objectif principal de ce travail de thèse est de proposer une méthode d’évaluation de ces algorithmes qui soit réaliste, pragmatique, opérationnel (que les acteurs de la surveillance pourront mettre simplement en œuvre), validé et reproductible. Cette méthode permettra de tester et d’évaluer les algorithmes pour en établir les caractéristiques et pour en définir les limites. Pour atteindre cet objectif, premièrement, nous proposons de modéliser le processus de surveillance avec ses tâches associées, la prise de décision et l’utilisation des ODA en conditions réelles. Un travail centré sur l’incertitude au cours de la gestion d’épidémie et l’identification d’outils potentiellement utilisables pour aider à la prise de décision a été réalisé.Deuxièmement, comme la maîtrise de l’ensemble du jeu de données d’évaluation est un préalable à toute évaluation, nous avons proposé une nouvelle approche qui permet de simuler en quelques minutes, à partir d’épidémies publiées, des courbes épidémiques réalistes. Nous avons utilisé les techniques de rééchantillonnage de Monte-Carlo permettant de résoudre un certain nombre de problèmes non traités dans la littérature et nous avons identifié la divergence du χ² comme une métrique intéressante pour réaliser le contrôle qualité de cette simulation. Nous avons également proposé une revue détaillée et commentée de l’ensemble des métriques d’évaluations publiées (>50). / The main goal of this work is to propose an assessment method to evaluate outbreak detection algorithm with the following characteristics: realistic, pragmatic, operational (easy to implement), validated and reproducible. This method will allow testing and evaluating outbreak detection algorithms with the objective to determine their features and limits. To reach this goal, firstly, we propose to model the surveillance process with their associated tasks, the decision-making and the use of ODA in real conditions. A work focused of uncertainty during the outbreak management and identification of possible tools to support the expert decision-making is presented.Secondly, because building a standardized dataset of evaluation is a prior before any evaluation, we proposed a new approach to simulate in few minutes, from published epidemics, realistic outbreak curve. We used a Monte-Carlo sampling approach to solved several problems non treated in literature and identified theχ²divergence to realized the quality control of data simulated. We also proposed a detailed and commented review on published evaluation metrics (>50). An example of ODA evaluation was realized by comparing several change point analysis (CPA) model and expert judgment while seeking to identify the complementarity between human and statistical tool in a goal of help to decision-making.

Background and Purpose: School nurses have the critical task of overseeing the health and wellness of school-aged students. Utah is 1 of 17 states which allow parents to exempt their children from vaccines. The most common parental reason for exempting children from vaccines is personal choice. With the number of students without vaccinations on the rise, school nurses are tasked with responsibilities related to the spread of vaccine-preventable diseases. However, few studies have explored the role of school nurses in managing a disease outbreak. Therefore, the purpose of this study was to 1) explore the responsibilities of Utah school nurses during a disease outbreak; 2) review disease outbreak training for Utah school nurses; 3) identify groups with which the Utah school nurse would collaborate during a disease outbreak; and 4) identify Utah school nurse concerns while attempting to manage a disease outbreak. Methods: A qualitative descriptive design was used with a semi-structured interview guide for focus groups (3 focus groups, 24 total participants) of Utah school nurses. Qualitative analysis of content and themes was utilized. Results: School nurses' responses revealed their collaborative role and cited strong teamwork with the local health department; lack of standardized disease outbreak training; high student-to-nurse ratios; and concerns with communication with parents and community. Thematic descriptions with illustrative quotes are presented as well as perceived challenges and barriers Utah school nurses faced during a disease outbreak. Conclusion: Utah school nurses face barriers that prevent them from working effectively during a disease outbreak. Most barriers are due to communication difficulties and lack of training for school nurses. Findings of this study have implications for standardized training, funding to decrease the high nurse-to-student ratio and for further education in the community to raise awareness of outbreak guidelines.

No description available.

In many drinking water systems in the United States, disinfectant is added to water as it leaves the plant to maintain a residual concentration in the distribution system. The disinfectant residual is maintained to inactivate contamination that enters the distribution system, to control biofilms, and to act as a sentinel for contamination in the distribution system. A model was developed to evaluate the potential effectiveness of the disinfectant residual at inactivating contamination. The model was used to examine contamination of a hypothetical distribution system through backpressure at a cross-connection under different operating conditions. The dilution and pathway of the hypothetical contaminant were examined as the contaminant moved through the system. Disinfection and inactivation kinetic relationships were used to model the inactivation of the contaminant in the system by the amount of disinfectant present. The model showed that both chlorine and chloramines in each decay and inactivation condition considered provided some benefit over no disinfectant at all when examining susceptible organisms. Chlorine, under medium and low decay conditions, provided the best inactivation. Where 29.8% of total node time steps received a contamination of concern in the absence of disinfectant residual, as low as 4.8% of total node time steps received a contamination of concern in the presence of disinfectant residual. Chloramines was found to persist longer in the distribution system, but resulted in much lower inactivation compared to chlorine. Disinfectant doses typical of common distribution system operation were able to reduce the impact of contamination once it entered the distribution system but, except for four cases, were unable to prevent contamination from spreading within the distribution system. Therefore, it was concluded that presence of a disinfectant residual will reduce the total number of exposure opportunities from a contamination event, but cannot be relied upon to eliminate the chance of exposure resulting from contamination. / Master of Science

La surveillance épidémiologique est le recueil systématique et continu d’informations sur l’état de santé des populations, leur analyse, leur interprétation et leur diffusion à tous les décideurs ayant besoin d’être informés. Un de ses objectifs est la détection des événements inhabituels, i.e. des épidémies, nécessitant la mise en place rapide de contre-mesures. Les objectifs de ce travail de thèse sont : (i) d’évaluer les principales méthodes statistiques de détection publiées et communément employées dans différents systèmes de surveillance épidémiologique, (ii) de proposer une nouvelle approche reposant sur la combinaison optimale de méthodes de détection statistique des épidémies et (iii) de développer une nouvelle méthode statistique d’analyse étiologique d’une épidémie à partir des données de surveillance épidémiologique collectées en routine par le système.Pour atteindre ces objectifs, nous évaluons les principales méthodes statistiques de la littérature, à partir d’un jeu publié de données simulées. Puis nous proposons une approche originale pour la détection des épidémies sur le principe de la combinaison de méthodes sélectionnées lors de l’étape précédente. Les performances de cette approche sont comparées aux précédentes selon la méthodologie utiliséeà la première étape. Enfin, nous proposons une méthode d’analyse étiologique d’une épidémie à partir des données de surveillance en employant des modèles statistiques adaptés aux séries chronologiques. / Public health surveillance is the ongoing, systematic collection, analysis, interpretation, and dissemination of data for use in public health action to reduce morbidity and mortality of health-related events and to improve health. One of its objectives is the detection of unusualevents, i.e. outbreaks, requiring the rapid implementation of countermeasures.The objectives of this work are: (i) to evaluate the main published statistical methods for outbreak detection commonly implemented in different public health surveillance systems, (ii) to propose a new approach based on the optimal combination of statistical methods foroutbreak detection and benchmark it to other methods; and (iii) develop a new statistical method for the etiological analysis of an outbreak from public health surveillance data routinely collected by the system. To achieve these objectives, as a first step, we evaluate the main statistical methods, from a published set of simulated public health surveillance data. Statistical methods have been evaluated for an operational purpose: for all simulated time series, we used the tuning parameters recommended by their authors for each algorithm when available. We propose sensitivity and specificity metrics suitable for these tools. Then we propose an original approach for outbreak detection based on combination of methods selected in the previous step. The performance of this approach is compared to the previous ones according to the methodology implemented in the first step.Finally, we propose a method for the etiological analysis of an outbreak from surveillance data by using statistical models suitable for time series analysis

<b>Background</b>: The world is at risk of epidemics of novel and reemerging infectious diseases. These may be national, regional or international as in the case of Nipah, African Viral Haemorrhagic Fevers, SARS and H1N1 respectively. It is crucial that public health and clinical research is conducted in such epidemics. Yet the conduct of heath research during rapidly evolving epidemics or disasters represents an enormous challenge. In addition to the large number of practical challenges to undertaking such research there are also major ethical issues to consider. However, there is very little understanding of these ethical issues and very little empirical evidence of the views of patients, their families, society and key stakeholders. <b>Objective</b>: To collect and analyse data on ethical considerations arising in the setting of research on rapidly evolving epidemics posed by the urgent and unpredictable nature of epidemics. <b>Design</b>: The study was conducted in Oxford University Clinical Research Unit (OUCRU), Viet Nam and 3 other hospitals in Viet Nam with experience of epidemics. Data were collected by semi-structured interviews with key stakeholders representing research staff, IRB members, patients/family members and study sponsors/funders who have participated in or reviewed research projects on infectious diseases including SARS, H5N1, H1N1, dengue and Hand, Foot, Mouth disease. <b>Result</b>: A total of 64 interviews with all key stakeholders were conducted. Analysis of the ethical problems/challenges discussed in the interviews led to the identification of three themes 1) International research collaboration, 2) IRB review and 3) Consent. These tended to arise at three levels of relationship: macro (between institutions internationally), meso (within and between institutions nationally) and micro (within institutions and between health professionals and patients). <b>Conclusion</b>: The issues and types of considerations and their relative importance were raised and/or valued differently by the members of different key stakeholder groups due to their role and experience in research participation. Some of the issues raised also related to health research in other settings. However, many were unique to the setting of rapidly evolving epidemics. Addressing these issues is crucial for successful and appropriate research in the context of epidemics. It is inevitable that epidemics of emerging and reemerging infectious diseases will occur in the future and there is a clear need to undertake crucial scientific research in such settings. It is therefore imperative that we understand the challenges and ethical issues surrounding such research. It is desirable that further research into the ethical challenges identified in this thesis takes place in the inter-epidemic period in order to better prepare for the next epidemic.

Introdução: Norovírus é o principal agente viral de infecções gastrointestinais no mundo e sua alta infectividade gera aumento importante da demanda e dos custos para a saúde pública. Surtos ocorrem em ambientes fechados ou com aglomeração de pessoas. No município de São Paulo, o Norovírus tem se destacado como principal agente etiológico das gastroenterites. Objetivo: Descrever as noroviroses como causa de gastroenterite epidêmica no Município de São Paulo no período de 2010 a 2016. Métodos: Estudo transversal descritivo com dados dos sistemas de Vigilância Epidemiológica de surtos de gastroenterite e da Vigilância Sentinela Laboratorial do Rotavírus do Município de São Paulo entre os anos de 2010 a 2016. A definição de caso foi a identificação laboratorial do Norovírus como agente etiológico de surto de doença diarreica em todas as faixas etárias ou de casos esporádicos em menores de cinco anos internados em unidades sentinelas da Vigilância do Rotavírus. Os dados foram descritos segundo tempo, lugar e pessoa, por meio do Epi InfoTM versão 3.5.4 e ArcGIS versão 10.1. Resultados: O Norovírus foi associado a 20,4 por cento (68/334) dos surtos com pesquisa de agente realizada. Ocorrendo com maior frequência na região Norte, seguida das regiões Sul e Sudeste do Município de SP; principalmente em creches, domicílios e hospitais. Houve um predomínio de casos em crianças menores de 5 anos (47,2 por cento do sexo masculino; 28,6 por cento do sexo feminino) e em mulheres entre 20 a 49 anos (38,9 por cento). Na Vigilância Sentinela Laboratorial do Rotavírus do município de São Paulo, o Norovírus foi associado a 28,4 por cento (444/1565) dos casos menores de 5 anos. Os casos foram provenientes principalmente das regiões Norte e Sul, onde estão localizadas as duas unidades sentinelas. Verificou-se pico de ocorrência do Norovírus nos meses mais quentes. Destaca-se que o perfil das gastroenterites descrito foi fortemente influenciado pelas características da Vigilância Epidemiológica das Doenças de Transmissão Alimentar do Município de São Paulo. Conclusão: O Norovírus foi o principal agente etiológico de surtos de gastroenterite e de casos menores de 5 anos internados por diarreia aguda no Município de São Paulo. A vigilância das gastroenterites por Norovírus é importante para o estabelecimento de uma rede integrada entre diferentes estados e países que possibilitem o conhecimento da doença, planejamento de medidas de prevenção e controle e comunicação da informação. / Introduction: Norovirus is the major viral agent of gastroenteritis in the world and its high infectivity causes an important increase in demand and costs for public health. Outbreaks occur in closed environments or crowded settings. In the city of São Paulo, Norovirus has been highlighted as the main etiological agent of gastroenteritis. Objective: To describe the noroviruses as the cause of epidemic gastroenteritis in the city of São Paulo from 2010 to 2016. Methods: Descriptive cross-sectional study with data from the Epidemiological Surveillance systems of gastroenteritis outbreaks and Laboratory Sentinel Surveillance of Rotavirus of the city of São Paulo from 2010 and 2016. The case definition was the laboratory identification of Norovirus as the etiological agent of diarrheal disease outbreak in all age groups or sporadic cases in children under five years of age hospitalized in sentinel units of Rotavirus Surveillance. The data were described by time, place and person, using Epi InfoTM version 3.5.4 and ArcGIS version 10.1. Results: Norovirus was associated to 20.4 per cent (68/334) of outbreaks with agent identification performed. Occurred more frequently in the North region, followed by the South and Southeast regions of the city of São Paulo, especially in nurseries, residences and hospitals. A predominance of cases in children aged <5 years (47.2 per cent male, 28.6 per cent female) and in women aged 20 to 49 years (38.9 per cent) was observed. In the Laboratory Sentinel Surveillance of Rotavirus in the city of São Paulo, Norovirus was associated with 28.4 per cent (444/1565) of cases in children younger than 5 years old. The cases were mainly from the North and South regions, where the two sentinel units are placed. There was a peak of Norovirus occurrence in warmer months. It can be noticed that the profile of gastroenteritis described was strongly influenced by the characteristics of Foodborne Disease Surveillance of the city of São Paulo. Conclusion: Norovirus was the major etiological agent of gastroenteritis outbreaks and diarrhea cases under 5 years old hospitalized in the city of São Paulo. Surveillance of gastroenteritis caused by Norovirus is important for the establishment of an integrated network between different states and countries to contribute to disease knowledge, planning of prevention and control actions and distribution of information.

Introdução: Norovírus é o principal agente viral de infecções gastrointestinais no mundo e sua alta infectividade gera aumento importante da demanda e dos custos para a saúde pública. Surtos ocorrem em ambientes fechados ou com aglomeração de pessoas. No município de São Paulo, o Norovírus tem se destacado como principal agente etiológico das gastroenterites. Objetivo: Descrever as noroviroses como causa de gastroenterite epidêmica no Município de São Paulo no período de 2010 a 2016. Métodos: Estudo transversal descritivo com dados dos sistemas de Vigilância Epidemiológica de surtos de gastroenterite e da Vigilância Sentinela Laboratorial do Rotavírus do Município de São Paulo entre os anos de 2010 a 2016. A definição de caso foi a identificação laboratorial do Norovírus como agente etiológico de surto de doença diarreica em todas as faixas etárias ou de casos esporádicos em menores de cinco anos internados em unidades sentinelas da Vigilância do Rotavírus. Os dados foram descritos segundo tempo, lugar e pessoa, por meio do Epi InfoTM versão 3.5.4 e ArcGIS versão 10.1. Resultados: O Norovírus foi associado a 20,4 por cento (68/334) dos surtos com pesquisa de agente realizada. Ocorrendo com maior frequência na região Norte, seguida das regiões Sul e Sudeste do Município de SP; principalmente em creches, domicílios e hospitais. Houve um predomínio de casos em crianças menores de 5 anos (47,2 por cento do sexo masculino; 28,6 por cento do sexo feminino) e em mulheres entre 20 a 49 anos (38,9 por cento). Na Vigilância Sentinela Laboratorial do Rotavírus do município de São Paulo, o Norovírus foi associado a 28,4 por cento (444/1565) dos casos menores de 5 anos. Os casos foram provenientes principalmente das regiões Norte e Sul, onde estão localizadas as duas unidades sentinelas. Verificou-se pico de ocorrência do Norovírus nos meses mais quentes. Destaca-se que o perfil das gastroenterites descrito foi fortemente influenciado pelas características da Vigilância Epidemiológica das Doenças de Transmissão Alimentar do Município de São Paulo. Conclusão: O Norovírus foi o principal agente etiológico de surtos de gastroenterite e de casos menores de 5 anos internados por diarreia aguda no Município de São Paulo. A vigilância das gastroenterites por Norovírus é importante para o estabelecimento de uma rede integrada entre diferentes estados e países que possibilitem o conhecimento da doença, planejamento de medidas de prevenção e controle e comunicação da informação. / Introduction: Norovirus is the major viral agent of gastroenteritis in the world and its high infectivity causes an important increase in demand and costs for public health. Outbreaks occur in closed environments or crowded settings. In the city of São Paulo, Norovirus has been highlighted as the main etiological agent of gastroenteritis. Objective: To describe the noroviruses as the cause of epidemic gastroenteritis in the city of São Paulo from 2010 to 2016. Methods: Descriptive cross-sectional study with data from the Epidemiological Surveillance systems of gastroenteritis outbreaks and Laboratory Sentinel Surveillance of Rotavirus of the city of São Paulo from 2010 and 2016. The case definition was the laboratory identification of Norovirus as the etiological agent of diarrheal disease outbreak in all age groups or sporadic cases in children under five years of age hospitalized in sentinel units of Rotavirus Surveillance. The data were described by time, place and person, using Epi InfoTM version 3.5.4 and ArcGIS version 10.1. Results: Norovirus was associated to 20.4 per cent (68/334) of outbreaks with agent identification performed. Occurred more frequently in the North region, followed by the South and Southeast regions of the city of São Paulo, especially in nurseries, residences and hospitals. A predominance of cases in children aged <5 years (47.2 per cent male, 28.6 per cent female) and in women aged 20 to 49 years (38.9 per cent) was observed. In the Laboratory Sentinel Surveillance of Rotavirus in the city of São Paulo, Norovirus was associated with 28.4 per cent (444/1565) of cases in children younger than 5 years old. The cases were mainly from the North and South regions, where the two sentinel units are placed. There was a peak of Norovirus occurrence in warmer months. It can be noticed that the profile of gastroenteritis described was strongly influenced by the characteristics of Foodborne Disease Surveillance of the city of São Paulo. Conclusion: Norovirus was the major etiological agent of gastroenteritis outbreaks and diarrhea cases under 5 years old hospitalized in the city of São Paulo. Surveillance of gastroenteritis caused by Norovirus is important for the establishment of an integrated network between different states and countries to contribute to disease knowledge, planning of prevention and control actions and distribution of information.

A esporotricose é uma micose zoonótica que no Brasil afeta centros urbanos. O gato tem papel chave na transmissão fúngica desta doença. Nos últimos 3 anos, a cidade de Guarulhos já registrou mais de 1500 casos em gatos e assumiu o status de notificação compulsória. O objetivo do presente trabalho foi analisar a epidemiologia das cepas do clado clínico patogênico Sporothrix schenckii em relação aos aspectos fenotípicos, moleculares e de suscetibilidade aos fármacos das amostras isoladas de gatos no município de Guarulhos (São Paulo). O estudo foi dividido em dois experimentos, sendo o primeiro composto por 119 gatos divididos em três grupos: Caso, Contactante e Não-Contactante. As amostras foram obtidas por meio de suabe nas lesões dos animais do grupo Caso e dos demais grupos de suabe oral e submetidas à cultura micológica; em paralelo, amostras foram obtidas para processamento de citologia em meio líquido por emblocado celular (CB). As amostras isoladas foram submetidas a PCR para identificação da espécie, bem como aos testes de sensibilidade aos fármacos microdiluição e E-Test. Durante as colheitas 25 gatos foram submetidos à eutánasia e as amostras de pele e órgãos submetidos à análise histopatológica e imunohistoquímica. O segundo estudo foi composto por 135 gatos divididos em dois grupos: Sintomático e Assintomático. As amostras obtidas foram processadas para cultura micológica e PCR, só que desta vez, a PCR foi realizada diretamente da lesão e não após o isolamento fúngico. Neste estudo, foi obtido 92,31% de positividade dentre os gatos suspeitos com esporotricose em cultivo micológico. No projeto, 100% das amostras foram identificadas como S. brasiliensis. A técnica proposta de citologia em meio líquido por emblocado celular (CB) apresentou 93% de positividade para Sporothrix spp, com sensibilidade de 97,50% entre o isolamento fúngico e 94,87% para a imunocitoquímica. Concluindo deste modo, que o CB pode ser uma boa opção para diagnóstico em saúde pública. A investigação da susceptibilidade dos isolados aos fármacos: terbinafina, a anfotericina B, o itraconazol, fluconazol e o voriconazol foram de 0,06 0,5 &micro;g/ml, 0,002 2 &micro;g/mL e 0,023 - > 32 &micro;g/ml, > 256 &micro;g/mL e 1 - 8 &micro;g/mL, respectivamente. As amostras submetidas à histopatologia e imunhistoquímica demonstraram presença do Sporothrix spp em pele, linfonodo mesentérico, baço, fígado, pulmão e coração. Não foi observado elemento fúngico no rim. Não foi estabelecida relação entre intensidade de infiltrado inflamatório e intensidade de Sporothrix na pele. Conclui-se que a PCR realizada de amostra diretamente de lesão pode ser utilizada em áreas cuja frequência da doença é alta, visto que a sensibilidade diagnóstica foi de 90,20%, contudo a especificidade foi de 42,11%. Sendo assim, em áreas de baixa frequência da esporotricose, recomenda-se o emprego do padrão ouro que é a cultura micológica para pesquisa de Sporothrix spp e com a realização da PCR para as amostras cuja isolamento for obtido. As variáveis de tipo de lesão e início do tratamento interferem no resultado diagnóstico de PCR direto da lesão. / Sporotrichosis is a zoonotic mycosis that affects urban centers in Brazil. The cat plays key role in the fungal transmission of this disease. In the last 3 years, the city of Guarulhos has registered more than 1500 cases in cats and this situation received a status of compulsory notification. The objective of the present work was to analyze the epidemiology from the strains of Sporothrix schenckii complex in relation to the phenotypic, molecular and drug susceptibility aspects of isolated samples collected in cats from Guarulhos city (São Paulo). The study was divided in two experiments: the first one consisting of 119 cats divided into three groups: Case, Contacting and Non-Contacting. Samples were obtained by swab lesions from the cats of Case group and from the other oral swab groups and submitted to mycological culture; at the same time, samples were obtained for cytology processing in liquid medium by cell block (CB). The isolated samples were submitted to PCR for species identification, as well the drug sensibility tests - microdilution and E-Test. During the process, 25 cats were euthanized and skin and organ samples were submitted to histopathological and immunohistochemical analysis. The second study was made with 135 cats divided into two groups: Symptomatic and Asymptomatic. The obtained samples were processed for mycological culture and PCR, but this time PCR was performed directly from the lesion and not after fungal isolation. This study obtained 92.31% of positivity among the cats with suspected of sporotrichosis in mycological culture. In this project, 100% of the samples were identified as S. brasiliensis. The proposed technique of cytology in liquid medium by cell block (CB) presented 93% of positivity for Sporothrix spp, with sensitivity of 97.50% between fungal isolation and 94.87% for immunocytochemistry. In conclusion, CB may be a good option for public health diagnosis. Investigations about the susceptibility of the isolates to the drugs: terbinafine, amphotericin B, itraconazole, fluconazole and voriconazole were 0.06 - 0.5 &micro;g/ml, 0.002 - 2 &micro;g/mL and 0.023 -> 32 &micro;g/mL, > 256 &micro;g/mL and 1-8 &micro;g/mL, respectively. Samples submitted to histopathology and immunhistochemistry pointed the presence of Sporothrix spp on the skin, mesenteric lymph node, spleen, liver, lung and heart. No fungal element was observed in the kidney. There was no relationship between inflammatory infiltrate intensity and Sporothrix intensity in the skin. It is concluded that the PCR performed directly from the lesion can be used in areas with a high disease frequency, since the diagnostic sensitivity was 90.20%, but the specificity was 42.11%. Thus, in areas of low frequency of sporotrichosis, it is recommended to use the gold standard, which is the mycological culture for Sporothrix spp research, and to perform the PCR for samples whose isolation is obtained. The variables of lesions type and beginning of the treatment interfere in the diagnostic result of direct PCR of the lesion.

INTRODUÇÃO: A doença diarréica aguda é ainda importante causa de morbidade no mundo. Sua elevada incidência e a aceitação de sua ocorrência como fato "normal" impõem desafios para seu registro e implantação de seus sistemas de vigilância. OBJETIVOS: Conhecer as características epidemiológicas da diarréia aguda e avaliar a capacidade de detecção de surtos pelo Programa de Monitorização da Doença Diarréica Aguda, no município de Avaré. MÉTODOS: De 27 de fevereiro a 16 de julho 2005, realizou-se estudo prospectivo da diarréia em unidade sentinela do programa. Os surtos identificados foram investigados por estudos descritivos e analíticos. Amostras de fezes foram coletadas para os casos envolvidos nos surtos. A avaliação dos propósitos do programa embasou-se em indicadores de utilidade, sensibilidade e oportunidade. RESULTADOS: Foram identificados 408 casos (Coeficiente de Incidência = 4,7/1000 habitantes); idade mediana de 7 anos (variação de 1 mês a 89 anos) e 54% do sexo masculino. Dos quatro surtos de diarréia confirmados, dois ocorreram em uma creche e em um orfanato, devido à Giárdia lamblia e Cryptosporidum spp.; um intradomiciliar de origem alimentar, sem identificação do agente, e uma epidemia na comunidade associada ao rotavírus. Dos casos atendidos, 63 (15,5%) pertenciam a surtos, identificando-se mais 56 casos, em um total de 119 casos (Coeficiente de Incidência de Surtos=1,4/1000 habitantes). CONCLUSÕES: O estudo mostrou que o programa responde ao seu principal propósito, respeitando-se as condições de regularidade na informação, análises dos padrões da diarréia e investigação criteriosa. Intensificar treinamentos para aumentar a habilidade das equipes locais nas avaliações e investigações é uma das principais recomendações deste estudo. / BACKGROUND: Acute diarrheal illness remains an important cause of morbidity worldwide. Its high incidence and the acceptance of its occurrence as “normal" fact impose challenges for its report and implantation of its surveillance systems. OBJECTIVES: To describe the epidemiologic characteristics of the acute diarrhea and to evaluate the capacity of the Monitoring Program of the Acute Diarrheal Illness for early detection of outbreaks, in the city of Avaré, State of São Paulo, Brazil. METHODS: From February 16 to July 28, 2005, was a prospective study of the diarrhea in a sentinel health service of the program. Descriptive and analytical studies were developed to investigate the potential outbreaks identified in this period. Stool samples were collected from the involved cases in the outbreaks. The evaluation of purpose of the program was based on indicators of usefulness, sensitivity and timeliness. RESULTS: A total of 408 cases were identified (incidence rate=4.7/1000 inhabitants). The median age was 7 years (range 1-89 years) and 54% were male. Among four confirmed diarrhea outbreaks, two occurred in a day nursery and orphanage, due to Giardia lamblia and Cryptosporidum spp., respectively; one was caused by food in dwelling-house, without identification of the agent, and one caused by rotavirus spread citywide. Of all monitored cases, 63 (15.5%) were involved in outbreaks, linked to more 56 cases, in a total of 119 cases (outbreaks incidence rate=1.4/1000 inhabitants). CONCLUSIONS: The study showed that the program enables prompt detection and investigation of outbreaks, respected the conditions of reliability of the information, evaluation of the acute diarrhea trends and careful inquiry. To intensify training to increase the ability of local professionals to recognize patterns of possible outbreaks and for suitable investigations is one of the major recommendations of this study.