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.

Zika Brazilian Cohorts (ZBC) Consortium: Protocol for an Individual Participant Data Meta-Analysis of Congenital Zika Syndrome after Maternal Exposure during Pregnancy.

Despite great advances in our knowledge of the consequences of Zika virus to human health, many questions remain unanswered, and results are often inconsistent. The small sample size of individual studies has limited inference about the spectrum of congenital Zika manifestations and the prognosis of affected children. The Brazilian Zika Cohorts Consortium addresses these limitations by bringing together and harmonizing epidemiological data from a series of prospective cohort studies of pregnant women with rash and of children with microcephaly and/or other manifestations of congenital Zika. The objective is to estimate the absolute risk of congenital Zika manifestations and to characterize the full spectrum and natural history of the manifestations of congenital Zika in children with and without microcephaly. This protocol describes the assembly of the Consortium and protocol for the Individual Participant Data Meta-analyses (IPD Meta-analyses). The findings will address knowledge gaps and inform public policies related to Zika virus. The large harmonized dataset and joint analyses will facilitate more precise estimates of the absolute risk of congenital Zika manifestations among Zika virus-infected pregnancies and more complete descriptions of its full spectrum, including rare manifestations. It will enable sensitivity analyses using different definitions of exposure and outcomes, and the investigation of the sources of heterogeneity between studies and regions.

Reanálise da vacina tetravalente (RRV-TV) no contexto da prevenção das gastrenterites por rotavírus / Review of a tetravalent vaccine (RRT-TV) for prevention of gastroenteritis caused by rotavirus

Os rotavírus são considerados a principal causa de gastrenterite grave em crianças abaixo de cinco anos, principalmente nos países em desenvolvimento. A vacinação nos primeiros meses de vida se constitui na medida mais efetiva em saúde pública para o controle e prevenção das infecções por tais agentes. Não obstante o recente licenciamento de duas vacinas para uso corrente em lactentes (Rotarix® e RotaTeq®), as pesquisas prosseguem com novas alternativas de prevenção e tratamento. Neste contexto, procedeu-se à reanálise da Rhesus-Human Reassortant Rotavirus Tetravalent Vaccine (RRV-TV), com ênfase à eficácia clínica frente aos parâmetros clínicos, aos sorotipos mais prevalentes na região, à ocorrência de eventos adversos graves (intussuscepção) e a proteção seletiva aos quadros de maior gravidade. Os dados clínicos e epidemiológicos foram obtidos das fichas clínicas de 91 episódios diarreicos em crianças no âmbito de uma investigação prévia conduzida em Belém, Pará. Foram considerados como indicadores de gravidade, os parâmetros clínicos e um sistema de escores, comumente aplicado aos estudos de eficácia da RRV-TV. Os resultados mais expressivos do estudo, como a significativa proteção (p 14 relacionados ao sorotipo G2, a eficácia de 75 por cento contra os episódios mais graves, são discutidos à luz do contexto atual dos conhecimentos sobre o tema.

Rotaviruses are considered the leading cause of severe gastroenteritis in children under five years of age, especially in developing countries. Vaccination in the first months is the most effective public health action for the control and prevention of infections by such agents. Despite the recent licensing of two vaccines for use in infants (Rotarix® and Rota Teq®), researchers continue to seek new alternatives for prevention and treatment. Herein, we provide a review of the Rhesus-Human Reassortant Rotavirus Tetravalent Vaccine (RRV-TV), with an emphasis on its clinical efficacy as regards clinical parameters, the most prevalent serotypes in the region, the occurrence of severe adverse events (e.g., intussusception), and selective protection in the most severe cases. The clinical and epidemiological data were obtained from medical records pertaining to 91 episodes of diarrhea among children in a previous investigation conducted in Belém, Pará State, Brazil. Clinical patterns and a scoring system commonly used in studies on the efficacy of RRV-TV were considered as indicators of severity. The most impressive results of this study, such as a significant protection (p 14 related to serotype G2, a 75 percent efficacy rate against severe episodes, and the non-occurrence of intussusception, are discussed in the context of current knowledge on this issue.

Molecular characterization of norovirus, sapovirus and astrovirus in children with acute gastroenteritis from Belém, Pará, Brazil / Caracterização molecular de norovírus, sapovírus e astrovírus em crianças com gastroenterite aguda em Belém, Pará, Brasil

The importance of norovirus (NoVs), sapovirus (SaVs) and human astrovirus (HAstVs) as causes of gastroenteritis outbreaks are already well-defined, but a few studies have described sporadic cases of acute gastroenteritis caused by these viral entities. The aim of this study was to determine the role of these viruses in the etiology of acute gastroenteritis in children enrolled to participate in hospital – and emergency department – based intensive surveillance carried out in Belém, Brazil, from March to September 2003. A total of 305 stool specimens from patients with severe gastroenteritis were collected and screened by reverse transcription followed by polymerase chain reaction (RT-PCR), using the specific primers Mon 269 and Mon 270 for HAstVs, p289 and p290 for human calicivirus (HuCVs), and Mon 431/433 and Mon 432/434 for NoVs. Sequencing of RT-PCR HAstV, HuCVs and NoVs amplicons was carried out using the same primers. Of the 305 samples tested, 96 (31.5 percent) were positive, with 51 diagnosed as HuCVs, 40 as HAstVs and five as mixed infections. Of the 56 (18.4 percent) HuCVs sequenced, 30 were NoVs (9.8 percent) of genogroups GI-4 and GII-4, and 15 (4.9 percent) were SaVs of types GI-1, GI-2 and GII-1. HAstVs, including genotypes 1, 8 and 2, were detected in 45 (14.7 percent) samples. This study has highlighted the importance of these viruses as causes of acute gastroenteritis and established the circulation of different genotypes during the study period. These results reinforce the need for establishing an intensive surveillance for gastroenteritis caused by these viruses to assess the burden of disease and to monitor the circulation of genotypes.

A importância dos norovírus (NoVs), sapovírus (SaVs) e astrovírus humanos (HAstVs) como causa de surtos de gastroenteritis já está bem definida. Entretanto, poucos estudos têm descrito casos esporádicos de gastroenterites aguda causados por esses agentes. O objetivo deste estudo foi determinar o papel destes vírus na etiologia da gastroenterite aguda em crianças atendidas durante uma vigilância intensiva realizada em hospitais e ambulatórios de Belém, Brasil, de março a setembro de 2003. Um total de 305 espécimes fecais de pacientes com gastrenterite grave foram coletados e testados por reação em cadeia da polimerase precedida de transcrição reversa (RT-PCR), utilizando iniciadores específicos Mon 269 e Mon 270 para os HAstVs; p289 e p290 para os calicivírus humanos (HuCVs); e Mon 431/433 e Mon 432/434 para os NoVs. Sequenciamento dos amplicons de HAstV, HuCVs e NoVs, obtidos por RT-PCR, foi realizado usando os mesmos iniciadores. Das 305 amostras testadas, 96 (31,5 por cento) apresentaram resultados positivos, sendo que 51 diagnosticadas como HuCVs, 40 como HAstVs e cinco infecções mistas. Das 56 (18,4 por cento) amostras de HuCVs sequenciadas, 30 foram NoVs (9,8 por cento) pertencentes aos genogrupos GI-4 e GII-4, e 15 (4,9 por cento) SaVs dos grupos GI-1, GI-2 e GII-1. HAstVs foram detectados em 45 (14,7 por cento) das amostras, incluindo os genótipos 1, 8 e 2. Esta pesquisa ressalta a importância destas viroses como causa de gastrenterite aguda e demonstra a circulação de diferentes genótipos durante o período de estudo. Estes resultados reforçam a necessidade de se estabelecer uma vigilância intensiva das gastrenterite causadas por estes vírus, de forma a poder avaliar o impacto da doença e monitorar os genótipos circulantes.

Mononucleose infecciosa em crianças e adolescentes de Belém, Pará, Brasil: abordagem clínica e soroepidemiológica / Infection mononucleosis among children and adolescent living in Belem-PA Brasil

Um total de 234 crianças e adolescentes, menores de 16 anos (média de idade = ñ 5,8 anos), com suspeita clínica de mononucleose infecciosa, foi atendido no "Serviço de Virologia Geral" do "Instituto Evandro Chagas (IEC)", no período de junho a dezembro de 1995. As amostras de soro foram testadas quanto à presença de anticorpos das classes IgG e IgM anti-Epstein Barr (EBV), através do procedimento imunoenzimático (ELISA), especificamente contra o antígeno do capsídeo viral (anti-VCA). Para tanto se utilizou o Kit da Clark Laboratories(tm) (Jamestown - NY - EUA). O objetivo deste trabalho foi de estabelecer a frequência de infecçäo primária pelo EBV, avaliando as características clínicas em crianças e adolescentes. Dentre as 234 amostras analisadas a soropositividade em termos de IgG foi de 56 por cento (131/234), sendo que 55 por cento (72/131) e 45 por cento (59/131) eram do sexo masculino e feminino, respectivamente. Em 10,6 por cento (25/234) das crianças e adolescentes com mononucleose infecciosa ativa (presença de anticorpos IgM-EBV), registramos os seguintes achados clínicos: linfadonopatias (76 por cento), febre (68 por cento), erupçäo cutânea (12 por cento) e hepatomegalia (12 por cento). Os resultados indicam que, já aos seis anos de idade, metade das crianças já foram infectadas pelo EBV