Hepatitis A vaccination coverage survey in 24-month-old children living in Brazilian capitals, 2020.

OBJECTIVE: To estimate hepatitis A vaccination coverage in 24-month-old children and identify factors associated with non-vaccination. METHODS: This was a survey involving a sample stratified by socioeconomic strata in capital cities (2020-2022), with coverage estimates and 95% confidence intervals (95%CI), the factor analysis was performed using the prevalence ratio (PR) by means of Poisson regression. RESULTS: Among 31,001 children, hepatitis A coverage was 88.1% (95%CI 86.8;89.2). Regarding socioeconomic strata (A/B), the variable immigrant parents/guardians was associated with non-vaccination (PR = 1.91; 95%CI 1.09;3.37); in strata C/D, children of Asian race/skin color (PR = 4.69; 95%CI 2.30;9.57), fourth-born child or later (PR = 1.68; 95%CI 1.06;2 .66), not attending daycare/nursery (PR = 1.67; 95%CI 1.24;2.24) and mother with paid work (PR = 1.42; 95%CI 1.16;1.74) were associated with non-vaccination. CONCLUSION: Hepatitis A coverage was below the target (95%), suggesting that specificities of social strata should be taken into consideration. MAIN RESULTS: Hepatitis A vaccination coverage was 88%. Non-vaccination was greater in children with immigrant guardians (strata A/B); of Asian race/skin color, fourth-born child or later, those not attending daycare/nursery and mother with paid work (C/D strata). IMPLICATIONS FOR SERVICES: The results of this study contributed to the Ministry of Health and Health Departments in monitoring vaccination coverage and identifying factors that may negatively impact hepatitis A vaccination coverage. PERSPECTIVES: Further research is needed on the impact of migration on hepatitis A vaccination and vaccination in general. Health managers should be attentive to the different factors affecting vaccination among social strata.

Vaccination coverage and delay in vaccination of infants born in 2017 and 2018 in municipalities in the Southern region of Brazil: National Vaccination Coverage Survey 2020.

OBJECTIVE: To evaluate vaccination coverage and delay in vaccine dose administration in infants in six municipalities in the Southern region of Brazil. METHODOLOGY: National Vaccination Coverage Survey 2020, with infants born alive in 2017 and 2018, carried out from September 2020 to March 2022. Coverage of doses administered, doses administered on time and delay in dose administration were evaluated. RESULTS: For 4681 infants analyzed, coverage for vaccines recommended up to 24 months was 68.0% (95%CI 63.9;71.8%) for doses administered and 3.9% (95%CI 2.7%;5.7%) for doses administered on time. Delay time for the majority of late vaccinations was ≤ 3 months. For some boosters, 25% of vaccine administration was delayed by ≥ 6 months. CONCLUSION: In addition to tracking vaccine defaulters, strategies are needed to encourage compliance with the vaccination schedule at the recommended ages. MAIN RESULTS: Vaccination coverage for the set of vaccines recommended up to 24 months was 68.0% and 3.9% for on-time doses. Delay time for some doses exceeded six months in up to 25% of infants with delayed vaccination. IMPLICATIONS FOR SERVICES: Monitoring vaccine administration at the recommended ages is necessary, with the adoption of strategies that reinforce routine vaccination to prevent vaccination delays and abandonment. PERSPECTIVES: Primary care in surveillance and care for infants needs to reinforce actions to ensure timely vaccination. Studies to deepen knowledge of vaccination delay, determinants and strategies for their reduction are necessary.

Reliability of information recorded on the National Immunization Program Information System.

OBJECTIVE: To analyze the reliability of records held on the National Immunization Program Information System (SI-PNI) in a subsample of children included in the national vaccination coverage survey in Brazilian state capitals and Federal District in 2020. METHODS: This was a study of agreement between data recorded on vaccination cards (doses and dates) and on the SI-PNI for 4050 children with full coverage at 24 months. RESULTS: Data on 3587 children were held on the SI-PNI, with losses of 11% (95%CI: 10;12). Total agreement between doses and dates in the two sources was 86% (95%CI: 86;87), however taking each dose and vaccine individually, variation was greater, with 32% of data in only one source. CONCLUSION: Part of the information was not recorded, but the discrepancy can be considered small. Nonetheless, underrecording of doses and children can compromise vaccination coverage estimates, altering the numerator and denominator data. MAIN RESULTS: Subsample of 4,050 children, among those completing the full schedule at 24 months studied in the national survey, 11% had not been recorded on the SI-PNI, 32% had unrecorded doses (doses or dates) and there was 8% disagreement between vaccination cards and SI-PNI records. IMPLICATIONS FOR SERVICES: Recognizing the difficulties faced by the SI-PNI and the discrepancies between sources is essential for adopting initiatives to improve data quality, so as to avoid inaccurate estimates of childhood vaccination coverage. PERSPECTIVES: This study is expected to contribute to improving the quality of records and the usability of data for monitoring vaccination coverage of the immunization program from the local to the national level.

Vaccination coverage survey by social stratum in children up to 24 months of age in Londrina, Paraná, Brazil, between 2021 and 2022.

OBJECTIVE: To analyze vaccination coverage according to social strata in children up to 24 months old, living in the municipality of Londrina (PR), Brazil. METHODS: This was a population-based survey conducted between 2021 and 2022, in which vaccination coverage and sociodemographic aspects of mothers and families were evaluated using Pearson's chi-square test. RESULTS: In a sample of 456 children, complete vaccination coverage varied according to social strata, being 36.0% (95%CI 26.8;57.8); in stratum A; 59.5% (95%CI 26.1;86); in stratum B; 66.2% (95%CI 51.7;78.1); in stratum C; and 70.0% (95%CI 56.1;81.0) in stratum D. CONCLUSION: The analysis of vaccination coverage indicated that social stratum A is at highest risk for vaccine-preventable diseases. MAIN RESULTS: The results of the study showed low full vaccination coverage in children up to 24 months of age in Londrina, being higher in the less financially advantaged social stratum, compared to the most advantaged. IMPLICATIONS FOR SERVICES: The results found can support the qualification of the immunization program and enable, based on planning and ongoing health education, the definition of unique strategies to improve vaccination coverage. PERSPECTIVES: Future perspectives point to the importance of carrying out investigations into the challenges inherent to vaccination, as well as qualitative and quantitative research addressing health professionals to better understand the data.

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.

Vaccination coverage and delay in vaccination of infants born in 2017 and 2018 in municipalities in the Southern region of Brazil: National Vaccination Coverage Survey 2020 / Cobertura vacunal y retraso en la vacunación de lactantes nacidos en 2017 y 2018 en municipios de la región Sur de Brasil: Encuesta Nacional de Cobertura de Vacunación 2020 / Cobertura vacinal e atraso na vacinação de lactentes nascidos em 2017 e 2018 em municípios da região Sul do Brasil: Inquérito Nacional de Cobertura Vacinal

ABSTRACT Objective To evaluate vaccination coverage and delay in vaccine dose administration in infants in six municipalities in the Southern region of Brazil. Methodology National Vaccination Coverage Survey 2020, with infants born alive in 2017 and 2018, carried out from September 2020 to March 2022. Coverage of doses administered, doses administered on time and delay in dose administration were evaluated. Results For 4681 infants analyzed, coverage for vaccines recommended up to 24 months was 68.0% (95%CI 63.9;71.8%) for doses administered and 3.9% (95%CI 2.7%;5.7%) for doses administered on time. Delay time for the majority of late vaccinations was ≤ 3 months. For some boosters, 25% of vaccine administration was delayed by ≥ 6 months. Conclusion In addition to tracking vaccine defaulters, strategies are needed to encourage compliance with the vaccination schedule at the recommended ages.

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RESUMO Objetivo Avaliar as coberturas vacinais e o atraso nas doses de vacinas em lactentes em seis municípios da região Sul do Brasil. Metodologia Inquérito Nacional de Cobertura Vacinal 2020, com lactentes nascidos vivos em 2017 e 2018, realizado entre setembro de 2020 e março de 2022. Foram avaliadas as coberturas de doses aplicadas, doses em dia e o tempo de atraso da aplicação. Resultados Para 4.681 lactentes analisados, as coberturas para vacinas indicadas até os 24 meses foram de 68,0% (IC95% 63,9;71,8) para doses aplicadas e 3,9% (IC95% 2,7;5,7) para doses em dia. A maioria das aplicações em atraso foi ≤ 3 meses. Para alguns reforços, 25% das aplicações atrasaram ≥ 6 meses. Conclusão Além da busca de faltosos às vacinas, são necessárias estratégias para estímulo ao cumprimento do esquema de vacinação nas idades preconizadas.

Hepatitis A vaccination coverage survey in 24-month-old children living in Brazilian capitals, 2020 / Encuesta de cobertura de vacunación contra la hepatitis A en niños de 24 meses residentes en las capitales de Brasil, 2020 / Inquérito de cobertura vacinal da hepatite A em crianças de 24 meses de idade residentes em capitais do Brasil, 2020

ABSTRACT Objective To estimate hepatitis A vaccination coverage in 24-month-old children and identify factors associated with non-vaccination. Methods This was a survey involving a sample stratified by socioeconomic strata in capital cities (2020-2022), with coverage estimates and 95% confidence intervals (95%CI), the factor analysis was performed using the prevalence ratio (PR) by means of Poisson regression. Results Among 31,001 children, hepatitis A coverage was 88.1% (95%CI 86.8;89.2). Regarding socioeconomic strata (A/B), the variable immigrant parents/guardians was associated with non-vaccination (PR = 1.91; 95%CI 1.09;3.37); in strata C/D, children of Asian race/skin color (PR = 4.69; 95%CI 2.30;9.57), fourth-born child or later (PR = 1.68; 95%CI 1.06;2 .66), not attending daycare/nursery (PR = 1.67; 95%CI 1.24;2.24) and mother with paid work (PR = 1.42; 95%CI 1.16;1.74) were associated with non-vaccination. Conclusion Hepatitis A coverage was below the target (95%), suggesting that specificities of social strata should be taken into consideration.

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RESUMO Objetivo Estimar a cobertura vacinal da hepatite A em crianças de 24 meses e identificar fatores associados à ausência de vacinação. Métodos Inquérito em amostra estratificada por estratos socioeconômicos em capitais (2020-2022), com estimativa de cobertura e intervalos de confiança de 95% (IC95%) e análise de fatores pela razão de prevalência (RP) via regressão de Poisson. Resultados Nas 31.001 crianças, a cobertura da hepatite A foi de 88,1% (IC95% 86,8;89,2). Nos estratos socioeconômicos (A/B), a variável pais/responsáveis imigrantes foi associada à ausência de vacinação (RP = 1,91; IC95% 1,09;3,37); nos estratos C/D, crianças de cor amarela (RP = 4,69; IC95% 2,30;9,57), 4ª ordem de nascimento ou mais (RP = 1,68; IC95% 1,06;2,66), não frequentar creche/berçário (RP = 1,67; IC95% 1,24;2,24) e mãe com trabalho remunerado (RP = 1,42; IC95% 1,16;1,74) foram associadas à ausência de vacinação. Conclusão Cobertura da hepatite A abaixo da meta (95%), sugerindo-se considerar especificidades dos estratos sociais.

Vaccination coverage survey by social stratum in children up to 24 months of age in Londrina, Paraná, Brazil, between 2021 and 2022 / Encuesta de cobertura vacunal según estrato social en niños de hasta 24 meses de vida, en Londrina, Paraná, entre 2021 y 2022 / Inquérito de cobertura vacinal segundo estrato social em crianças até 24 meses de vida, em Londrina, Paraná, entre 2021 e 2022

ABSTRACT Objective To analyze vaccination coverage according to social strata in children up to 24 months old, living in the municipality of Londrina (PR), Brazil. Methods This was a population-based survey conducted between 2021 and 2022, in which vaccination coverage and sociodemographic aspects of mothers and families were evaluated using Pearson's chi-square test. Results In a sample of 456 children, complete vaccination coverage varied according to social strata, being 36.0% (95%CI 26.8;57.8); in stratum A; 59.5% (95%CI 26.1;86); in stratum B; 66.2% (95%CI 51.7;78.1); in stratum C; and 70.0% (95%CI 56.1;81.0) in stratum D. Conclusion The analysis of vaccination coverage indicated that social stratum A is at highest risk for vaccine-preventable diseases.

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RESUMO Objetivo Analisar a cobertura vacinal segundo estrato social, em crianças até 24 meses de vida, residentes no município de Londrina (PR). Métodos Inquérito de base populacional, realizado entre em 2021 e 2022, em que se avaliou a cobertura vacinal e os aspectos sociodemográficos das mães e das famílias, através do teste qui-quadrado de Pearson. Resultados Em uma amostra de 456 crianças, a cobertura vacinal completa variou de acordo com o estrato social, sendo no estrato A de 36,0% (IC95% 26,8;57,8); no estrato B, de 59,5% (IC95% 26,1;86); no estrato C, de 66,2% (IC95% 51,7;78,1); e no estrato D, de 70,0% (IC95% 56,1;81,0). Conclusão A análise da cobertura vacinal indicou o estrato social A como o de maior risco para doenças prevenidas por vacinas.

Reliability of information recorded on the National Immunization Program Information System / Confiabilidad de la información registrada en el Sistema de Información del Programa Nacional de Imunizaciones / Confiabilidade das informações registradas no Sistema de Informação do Programa Nacional de Imunizações

ABSTRACT Objective To analyze the reliability of records held on the National Immunization Program Information System (SI-PNI) in a subsample of children included in the national vaccination coverage survey in Brazilian state capitals and Federal District in 2020. Methods This was a study of agreement between data recorded on vaccination cards (doses and dates) and on the SI-PNI for 4050 children with full coverage at 24 months. Results Data on 3587 children were held on the SI-PNI, with losses of 11% (95%CI: 10;12). Total agreement between doses and dates in the two sources was 86% (95%CI: 86;87), however taking each dose and vaccine individually, variation was greater, with 32% of data in only one source. Conclusion Part of the information was not recorded, but the discrepancy can be considered small. Nonetheless, underrecording of doses and children can compromise vaccination coverage estimates, altering the numerator and denominator data.

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RESUMO Objetivo Analisar a confiabilidade dos registros no Sistema de Informação do Programa Nacional de Imunizações (SI-PNI) em uma subamostra de crianças incluídas no inquérito nacional de cobertura vacinal nas capitais brasileiras e no Distrito Federal, em 2020. Método Estudo de concordância entre registros nas cadernetas (doses e datas) e no SI-PNI para 4.050 crianças com esquema completo aos 24 meses. Resultados Foram localizados registros de 3.587 crianças no SI-PNI, havendo 11% (IC95%10,0;12,0) de perdas. A concordância total entre doses e datas nas duas fontes foi de 86% (IC95% 86,0;87,0), porém para cada dose e vacina a variação foi maior, com 32% de dados só em uma fonte. Conclusão Parte das informações não vem sendo adequadamente registrada, mas para os dados existentes nas duas fontes a discordância pode ser considerada pequena. O sub-registro de doses e crianças pode comprometer as estimativas de cobertura vacinal, alterando os dados do numerador e do denominador.

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.

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 Health Risk Assessment of Heavy Metals and Metalloids in Herbal Medicines Used to Treat Anxiety: Monitoring of Safety.

The present study estimated the human health risk assessment and daily intake of heavy metals and metalloids in herbal medicines used to treat anxiety in Brazil. Six different brands of herbal medicines were purchased in the city of Campo Grande/MS, Brazil: Pasalix®, Calman®, Serenus®, Maracugina®, Prakalmar® and Calmasyn®. In total, eight elements including As, Ba, Cd, Co, Cr, Cu, Fe, and Pb were analyzed using optical emission spectrometry with inductively coupled plasma (ICP OES). Only the concentration of As in the herbal medicine Prakalmar® is above the values established by United States Pharmacopoeia Convention (USP) and Brazilian Pharmacopoeia (BF) for permitted concentration of elemental impurities in drugs substances. The concentration of Ba, Cd, Co, Cr and Cu in all herbal medicines are lower than the values set by USP and FB. The concentration of Pb in Calman® is lower than the limits established by BF, but higher than those established by USP. Pasalix, Serenus®, Calmasyn®, Prakalmar® and Marcacugina® have a higher Pb concentration than the values allowed by USP and BF. All herbal medications have concentrations within safe ranges for human consumption, with the exception of Calmasyn®, which has Pb over the value defined by USP for oral permissible daily exposure (PDE) for elemental impurities. The values of estimated daily intake (EDI) of metal (loid)s in adults and children obtained from the consumption of the herbal medicines are below the values stipulated by the minimal risk levels (MRLs). All the hazard index (HI) values recorded in this study were below 1. However, monitoring by regulatory agency is necessary, large doses of heavy metal may cause acute or chronic toxicities.

Potential Health Risks of Macro- and Microelements in Commercial Medicinal Plants Used to Treatment of Diabetes.

Information on the content of medicinal plants used in the treatment of diabetes is scarce in the literature. The objectives of this study were to determine the levels of macroelements and microelements in three different medicinal plant species including the dry samples and teas from Bauhinia forficata, Eleusine Indica, and Orthosiphon stamineus and assess the human health risks of ingestion of the tea. The content of the dry samples and teas was obtained using the technique of inductively coupled plasma optical emission spectrometry (ICP OES) after microwave digestion procedure. The hazard quotient (HQ) method was used to access the human health risks posed by heavy metal through tea consumption. The results revealed the presence of K, Mg, Na, P, Al, Fe, Zn, Mn, Cu, Ni, and Se in dry samples and plant teas. The dry plants have high concentration of K and P. All dry plants contain Mg, Na, Al, Fe, Mn, Ni, Zn, and Cu above the limit permissible level set by the World Health Organization (WHO). All the hazard index (HI) values in plant teas were found to be within safe limits for human consumption (HI < 1). The plants may have possible action benefits when used in popular medicine. However, the ingestion through capsules prepared by enclosing a plant powder or teas can be harmful to the health of diabetics. The prescription of this plant for the treatment of diabetes should be treated with caution.

Determination of Macro- and Microelements in the Inflorescences of Banana Tree Using ICP OES: Evaluation of the Daily Recommendations of Intake for Humans.

The inflorescence of Musa paradisiaca, known as "banana heart" is a structure that includes flowers and bracts of banana, commonly used as food source worldwide. The aims of this study were (1) to determine the mineral components of Musa paradisiaca and (2) to compare the obtained results with previously reported data of Recommendation Dietary Allowances (RDAs) and edible plant permissible limits set by FAO/WHO. The samples were digested using microwave-assisted equipment, while elemental contents were determined by inductively coupled plasma optical emission spectroscopy (ICP OES). Metal (Mg, Ca, Cr, Ni, Cu, Fe, and Zn) and nonmetal (S and P) contents were detected. According to RDA, the inflorescences could be excellent sources of Mg, P, Cr, Cu, Zn, and Fe for females, males, and pregnant women, all age 31-50 y, as well as children (4-8 y). Bracts are good source of Zn for male and pregnant women and good source of Fe for children. All the samples contained considerable amounts of Mg, Ca, P, Ni, Cu, Zn, and Fe, which were quite low to induce deleterious effects (UL). FAO/WHO limits for edible plants have not yet been established for S, P, Mg, and Ca, but Ni and Zn are below of those limit values. However, Cr and Cu concentrations are higher than the values established for edible plants and may pose a threat to human health. Farmers should be encouraged by government agencies, not only for sustainability of production but also to ensure the storage and trade of banana tree inflorescence.

The Hazardous Level of Heavy Metals in Different Medicinal Plants and Their Decoctions in Water: A Public Health Problem in Brazil.

The determination of Cd, Co, Cr, Cu, Fe, Na, Zn, and Pb by inductively coupled plasma-optical emission spectrometry (ICP OES) was performed on dry matter and decoctions of the medicinal plants Cordia salicifolia, Chiococca alba (L.) Hitchc., and Echites peltata used as an appetite suppressant and diuretic in Brazil. The accuracy of the measurements was analyzed by the spike recovery test. Results showed that the concentration of these seven metals (Cd, Co, Cr, Cu, Fe, Na, and Zn) in dry plant samples is below the oral concentration of elemental impurities established by the United States Pharmacopoeia Convention (USP). However, there are no concentration limits for Fe, Na, and Zn established by the USP in drug substances and excipients. Levels higher than the recommended value by the USP were observed for Pb and the lowest for Cd, Co, Cr, and Cu, both in dried plant samples and their decoctions. In the decoctions prepared from these plants were found elements such as Cd, Co, Cr, Cu, Fe, Na, Zn, and Pb. In the decoction prepared from 40 g C. salicifolia leaves and 40 g C. alba wood, the content of Cd is above the oral daily exposure value set by the USP. Hazard index (HI) for decoctions prepared from these plants exceeded the threshold (1). Given the uncertainties associated with the estimates of toxicity values and exposure factors, futures researches should address the possible toxicity in humans. Uncontrolled selling and long-term ingestion of medicinal plants can cause toxicity and interfere with the effect of drugs. Limited knowledge on the interaction potential of medicinal plants poses a challenge and public health problem in Brazil and other countries.