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Antas PRZ, Flores-Valdez MA, Locht C. Revamping the BCG revaccination strategy: Records to recall, or just call it phoenix? Hum Vaccin Immunother 2024; 20:2300158. [PMID: 38287731 PMCID: PMC10829833 DOI: 10.1080/21645515.2023.2300158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024] Open
Affiliation(s)
- Paulo R. Z. Antas
- Fundação Oswaldo Cruz, Fiocruz, Brazil
- Programa de Pós-graduação em Patologia, Universidade Federal do Ceará, Brazil
| | - Mario A. Flores-Valdez
- Biotecnología Médica y Farmacéutica, Centro de Investigación y Asistencia en Tecnología y diseño del Estado de Jalisco, Mexico
| | - Camille Locht
- University of Lille, CNRS, Inserm, CHU Lille, Institut Pasteur de Lille, Center for Infection and Immunity of Lille, France
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2
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Sartori AL, Buffarini R, Machado da Silva A, Amaral de Andrade Leão O, Ramos Flores T, Dâmaso Bertoldi A, Curi Hallal P, Freitas da Silveira M. Child COVID-19 vaccine uptake among participants of the 2015 Pelotas (Brazil) Birth Cohort Study. Vaccine 2024:S0264-410X(24)00746-1. [PMID: 38991916 DOI: 10.1016/j.vaccine.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 06/27/2024] [Accepted: 07/02/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVE To analyze COVID-19 vaccine uptake in children and to investigate factors associated with two outcomes variables: (a) not even beginning; (b) not completing the COVID-19 vaccine series. METHODS We used data of children aged 6-7 years from the 2015 Pelotas c Birth Cohort Study. COVID-19 vaccination status was collected from immunization cards and National Immunization Program Information System. Adjusted analyses were performed using a hierarchical model to identify factors associated with the two study outcomes. RESULTS Among 3867 children, 20.7 % (95 % CI, 19.5 %-22.0 %) did not even begin the 2-dose primary COVID-19 vaccine series, and 28.2 % (95 % CI, 26.6 %-29.8 %) did not complete the series with the second dose. Children not even beginning the COVID-19 vaccine series were more likely to have a White mother, not to have obesity, to have a history of COVID-19 infection, to have received non-recommended drugs for COVID-19, to be afraid of needles, and to have an incomplete diphtheria-tetanus-pertussis (DTP) and poliovirus immunization schedule. Not completing the 2-dose series was associated with lower maternal age and education, mother's self-identification as White or Brown, lower household income, lack of access to health services, not having completed the DTP and poliovirus immunization schedule and living with a person with a history of infection with COVID-19. CONCLUSION The results highlight a vaccine-hesitant parents' group who chose not beginning the COVID-19 vaccine series of their children and, another group of parents who failure to complete the child's series due to difficulty accessing health services.
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Affiliation(s)
- Ana Lucia Sartori
- Postgraduate Program in Epidemiology, Federal University of Pelotas, 1160 Marechal Deodoro Street, 3rd floor, 96020-220 Pelotas, RS, Brazil; Institute of Health Sciences, Federal University of Mato Grosso, 1200 Alexandre Ferronato Avenue, 78550-728, Sinop, MT, Brazil.
| | - Romina Buffarini
- Postgraduate Program in Epidemiology, Federal University of Pelotas, 1160 Marechal Deodoro Street, 3rd floor, 96020-220 Pelotas, RS, Brazil; Postgraduate Program in Health Sciences, Federal University of Rio Grande, General Osório Street, 96200-400 Rio Grande, RS, Brazil.
| | - Aline Machado da Silva
- Pelotas Municipal Health Department, 1764 Lobo da Costa Street, 96020-360 Pelotas, RS, Brazil.
| | - Otávio Amaral de Andrade Leão
- Postgraduate Program in Epidemiology, Federal University of Pelotas, 1160 Marechal Deodoro Street, 3rd floor, 96020-220 Pelotas, RS, Brazil; Department of Health and Kinesiology, University of Illinois Urbana-Champaign, 1206 S 4th St, 61820, Urbana/Champaign, Champaign, IL, USA.
| | - Thaynã Ramos Flores
- Postgraduate Program in Epidemiology, Federal University of Pelotas, 1160 Marechal Deodoro Street, 3rd floor, 96020-220 Pelotas, RS, Brazil.
| | - Andréa Dâmaso Bertoldi
- Postgraduate Program in Epidemiology, Federal University of Pelotas, 1160 Marechal Deodoro Street, 3rd floor, 96020-220 Pelotas, RS, Brazil.
| | - Pedro Curi Hallal
- Postgraduate Program in Epidemiology, Federal University of Pelotas, 1160 Marechal Deodoro Street, 3rd floor, 96020-220 Pelotas, RS, Brazil; Department of Health and Kinesiology, University of Illinois Urbana-Champaign, 906 S. Goodwin, 61801-3841, Urbana/Champaign, Champaign, IL, USA.
| | - Mariângela Freitas da Silveira
- Postgraduate Program in Epidemiology, Federal University of Pelotas, 1160 Marechal Deodoro Street, 3rd floor, 96020-220 Pelotas, RS, Brazil.
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3
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Borges LCR, Marcon SS, Brito GS, Terabe M, Pleutim NI, Mendes AH, Teston EF. Adherence to Covid-19 vaccination during the pandemic: the influence of fake news. Rev Bras Enferm 2024; 77:e20230284. [PMID: 38655979 PMCID: PMC11034379 DOI: 10.1590/0034-7167-2023-0284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 11/17/2023] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVES to understand how fake news has influenced adherence to Covid-19 immunization, from the perspective of health professionals. METHODS a qualitative, descriptive-exploratory study was conducted in Campo Grande - MS. Twenty nursing professionals working in vaccine rooms or managing immunobiologicals participated through semi-structured interviews. The interviews were audio-recorded, fully transcribed, and subjected to thematic content analysis. RESULTS two categories emerged in which the professionals highlighted an increase in vaccine hesitancy among the population, influenced by fake news and denialist actions, which negatively interfered with the population's trust in vaccines and in the professionals administering them. FINAL CONSIDERATIONS concerns about vaccine safety and denialist actions by authorities and media outlets can contribute to the phenomenon of non-vaccination. The valorization of science, the promotion of educational actions, and raising public awareness about immunization were presented as strategies to increase vaccine coverage.
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Affiliation(s)
| | | | | | - Miriam Terabe
- Universidade Estadual de Maringá, Maringá, Paraná, Brazil
| | | | | | - Elen Ferraz Teston
- Universidade Federal de Mato Grosso do Sul. Campo Grande, Mato Grosso do Sul, Brazil
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Murray J, Leão OADA, Flores TR, Demarco FF, Tovo-Rodrigues L, Oliveira IO, Arteche A, Blumenberg C, Bertoldi AD, Domingues MR, Silveira MF, Hallal PC. Cohort Profile Update: 2015 Pelotas (Brazil) Birth Cohort Study-follow-ups from 2 to 6-7 years, with COVID-19 impact assessment. Int J Epidemiol 2024; 53:dyae048. [PMID: 38609323 PMCID: PMC11014790 DOI: 10.1093/ije/dyae048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 03/13/2024] [Indexed: 04/14/2024] Open
Affiliation(s)
- Joseph Murray
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Human Development and Violence Research Centre (DOVE), Federal University of Pelotas, Pelotas, Brazil
| | - Otavio Amaral de Andrade Leão
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana-Champaign, IL, USA
| | - Thaynã Ramos Flores
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | | | - Luciana Tovo-Rodrigues
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Human Development and Violence Research Centre (DOVE), Federal University of Pelotas, Pelotas, Brazil
| | - Isabel O Oliveira
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | - Adriane Arteche
- Postgraduate Program in Psychology, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Cauane Blumenberg
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Causale Consultoria, Pelotas, Rio Grande do Sul, Brazil
| | | | | | | | - Pedro Curi Hallal
- Department of Kinesiology and Community Health, University of Illinois Urbana-Champaign, Urbana-Champaign, IL, USA
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5
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Pereira MAD, Arroyo LH, Gallardo MDPS, Arcêncio RA, Gusmão JD, Amaral GG, de Oliveira VC, Guimarães EADA. Vaccination coverage in children under one year of age and associated socioeconomic factors: maps of spatial heterogeneity. Rev Bras Enferm 2023; 76:e20220734. [PMID: 37729269 PMCID: PMC10506597 DOI: 10.1590/0034-7167-2022-0734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 02/15/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE to analyze vaccination coverage spatial distribution in children under one year old and the socioeconomic factors associated with meeting the recommended goals in Minas Gerais. METHODS an ecological study, carried out in 853 municipalities in the state. Pentavalent, poliomyelitis, meningococcal conjugate, yellow fever, rotavirus, and 10-valent pneumococcal conjugate vaccination coverage were analyzed. Scan statistics and multiple logistic regression were performed to identify spatial clusters and factors associated with meeting coverage goals. RESULTS spatial analysis revealed clusters with risk of low coverage for all vaccines. Number of families with per capita income of up to 1/2 wage, Minas Gerais Social Responsibility Index and percentage of the poor or extremely poor population were associated with meeting the established goals. CONCLUSIONS the results are useful for designing interventions regarding the structuring of vaccination services and the implementation of actions to increase vaccination coverage in clusters with less propensity to vaccinate.
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Affiliation(s)
| | | | | | | | - Josianne Dias Gusmão
- Secretaria de Estado da Saúde de Minas Gerais. Belo Horizonte, Minas Gerais, Brazil
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Seara-Morais GJ, Avelino-Silva TJ, Couto M, Avelino-Silva VI. The pervasive association between political ideology and COVID-19 vaccine uptake in Brazil: an ecologic study. BMC Public Health 2023; 23:1606. [PMID: 37612648 PMCID: PMC10464231 DOI: 10.1186/s12889-023-16409-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 07/27/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Despite the unequivocal benefits of vaccination, vaccine coverage has been falling in several countries in the past few years. Studies suggest that vaccine hesitancy is an increasingly significant phenomenon affecting adherence to vaccines. More recently, during the COVID-19 pandemic, political views have emerged as an additional influencing factor for vaccine hesitancy. METHODS In this ecologic study, we used information from publicly available databases to investigate the association between political ideology, depicted by the percentage of votes for the right-wing candidate Jair Bolsonaro in the presidential elections of 2018 and 2022, and COVID-19 vaccination in Brazilian municipalities. The primary endpoint was the COVID-19 vaccination index, calculated as the number of COVID-19 vaccine doses administered up to September 2022 divided by the number of inhabitants in each municipality. The analysis was conducted using Pearson correlation coefficients and linear regression models adjusted for HDI, the percentage of male voters, the percentage of voters who were older than 50 years old, and the percentage of voters with a middle school education or less. In addition, we explored whether the effect of the percentage of Bolsonaro voters on the COVID-19 vaccination index was modified in different quartiles of HDI using an interaction term. RESULTS Five thousand five hundred sixty-three Brazilian municipalities were included in the analysis. For both the 2018 and 2022 elections, the percentage of votes for Jair Bolsonaro was significantly and inversely associated with COVID-19 vaccine uptake after adjustment for the sociodemographic characteristics of the voters (change in mean vaccination index in 2018 for each 1% increase in Bolsonaro voters -0.11, 95% confidence interval [CI] -0.13 to -0.08, p < 0.001; change in mean vaccination index in 2022 for each 1% increase in Bolsonaro voters -0.09, 95% CI -0.11 to -0.07, p < 0.001). We also found a statistically significant interaction between the primary predictor of interest and HDI scores, with a more significantly detrimental effect of the right-wing political stance in municipalities in the lower HDI quartiles (interaction p < 0.001 for the first HDI quartile; p = 0.001 for the second HDI quartile). CONCLUSION Our findings suggest that political ideologies have influenced COVID-19 vaccine hesitancy in Brazilian municipalities, affecting communities inequitably. The politicization of vaccines is a new challenge for vaccine programs. Strategies to face these challenges should include joint efforts from governments and civil society for a common public health goal.
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Affiliation(s)
- Gabriel J Seara-Morais
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Thiago J Avelino-Silva
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
- Laboratorio de Investigacao Medica Em Envelhecimento (LIM-66), Servico de Geriatria, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
- Atlantic Fellowship for Equity in Brain Health at the Global Brain Health Institute, University of California, San Francisco, CA, USA
| | - Marcia Couto
- Department of Preventive Medicine, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
| | - Vivian I Avelino-Silva
- Faculdade Israelita de Ciências da Saúde Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
- Department of Preventive Medicine, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil
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Godin A, Pescarini JM, Raja AI, Paixao ES, Ichihara MY, Sato APS, Smeeth L, Barreto ML, Brickley EB. Municipality-level measles, mumps, and rubella (MMR) vaccine coverage and deprivation in Brazil: A nationwide ecological study, 2006 to 2020. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002027. [PMID: 37527234 PMCID: PMC10393142 DOI: 10.1371/journal.pgph.0002027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/26/2023] [Indexed: 08/03/2023]
Abstract
To better understand the declining rates of routine childhood vaccination in Brazil, we investigated the association between measles, mumps, and rubella (MMR) first dose vaccine coverage and deprivation at the municipality level. Using routinely collected data from 5565 Brazilian municipalities from 2006 to 2020, we investigated the association between municipality-level MMR vaccine first dose coverage (i.e., as a continuous variable and as a percentage of municipalities attaining the 95% target coverage) in relation to quintiles of municipality-level deprivation, measured by the Brazilian Deprivation Index (Índice Brasileiro de Privação, IBP), and geographic regions. From 2006 to 2020, the mean municipality-level MMR vaccine coverage declined across all deprivation quintiles and regions of Brazil, by an average of 1.2% per year. The most deprived quintile of municipalities had higher coverage on average, but also the steepest declines in coverage (i.e., an annual decline of 1.64% versus 0.61% in the least deprived quintile) in the period of 2006-2020, and the largest drop in coverage at the beginning of the COVID-19 pandemic (2019-2020). Across all deprivation quintiles and regions (except for the Southeast region), less than 50% of municipalities in Brazil met the 95% MMR coverage target in 2020.The decrease in MMR first dose vaccine coverage in Brazil is widespread, but steeper declines have been observed in the most deprived municipalities. To promote vaccine equity and prevent future outbreaks, further research is urgently needed to understand the causal mechanisms underlying the observed associations between municipality-level MMR vaccine coverage and deprivation.
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Affiliation(s)
- Audrey Godin
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Julia M Pescarini
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Amber I Raja
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Enny S Paixao
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Maria Yury Ichihara
- Centro de Integração de Dados e Conhecimentos para Saúde, Fundação Oswaldo Cruz, Salvador, Brasil
| | - Ana Paula S Sato
- Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brasil
| | - Liam Smeeth
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Mauricio L Barreto
- Centro de Integração de Dados e Conhecimentos para Saúde, Fundação Oswaldo Cruz, Salvador, Brasil
| | - Elizabeth B Brickley
- Health Equity Action Lab, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Barata RB, França AP, Guibu IA, Vasconcellos MTLD, Moraes JCD. National Vaccine Coverage Survey 2020: methods and operational aspects. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2023; 26:e230031. [PMID: 37377252 PMCID: PMC10292804 DOI: 10.1590/1980-549720230031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 04/27/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVE The national vaccination coverage survey on full vaccination at 12 and 24 months of age was carried out to investigate drops in coverage as of 2016. METHODS A sample of 37,836 live births from the 2017 or 2018 cohorts living in capital cities, the Federal District, and 12 inner cities with 100 thousand inhabitants were followed for the first 24 months through vaccine record cards. Census tracts stratified according to socioeconomic levels had the same number of children included in each stratum. Coverage for each vaccine, full vaccination at 12 and 24 months and number of doses administered, valid and timely, were calculated. Family, maternal and child factors associated with coverage were surveyed. The reasons for not vaccinating analyzed were: medical contraindications, access difficulties, problems with the program, and vaccine hesitancy. RESULTS Preliminary results showed that less than 1% of children were not vaccinated, full coverage was less than 75% at all capitals and the Federal District, vaccines requiring more than one dose progressively lost coverage, and there were inequalities among socioeconomic strata, favorable to the highest level in some cities and to the lowest in others. CONCLUSION There was an actual reduction in full vaccination in all capitals and the Federal District for children born in 2017 and 2018, showing a deteriorating implementation of the National Immunization Program from 2017 to 2019. The survey did not measure the impacts of the COVID-19 pandemic, which may have further reduced vaccination coverage.
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Affiliation(s)
| | - Ana Paula França
- Santa Casa de São Paulo, Faculdade de Ciências Médicas - São Paulo (SP), Brazil
| | - Ione Aquemi Guibu
- Santa Casa de São Paulo, Faculdade de Ciências Médicas - São Paulo (SP), Brazil
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Oliveira GCCFD, Arroyo LH, Vimieiro AM, Gusmão JD, Oliveira VCD, Guimarães EADA. Spatial behavior of hepatitis A, MMR, and varicella vaccination coverage in the state of Minas Gerais, 2020. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2023; 26:e230030. [PMID: 37377251 DOI: 10.1590/1980-549720230030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 04/14/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVE To analyze the spatial behavior of hepatitis A, measles, mumps, and rubella (MMR), and varicella vaccination coverage in children and its relationship with socioeconomic determinants in the state of Minas Gerais. METHODS This ecological study investigated records of doses administered to children, extracted from the Immunization Information System of 853 municipalities in Minas Gerais, in 2020. We analyzed the vaccination coverage and socioeconomic factors. Spatial scan statistics were used to identify spatial clusters and measure the relative risk based on the vaccination coverage indicator and the Bivariate Moran Index, and thus detect socioeconomic factors correlated with the spatial distribution of vaccination. We used the cartographic base of the state and its municipalities and the ArcGIS and SPSS software programs. RESULTS Hepatitis A (89.0%), MMR (75.7%), and varicella (89.0%) showed low vaccination coverage. All vaccines analyzed had significant clusters. The clusters most likely to vaccinate their population were mainly located in the Central, Midwest, South Central, and Northwest regions, while the least likely were in the North, Northeast, and Triângulo do Sul regions. The municipal human development index, urbanization rate, and gross domestic product were spatially dependent on vaccination coverage. CONCLUSIONS The spatial behavior of hepatitis A, MMR, and varicella vaccination coverage is heterogeneous and associated with socioeconomic factors. We emphasize that vaccination records require attention and should be continuously monitored to improve the quality of information used in services and research.
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Donalisio MR, Boing AC, Sato APS, Martinez EZ, Xavier MO, Almeida RLFD, Moreira RDS, Queiroz RCDS, Matijasevich A. Vaccination against poliomyelitis in Brazil from 2011 to 2021: successes, setbacks, and challenges ahead. CIENCIA & SAUDE COLETIVA 2023; 28:337. [PMID: 36651390 DOI: 10.1590/1413-81232023282.17842022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 11/17/2022] [Indexed: 01/17/2023] Open
Abstract
The drop in childhood vaccination coverage (VC), including poliomyelitis, has become a health concern. The objective was to analyze the temporal trend of coverage of the three doses of the polio vaccine in the first 12 months of life between 2011 and 2021, in addition to mapping vaccination coverage in Brazil, including the COVID-19 pandemic period. An ecological study was carried out using interrupted time series (STI) techniques and spatial analysis, with data from the National Immunization Program Information System. The VC trend was adjusted by the Newey-West variance estimator according to the federated units and the Brazilian Deprivation Index. The VC distribution was estimated by Bayesian models and the spatial clusters by the global and local Moran index, identifying areas of lower coverage in the health regions. There was a reduction in the VC over the period in all regions, being more pronounced in the North and Northeast regions and during the Covid-19 pandemic. The biggest drops were identified in states and health regions with greater social vulnerability after 2019. The drop in VC shows that the risk of reintroduction of the wild virus is imminent and the challenges need to be faced with the strengthening of the Brazilian Health System (SUS).
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Affiliation(s)
- Maria Rita Donalisio
- Departamento de Saúde Coletiva, Faculdade de Ciências Médicas, Universidade Estadual de Campinas. R. Tessália Vieira de Camargo 126, Cidade Universitária Zeferino Vaz. 13083-887 Campinas SP Brasil.
| | - Alexandra Crispim Boing
- Departamento de Saúde Pública, Universidade Federal de Santa Catarina. Florianópolis SC Brasil
| | | | - Edson Zangiacomi Martinez
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. Ribeirão Preto SP Brasil
| | - Mariana Otero Xavier
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo. São Paulo SP Brasil
| | | | - Rafael da Silveira Moreira
- Departamento de Medicina Social, Centro de Biociências, Universidade Federal de Pernambuco Centro. Recife PE Brasil
| | | | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo. São Paulo SP Brasil
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Sato APS, Boing AC, Almeida RLFD, Xavier MO, Moreira RDS, Martinez EZ, Matijasevich A, Donalisio MR. Measles vaccination in Brazil: where have we been and where are we headed? CIENCIA & SAUDE COLETIVA 2023. [DOI: 10.1590/1413-81232023282.19172022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Abstract The re-emergence of vaccine-preventable diseases due to the decline in vaccine coverage (VC) has been documented in several countries. The objective was to analyze the VC, the homogeneity of VC, and measles cases in Brazil from 2011 to 2021, focusing on the period of the COVID-19 pandemic, its temporal trend, space-time distribution, and factors associated with clusters of lower VC. This is an ecological study on measles VC (dose 1), with methods of interrupted time series and evaluation of spatio-temporal disposition, through the sweep test to identify clusters of VC. Starting in 2015, we observe a progressive decline in VC and homogeneity, with an accentuation after 2020, in all regions, particularly in the North and Northeast. Low VC clusters were associated with worse human development indicators, social inequality, and less access to the Family Health Strategy. In Brazil, the pandemic intensified health inequalities with low VC of measles in socially more vulnerable and unequal municipalities. There is a risk of virus circulation, however, the challenge of strengthening primary care, improving health communication and guaranteeing access to the vaccine, reducing missed opportunities for vaccination and vaccine hesitancy, is highlighted.
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12
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Sato APS, Boing AC, Almeida RLFD, Xavier MO, Moreira RDS, Martinez EZ, Matijasevich A, Donalisio MR. Measles vaccination in Brazil: where have we been and where are we headed? CIENCIA & SAUDE COLETIVA 2023; 28:351-362. [PMID: 36651391 DOI: 10.1590/1413-81232023282.19172022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 11/29/2022] [Indexed: 01/18/2023] Open
Abstract
The re-emergence of vaccine-preventable diseases due to the decline in vaccine coverage (VC) has been documented in several countries. The objective was to analyze the VC, the homogeneity of VC, and measles cases in Brazil from 2011 to 2021, focusing on the period of the COVID-19 pandemic, its temporal trend, space-time distribution, and factors associated with clusters of lower VC. This is an ecological study on measles VC (dose 1), with methods of interrupted time series and evaluation of spatio-temporal disposition, through the sweep test to identify clusters of VC. Starting in 2015, we observe a progressive decline in VC and homogeneity, with an accentuation after 2020, in all regions, particularly in the North and Northeast. Low VC clusters were associated with worse human development indicators, social inequality, and less access to the Family Health Strategy. In Brazil, the pandemic intensified health inequalities with low VC of measles in socially more vulnerable and unequal municipalities. There is a risk of virus circulation, however, the challenge of strengthening primary care, improving health communication and guaranteeing access to the vaccine, reducing missed opportunities for vaccination and vaccine hesitancy, is highlighted.
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Affiliation(s)
- Ana Paula Sayuri Sato
- Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo. Av. Dr. Arnaldo 715. 01246-904 São Paulo SP Brasil.
| | - Alexandra Crispim Boing
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal de Santa Catarina. Florianópolis SC Brasil
| | | | - Mariana Otero Xavier
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo. São Paulo SP Brasil
| | - Rafael da Silveira Moreira
- Departamento de Saúde Coletiva, Fundação Oswaldo Cruz - Instituto Aggeu Magalhães. Centro de Ciências Médicas, Universidade Federal de Pernambuco. Recife PE Brasil
| | - Edson Zangiacomi Martinez
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. Ribeirão Preto SP Brasil
| | - Alicia Matijasevich
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo. São Paulo SP Brasil
| | - Maria Rita Donalisio
- Departamento de Saúde Coletiva, Faculdade de Ciências Médicas, Universidade Estadual de Campinas. Campinas SP Brasil
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Donalisio MR, Boing AC, Sato APS, Martinez EZ, Xavier MO, Almeida RLFD, Moreira RDS, Queiroz RCDS, Matijasevich A. Vaccination against poliomyelitis in Brazil from 2011 to 2021: successes, setbacks, and challenges ahead. CIENCIA & SAUDE COLETIVA 2023. [DOI: 10.1590/1413-81232023282.17842022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Abstract The drop in childhood vaccination coverage (VC), including poliomyelitis, has become a health concern. The objective was to analyze the temporal trend of coverage of the three doses of the polio vaccine in the first 12 months of life between 2011 and 2021, in addition to mapping vaccination coverage in Brazil, including the COVID-19 pandemic period. An ecological study was carried out using interrupted time series (STI) techniques and spatial analysis, with data from the National Immunization Program Information System. The VC trend was adjusted by the Newey-West variance estimator according to the federated units and the Brazilian Deprivation Index. The VC distribution was estimated by Bayesian models and the spatial clusters by the global and local Moran index, identifying areas of lower coverage in the health regions. There was a reduction in the VC over the period in all regions, being more pronounced in the North and Northeast regions and during the Covid-19 pandemic. The biggest drops were identified in states and health regions with greater social vulnerability after 2019. The drop in VC shows that the risk of reintroduction of the wild virus is imminent and the challenges need to be faced with the strengthening of the Brazilian Health System (SUS).
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Felzer JR, Finney Rutten LJ, Wi CI, LeMahieu AM, Beam E, Juhn YJ, Jacobson RM, Kennedy CC. Disparities in vaccination rates in solid organ transplant patients. Transpl Infect Dis 2023; 25:e14010. [PMID: 36715676 PMCID: PMC10085850 DOI: 10.1111/tid.14010] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/23/2022] [Accepted: 11/06/2022] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Vaccinations against preventable respiratory infections such as Streptococcus pneumoniae and influenza are important in immunosuppressed solid organ transplant (SOT) recipients. Little is known about the role of age, race, ethnicity, sex, and sociodemographic factors including rurality, or socioeconomic status (SES) associated with vaccine uptake in this population. METHODS We conducted a population-based study using the Rochester Epidemiology Project, a medical records linkage system, to assess socioeconomic and demographic factors associated with influenza and pneumococcal vaccination rates among adult recipients of solid organ transplantation (aged 19-64 years) living in four counties in southeastern Minnesota. Vaccination data were obtained from the Minnesota Immunization Information Connection from June 1, 2010 to June 30, 2020. Vaccination rate was assessed with Poisson and logistic regression models. RESULTS A total of 468 SOT recipients were identified with an overall vaccination rate of 57%-63% for influenza and 56% for pneumococcal vaccines. As expected, vaccination for pneumococcal vaccine positively correlated with influenza vaccination. Rural patients had decreased vaccination in both compared to urban patients, even after adjusting for age, sex, race, ethnicity, and SES. Although the population was mostly White and non-Hispanic, neither vaccination differed by race or ethnicity, but influenza vaccination did by SES. Among organ transplant groups, liver and lung recipients were least vaccinated for influenza, and heart recipients were least up-to-date on pneumococcal vaccines. CONCLUSIONS Rates of vaccination were below national goals. Rurality was associated with undervaccination. Further investigation is needed to understand and address barriers to vaccination among transplant recipients.
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Affiliation(s)
- Jamie R Felzer
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Lila J Finney Rutten
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Chung-Il Wi
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Allison M LeMahieu
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Elena Beam
- Division of Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Young J Juhn
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert M Jacobson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA.,Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Cassie C Kennedy
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA.,Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota, USA
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15
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Ferreira LS, Darcie Marquitti FM, Paixão da Silva RL, Borges ME, Ferreira da Costa Gomes M, Cruz OG, Kraenkel RA, Coutinho RM, Prado PI, Bastos LS. Estimating the impact of implementation and timing of the COVID-19 vaccination programme in Brazil: a counterfactual analysis. LANCET REGIONAL HEALTH. AMERICAS 2023; 17:100397. [PMID: 36439909 PMCID: PMC9676113 DOI: 10.1016/j.lana.2022.100397] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 09/30/2022] [Accepted: 10/27/2022] [Indexed: 11/22/2022]
Abstract
Background Vaccines developed between 2020 and 2021 against the SARS-CoV-2 virus were designed to diminish the severity and prevent deaths due to COVID-19. However, estimates of the effectiveness of vaccination campaigns in achieving these goals remain a methodological challenge. In this work, we developed a Bayesian statistical model to estimate the number of deaths and hospitalisations averted by vaccination of older adults (above 60 years old) in Brazil. Methods We fit a linear model to predict the number of deaths and hospitalisations of older adults as a function of vaccination coverage in this group and casualties in younger adults. We used this model in a counterfactual analysis, simulating alternative scenarios without vaccination or with faster vaccination roll-out. We estimated the direct effects of COVID-19 vaccination by computing the difference between hypothetical and realised scenarios. Findings We estimated that more than 165,000 individuals above 60 years of age were not hospitalised due to COVID-19 in the first seven months of the vaccination campaign. An additional contingent of 104,000 hospitalisations could have been averted if vaccination had started earlier. We also estimated that more than 58 thousand lives were saved by vaccinations in the period analysed for the same age group and that an additional 47 thousand lives could have been saved had the Brazilian government started the vaccination programme earlier. Interpretation Our estimates provided a lower bound for vaccination impacts in Brazil, demonstrating the importance of preventing the suffering and loss of older Brazilian adults. Once vaccines were approved, an early vaccination roll-out could have saved many more lives, especially when facing a pandemic. Funding The Coordenação de Aperfeiçoamento de Pessoal de Nível Superior-Brazil (Finance Code 001 to F.M.D.M. and L.S.F.), Conselho Nacional de Desenvolvimento Científico e Tecnológico - Brazil (grant number: 315854/2020-0 to M.E.B., 141698/2018-7 to R.L.P.d.S., 313055/2020-3 to P.I.P., 311832/2017-2 to R.A.K.), Fundação de Amparo à Pesquisa do Estado de São Paulo - Brazil (contract number: 2016/01343-7 to R.A.K.), Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro - Brazil (grant number: E-26/201.277/2021 to L.S.B.) and Inova Fiocruz/Fundação Oswaldo Cruz - Brazil (grant number: 48401485034116) to L.S.B., O.G.C. and M.G.d.F.C. The funding agencies had no role in the conceptualization of the study.
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Affiliation(s)
- Leonardo Souto Ferreira
- Instituto de Física Teórica, Universidade Estadual Paulista, São Paulo, Brazil,Observatório COVID-19 BR, Brazil
| | - Flavia Maria Darcie Marquitti
- Observatório COVID-19 BR, Brazil,Instituto de Física ‘Gleb Wataghin’ and Instituto de Biologia, Universidade Estadual de Campinas, Campinas, Brazil,Corresponding author. Instituto de Física ‘Gleb Wataghin’, Rua Sérgio Buarque de Holanda, 777 - Cidade Universitária, Universidade Estadual de Campinas, Campinas, Brazil Zip-code: 13083-859
| | - Rafael Lopes Paixão da Silva
- Instituto de Física Teórica, Universidade Estadual Paulista, São Paulo, Brazil,Observatório COVID-19 BR, Brazil
| | | | | | - Oswaldo Gonçalves Cruz
- Observatório COVID-19 BR, Brazil,Fundação Oswaldo Cruz, Programa de Computação Científica, Rio de Janeiro, Brazil
| | - Roberto André Kraenkel
- Instituto de Física Teórica, Universidade Estadual Paulista, São Paulo, Brazil,Observatório COVID-19 BR, Brazil
| | - Renato Mendes Coutinho
- Observatório COVID-19 BR, Brazil,Centro de Matemática, Computação e Cognição, Universidade Federal do ABC, Santo André, Brazil
| | - Paulo Inácio Prado
- Observatório COVID-19 BR, Brazil,Instituto de Biociências, Universidade de São Paulo, São Paulo, Brazil
| | - Leonardo Soares Bastos
- Observatório COVID-19 BR, Brazil,Fundação Oswaldo Cruz, Programa de Computação Científica, Rio de Janeiro, Brazil
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Rodrigues RN, do Nascimento GLM, Arroyo LH, Arcêncio RA, de Oliveira VC, Guimarães EADA. The COVID-19 pandemic and vaccination abandonment in children: spatial heterogeneity maps. Rev Lat Am Enfermagem 2022; 30:e3642. [PMID: 36228235 PMCID: PMC9545939 DOI: 10.1590/1518-8345.6132.3642] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/03/2022] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE to identify spatial clusters corresponding to abandonment of routine vaccines in children. METHOD an ecological study, according to data from the 853 municipalities of a Brazilian state. The records analyzed were those of the multidose pentavalent, pneumococcal 10-valent, inactivated poliomyelitis and oral human rotavirus vaccines of 781,489 children aged less than one year old. The spatial scan statistics was used to identify spatial clusters and assess the relative risk based on the vaccination abandonment indicator. RESULTS the spatial scan statistics detected the presence of statistically significant clusters for abandonment regarding the four vaccines in all the years analyzed. However, the highest number of clusters with high relative risk estimates was identified in 2020. The Vale do Aço and West, North and West, and Southwest regions stand out for the pentavalent, poliomyelitis and rotavirus vaccines, respectively. CONCLUSION in an attempt to mitigate the devastating impact of the COVID-19 pandemic, the immunization program experienced setbacks. The presence of clusters points to the need to implement integrated strategies that may involve different sectors for an active search for children and prevent outbreaks of vaccine-preventable diseases in the near future.
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Affiliation(s)
| | | | | | - Ricardo Alexandre Arcêncio
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto,
Centro Colaborador da OPAS/OMS para o Desenvolvimento da Pesquisa em Enfermagem,
Ribeirão Preto, SP, Brazil
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17
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Barakat A, Mostafa A, Ali M, Al-Majid AM, Domingo LR, Kutkat O, Moatasim Y, Zia K, Ul-Haq Z, Elshaier YAMM. Design, Synthesis and In Vitro Evaluation of Spirooxindole-Based Phenylsulfonyl Moiety as a Candidate Anti-SAR-CoV-2 and MERS-CoV-2 with the Implementation of Combination Studies. Int J Mol Sci 2022; 23:ijms231911861. [PMID: 36233160 PMCID: PMC9569468 DOI: 10.3390/ijms231911861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 09/27/2022] [Accepted: 09/30/2022] [Indexed: 12/03/2022] Open
Abstract
The search for an effective anti-viral to inhibit COVID-19 is a challenge for the specialized scientific research community. This work investigated the anti-coronavirus activity for spirooxindole-based phenylsulfone cycloadducts in a single and combination protocols. The newly designed anti-SARS-CoV-2 therapeutics spirooxindoles synthesized by [3 + 2] cycloaddition reactions represent an efficient approach. One-pot multicomponent reactions between phenyl vinyl sulfone, substituted isatins, and amines afforded highly stereoselective anti-SARS-CoV-2 therapeutics spirooxindoles with three stereogenic centers. Herein, the newly synthesized spirooxindoles were assessed individually against the highly pathogenic human coronaviruses and proved to be highly potent and safer. Interestingly, the synergistic effect by combining the potent, tested spirooxindoles resulted in an improved antiviral activity as well as better host-cell safety. Compounds 4i and 4d represented the most potent activity against MERS-CoV with IC50 values of 11 and 23 µM, respectively. Both compounds 4c and 4e showed equipotent activity with the best IC50 against SARS-CoV-2 with values of 17 and 18 µM, respectively, then compounds 4d and 4k with IC50 values of 24 and 27 µM, respectively. Then, our attention oriented to perform a combination protocol as anti-SARS-CoV-2 for the best compounds with a different binding mode and accompanied with different pharmacophores. Combination of compound 4k with 4c and combination of compounds 4k with 4i proved to be more active and safer. Compounds 4k with 4i displayed IC50 = 3.275 µM and half maximal cytotoxic-concentration CC50 = 11832 µM. MD simulation of the most potential compounds as well as in silico ADMET properties were investigated. This study highlights the potential drug-like properties of spirooxindoles as a cocktail anti-coronavirus protocol.
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Affiliation(s)
- Assem Barakat
- Department of Chemistry, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia
- Correspondence: (A.B.); (Y.A.M.M.E.); Tel.: +966-11467-5901 (A.B.); Fax: +966-11467-5992 (A.B.)
| | - Ahmed Mostafa
- Center of Scientific Excellence for Influenza Viruses, National Research Centre, Giza 12622, Egypt
| | - M. Ali
- Department of Chemistry, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia
| | - Abdullah Mohammed Al-Majid
- Department of Chemistry, College of Science, King Saud University, P.O. Box 2455, Riyadh 11451, Saudi Arabia
| | - Luis R. Domingo
- Department of Organic Chemistry, University of Valencia, Dr. Moliner 50, 46100 Burjassot, Valencia, Spain
| | - Omnia Kutkat
- Center of Scientific Excellence for Influenza Viruses, National Research Centre, Giza 12622, Egypt
| | - Yassmin Moatasim
- Center of Scientific Excellence for Influenza Viruses, National Research Centre, Giza 12622, Egypt
| | - Komal Zia
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi 75270, Pakistan
| | - Zaheer Ul-Haq
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi 75270, Pakistan
- H.E.J. Research Institute of Chemistry, International Center for Chemical and Biological Sciences, University of Karachi, Karachi 75270, Pakistan
| | - Yaseen A. M. M. Elshaier
- Department of Organic and Medicinal Chemistry, Faculty of Pharmacy, University of Sadat City, Menoufiya 32958, Egypt
- Correspondence: (A.B.); (Y.A.M.M.E.); Tel.: +966-11467-5901 (A.B.); Fax: +966-11467-5992 (A.B.)
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Evaluation of early innate and adaptive immune responses to the TB vaccine Mycobacterium bovis BCG and vaccine candidate BCGΔBCG1419c. Sci Rep 2022; 12:12377. [PMID: 35858977 PMCID: PMC9300728 DOI: 10.1038/s41598-022-14935-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 05/03/2022] [Indexed: 12/30/2022] Open
Abstract
The vaccine Mycobacterium bovis Bacillus Calmette-Guérin (BCG) elicits an immune response that is protective against certain forms of tuberculosis (TB); however, because BCG efficacy is limited it is important to identify alternative TB vaccine candidates. Recently, the BCG deletion mutant and vaccine candidate BCGΔBCG1419c was demonstrated to survive longer in intravenously infected BALB/c mice due to enhanced biofilm formation, and better protected both BALB/c and C57BL/6 mice against TB-induced lung pathology during chronic stages of infection, relative to BCG controls. BCGΔBCG1419c-elicited protection also associated with lower levels of proinflammatory cytokines (i.e. IL6, TNFα) at the site of infection in C57BL/6 mice. Given the distinct immune profiles of BCG- and BCGΔBCG1419c-immunized mice during chronic TB, we set out to determine if there are early immunological events which distinguish these two groups, using multi-dimensional flow cytometric analysis of the lungs and other tissues soon after immunization. Our results demonstrate a number of innate and adaptive response differences between BCG- and BCGΔBCG1419c-immunized mice which are consistent with the latter being longer lasting and potentially less inflammatory, including lower frequencies of exhausted CD4+ T helper (TH) cells and higher frequencies of IL10-producing T cells, respectively. These studies suggest the use of BCGΔBCG1419c may be advantageous as an alternative TB vaccine candidate.
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19
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de Souza EL, Eshriqui I, Masuda ET, Bonfim D, Barra RP, Paresque MAC. Diagnosis of vaccination rooms in Brazilian primary health care centers taking part in the PlanificaSUS project, 2019. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2022; 31:e2022069. [PMID: 35830063 PMCID: PMC9887981 DOI: 10.1590/s2237-96222022000200016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 05/24/2022] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To describe the diagnosis of vaccination rooms in primary healthcare centers in Brazil. METHODS This was a cross-sectional study with secondary data of convenience sampling comprised of 25 rooms. Results of a checklist adapted from the Vaccine Room Supervision Tool of the National Immunization Program in 2019 regarding the dimensions 'general organization', 'general aspects', 'technical procedures', 'cold chain', 'information system', 'adverse events following vaccination', 'special immunobiological agents', 'epidemiological surveillance' and 'health education', were used. Percentages of scores, both overall and by dimensions were described in median, interquartile range, minimum and maximum values. RESULTS The overall median was 77.1%, higher for 'health education' (100.0%) and 'cold chain' (86.7%), and lower for 'special immunobiological agents' (50.0%) and 'general organization' (58.3%). CONCLUSION Using the checklist enabled the diagnosis in different macro-regions, inter- and intra-regional differences were found in the dimensions, and positive results and opportunities for improvement in the general plan.
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Affiliation(s)
- Evelyn Lima de Souza
- Hospital Israelita Albert Einstein, Centro de Estudos, Pesquisa e
Prática em APS e Redes, São Paulo, SP, Brazil
| | - Ilana Eshriqui
- Hospital Israelita Albert Einstein, Centro de Estudos, Pesquisa e
Prática em APS e Redes, São Paulo, SP, Brazil
| | - Eliana Tiemi Masuda
- Hospital Israelita Albert Einstein, Centro de Estudos, Pesquisa e
Prática em APS e Redes, São Paulo, SP, Brazil
| | - Daiana Bonfim
- Hospital Israelita Albert Einstein, Centro de Estudos, Pesquisa e
Prática em APS e Redes, São Paulo, SP, Brazil
| | - Rubia Pereira Barra
- Centro Colaborador da Planificação da Atenção à Saúde, Uberlândia,
MG, Brazil
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20
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Moura C, Truche P, Sousa Salgado L, Meireles T, Santana V, Buda A, Bentes A, Botelho F, Mooney D. The impact of COVID-19 on routine pediatric vaccination delivery in Brazil. Vaccine 2022; 40:2292-2298. [PMID: 35287987 PMCID: PMC8885307 DOI: 10.1016/j.vaccine.2022.02.076] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 11/10/2021] [Accepted: 02/23/2022] [Indexed: 12/21/2022]
Abstract
Introduction Childhood vaccination rates have decreased significantly during the COVID-19 pandemic. The Brazilian immunization program, Programa Nacional de Imunização (PNI), is a model effort, achieving immunization rates comparable to high-income countries. This study aimed to evaluate the impact of the COVID-19 pandemic in pediatric vaccinations administered by the PNI, as a proxy of adherence to vaccinations during 2020. Methods Data on the number of vaccines administered to children under 10 years of age nationally and in each of Brazil’s five regions were extracted from Brazil’s federal health delivery database. Population adjusted monthly vaccination rates from 2015 through 2019 were determined, and autoregressive integrated moving average (ARIMA) models were used to forecast expected vaccinated rates in 2020. We compared the forecasts to reported vaccine administrations to assess adequacy of pediatric vaccine delivery during the COVID-19 pandemic. Results From January 2015 to February 2020, the average rate of vaccine administration to children was 53.4 per 100,000. After February 2020, this rate decreased to 50.4, a 9.4% drop compared to 2019 and fell outside of forecasted ranges in December 2020. In Brazil's poorest region, the North, vaccine delivery fell outside of the forecasted ranges earlier in 2020 but subsequently rebounded, meeting expected targets by the end of 2020. However, in Brazil's wealthiest South and Southeast regions, initial vaccine delivery fell and remained well below forecasted rates through the end of 2020. Conclusion In Brazil, despite a model national pediatric vaccination program with an over 95% national coverage, vaccination rates decreased during the COVID-19 pandemic. Coordinated governmental efforts have ameliorated some of the decrease, but more efforts are needed to ensure continued protection from preventable communicable diseases for children globally.
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Affiliation(s)
- Carolina Moura
- Faculdade da Saúde e Ecologia Humana, FASEH, Vespasiano, MG, Brazil
| | - Paul Truche
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Lucas Sousa Salgado
- União Educacional do Vale do Aço, UNIVAÇO, Departamento de Medicina, Ipatinga, MG, Brazil
| | - Thiaro Meireles
- Faculdade de Medicina da Universidade de São Paulo, FMUSP, São Paulo, SP, Brazil
| | - Vitor Santana
- Faculdade de Medicina da Universidade Federal de Minas Gerais, UFMG, Belo Horizonte, MG, Brazil
| | - Alexandra Buda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA
| | - Aline Bentes
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Departamento de Infectologia Pediátrica, Belo Horizonte, MG, Brazil
| | - Fabio Botelho
- Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, Montreal, Canada
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Parthasarathi A, Puvvada RK, Basappa S, Krishna MT, P A M. Global intention of the general public to undergo COVID-19 vaccination: time trends and risk factors for vaccine refusal, a Systematic Review and Meta-analysis. Wellcome Open Res 2022. [DOI: 10.12688/wellcomeopenres.17517.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: Knowledge of facilitators and barriers regarding the uptake of COVID-19 vaccination at a global population level is critical for combating the pandemic, saving lives, and protecting the economy. The aim of this work was to determine the proportion of people likely to accept or refuse to undergo COVID-19 vaccination. This study also investigated (a) time trends regarding the intention to undergo COVID-19 vaccination and (b) socio-demographic risk factors influencing vaccine refusal. Methods: Databases (01 March 2020-01 March 2021) searched included PubMed, MEDLINE, and Scopus. The sample size was n ≥1000 and selected studies were those that determined vaccine ‘acceptance’, ‘refusal’ and ‘hesitancy’. A random-effects model was employed to obtain the overall odds ratio (OR) and 95% confidence interval (CI) for socio-demographic predictors for vaccine refusal. Results: A total of 832 citations were screened and 35 studies from 21 countries (n=130,179) were analyzed. The pooled proportion of individuals reporting an intention to vaccinate was 0.70 (95% CI: 0.65 to 0.74; I2 = 99.68%). The proportion of people intending to vaccinate decreased (regression coefficient = -0.13; p<0.001) during the study period and odds of refusal to vaccinate increased by 1.37-fold (95% CI: 1.33-1.41) during the second half. Risk factors identified for vaccine refusal included being female, rural residence, lower income, and lower level of formal education. Conclusions: A moderate proportion of people showed an intention to receive vaccination, although this declined during the study period. A global and national multi-pronged strategic and targeted approach is urgently needed to enhance vaccination uptake amongst females, those with a relatively lower educational and socioeconomic status, and those in rural areas.
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Tomasi E, de Assis TM, Muller PG, da Silveira DS, Neves RG, Fantinel E, Thumé E, Facchini LA. Evolution of the quality of prenatal care in the primary network of Brazil from 2012 to 2018: What can (and should) improve? PLoS One 2022; 17:e0262217. [PMID: 35041716 PMCID: PMC8765636 DOI: 10.1371/journal.pone.0262217] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 12/20/2021] [Indexed: 11/19/2022] Open
Abstract
The article describes the temporal evolution of prenatal quality indicators in the primary health care network in Brazil and investigates regional differences. This study used data from the external evaluation of Brazil's National Program for Improving Primary Care Access and Quality (PMAQ) with health teams participating in Cycles I, II and III of the Program, carried out respectively in 2012, 2013/14 and 2017/18. The number of visits, physical examination procedures, guidelines and request for laboratory tests were investigated. There was a positive evolution for tests-HIV, syphilis, blood glucose and ultrasound, and for all tests, guidance on feeding and weight gain of the baby and examination of the oral cavity. The indicators that performed the worst were: performance of tetanus vaccine, six or more visits, receiving guidance on exclusive breastfeeding and care for the newborn, and the procedures-all, measurement of uterine height, gynecological exam and cervix cancer prevention. These changes had a varied behavior between the regions of the country.
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Affiliation(s)
- Elaine Tomasi
- Department of Social Medicine–Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Programme in Family Health (PROFSAÚDE), Universidade Federal de Pelotas, Pelotas, Brazil
| | | | | | - Denise Silva da Silveira
- Department of Social Medicine–Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Programme in Family Health (PROFSAÚDE), Universidade Federal de Pelotas, Pelotas, Brazil
| | | | - Everton Fantinel
- Department of Social Medicine–Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Programme in Nursing, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Elaine Thumé
- Postgraduate Programme in Family Health (PROFSAÚDE), Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Programme in Nursing, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Luiz Augusto Facchini
- Department of Social Medicine–Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Programme in Family Health (PROFSAÚDE), Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Programme in Nursing, Universidade Federal de Pelotas, Pelotas, Brazil
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23
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Rodrigues RN, Nascimento GLMD, Arroyo LH, Arcêncio RA, Oliveira VCD, Guimarães EADA. Pandemia de COVID-19 y abandono de la vacunación en niños: mapas de heterogeneidad espacial. Rev Lat Am Enfermagem 2022. [DOI: 10.1590/1518-8345.6132.3643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Resumen Objetivo: identificar grupos espaciales que abandonaron la vacunación de rutina de los niños. Método: estudio ecológico, basado en los datos de 853 municipios de un Estado brasileño. Se analizaron los registros de vacunas multidosis pentavalente, antineumocócica 10-valente y antipoliomielítica inactivada y vacuna oral contra el rotavirus humano de 781.489 niños menores de un año de edad. Se utilizó la estadística scan espacial para identificar agrupaciones espaciales y medir el riesgo relativo del indicador abandono de la vacunación. Resultados: la estadística scan espacial detectó la presencia de grupos estadísticamente significativos para el abandono de las cuatro vacunas en todos los años analizados. Sin embargo, el mayor número de grupos con estimaciones altas de riesgos relativos se identificó en 2020. Se destacan las macrorregiones del Vale do Aço y Oeste; Norte y Oeste; y Sudeste para las vacunas pentavalente, antipoliomielítica y contra el rotavirus, respectivamente. Conclusión: mientras se intentaba disminuir el impacto devastador de la pandemia de COVID-19, retrocedió el programa de inmunización. La presencia de grupos indica que es necesario implementar estrategias integradas que puedan involucrar a diferentes sectores para la búsqueda activa de niños y evitar brotes de enfermedades inmunoprevenibles en el futuro próximo.
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Discovery of Highly Potent Fusion Inhibitors with Potential Pan-Coronavirus Activity That Effectively Inhibit Major COVID-19 Variants of Concern (VOCs) in Pseudovirus-Based Assays. Viruses 2021; 14:v14010069. [PMID: 35062273 PMCID: PMC8780828 DOI: 10.3390/v14010069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 12/26/2021] [Accepted: 12/29/2021] [Indexed: 12/30/2022] Open
Abstract
We report the discovery of several highly potent small molecules with low-nM potency against severe acute respiratory syndrome coronavirus (SARS-CoV; lowest half-maximal inhibitory concentration (IC50: 13 nM), SARS-CoV-2 (IC50: 23 nM), and Middle East respiratory syndrome coronavirus (MERS-CoV; IC50: 76 nM) in pseudovirus-based assays with excellent selectivity index (SI) values (>5000), demonstrating potential pan-coronavirus inhibitory activities. Some compounds showed 100% inhibition against the cytopathic effects (CPE; IC100) of an authentic SARS-CoV-2 (US_WA-1/2020) variant at 1.25 µM. The most active inhibitors also potently inhibited variants of concern (VOCs), including the UK (B.1.1.7) and South African (B.1.351) variants and the Delta variant (B.1.617.2) originally identified in India in pseudovirus-based assay. Surface plasmon resonance (SPR) analysis with one potent inhibitor confirmed that it binds to the prefusion SARS-CoV-2 spike protein trimer. These small-molecule inhibitors prevented virus-mediated cell-cell fusion. The absorption, distribution, metabolism, and excretion (ADME) data for one of the most active inhibitors, NBCoV1, demonstrated drug-like properties. An in vivo pharmacokinetics (PK) study of NBCoV1 in rats demonstrated an excellent half-life (t1/2) of 11.3 h, a mean resident time (MRT) of 14.2 h, and oral bioavailability. We expect these lead inhibitors to facilitate the further development of preclinical and clinical candidates.
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Silveira MM, Conrad NL, Leivas Leite FP. Effect of COVID-19 on vaccination coverage in Brazil. J Med Microbiol 2021; 70. [PMID: 34845982 DOI: 10.1099/jmm.0.001466] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
During the COVID-19 pandemic, recommendations for maintaining physical distance, restricted mobility measures, as well as fear of mass transmission by going to health centers have significantly contributed to the general vaccination coverage, which by and large is decreasing worldwide; thus, favoring the potential re-emergence of vaccine-preventable diseases. In this study, we have used the existing data on vaccination coverage during the pre-pandemic (2019) as well as the pandemic (2020) period to evaluate the impact of coronavirus outbreaks during the vaccination drive in Brazil. Furthermore, we have accumulated data since 2015 among the different regions of the country to acquire more consistent information. The various vaccines analyzed in our study were meningococcal C conjugate, Triple antigen vaccine, 10-valent pneumococcal conjugate, and BCG; subsequently, the data were obtained from the National Disease Notification System. This study revealed that the ongoing immunization drive saw a steep decline of around 10 to 20% during the (2019-2020) pandemic period in Brazil. These results provide strong evidence towards the decreasing trends following the vaccination programs during the COVID-19 pandemic period in Brazil. Furthermore, our results also highlight the importance of adopting widespread multi-component interventions to improve vaccination uptake rates.
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Affiliation(s)
| | - Neida Lucia Conrad
- Biotechnology Unit, Technological Development Centre, Federal University of Pelotas, Pelotas, Brazil
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Abstract
PURPOSE OF REVIEW We reviewed the literature about parental vaccine hesitancy, focusing on publications from October 2019 to April 2021 to describe patterns and causes of hesitancy and interventions to address hesitancy. RECENT FINDINGS Recent studies expand understanding of the prevalence of vaccine hesitancy globally and highlight associated individual and contextual factors. Common concerns underlying hesitancy include uncertainty about the need for vaccination and questions about vaccine safety and efficacy. Sociodemographic factors associated with parental vaccine hesitancy vary across locations and contexts. Studies about psychology of hesitancy and how parents respond to interventions highlight the role of cognitive biases, personal values, and vaccination as a social contract or norm. Evidence-based strategies to address vaccine hesitancy include presumptive or announcement approaches to vaccine recommendations, motivational interviewing, and use of immunization delivery strategies like standing orders and reminder/recall programs. A smaller number of studies support use of social media and digital applications to improve vaccination intent. Strengthening school vaccine mandates can improve vaccination rates, but policy decisions must consider local context. SUMMARY Vaccine hesitancy remains a challenge for child health. Future work must include more interventional studies to address hesitancy and regular global surveillance of parental vaccine hesitancy and vaccine content on social media.
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Affiliation(s)
- Jessica R Cataldi
- Department of Pediatrics, University of Colorado School of Medicine
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA
| | - Sean T O'Leary
- Department of Pediatrics, University of Colorado School of Medicine
- Adult and Child Consortium for Health Outcomes Research and Delivery Science (ACCORDS), University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA
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Factors Associated with the Completeness of the Vaccination Schedule of Children at 12 and 24 Months of Age in a Brazilian Medium-Size Municipality. J Pediatr Nurs 2021; 60:e46-e53. [PMID: 33744058 DOI: 10.1016/j.pedn.2021.02.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 02/23/2021] [Accepted: 02/27/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To analyse the factors associated with the completeness of the vaccination schedule of children at 12 and 24 months of age, in a Brazilian municipality. DESIGN AND METHODS Cross-sectional study conducted in Araraquara-São Paulo with a probabilistic sample of 388 children born in 2015. The completeness of the vaccination schedule at 12 and 24 months of age was considered a dependent variable. Socioeconomic and demographic characteristics, use of health services and vaccination were the independent variables. For analysis, descriptive statistics and Poisson regression with robust variance were used. RESULTS The completeness of the vaccination schedule at 12 and 24 months of age was identified in 77.1% and 68.8% of children, respectively. Coverage at 12 months was greater among children of mothers who received guidance from health professionals on vaccination or had health problems during childbirth or in the first seven days. Those who reported a previous episode of adverse reaction to the vaccine, coverage was lower. Coverage at 24 months was greater among those who received guidance from health professionals on vaccination or had health problems during childbirth or in the first seven days. Those who reported a previous episode of adverse reaction to the vaccine, coverage was lower. CONCLUSIONS This study points to the importance of guiding health professionals, particulary nurses, on the vaccination and vaccine safety. CLINICAL IMPLICATIONS It is necessary the competent act of the health professionals in of immunization programs, as they are able to provide clear and accurate information of the vaccination.
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Barcelos RS, Santos IS, Munhoz TN, Blumenberg C, Bortolotto CC, Matijasevich A, Salum C, Santos Júnior HGD, Santos LMD, Correia L, Souza MRD, Lira PICD, Altafim E, Macana EC, Victora CG. Vaccination coverage in children up to 2 years old, receiving financial support from the Family Income Transfer Program, Brazil. ACTA ACUST UNITED AC 2021; 30:e2020983. [PMID: 34287553 DOI: 10.1590/s1679-49742021000300010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 03/01/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess vaccination coverage, based on the National Immunization Program schedule, among children receiving financial support from the Family Income Transfer Program, Brazil, according to the family socioeconomic status and maternal characteristics. METHODS 3,242 children under 12 months old were assessed between August/2018 and April/2019, of whom 3,008 were reassessed between September/2019 and January/2020. The analyses were performed using multilevel models (level 3, Federative Unit; level 2, municipality; level 1, children). RESULTS Vaccination coverage was 2.5 fold higher in the first follow-up (61.0% - 95% CI 59.3;62.6%), compared to the second follow-up (24.8% - 95% CI 22.8;25.9%) (p<0.001). In the first follow-up, coverage was higher in the richest quintile (67.9%) and in children whose mothers had ≥9 years of schooling (63.3%). In the second follow-up, there were no differences. The highest coverage occurred between 0.5-2.5 (93.5%) and 12.5-15.5 months (34.4%), respectively, first and second follow-ups. CONCLUSION Low coverage was found, both in the first and second year of life.
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Affiliation(s)
- Raquel Siqueira Barcelos
- Universidade Federal de Pelotas, Programa de Pós-graduação em Epidemiologia, Pelotas, RS, Brasil
| | - Iná S Santos
- Universidade Federal de Pelotas, Programa de Pós-graduação em Epidemiologia, Pelotas, RS, Brasil
| | - Tiago N Munhoz
- Universidade Federal de Pelotas, Programa de Pós-graduação em Epidemiologia, Pelotas, RS, Brasil
| | - Cauane Blumenberg
- Universidade Federal de Pelotas, Programa de Pós-graduação em Epidemiologia, Pelotas, RS, Brasil
| | - Caroline C Bortolotto
- Universidade Federal de Pelotas, Programa de Pós-graduação em Epidemiologia, Pelotas, RS, Brasil
| | - Alicia Matijasevich
- Universidade de São Paulo, Departamento de Medicina Preventiva, São Paulo, SP, Brasil
| | - Cristiane Salum
- Universidade Federal do ABC, Núcleo Interdisciplinar de Neurociência Aplicada, São Bernardo do Campo, SP, Brasil
| | | | | | - Luciano Correia
- Universidade Federal do Ceará, Departamento de Saúde Comunitária, Fortaleza, CE, Brasil
| | - Marta Rovery de Souza
- Universidade Federal de Goiás, Instituto de Patologia Tropical e Saúde Pública, Goiânia, GO, Brasil
| | | | - Elisa Altafim
- Fundação Maria Cecília Souto Vidigal, São Paulo, SP, Brasil
| | | | - Cesar G Victora
- Universidade Federal de Pelotas, Programa de Pós-graduação em Epidemiologia, Pelotas, RS, Brasil
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Silveira MF, Tonial CT, Goretti K Maranhão A, Teixeira AMS, Hallal PC, Maria B Menezes A, Horta BL, Hartwig FP, Barros AJD, Victora CG. Missed childhood immunizations during the COVID-19 pandemic in Brazil: Analyses of routine statistics and of a national household survey. Vaccine 2021; 39:3404-3409. [PMID: 33941406 DOI: 10.1016/j.vaccine.2021.04.046] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 04/07/2021] [Accepted: 04/23/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION There is widespread concern that disruption to health services during the COVID-19 pandemic has led to declines in immunization coverage among young children, but there is limited information on the magnitude of such impact. High immunization coverage is essential for reducing the risk of vaccine preventable diseases. METHODS We used data from two nationwide sources covering the whole of Brazil. Data from the Information System of the National Immunization Program (SIPNI) on the monthly number of vaccine doses administered to young children were analyzed. The second source was a survey in 133 large cities in the 27 states in the country, carried out from August 24-27. Respondents answered a question on whether children under the age of three years had missed any scheduled vaccinations during the pandemic, and available vaccination cards were photographed for later examination. RESULTS SIPNI data showed that, relative to January and February 2020, there was a decline of about 20% in vaccines administered to children aged two months or older during March and April, when social distancing was at the highest level in the country. After May, vaccination levels returned to pre-pandemic values. Survey data, based on the interviews and on examination of the vaccine cards, showed that 19.0% (95% CI 17.0;21.1%) and 20.6% (95% CI 19.0;23.1%) of children, respectively, had missed immunizations. Missed doses were most common in the North (Amazon) region and least common in the South and Southeast, and also more common among children from poor than from wealthy families. INTERPRETATION Our results show that the pandemic was associated with a reduction of about 20% in child vaccinations, but this was reverted in recent months. Children from poor families and from the least developed regions of the country were most affected. There is an urgent need to booster immunization activities in the country to compensate for missed doses, and to reduce geographic and socioeconomic inequalities.
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Affiliation(s)
- Mariangela F Silveira
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Cristian T Tonial
- Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Antonia M S Teixeira
- Avenida Abel Cabral, 577, Condomínio Residencial SunHappy 1404 D, Nova Paranamirirm, Parnamirim/ RN CEP 59151-250, Brazil
| | - Pedro C Hallal
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Ana Maria B Menezes
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Bernardo L Horta
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Fernando P Hartwig
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Aluisio J D Barros
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
| | - Cesar G Victora
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, RS, Brazil
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Reno C, Maietti E, Fantini MP, Savoia E, Manzoli L, Montalti M, Gori D. Enhancing COVID-19 Vaccines Acceptance: Results from a Survey on Vaccine Hesitancy in Northern Italy. Vaccines (Basel) 2021; 9:378. [PMID: 33924534 PMCID: PMC8070202 DOI: 10.3390/vaccines9040378] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/09/2021] [Accepted: 04/11/2021] [Indexed: 11/16/2022] Open
Abstract
In March 2021, the coronavirus disease 2019 (COVID-19) pandemic still poses a threat to the global population, and is a public health challenge that needs to be overcome. Now more than ever, action is needed to tackle vaccine hesitancy, especially in light of the availability of effective and safe vaccines. A cross-sectional online survey was carried out on a representative random sample of 1011 citizens from the Emilia-Romagna region, in Italy, in January 2021. The questionnaire collected information on socio-demographics, comorbidities, past vaccination refusal, COVID-19-related experiences, risk perception of infection, and likelihood to accept COVID-19 vaccination. Multiple logistic regression analyses and classification tree analyses were performed to identify significant predictors of vaccine hesitancy and to distinguish groups with different levels of hesitancy. Overall, 31.1% of the sample reported hesitancy. Past vaccination refusal was the key discriminating variable followed by perceived risk of infection. Other significant predictors of hesitancy were: ages between 35 and 54 years, female gender, low educational level, low income, and absence of comorbidities. The most common concerns about the COVID-19 vaccine involved safety (54%) and efficacy (27%). Studying the main determinants of vaccine hesitancy can help with targeting vaccination strategies, in order to gain widespread acceptance-a key path to ensure a rapid way out of the current pandemic emergency.
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Affiliation(s)
- Chiara Reno
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum—University of Bologna, 40126 Bologna, Italy; (C.R.); (M.P.F.); (M.M.); (D.G.)
| | - Elisa Maietti
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum—University of Bologna, 40126 Bologna, Italy; (C.R.); (M.P.F.); (M.M.); (D.G.)
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum—University of Bologna, 40126 Bologna, Italy; (C.R.); (M.P.F.); (M.M.); (D.G.)
| | - Elena Savoia
- Emergency Preparedness Research Evaluation & Practice (EPREP) Program, Division of Policy Translation & Leadership Development, Harvard T.H. Chan School of Public Health, Boston, MA 01451, USA;
| | - Lamberto Manzoli
- Department of Medical Sciences, University of Ferrara, Via Fossato di Mortara 64B, 44121 Ferrara, Italy;
| | - Marco Montalti
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum—University of Bologna, 40126 Bologna, Italy; (C.R.); (M.P.F.); (M.M.); (D.G.)
| | - Davide Gori
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum—University of Bologna, 40126 Bologna, Italy; (C.R.); (M.P.F.); (M.M.); (D.G.)
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Couto MT, Barbieri CLA, Matos CCDSA. Considerações sobre o impacto da covid-19 na relação indivíduo-sociedade: da hesitação vacinal ao clamor por uma vacina. SAUDE E SOCIEDADE 2021. [DOI: 10.1590/s0104-12902021200450] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Desde março de 2020, quando a Organização Mundial de Saúde declarou que o mundo vivia uma pandemia de covid-19, acompanhamos um quadro sanitário sem precedentes nos últimos 100 anos. As medidas atuais contra a doença têm como objetivo o controle da transmissão e envolvem ações individuais e coletivas de higiene e distanciamento físico, enquanto a busca por uma vacina se apresenta como a esperança para vencer a pandemia. Considerando o contexto social de clamor por uma nova vacina, este ensaio crítico discute o paradoxo e as contradições da relação indivíduo-sociedade no contexto da covid-19 à luz da hesitação vacinal como fenômeno histórico e socialmente situado. Este ensaio aponta que as tomadas de decisão sobre (não) vacinar ou sobre (não) seguir as medidas preventivas e de controle da propagação da covid-19 são conformadas por pertencimentos sociais e atravessadas por desigualdades que tendem a se exacerbar. A infodemia que cerca a covid-19 e a hesitação vacinal refletem a tensão entre o risco cientificamente validado e o risco percebido subjetivamente, também influenciada pela crise de confiança na ciência. Percepções de risco e adesão a medidas de saúde extrapolam aspectos subjetivos e racionais e espelham valores e crenças conformados pelas dimensões política, econômica e sociocultural.
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Cata-Preta BDO, Wehrmeister FC, Santos TM, Barros AJD, Victora CG. Patterns in Wealth-related Inequalities in 86 Low- and Middle-Income Countries: Global Evidence on the Emergence of Vaccine Hesitancy. Am J Prev Med 2021; 60:S24-S33. [PMID: 33131990 PMCID: PMC7613086 DOI: 10.1016/j.amepre.2020.07.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 07/03/2020] [Accepted: 07/06/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Coverage of health interventions usually shows social gradients with higher levels among wealthy than among poor individuals. Owing to the upsurge of vaccine hesitancy in high-income countries, the authors hypothesized that the social gradient may also be changing over time in the low- and middle-income countries and set out to test this hypothesis. METHODS In January 2020, surveys conducted from 2010 to 2018 in 86 low- and middle-income countries were analyzed to assess full immunization coverage in children aged 12-23 months. The authors calculated full immunization coverage point estimates and 95% CIs for each country and wealth quintile. To explore wealth-related inequalities, the authors estimated the slope index of inequality and calculated the Pearson correlation coefficient between these values and per capita gross domestic product. Time trends were analyzed in 10 countries with recent evidence of hesitancy. RESULTS Pro-poor patterns were defined as significant slope index of inequality values with higher coverage among poor children, and pro-rich patterns were defined as the reverse pattern. A total of 11 countries showed pro-poor patterns in the most recent survey, accounting for 20% of upper middle- and 7% of low-income countries. The correlation between the slope index of inequality and log per capita gross domestic product was -0.38 (p<0.001). Among the 10 countries with recent evidence of hesitancy, 5 showed full immunization coverage declines over time in the wealthiest quintiles, and 4 switched from pro-rich to pro-poor patterns throughout the years. CONCLUSIONS Lower full immunization coverage was found among the wealthy than among the poor in 10 countries, especially in the upper middle-income group, consistent with the emergence of vaccine hesitancy. SUPPLEMENT INFORMATION This article is part of a supplement entitled Global Vaccination Equity, which is sponsored by the Global Institute for Vaccine Equity at the University of Michigan School of Public Health.
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Affiliation(s)
- Bianca de O Cata-Preta
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil.
| | - Fernando C Wehrmeister
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Thiago M Santos
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Aluísio J D Barros
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Cesar G Victora
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
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Sato APS. Pandemic and vaccine coverage: challenges of returning to schools. Rev Saude Publica 2020; 54:115. [PMID: 33175029 PMCID: PMC7647469 DOI: 10.11606/s1518-8787.2020054003142] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/16/2020] [Indexed: 12/16/2022] Open
Abstract
Since March 2020, Brazil has faced the pandemic of the coronavirus disease 2019 (Covid-19), which has severely modified the way in which the population lives and uses health services. As such, face-to-face attendance has dropped dramatically, even for child vaccination, due to measures of social distancing to mitigate the transmission of the virus. Several countries have recorded a substantial drop in vaccination coverage in children, especially of those under two years of age. In Brazil, administrative data indicate the impact of the covid-19 pandemic on this downward trend, which was already an important challenge of the National Immunization Program in recent years. Many children will be susceptible to immunopreventable diseases, which reinforces the need to assess the vaccine status of schoolchildren before returning to face-to-face classes.
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Affiliation(s)
- Ana Paula Sayuri Sato
- Universidade de São Paulo. Faculdade de Saúde Pública. Departamento de Epidemiologia. São Paulo, SP, Brasil
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Longitudinal profiling of the vaccination coverage in Brazil reveals a recent change in the patterns hallmarked by differential reduction across regions. Int J Infect Dis 2020; 98:275-280. [PMID: 32619762 PMCID: PMC7326384 DOI: 10.1016/j.ijid.2020.06.092] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/24/2020] [Accepted: 06/26/2020] [Indexed: 11/26/2022] Open
Abstract
There has been a recent reduction in vaccination coverage across the Brazilian regions. The most relevant reduction in vaccination coverage has occurred in childhood immunization. Increased web searches for anti-vaccine material has been associated with the reduction in immunization coverage.
Objective Vaccination coverage is decreasing worldwide, favoring the potential reemergence of vaccine-preventable diseases. In this study, we performed a longitudinal characterization of vaccination coverage in Brazil and compared the profiles between the distinct regions in the country to test whether there has been a substantial change over the last 5 years. Methods De-identified publicly available data were retrieved from the repository of the Brazilian Ministry of Health, comprising detailed information on vaccination coverage in all age groups between 1994 and 2019. The vaccination coverage for the whole country and for each Brazilian region, by year, was examined, and a time-series pattern analysis was performed. Results A significant decrease in overall vaccination coverage across the country regions was observed between 2017 and 2019, especially in childhood immunization. A reduction in BCG, hepatitis B, influenza, and rotavirus vaccine coverage was observed. Conversely, vaccines against measles, mumps, rubella, varicella, and meningococcus showed an increase in coverage. Region-specific changes in vaccination patterns within the study period were observed. Conclusions A substantial reduction in vaccination coverage was detected in Brazil, a country already highly susceptible to the emergence of epidemic infectious diseases. Continuing evaluation of the immunization program actions may help to improve vaccination coverage and prevent new epidemics.
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Buffarini R, Barros FC, Silveira MF. Vaccine coverage within the first year of life and associated factors with incomplete immunization in a Brazilian birth cohort. ACTA ACUST UNITED AC 2020; 78:21. [PMID: 32292586 PMCID: PMC7140489 DOI: 10.1186/s13690-020-00403-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 03/02/2020] [Indexed: 11/10/2022]
Abstract
Background Immunization has been held as a major achievement for global health, however, still exist many children who are not completely vaccinated. Knowledge about factors contributing to the incomplete immunization is important to develop effective strategies and interventions to achieve universal coverage to control or eradicate vaccine-preventable diseases. This study aimed to describe immunization coverage within the first year of life and associated factors with incompleteness among participants of the 2015 Pelotas Birth Cohort, Brazil. Methods Cross-sectional analyses were performed using data from a population-based cohort. Information on vaccination status was collected from immunization cards and verbal mother's reports from 4014 children aged 24 months. Coverage was described for each vaccine, for the basic and the complete national schedule. Incomplete vaccination was defined as failure to receive the recommended number of doses by the National Immunization Program in 2015. Bivariate and multivariate Poisson regressions with robust variance were conducted to identify factors associated with incompleteness. Results Vaccine coverage of individual vaccines varied from 81% (Hepatitis A) to 97% (BCG). Full immunization coverage were 77% (95% CI: 75.8; 78.4) and 66.1% (95% CI: 64.6; 67.5), for basic and expanded indicators, relatively. Multivariate analyses showed that factors associated with incompleteness (for both basic and expanded coverage) were high family income, high parity, low number of prenatal consultations, not have done the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine during pregnancy, not have breastfeed the child until at age 12 months and not have used public health care services for child's vaccination. Conclusion Findings of our study show the need to develop and implement policies and programs to achieve complete immunization during the first year of life. Some strategies would include an increase in the primary health care services networks, improving their quality and access, the dissemination of scientific-based evidence about the benefits of vaccination, through communication campaigns and guidance provided by health professionals, especially those responsible for prenatal care.
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Affiliation(s)
- Romina Buffarini
- 1Federal University of Pelotas, Marechal Deodoro 1160, 3rd floor, Pelotas, RS 96020-220 Brazil
| | - Fernando C Barros
- 2Catholic University of Pelotas, Gonçalves Chaves 373, Pelotas, RS 96015-560 Brazil
| | - Mariângela F Silveira
- 1Federal University of Pelotas, Marechal Deodoro 1160, 3rd floor, Pelotas, RS 96020-220 Brazil
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