Description of vaccination coverage and hesitancy obtained by epidemiological survey of children born in 2017-2018, in Belo Horizonte and Sete Lagoas, Minas Gerais, Brazil.

OBJECTIVE: To describe vaccination coverage and hesitation for the basic children's schedule in Belo Horizonte and Sete Lagoas, Minas Gerais state, Brazil. METHODS: Population-based epidemiological surveys performed from 2020 to 2022, which estimated vaccine coverage by type of immunobiological product and full schedule (valid and ministered doses), according to socioeconomic strata; and reasons for vaccination hesitancy. RESULTS: Overall coverage with valid doses and vaccination hesitancy for at least one vaccine were, respectively, 50.2% (95%CI 44.1;56.2) and 1.6% (95%CI 0.9;2.7), in Belo Horizonte (n = 1,866), and 64.9% (95%CI 56.9;72.1) and 1.0% (95%CI 0.3;2.8), in Sete Lagoas (n = 451), with differences between socioeconomic strata. Fear of severe reactions was the main reason for vaccination hesitancy. CONCLUSION: Coverage was identified as being below recommended levels for most vaccines. Disinformation should be combated in order to avoid vaccination hesitancy. There is a pressing need to recover coverages, considering public health service access and socioeconomic disparities. MAIN RESULTS: Vaccination coverage of children up to 4 years old was 50.2% in Belo Horizonte, and 64.9% in Sete Lagoas. Fear of severe reactions and believing that vaccination against eradicated diseases is unnecessary were the main reasons for vaccination hesitancy. IMPLICATIONS FOR SERVICES: Recovery of high vaccination coverage among children, considering public health service access conditions and socioeconomic inequities. Acting on reasons for hesitancy that can assist in targeting actions. PERSPECTIVES: The multifactorial context of vaccination hesitancy demands the development of health education strategies to raise awareness about child immunization.

Racial inequalities in child vaccination and barriers to vaccination in Brazil among live births in 2017 and 2018: an analysis of a retrospective cohort of the first two years of life.

OBJECTIVE: To describe timely vaccination completion and obstacles in the first 24 months of life in Brazil, examining associations with maternal race/skin color. METHODS: Study participants were 37,801 children born in 2017 and 2018 included in the National Immunization Coverage Survey. We calculated prevalence and 95% confidence intervals for timely vaccine completeness and obstacles at 5, 12 and 24 months of life, according to maternal race/skin color. Associations were analyzed using logistic regression. RESULTS: 7.2% (95%CI 6.3;8.2) of mothers faced difficulties in taking their children to be vaccinated, and 23.4% (95%CI 21.7;25.1) were not vaccinated when taken. These proportions were 75% (95%CI 1.25;2.45) and 97% (95%CI 1.57;2.48) higher, respectively, among Black mothers. At least one vaccination was delayed among 49.9% (95%CI 47.8;51.9) and 61.1% (95%CI 59.2;63.0) of children by 5 and 12 months, respectively. These rates were higher among Black/mixed race mothers. CONCLUSION: There are racial inequalities in both the obstacles faced and in vaccination rates in Brazil. MAIN RESULTS: Marked racial inequalities were found in the obstacles to vaccination of children under 24 months in Brazil and to timely vaccination at 5 months and in the first year of life. IMPLICATIONS FOR SERVICES: Racial inequalities in the occurrence of vaccination shortcomings in health services, in the objective restrictions faced by families in taking their children to vaccination centers and in incomplete vaccination in a timely manner need to be addressed by the Brazilian National Health System. PERSPECTIVES: Equal public policies to address barriers to vaccination and qualification of health services need to be implemented. Studies need to deepen understanding of the structural determinants that lead to racial disparities.

First Detection of Hepatitis B Virus Subgenotype A5, and Characterization of Occult Infection and Hepatocellular Carcinoma-Related Mutations in Latin American and African Immigrants in Brazil.

This study aims to characterize the molecular profile of the hepatitis B virus (HBV) among socially vulnerable immigrants residing in Brazil to investigate the introduction of uncommon HBV strains into the country. Serum samples from 102 immigrants with positive serology for the HBV core antibody (anti-HBc) were tested for the presence of HBV DNA by PCR assays. Among these, 24 were also positive for the HBV surface antigen (HBsAg). The full or partial genome was sequenced to determine genotype by phylogenetic analysis. Participants were from Haiti (79.4%), Guinea-Bissau (11.8%), Venezuela (7.8%), and Colombia (1%). Of the 21 HBV DNA-positive samples, subgenotypes A1 (52.4%), A5 (28.6%), E (9.5%), F2 (4.8%), and F3 (4.8%) were identified. Among the 78 HBsAg-negative participants, four were positive for HBV DNA, resulting in an occult HBV infection rate of 5.1%. Phylogenetic analysis suggested that most strains were likely introduced to Brazil by migration. Importantly, 80% of A5 sequences had the A1762T/G1764A double mutation, linked to an increased risk of hepatocellular carcinoma development. In conclusion, this study is the first report of HBV subgenotype A5 in Brazil, shedding new light on the diversity of HBV strains circulating in the country. Understanding the genetic diversity of HBV in immigrant communities can lead to better prevention and control strategies, benefiting both immigrants and wider society.

Lessons from the COVID-19 pandemic: the unequal burden of COVID-19 on vulnerable populations in the Brazilian Central-West.

This study aimed to estimate the prevalence and identify social factors and preventive strategies associated with the coronavirus disease 2019 (COVID-19) in socio and economically vulnerable people (recyclable waste pikers, immigrants/refugees, and homeless people) in Goiânia, Goiás State, Central-Western Brazil. A cross-sectional study was conducted from July 2020 to October 2020. COVID-19 positivity was defined as a positive total anti-SARS-COV-2 antibody test and/or RNA test for SARS-COV-2. Univariable and multiple regression analyses were performed to identify the variables associated with COVID-19. Of the 594 participants, 47.3% were recyclable waste pickers, 29.6% were immigrants/refugees, and 23.1% were homeless people. The positivity for SARS-CoV-2 RNA was 14.1%, whereas for anti-SARS-CoV-2 a total of 30.8% were positive, and 39.4% were positive for at least one COVID-19 marker. Among the 541 individuals, being immigrants/refugees, not wearing a surgical mask, and having three or more people sleeping in the same room were associated with SARS-CoV-2 infection, while using TV news as the main source of information about the pandemic was a protective predictor of COVID-19. This study revealed ethnic and socioeconomic inequalities in the prevalence of COVID-19 among impoverished people in Brazil. Additionally, a high prevalence of COVID-19 was detected in all three groups. Developing new strategies to combat and prevent communicable diseases affecting this population is essential for mitigating future and ongoing pandemics.

Cocaine/crack and cannabis use among transgender women in Goiás, Central Brazil.

INTRODUCTION: Illicit drug use is a significant public health problem. Studies have shown a high prevalence of cocaine and cannabis use in transgender women (TGW). OBJECTIVE: To describe the consumption patterns of cannabis and cocaine/crack use and variables associated with their use in TGW in Central Brazil. METHODS: A cross-sectional study was conducted on TGW in Goiás, Brazil. Participants were recruited using a respondent-driven sampling method and were interviewed face-to-face about cannabis and crack-cocaine and the variables associated with them. The Alcohol Smoking and Substance Involvement Screening Test was used to assess substance use. Unweighted logistic regression was used to identify variables associated with cannabis and crack cocaine use. P-values < 0.05 were considered statistically significant. RESULTS: A total of 440 transgender women participated in the study. Their median age was 25 years (interquartile range: 20.5-29.5 years). Most participants were single (85.5%) and had engaged in sex work in their lifetime (58.6%). Cannabis was reported by 68.9% and 53.4% of participants in their lifetime and in the past three months, respectively, and cocaine/crack use was reported by 59.8% and 44.1% of participants in their lifetime and the past three months, respectively. Of the participants, 10.2% reported high-risk cannabis use, and 9.1% reported high-risk cocaine/crack use. Furthermore, 35% of participants reported using both drugs. Previous physical violence (Adjusted Odds Ratio (AOR): 2.37), inconsistent condom uses during anal sex (AOR: 2.17), and moderate-/high-risk cocaine/crack use (AOR: 3.14) were associated with high-risk cannabis use. Previous sexual violence (AOR: 2.84), previous STI (AOR: 2.90), moderate-/high-risk cannabis (AOR: 3.82), and binge drinking (AOR; 3.28) were associated with high-risk cocaine/crack use. CONCLUSION: Our study found a high frequency, significant overlap in the use of cannabis and cocaine/crack use and violence associated with these drugs consumption among TGW, highlighting the urgent need for health policies for drug disorders among this socially marginalized group.

Alarming patterns of moderate and high-risk alcohol use among transgender women in Goiás, Central Brazil.

Background: Scant studies have examined alcohol consumption among transgender women in Latin America. This cross-sectional study estimated the prevalence and associated factors of risky alcohol use among transgender women in Goiás, a state located in the center of Brazil. Methods: Participants were 440 transgender women (median age = 35 years, interquartile range = 9) recruited through respondent-driven sampling. All participants were interviewed about sociodemographic characteristics, violence, and risk behavior. Alcohol use was assessed using the alcohol use disorders identification test (AUDIT). An AUDIT score greater than or equal to eight was considered as risky alcohol consumption. Logistic regression analysis was used to examine predictors of risky alcohol use, and p-values <0.05 were considered significant. Results: The majority were young, single, sex workers. Most transgender women had used alcohol in the previous year (85.7%), and more than half (56.6%) reported binge drinking and risky alcohol consumption (60.2%). There was a high overlap between sexual behavior, drugs, and alcohol use. Using alcohol during sex (adjusted odds ratio [aOR]: 2.9; 95% confidence interval [CI]: 1.7-4.8), cocaine/crack use (aOR: 2.3; 95% CI: 1.5-3.7) and having a drug user as a sexual partner (aOR: 2.9; 95% CI: 1.5-5.9) were independently associated with risky alcohol consumption. Conclusion: Alcohol consumption was highly prevalent, and drugs seem to play an important role in risky alcohol consumption among transgender women Goiás. These findings support stakeholders to promote intervention strategies to reduce this pattern of alcohol consumption and reduce the burden of substance use disorders among transgender women.

Getting knowledge to provide care: prevalence and factors associated with Sexually Transmitted Infections in immigrants from Goiás.

OBJECTIVE: To estimate the prevalence of Sexually Transmitted Infections (STIs) in immigrants and refugees living in the metropolitan region of Goiânia, Goiás. METHOD: This is a cross-sectional and analytical study. Data collection was carried out from July 2019 to January 2020 and 308 immigrants and refugees were included in the sample. All were underwent face-to-face interviews and were tested for HIV, Syphilis, and Hepatitis B, using rapid tests. RESULTS: The general prevalence for any of the STIs investigated was 8.8% (95%CI 6.0% - 12.3%), being 5.8% (95%CI 3.6% - 8.9%) for Hepatitis B, 2.3% for Syphilis (95%CI 1.00% - 4.4%) and 0.7% for HIV (95%CI 0.1% - 2.1%). Multiple analysis, using logistic regression, showed that the variables male gender (OR = 2.7) and length of time living in Brazil (OR = 2.6) were significantly associated with STIs (p < 0.05). CONCLUSION: The results of this study suggest that STIs are a health problem in immigrants/refugees, which appear to be enhanced with the length of migration in the country. Public policies that guarantee health care for this population shall be considered.

Lessons from the COVID-19 pandemic: the unequal burden of COVID-19 on vulnerable populations in the Brazilian Central-West / Lições sobre a pandemia da COVID-19: a carga desigual da COVID-19 sobre as populações vulneráveis da região central do Brasil / Lecciones de la pandemia del COVID-19: la carga desigual del COVID-19 sobre las poblaciones vulnerables en la región central de Brasil

Abstract: This study aimed to estimate the prevalence and identify social factors and preventive strategies associated with the coronavirus disease 2019 (COVID-19) in socio and economically vulnerable people (recyclable waste pikers, immigrants/refugees, and homeless people) in Goiânia, Goiás State, Central-Western Brazil. A cross-sectional study was conducted from July 2020 to October 2020. COVID-19 positivity was defined as a positive total anti-SARS-COV-2 antibody test and/or RNA test for SARS-COV-2. Univariable and multiple regression analyses were performed to identify the variables associated with COVID-19. Of the 594 participants, 47.3% were recyclable waste pickers, 29.6% were immigrants/refugees, and 23.1% were homeless people. The positivity for SARS-CoV-2 RNA was 14.1%, whereas for anti-SARS-CoV-2 a total of 30.8% were positive, and 39.4% were positive for at least one COVID-19 marker. Among the 541 individuals, being immigrants/refugees, not wearing a surgical mask, and having three or more people sleeping in the same room were associated with SARS-CoV-2 infection, while using TV news as the main source of information about the pandemic was a protective predictor of COVID-19. This study revealed ethnic and socioeconomic inequalities in the prevalence of COVID-19 among impoverished people in Brazil. Additionally, a high prevalence of COVID-19 was detected in all three groups. Developing new strategies to combat and prevent communicable diseases affecting this population is essential for mitigating future and ongoing pandemics.

Resumo: Este estudo teve como objetivo estimar a prevalência da COVID-19 e identificar fatores sociais e estratégias preventivas associadas a essa doença em pessoas em situação de vulnerabilidade socioeconômica (catadores de lixo, imigrantes/refugiados e moradores de rua) em Goiânia, Estado de Goiás, na região central do Brasil. Trata-se de um estudo transversal realizado de julho a outubro de 2020. Foram considerados positivos para a covid-19 indivíduos que apresentaram um teste de anticorpos anti-SARS-COV-2 e/ou teste de RNA para SARS-COV-2 com resultado positivo. Foram realizadas análises de regressão univariável e múltipla para identificar as variáveis associadas à COVID-19. Dos 594 participantes, 47,3% eram catadores de lixo reciclável, 29,6% eram imigrantes/refugiados e 23,1% eram moradores de rua. A positividade foi de 14,1% para o RNA do SARS-CoV-2, 30,8% para o total de anti-SARS-CoV-2 e 39,4% para pelo menos um marcador da COVID-19. Entre os 541 indivíduos, ser imigrante/refugiado, não usar máscara cirúrgica e ter três ou mais pessoas dormindo no mesmo quarto foram fatores associados à infecção por SARS-CoV-2, enquanto confiar em informações sobre a pandemia, principalmente aquelas transmitidas por noticiários de TV, foi um indicador de proteção contra a COVID-19. Este estudo revelou desigualdades étnicas e socioeconômicas na prevalência da COVID-19 entre pessoas de baixa renda no Brasil. Além disso, uma alta prevalência de COVID-19 foi detectada nos três grupos. O desenvolvimento de novas estratégias para combater e prevenir doenças transmissíveis que afetam essa população é essencial para mitigar pandemias futuras e atuais.

Resumen: Este estudio tuvo como objetivo estimar la prevalencia del COVID-19 e identificar los factores sociales y las estrategias preventivas asociadas a esta enfermedad en personas en situación de vulnerabilidad socioeconómica (recolectores de basura, inmigrantes/refugiados y personas sin hogar) en Goiânia, Estado de Goiás, en la región central de Brasil. Se trata de un estudio transversal realizado de julio a octubre de 2020. Las personas que tuvieron una prueba de anticuerpos anti-SARS-CoV-2 positiva y/o una prueba de ARN para SARS-CoV-2 se consideraron positivas para el COVID-19. Se realizaron análisis de regresión univariante y múltiple para identificar las variables asociadas al COVID-19. De los 594 participantes, el 47,3% eran recicladores; el 29,6% inmigrantes/refugiados; y el 23,1% eran personas sin hogar. La positividad fue del 14,1% para el ARN del SARS-CoV-2; del 30,8% para el total de anti-SARS-CoV-2; y del 39,4% para al menos un marcador del COVID-19. De los 541 participantes, ser inmigrante/refugiado, no usar mascarilla quirúrgica y tener tres o más personas que comparten la misma habitación fueron los factores asociados con la infección por SARS-CoV-2, mientras que confiar en la información sobre la pandemia, especialmente transmitidas por los noticiarios, fue un indicador de protección contra esta enfermedad. Este estudio reveló las desigualdades étnicas y socioeconómicas en la prevalencia del COVID-19 entre las personas de bajos ingresos en Brasil. Además, se detectó una alta prevalencia del COVID-19 en los tres grupos. El desarrollo de nuevas estrategias para combatir y prevenir las enfermedades transmisibles que afectan a esta población es fundamental para mitigar las pandemias futuras y actuales.

Description of vaccination coverage and hesitancy obtained by epidemiological survey of children born in 2017-2018, in Belo Horizonte and Sete Lagoas, Minas Gerais, Brazil / Descripción de la cobertura de vacuna y de las vacunaciones obtenidas por la encuesta epidemiológica de niños nacidos en 2017-2018, en Belo Horizonte y Sete Lagoas, Minas Gerais / Descrição da cobertura e da hesitação vacinal obtida por inquérito epidemiológico de crianças nascidas em 2017-2018, em Belo Horizonte e Sete Lagoas, Minas Gerais

ABSTRACT Objective To describe vaccination coverage and hesitation for the basic children's schedule in Belo Horizonte and Sete Lagoas, Minas Gerais state, Brazil. Methods Population-based epidemiological surveys performed from 2020 to 2022, which estimated vaccine coverage by type of immunobiological product and full schedule (valid and ministered doses), according to socioeconomic strata; and reasons for vaccination hesitancy. Results Overall coverage with valid doses and vaccination hesitancy for at least one vaccine were, respectively, 50.2% (95%CI 44.1;56.2) and 1.6% (95%CI 0.9;2.7), in Belo Horizonte (n = 1,866), and 64.9% (95%CI 56.9;72.1) and 1.0% (95%CI 0.3;2.8), in Sete Lagoas (n = 451), with differences between socioeconomic strata. Fear of severe reactions was the main reason for vaccination hesitancy. Conclusion Coverage was identified as being below recommended levels for most vaccines. Disinformation should be combated in order to avoid vaccination hesitancy. There is a pressing need to recover coverages, considering public health service access and socioeconomic disparities.

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RESUMO Objetivo Descrever as coberturas e hesitação das vacinas do calendário básico infantil em Belo Horizonte e Sete Lagoas, Minas Gerais. Métodos Inquéritos epidemiológicos de base populacional realizados de 2020 a 2022, para estimar coberturas vacinais por tipo de imunobiológico e esquema completo (doses válidas e aplicadas) segundo estratos socioeconômicos, e os motivos de hesitação vacinal. Resultados A cobertura global com doses válidas e a hesitação vacinal de pelo menos uma vacina foram, respectivamente, de 50,2% (IC95% 44,1;56,2) e 1,6% (IC95% 0,9;2,7), em Belo Horizonte (n = 1.866), e de 64,9% (IC95% 56,9;72,1) e 1,0% (IC95% 0,3;2,8), em Sete Lagoas (n = 451), com diferenças entre os estratos. O receio de reações graves foi o principal motivo de hesitação vacinal. Conclusão Identificou-se coberturas abaixo do preconizado para a maioria das vacinas. A desinformação deve ser combatida, evitando-se a hesitação vacinal. Há necessidade premente de recuperar as coberturas, considerando acesso ao SUS e disparidades socioeconômicas.

Racial inequalities in child vaccination and barriers to vaccination in Brazil among live births in 2017 and 2018: an analysis of a retrospective cohort of the first two years of life / Desigualdades raciales en la vacunación infantil y obstáculos para la vacunación en Brazil entre nacidos vivos en 2017 y 2018: análisis de uma cohorte retrospectiva de los dos primeros años de vida / Desigualdades raciais na vacinação infantil e nos obstáculos à vacinação no Brasil entre nascidos vivos em 2017 e 2018: análise de uma coorte retrospectiva dos dois primeiros anos de vida

ABSTRACT Objective To describe timely vaccination completion and obstacles in the first 24 months of life in Brazil, examining associations with maternal race/skin color. Methods Study participants were 37,801 children born in 2017 and 2018 included in the National Immunization Coverage Survey. We calculated prevalence and 95% confidence intervals for timely vaccine completeness and obstacles at 5, 12 and 24 months of life, according to maternal race/skin color. Associations were analyzed using logistic regression. Results 7.2% (95%CI 6.3;8.2) of mothers faced difficulties in taking their children to be vaccinated, and 23.4% (95%CI 21.7;25.1) were not vaccinated when taken. These proportions were 75% (95%CI 1.25;2.45) and 97% (95%CI 1.57;2.48) higher, respectively, among Black mothers. At least one vaccination was delayed among 49.9% (95%CI 47.8;51.9) and 61.1% (95%CI 59.2;63.0) of children by 5 and 12 months, respectively. These rates were higher among Black/mixed race mothers. Conclusion There are racial inequalities in both the obstacles faced and in vaccination rates in Brazil.

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RESUMO Objetivo Descrever a completude vacinal em tempo oportuno nos primeiros 24 meses de vida no Brasil e os obstáculos para vacinação, testando-se associações com raça/cor da pele materna. Métodos Fez-se coleta de informações sobre os nascidos em 2017 e 2018, constantes no Inquérito Nacional de Cobertura Vacinal. Foram calculados prevalência e intervalos de confiança de 95% de obstáculos à vacinação e completude vacinal em tempo oportuno aos 5 meses, primeiro e segundo ano, segundo raça/cor da pele materna. Empregou-se regressão logística para análise de associações. Resultados Analisaram-se dados de 37.801 crianças. Do total, 7,2% (IC95% 6,3;8,2) dos responsáveis enfrentaram dificuldades para levar seus filhos para vacinação e 23,4% (IC95% 21,7;25,1) das crianças não foram vacinadas, mesmo sendo levadas. Essas proporções foram 75% (IC95% 1,25;2,45) e 97% (IC95% 1,57;2,48) mais elevadas, respectivamente, entre pretas; e 49,9% (IC95% 47,8;51,9) e 61,1% (IC95% 59,2;63,0) das crianças tiveram atraso em alguma vacina até os 5 meses e o primeiro ano, respectivamente. Tais valores foram maiores entre pardas/pretas. Conclusão Há desigualdades raciais nos obstáculos enfrentados e na vacinação no Brasil.

Seroprevalence of Hantavirus among Manual Cane Cutters and Epidemiological Aspects of HPS in Central Brazil.

Hantavirus pulmonary syndrome (HPS) is a rodent-borne zoonotic disease that is endemic throughout the Americas. Agricultural activities increase exposure to wild rodents, especially for sugarcane cutters. We carried out a survey of the epidemiological aspects of HPS and investigated the prevalence of hantavirus infection in the sugarcane cutter population from different localities in the Brazilian Midwest region. We conducted a retrospective study of all confirmed HPS cases in the state of Goiás reported to the National HPS surveillance system between 2007 and 2017, along with a seroepidemiological study in a population of sugarcane cutters working in Goiás state in 2016, using the anti-hantavirus (Andes) ELISA IgG. A total of 634 serum samples from cane cutters were tested for hantavirus antibodies, with 44 (6.9%) being IgG-reactive according to ELISA. The destination of garbage was the only statistically significant variable (p = 0.03) related to the detection of hantavirus IgG (p < 0.05). We described the epidemiological profile of reported hantavirus cases in Goiás-a highly endemic area for HPS, and where the seroepidemiological study was conducted. Our results increase our knowledge about hantavirus infections in Brazil and highlight the vulnerability of sugarcane cutters to a highly lethal disease that, to date, has no specific treatment or vaccination.

Human T-lymphotropic virus 1/2 infection among immigrants and refugees in Central Brazil, an emerging vulnerable population.

Introduction: Migratory flows play a significant role in the spread of human T-lymphotropic virus 1/2 (HTLV-1/2). In the last decade, a substantial migration of individuals occurred from Haiti and Venezuela to Brazil. However, data on the prevalence of HTLV-1/2 infection among these international migrants in Brazil are scarce. This study describes the prevalence of this infection among immigrants and refugees in Central Brazil. Methods: A cross-sectional study was conducted with 537 international migrants in the State of Goiás, Central Brazil. Participants were interviewed, and blood samples were collected. Serological screening for anti-HTLV-1/2 was performed using an enzyme-linked immunosorbent assay (ELISA; Murex HTLV-I + II, DiaSorin, Dartford, UK), and seropositive samples were submitted for confirmation by a line immunoassay (INNO-LIA HTLV I/II, Fujirebio, Europe N.V., Belgium). Results: The majority of participants were males (54.4%), between 18 and 50 years old (78%; mean age: 29.1 years), self-declared black (55.1%), reported 1 to 12 years of formal education (70.9%), and were either Venezuelans (47.9%) or Haitians (39.7%). Additionally, 50.1% were immigrants, 49% were refugees, and five were Brazilian children (0.9%) born to Haitian immigrant parents. The overall prevalence of anti-HTLV-1/2 was 0.95% (95% CI: 0.31-2.28), with HTLV-1 at 0.19% and HTLV-2 at 0.76%. All seropositive individuals (n = 5) were refugees from Venezuela, resulting in a rate of 2.26% for anti-HTLV-1/2, HTLV-1 (0.45%) and HTLV-2 (1.81%) among Venezuelan refugees. Of the demographic and behavioral characteristics evaluated, unprotected sexual intercourse and having more than one sexual partner (≥2) in the previous 12 months were associated with HTLV-1/2 seropositivity among Venezuelans. Conclusion: This study revealed, despite the low seroprevalence of HTLV-1/2 among international migrants in Central Brazil, evidence of HTLV-1 and HTLV-2 infections in Venezuelan refugees. In addition, their characteristics highlight that specific social and health programs should be implemented for these emergent and socially vulnerable migrant groups.

Hepatitis E Prevalence in Vulnerable Populations in Goiânia, Central Brazil.

A transversal study was conducted among 472 vulnerable individuals (recyclable waste pickers, immigrants and refugees, homeless individuals, as well as lesbian, gay, bisexual, and transexual individuals) in Goiânia City, the capital of the State of Goiás, Brazil, to investigate the prevalence of hepatitis E virus (HEV) infection. A total of 459 (97.2%) serum samples were tested for anti-HEV IgG and IgM antibodies using fully automated chemiluminescence immunoassays (Liaison® Murex Anti-HEV IgG and IgM assays, DiaSorin, Saluggia, Italy). Positive samples were tested for the presence of HEV RNA by a real-time polymerase chain reaction. A seroprevalence of 0.87% (95% confidence interval [CI]: 0.34-2.22) was found for anti-HEV IgG. Furthermore, anti-HEV IgM was detected in only one individual (0.22%; 95% CI: 0.04-1.22), who was also negative for HEV RNA. These findings revealed that HEV infection is infrequent in vulnerable individuals in Central Brazil, with low seroprevalence of past and recent HEV infections.

National Vaccine Coverage Survey 2020: methods and operational aspects.

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.

Human Papillomavirus Positivity at 3 Anatomical Sites Among Transgender Women in Central Brazil.

BACKGROUND: Transgender women (TGW) are susceptible to the acquisition of sexually transmitted infections (STIs), including human papillomavirus (HPV). Nonetheless, the exact data for this population are scarce. We estimated HPV positivity at the anal, genital, and oral sites among TGW and also identified the related characteristics and behaviors that could be risk factors for HPV infection in a sample of TGW in Brazil. Furthermore, we characterized the site-specific HPV genotypes among those who were positive for HPV at these 3 sites. METHODS: A cross-sectional study was conducted on TGW in Goiânia City (Central-Midwest region), Brazil, between April 2018 and August 2019. Respondent-driven sampling was applied for recruitment. Next, self-collected anal, genital, and oral samples were examined for HPV DNA using polymerase chain reaction (SPF-10 primer). Human papillomavirus genotypes were identified in 12 TGW. RESULTS: In the TGW included in the study, the anal, genital, and oral HPV positivity values were 77.2% (95% confidence interval [CI], 67.3%-84.6%), 33.5% (95% CI, 26.1%-48.9%), and 10.9% (95% CI, 5.8%-17.0%), respectively. In addition, the majority of 12 participants who tested for HPV had multiple genotypes. HPV-52 was the most prevalent genotype identified at the anal (66.6%) and genital (40.0%) sites, whereas HPV-62 and HPV-66 were the most common at the oral site (25.0%). CONCLUSIONS: A high HPV positivity was observed among TGW. Therefore, additional epidemiological studies on HPV genotypes should generate health intervention information, including the prevention, diagnosis, and treatment of sexually transmitted infections.

Low Vaccine Coverage and Factors Associated with Incomplete Childhood Immunization in Racial/Ethnic Minorities and Rural Groups, Central Brazil.

Discrimination and limited access to healthcare services in remote areas can affect vaccination coverage. Therefore, this study aimed to estimate vaccination coverage for children living in quilombola communities and rural settlements in the central region of Brazil during their first year of life and to analyze the factors associated with incomplete vaccination. An analytical cross-sectional study was conducted on children born between 2015 and 2017. The percentage of children who received all vaccines recommended by the National Immunization Program in Brazil by 11 months and 29 days was used to calculate immunization coverage. Children who received the following vaccines were considered as having a complete basic vaccination schedule: one dose of BCG; three doses of Hepatitis B, of Diphtheria-Tetanus-Pertussis (DPT), of Haemophilus influenzae type b (Hib), and of Poliovirus (Polio); two doses of Rotavirus, of 10-valent pneumococcal (PCV10), and of Serogroup C meningococcal conjugate (MenC); and one dose of Yellow Fever (YF). Measles-mumps-rubella (MMR) and other doses recommended at or after 12 months were not included. Consolidated logistic regression was used to identify factors associated with incomplete vaccination coverage. Overall vaccination coverage was 52.8% (95% CI: 45.5-59.9%) and ranged from 70.4% for the Yellow Fever vaccine to 78.3% for the Rotavirus vaccine, with no significant differences between the quilombola and settler groups. Notably, the likelihood of incomplete general vaccination coverage was higher among children who did not receive a visit from a healthcare professional. Urgent strategies are required to achieve and ensure health equity for this unique and traditionally distinct group with low vaccination coverage.

Prevalence, Risk Factors and Vaccine Response against Hepatitis B in People Aged 50 Years or Older.

Universal immunization against hepatitis B has contributed to reducing incidence of the disease, but older individuals remain susceptible to acquiring the hepatitis B virus worldwide. Thus, this study aimed to investigate the epidemiology of HBV infection in individuals aged 50 years and over in central Brazil and to evaluate the immunogenicity of the monovalent vaccine against hepatitis B in this age group using two vaccine regimens. METHOD: Initially, a cross-sectional and analytical study was carried out to investigate the epidemiology of hepatitis B. Then, individuals without proof of vaccination for hepatitis B were recruited for a phase IV randomized and controlled clinical trial using two vaccine regimens: Intervention Regimen (IR) (three doses of 40 µg at months 0, 1 and 6) vs. Comparison Regimen (CR) (three doses of 20 µg at months 0, 1 and 6). RESULTS: The overall prevalence of exposure to HBV was 16.6% (95% CI: 14.0%-9.5%). In the clinical trial, statistical differences in protective titers were observed (p = 0.007; IR 96% vs. CR 86%) and the geometric mean of anti-HBs titers was higher in individuals who received the IR (518.2 mIU/mL vs. 260.2 mIU/mL). In addition, the proportion of high responders was higher among those who received the IR (65.3%). CONCLUSION: reinforced doses should be used in individuals aged 50 years or older to overcome the lower efficacy of the vaccine against hepatitis B.

RT-LAMP Multicenter Study for SARS-CoV-2 Genome Molecular Detection in Brazilian Swab and Saliva Samples.

Reverse transcription loop-mediated isothermal amplification (RT-LAMP) is a rapid method that can replace RT-qPCR. A simple molecular assay for SARS-CoV-2 RNA detection in gold-standard diagnosis through swabs and alternative specimens such as saliva could be helpful in promoting genomic surveillance. A multicenter study was conducted to evaluate the RT-LAMP assay method as an alternative for the molecular detection of SARS-CoV-2 lineages in swab and saliva samples. A total of 350 swabs from individuals with (n = 276) or without (n = 74) COVID-19 tested by RT-qPCR were collected. Paired saliva was also collected from 90 individuals who had SARS-CoV-2 RNA that was detectable (n = 30) or undetectable (n = 60) via RT-qPCR. For the RT-LAMP methodology, six primers were used for ORF1 gene amplification. As for SARS-CoV-2 genotyping, 39 swabs had the whole genome sequenced by MinION. The sensitivity of RT-LAMP to the swab was 90.2%. For the swab samples with Ct ≤ 30, the sensitivity improved by 96%. Considering saliva with Ct ≤ 30 in RT-qPCR testing, the RT-LAMP sensitivity was 100%. The RT-LAMP specificity was 100% for both the swab and saliva samples. This RT-LAMP assay was capable of detecting all the SARS-CoV-2 lineages circulating in the Brazilian swab samples. The RT-LAMP method has significant potential for use in clinical routines since it was capable of detecting SARS-CoV-2 RNA in swab and saliva samples.

Long-Term Symptoms after Mild Coronavirus Disease in Healthy Healthcare Professionals: A 12-Month Prospective Cohort Study.

The coronavirus disease 2019 (COVID-19) pandemic has changed the course of human history and killed millions of people worldwide. Its long-term consequences remain uncertain. This study aimed to describe the short- and long-term symptoms of COVID-19 among individuals in Goiás, central Brazil, who experienced acute mild or non-symptomatic SARS-CoV-2 infection during the first wave of the pandemic. This prospective cohort study included 110 healthcare workers, 18 safety workers, and 19 administrative support workers, who were followed up for 12 months after the onset of COVID-19. Most participants were healthy adult female healthcare professionals. At the onset of infection, the major symptoms were headache, myalgia, nasal congestion, cough, coryza, anosmia, ageusia, sore throat, fatigue, diarrhea, and dyspnea. Furthermore, 20.3% of the participants had three or more COVID-19 symptoms that persisted for at least 12 months. These included coryza, congestion, hair loss, sore throat, headache, myalgia, cough, memory loss, anosmia, and fatigue. This study revealed a high prevalence of persistent symptoms of COVID-19 in healthy individuals from central Brazil, which may present an additional burden on healthcare services. Further studies are required to investigate the sequelae of COVID-19 over periods greater than 12 months.