Chemsex among men who have sex with men during the Mpox health crisis in Brazil: A nationwide web survey.

OBJECTIVE: To understand the factors associated with the practice of chemsex among MSM in Brazil, especially during the Mpox health crisis, and to design effective prevention and intervention strategies specifically for this population. DESIGN: A cross-sectional and analytical study using an electronic survey, conducted from September to December 2022, during the peak of the Mpox outbreak in Brazil. SAMPLE: A total of 1452 MSM aged 18 and older. MEASUREMENTS: Data were collected via the REDCap platform through a survey with 46 questions. These addressed demographic data, sexual affiliations, practices, experiences with Mpox, healthcare service usage, and stigma or fear related to Mpox. RESULTS: The prevalence of chemsex was 19.42% (n = 282). Multivariate Poisson modeling indicated a high incidence of chemsex among those diagnosed with Mpox and those involved in high-risk behaviors. The practice of chemsex was six times higher among those diagnosed with Mpox (95% CI: 4.73-9.10). MSM who engage in bugchasing had a prevalence twice that of the main outcome (95% CI: 1.31-3.16). CONCLUSION: There is a significant need for targeted interventions for MSM in Brazil, especially given the Mpox outbreak. This study highlights the strong relationships between chemsex, experiences with Mpox, and various sexual behaviors, underscoring the importance of effective public health initiatives.

Temporal trend, spatial analysis and spatiotemporal clusters of infant mortality associated with congenital toxoplasmosis in Brazil: Time series from 2000 to 2020.

OBJECTIVE: To analyse the spatial, temporal and spatial-temporal patterns of infant mortality associated with congenital toxoplasmosis in Brazil between the years 2000 and 2020. METHODS: Ecological study of time series, with spatial analysis and spatiotemporal scan of infant mortality associated with congenital toxoplasmosis from the records of deaths of the Mortality Information System of the Brazilian Ministry of Health. The rates were smoothed by the Local Empirical Bayesian model. The Global Moran Index, Global Geary's Contiguity and Getis-Ord General statistics were calculated for spatial autocorrelation assessment. The trends were evaluated by the Joinpoint method. RESULTS: We identified 1183 infant deaths associated with congenital toxoplasmosis in Brazil between 2000 and 2020. The predominant characteristics were male sex (52.1%), post-neonatal age group (51.9%), white race/colour (45.7%), and Southeast region of residence (40.0%). The infant mortality rate associated with congenital toxoplasmosis showed an increasing trend in the country in the years analysed. The spatial analysis showed heterogeneous distribution of mortality in the Brazilian territory and found no evidence of spatial autocorrelation; but spatial-temporal analysis identified three risk clusters involving 703 municipalities. CONCLUSION: Infant mortality associated with congenital toxoplasmosis is a persistent public health problem in Brazil. The risk factors male sex, indigenous race/colour, early neonatal age, North and Northeast regions and risk clusters mapped in this study should be observed for future analysis and planning of health care policies in the control of infant deaths associated with congenital toxoplasmosis. Health surveillance strategies and public health policies need to be strengthened.

Systematic Review of Pooling Sputum as an Efficient Method for Xpert MTB/RIF Tuberculosis Testing during the COVID-19 Pandemic.

GeneXpert-based testing with Xpert MTB/RIF or Ultra assays is essential for tuberculosis diagnosis. However, testing may be affected by cartridge and staff shortages. More efficient testing strategies could help, especially during the coronavirus disease pandemic. We searched the literature to systematically review whether GeneXpert-based testing of pooled sputum samples achieves sensitivity and specificity similar to testing individual samples; this method could potentially save time and preserve the limited supply of cartridges. From 6 publications, we found 2-sample pools using Xpert MTB/RIF had 87.5% and 96.0% sensitivity (average sensitivity 94%; 95% CI 89.0%-98.0%) (2 studies). Four-sample pools averaged 91% sensitivity with Xpert MTB/RIF (2 studies) and 98% with Ultra (2 studies); combining >4 samples resulted in lower sensitivity. Two studies reported that pooling achieved 99%-100% specificity and 27%-31% in cartridge savings. Our results show that pooling may improve efficiency of GeneXpert-based testing.

Spatial and temporal analysis of tuberculosis in an area of social inequality in Northeast Brazil.

BACKGROUND: Tuberculosis is an infectious disease caused by Mycobacterium tuberculosis. It is a disease known worldwide for its vulnerability factors, magnitude and mortality. The objective of the study was to analyze the spatial and temporal dynamics of TB in the area of social inequality in northeast Brazil between the years 2001 and 2016. METHODS: An ecological time series study with the use of spatial analysis techniques was carried out from 2001 to 2016. The units of analysis were the 75 municipalities in the state of Sergipe. Data from the Notification of Injury Information System were used. For the construction of the maps, the cartographic base of the state of Sergipe, obtained at the Instituto Brasileiro de Geografia e Estatística, was used. Georeferenced data were analysed using TerraView 4.2.2 software (Instituto Nacional de Pesquisas Espaciais) and QGis 2.18.2 (Open Source Geospatial Foundation). Spatial analyses included the empirical Bayesian model and the global and local Moran indices. The time trend analyses were performed by the software Joinpoint Regression, Version 4.5.0.1, with the variables of sex, age, cure and abandonment. RESULTS: There was an increasing trend of tuberculosis cases in patients under 20 years old and 20-39 years old, especially in males. Cured cases showed a decreasing trend, and cases of treatment withdrawal were stationary. A spatial dependence was observed in almost all analysed territories but with different concentrations. Significant spatial correlations with the formation of clusters in the southeast and northeast of the state were observed. The probability of illness among municipalities was determined not to occur in a random way. CONCLUSION: The identification of risk areas and priority groups can help health planning by refining the focus of attention to tuberculosis control. Understanding the epidemiological, spatial and temporal dynamics of tuberculosis can allow for improved targeting of strategies for disease prevention and control.

Demographic evolution and natural increase projection of the Yanomami indigenous population in Brazil.

The Yanomami population, residing in Brazil's largest indigenous reserve in the Amazon Rainforest, face significant health challenges exacerbated by external threats such as infectious diseases, malnutrition, and mercury contamination from illegal mining. These issues, coupled with inadequate healthcare provision, have led to an alarming increase in mortality rates and potentially threaten the long-term survival of the Yanomami community. This ecological study utilized demographic data from the Special Secretariat of Indigenous Health to explore the demographic evolution and natural increase of the Yanomami Indigenous population in Brazil from 2003 to 2022. Employing population pyramids, crude rates of natural increase, the Mann-Kendall test for trend analysis, and linear regression modeling, the study analyzed vital statistics to forecast demographic trends, with analysis conducted using the R statistical software. Our findings showed a substantial growth of the Yanomami population, yet with a decreasing natural increase rate (τ = -0.33; p = 0.047), suggesting a shift toward population stagnation or decline within the next century. These results call for urgent, coordinated actions to address the complex demographic trends and health challenges faced by Yanomami Indigenous people, ensuring their demographic sustainability and the preservation of their traditional ways of life amidst ongoing environmental and health crises.

Impact of the COVID-19 Pandemic Surveillance of Visceral Leishmaniasis in Brazil: An Ecological Study.

The aim of the study was to assess the impact of the COVID-19 pandemic on the notification of new VL cases in Brazil in 2020. It is an ecological and time-series study (2015-2020) with spatial analysis techniques, whose units of analysis were the 5570 Brazilian municipalities. The study population consisted of all new cases of VL recorded between 2015 and 2020. The P-score was calculated to estimate the percentage variation in new VL cases. Global and local univariate Moran's Indices and retrospective space-time scan statistics were used in spatial and space-time analyses, respectively. It was expected that there would be 3627 new cases of VL in Brazil in 2020, but 1932 cases were reported (-46.73%). All Brazilian regions presented a negative percentage variation in the registration of new VL cases, with the Southeast (-54.70%), North (-49.97%), and Northeast (-44.22%) standing out. There was spatial dependence of the disease nationwide in both periods, before and during the first year of the COVID-19 pandemic. There was a significant reduction in the incidence of new VL cases in Brazil during the first year of the COVID-19 pandemic. These findings reinforce the need for better preparedness of the health system, especially in situations of new epidemics.

Temporal Analysis of Malaria Cases in the Brazilian Yanomami Pediatric Population: A Retrospective Ecologic Study From 2003 to 2022.

This retrospective ecological study investigated malaria incidence among Brazilian Yanomami children and adolescents from 2003 to 2022. Of the 145,573 recorded cases, 75.9% occurred in the Yanomami pediatric population. Moreover, an increase in the proportion of cases among the 10-19 age group has been observed, potentially associated with the recruitment of Indigenous adolescents to mining areas in recent years.

Pre-exposure prophylaxis among Brazilian men who have sex with men: a comparative study between migrants and non-migrants.

Introduction: Investigating the use and adherence to pre-exposure prophylaxis (PrEP) in MSM is a global health priority in the fight against HIV. Strategies must be capable of increasing usage and reaching not only the population living in the country but also those who immigrate, who face additional vulnerabilities. Based on this, in this observational, cross-sectional, and analytical study, our aim is to analyze the use of PrEP among Brazilian men who have sex with men, whether they are migrants or not. We aim to highlight preventive opportunities and strategies for the global health scenario. Methods: We utilized a sample of Brazilians living in the country and Brazilian immigrants residing in Portugal, one of the main destinations for Brazilians in recent years. To estimate the prevalence ratio (PR) of PrEP use, we employed the Poisson regression model with robust variance estimation using a covariance matrix. Results: A total of 1,117 Brazilian MSM PrEP users participated in this study, with 788 residing in Brazil and 328 in Portugal. Multivariate analysis was conducted in three stages: overall, and for subgroups of residents in Brazil and immigrants in Portugal. We identified four convergent factors that increased the prevalence of PrEP use in Brazilians regardless of migration status: having two or more casual sexual partners per month, engaging in challenging sexual practices as the receptive partner, disclosing serological status on apps, and being single. Among native Brazilians, four unique factors stood out: being in a polyamorous relationship, having sexual relations with unknown casual partners, and having higher levels of education. Discussion: This study highlights the need to implement strategies to strengthen PrEP adherence in Brazil and create international programs that facilitate its usage among populations migrating between these two countries.

Knowledge, Attitude and Practices towards the Prevention of Schistosomiasis Mansoni in an Endemic Area of Alagoas, Northeast Brazil.

We analyzed the knowledge, attitudes and practices (KAP) of schistosomiasis mansoni prevention in an endemic area of Brazil. This cross-sectional study was conducted between March and May 2021, with 412 participants living in the municipality of Feira Grande, Alagoas, Brazil. Data collection occurred through visits to the Health Center Urbano II and Massapê, through an interview with a structured questionnaire to identify the levels of KAP regarding schistosomiasis prevention. Of all respondents, 70.87% lived in rural areas, 22.66% reported a history of past schistosomiasis and 52.71% never participated in schistosomiasis control program actions. Factors associated with better KAP scores were being part of an older age group, not using rainwater and having no history of past schistosomiasis. Specifically, among the domains, attitude was the highest score and knowledge was the lowest. Participation in a health intervention program, knowing someone who had schistosomiasis and having been informed through a public health program seemed to have an important impact on the population's KAP. Our results contributed to broadening perceptions about schistosomiasis prevention, highlighting the positive impacts that health programs and interventions have on disease control.

Intention to use PrEP among men who have sex with men and engage in chemsex: an international descriptive study.

Background: Pre-exposure prophylaxis (PrEP) is a valuable tool in the response to the HIV epidemic, recommended for groups with a higher risk of HIV infection, such as men who have sex with men (MSM), particularly in the context of high-risk sexual behavior such as chemsex. Purpose: This study aimed to analyze the prevalence and factors associated with the intention to use PrEP among MSM who engage in chemsex in Brazil and Portugal. Methods: This was a cross-sectional study of a secondary dataset from a larger study conducted between January 2020 and May 2021 throughout Brazil and Portugal involving 1852 MSM who engage in chemsex. An initial descriptive analysis was performed to calculate the absolute and relative frequencies of independent variables related to the intention to use PrEP among MSM. A multivariate regression model was developed to identify factors independently associated with the intention to use PrEP. Results: Although a high level of PrEP knowledge (85.75%) was observed among MSM who engage in chemsex, the prevalence of intention to use PrEP was only 59.07%. Five variables were associated with a higher prevalence of intention to use PrEP [engaging in double penetration - adjusted prevalence ratio (aPR): 1.56, 95% CI: 1.44-1.69; being assigned female sex at birth - aPR: 1.34, 95% CI: 1.12-1.61; cruising - aPR: 1.21, 95% CI: 1.06-1.38; not using condoms - aPR: 1.20, 95% CI: 1.05-1.36; and being an immigrant - aPR: 1.16; 95% CI: 1.07-1.25], while having knowledge of postexposure prophylaxis (aPR: 0.91; 95% CI: 0.84-0.98), having a casual sexual partner (aPR: 0.86 and 0.85; 95% CI: 0.74-0.99 and 0.74-0.98), and engaging in group sex (aPR: 0.81; 95% CI: 0.73-0.90) were associated with a lower intention to use PrEP. Conclusion: The intention to use PrEP among MSM who engage in chemsex was high, and several factors were associated with this intention. Understanding the factors associated with the intention to use PrEP among MSM practicing chemsex is crucial for developing targeted interventions to increase PrEP uptake in this population. The results of this study suggest that tailored approaches are necessary to promote PrEP use in this population.

Sexual Practices and Predisposition to PrEP Use Among Men Ages 50 Years and Older Who Have Sex With Men: A Cross-Sectional Study.

ABSTRACT: This study aimed to evaluate the sexual practices of men ages 50 years or older who have sex with men (MSM) and factors influencing their predisposition to use preexposure prophylaxis (PrEP). An analytical cross-sectional study was conducted in Brazil and Portugal with 718 MSM. Of these, 278 (38.7%) were categorized as being at high risk for HIV based on the HIV Incidence Risk Index (HIRI), and 418 (58.2%) expressed a predisposition to use PrEP. Overall, sociodemographic factors and specific sexual practices increased the likelihood of being classified as high risk for HIV, particularly sexual position and sexual activity. However, factors that influenced the predisposition to use PrEP included age group, receptive anal sex, knowledge of postexposure prophylaxis, high HIRI score, and a history of syphilis. These findings underscore the urgent need for health services to provide comprehensive and adequate attention to the realities of this population, considering its complexities and specificities.

Adherence to Pre-Exposure Prophylaxis (PrEP) among Men Who Have Sex with Men (MSM) in Portuguese-Speaking Countries.

Strengthening strategies to improve adherence to the use of pre-exposure prophylaxis (PrEP) in key populations constitutes a global health priority to be achieved across countries, especially in countries that share a high flow of people such as Brazil and Portugal. This study aimed to analyze the factors associated with adherence to PrEP among MSM from two Portuguese-speaking countries, highlighting the opportunities and preventive strategies for the global health scenario. This was a cross-sectional analytical online survey conducted from January 2020 to May 2021 with MSM in Brazil and Portugal. For analysis of the data, the Poisson regression model was used to estimate the prevalence ratio (PR) for developing a model to evaluate the associated factors in both countries in a comparative and isolated way. Adherence to PrEP use corresponded to 19.5% (n = 1682) of the overall sample: 18.3% (n = 970) for Brazil and 21.5% (n = 712) for Portugal. Having more than two sex partners in the last 30 days (aPR: 30.87) and routinely undergoing HIV tests (aPR: 26.21) increased the use of this medication. Being an immigrant (PR: 1.36) and knowing the partner's serological status (PR: 1.28) increased adherence to PrEP in Portugal, whereas, in Brazil, it was being an immigrant (PR: 0.83) and not knowing the serological status (PR: 2.24) that promoted the use of this medication. Our findings reinforce the need to invest in programs and strategies to improve access and adherence to PrEP, especially in key populations.

Determinants of sexual exposure to HIV in Portuguese and Brazilian adolescents: a path analysis. / Fatores determinantes da exposição sexual ao HIV em adolescentes luso-brasileiros: uma análise de caminhos.

OBJECTIVE: to analyze the direct and indirect effects of determinants of sexual exposure to the human immunodeficiency virus among male adolescents who have sex with men and the implications for nursing care. METHOD: cross-sectional study carried out with 578 Portuguese and Brazilian adolescents aged 18 and 19. Interrelationships of conjugal status, use of dating apps, practice of chemsex, unawareness, partner credibility, challenging sexual practices and ineffective forms of protection against sexual exposure to the human immunodeficiency virus were evaluated using the Path Analysis technique. RESULTS: significant direct effect on sexual exposure to the human immunodeficiency virus: conjugal status (ß=-0.16), use of apps (ß=-0.30), challenging sexual practices (ß=0.48) and ineffective forms of protection (ß=0.35). Indirect paths: partner credibility influenced ineffective forms of protection (ß=0.77); having a steady/polyamorous relationship influenced the use of dating apps (ß=-0.46); chemsex, mediated by challenging sexual practices (ß=0.67), determined greater sexual exposure. CONCLUSION: adolescent sexual behaviors and forms of amorous/sexual relationship must be considered in nursing care planning to reduce sexual exposure to the human immunodeficiency virus.(1) Adolescents present high prevalence (81.0%) of sexual exposure to HIV. (2) Specificities of sexual practices are determinant factors of sexual exposure. (3) The higher the credibility given to a partner, the higher the sexual exposure to HIV. (4) Challenging sexual practices (such as fisting) determine sexual exposure. (5) Nursing care must focus on lowering exposure to HIV.

Influence of Sociodemographic and Emotional Factors on the Relationship between Self-Compassion and Perceived Stress among Men Residing in Brazil during the COVID-19 Pandemic.

The analysis of sociodemographic and emotional factors is essential to understanding how men perceive stress and practice self-compassion. In health crises, this problem becomes an emergency for public health. This study aimed to analyze the influence of sociodemographic and emotional factors on the relationship between self-compassion and the perceived stress of men residing in Brazil during the COVID-19 pandemic. This is a nationwide cross-sectional study carried out between June and December 2020 with 1006 men who completed a semi-structured electronic questionnaire. Data were collected using the snowball technique. Perceived stress was measured by the Perceived Stress Scale (PSS-14), and self-compassion was assessed using the Self-Compassion Scale. Most men had low self-compassion (51.5%; n = 516) and a moderate level of perceived stress (60.9%; n = 613), while 15.9% (n = 170) had a high level of stress. The prevalence of men in the combined situation of low self-compassion and high perceived stress was 39.4% (n = 334). Living with friends had a higher prevalence of low self-compassion and high perceived stress. The prevalence of common mental disorders was high (54.3%). Men with low levels of self-compassion reported higher levels of perceived stress; however, this association was moderated by emotional and sociodemographic variables. These findings highlight the importance of considering individual and contextual factors in public policies promoting men's mental health.

Early identification of individuals at risk for loss to follow-up of tuberculosis treatment: A generalised hierarchical analysis.

BACKGROUND: We characterise the loss to follow-up (locally termed abandoned) of tuberculosis treatment with individual and ecological health determinants and to identify the predictive capacity of these risk factors. METHODS: A cohort study with individual and ecological characterisation of patients diagnosed with tuberculosis in Sergipe/Brazil from 2015 to 2018 with either loss to follow-up or completion of treatment as a therapeutic outcome was performed. The examined variables were based on the social determinants of health with descriptive analysis, binary logistic regression, a generalised hierarchical model and graphical presentation using a nomogram. RESULTS: The loss to follow-up accounted for 18.21% of the 2,449 studied cases. The characteristics revealed that the highest abandonment percentages were people who: were male (20.0%), had black skin colour (20.3%), were aged 20-39 years (21.8%), had 4-7 years of schooling (23.6%), re-entered treatment after abandonment (36.5%), used alcohol (31.0%), used drugs (39.3%), were smokers (26.5%) and were homeless (55.4%). The ecological characteristics showed that individuals living in municipalities with a high human development index (HDI; odds ratio [OR]: 1.91) and high-income inequality (OR: 1.81) had a greater chance of not finishing the treatment. Most of these variables were identified as predictors in the generalised hierarchical model; the receiver operating characteristic curve (ROC) curve had 0.771 precision and 84.0% accuracy. CONCLUSION: The group of identified characteristics influenced the loss to follow-up of tuberculosis treatment. This data provides evidence for the early identification of individuals who are at greater risk of abandoning tuberculosis treatment.

Factors associated with chemsex in Portugal during the COVID-19 pandemic.

OBJECTIVE: to investigate the factors associated with the practice of sex under the influence of drugs (chemsex) among Portuguese men who have sex with men during the period of social distancing to prevent the COVID-19. METHOD: online survey applied in May 2020 to a sample of 1,301 participants living in Portugal, recruited according to Respondent Driven Sampling and via social media Facebook®. Descriptive and bivariate analyses were performed along with logistic regression to calculate adjusted Odds Ratio (ORa). RESULTS: the prevalence of chemsex was 20.2%. The likelihood of practicing chemsex increased with group sex (ORa: 28.4, 95%CI 16.93-47.49); unprotected sex (ORa: 7.1 95%CI 4.57-10.99); the use of pre-exposure prophylaxis (PrEP) to prevent COVID-19 (ORa: 4.2, 95%CI 2.71-6.39) and COVID-19 testing (ORa: 1.9, 95%CI 1.15-3.10). CONCLUSION: the practice of chemsex among men who have sex with men during the COVID-19 pandemic in Portugal was very frequent and may support greater understanding of the role and impact of sexual behavior on the COVID-19 transmission rates and the current pandemic situation in Portugal.

Construction and validation of an instrument for assessing the functionality of individuals with schistosomiasis.

OBJECTIVES: to construct and validate an instrument for assessing the functionality of individuals with schistosomiasis. METHODS: methodological study, developed in three stages: 1) construction of the instrument and its association with categories of the International Classification of Functionality, which the study used to elaborate the questions; 2) validation of content, performed by judges experts in the subject; 3) application of the instrument by the test-retest technique in the population with schistosomiasis in 14 days. The study used the correlation coefficient kappa to calculate the degree of agreement between the judges kappa. RESULTS: in its final version, the instrument consists of 27 items, 9 of which are from the Body functions component, 6 from Body structures, 4 from Activity and participation, and 8 from Environmental factors. CONCLUSIONS: the constructed instrument has a biopsychosocial approach, considering four components of the ICF, besides presenting good validity and interobserver reliability.

Sexual Exposure to HIV Infection during the COVID-19 Pandemic in Men Who Have Sex with Men (MSM): A Multicentric Study.

The practice of sex with casual partners without the use of adequate prevention in the period of social distancing due to the COVID-19 pandemic among men who have sex with men (MSM) can expose them to the risk of infection by the HIV virus. To assess this, we conducted an online survey in April and May 2020 in the entire national territory of Brazil and Portugal. We used the snowball technique for sampling, associated with circulation in social networks, totaling 2934 participants. Bivariate and multivariate logistic regression was used to produce the adjusted Odds Ratio (aOR). Eight-hundred-and-forty-two (28.7%) MSM presented at-risk sexual exposure in this period. In general, the types of sexual practices that most increased the chances of sexual exposure were having multiple partners (aOR:14.045); having practiced chemsex (aOR:2.246) and group sex (aOR:2.431), as well as presenting a history of at-risk sexual exposure (aOR:5.136). When we consider each country separately, the chances are increased in Brazil since the probability of the outcome was increased in those who practiced group sex (aOR:5.928), had multiple partners (aOR:19.132), and reported a sexual history of at-risk exposure (aOR:8.861). Our findings indicate that practices that are classically associated with greater chances of engaging in risky sexual exposure to HIV infection were the factors that most increased the chances of acquiring the virus in the pandemic context.

Determinants of COVID-19 Vaccine Hesitancy in Portuguese-Speaking Countries: A Structural Equations Modeling Approach.

COVID-19 vaccine hesitancy (VH) has caused concerns due to the possible fluctuations that may occur directly impacting the control of the pandemic. In this study, we aimed to estimate the prevalence and factors associated with COVID-19 VH in Portuguese-speaking countries. We developed a web survey (N:6,843) using an online, structured, and validated questionnaire. We used Measurement Models, Exploratory Factor Analysis, Exploratory Structural Equation Models, and Confirmatory Factor Analysis for the data analysis. The overall prevalence of COVID-19 VH in Portuguese-speaking countries was 21.1%. showed a statistically significant direct effect for VH: vaccine-related conspiracy beliefs (VB) (ß = 0.886), perceived stress (PS) (ß = 0.313), COVID-19 Misinformation (MIS) (ß = 0.259) and individual responses to COVID-19 (CIR) (ß = -0.122). The effect of MIS and CIR for VH was greater among men and of PS and VB among women; the effect of PS was greater among the youngest and of VB and CIR among the oldest. No discrepant differences were identified in the analyzed education strata. In conclusion, we found that conspiracy beliefs related to the vaccine strongly influence the decision to hesitate (not to take or to delay the vaccine). Specific characteristics related to gender, age group, social and cognitive vulnerabilities, added to the knowledge acquired, poorly substantiated and/or misrepresented about the COVID-19 vaccine, need to be considered in the planning of vaccination campaigns. It is necessary to respond in a timely, fast, and accurate manner to the challenges posed by vaccine hesitancy.

[Tuberculosis among children and adolescents: an epidemiological and spatial analysis in the state of Sergipe, Brazil, 2001-2017]. / Tuberculose em crianças e adolescentes: uma análise epidemiológica e espacial no estado de Sergipe, Brasil, 2001-2017.

Tuberculosis continues to be of the most frequent diseases in the world and one of the main causes of morbidity and mortality. Data from the World Health Organization indicate that Brazil accounts for 75% of global cases involving children. The study aims to analyze the epidemiological and spatial pattern of tuberculosis in children and adolescents in the state of Sergipe during the period from 2001 to 2017. This is an ecological, temporal series study using secondary data. The categorical variables were summarized in simple and absolute frequency. In the spatial analysis the Bayesian method for rate smoothing and the Moran index were used to evaluate spatial autocorrelation. Trend analysis was performed using the Joinpoint regression model. The mean incidence rate was 5.9, with a predominance of 15 to 19 years of age (76.4%) and a steady trend, but with a positive annual variation in both sexes. Tuberculosis in children and adolescents has significant spatial dependence in the north and northeast regions. The knowledge of the epidemiological situation of tuberculosis over the years provides subsidies for the targeting of resources in risk areas and new strategies for prevention and control of the disease among children and adolescents.

A tuberculose continua como uma das doenças mais frequentes no mundo e uma das principais causas de morbimortalidade. Dados da Organização Mundial de Saúde indicam que o Brasil responde por 75% dos casos mundiais envolvendo crianças. O estudo objetiva analisar o padrão epidemiológico e espacial da tuberculose em crianças e adolescentes no estado de Sergipe durante o período de 2001 a 2017. Trata-se de um estudo ecológico, de serie temporal, com uso de dados secundários. As variáveis categóricas foram sumarizadas em frequência simples e absoluta. Na análise espacial foi utilizado o método bayesiano para suavização de taxas e o índice de Moran para avaliar a autocorrelação espacial. A análise de tendência foi realizada por meio do modelo de regressão Joinpoint. Verificou que a taxa média de incidência foi de 5,9 com predomínio na faixa etária 15 a 19 anos (76,4%) e tendência estacionaria, porém com variação anual positiva em ambos os sexos. A tuberculose em crianças e adolescentes apresenta dependência espacial significante nas regiões norte e nordeste. O conhecimento da situação epidemiológica da tuberculose ao longo dos anos fornece subsídios para o direcionamento de recursos em áreas de risco e às novas estratégias de prevenção e controle da doença em crianças e adolescentes.