Delayed vaccination the children up to 2 years of age.

OBJECTIVE: To analyze factors associated with vaccination delay in children up to 2 years of age. METHODS: Cross-sectional study with primary data from a probabilistic sample of 388 children born in 2015. The data were described using absolute and relative frequencies. For the analysis of factors associated with vaccination delay, Cox proportional risk regression was performed, considering the time from birth to the first vaccination delay as a dependent variable and as sociodemographic, economic, behavioral aspects related to health services as independent variables. RESULTS: The delayed vaccination rate was 88.66%. Variables associated with delayed vaccination were: mother's health problems during delivery or in the first 7 days (HR: 0.68; 95% CI: 0.48-0.96); hospitalization of the child in the first 2 years of life (HR: 1.52; 95% CI: 1.10-2.11); mother's poor bond with health professionals at the health unit (HR: 1.75; 95% CI: 1.01-3.03); purposeful decision to delay or not to vaccinate the child (HR: 1.56; 95% CI: 1.14-2.13). CONCLUSIONS: The factors associated with health care, such as the mother's health problems, the child's hospitalization in the first 2 years of life, and the bond between the mother and the health professionals affect the timeliness of vaccine doses.

COVID-19 outbreak in Brazil: adherence to national preventive measures and impact on people's lives, an online survey.

BACKGROUND: The first case of COVID-19 infection was diagnosed in Brazil 26th February 2020. By March 16th, physical distancing and confinement measures were implemented by the Brazilian government. Little is known about how these measures were followed up by the Brazilian people and their impact on daily routine. METHODS: In early April 2020, using an online platform, we organized an online survey among adults living in Brazil about their COVID-19 preventive behavior and impact on their daily routine. RESULTS: Data from 23,896 respondents were analyzed (mean age: 47.4 years). Due to COVID-19 restrictions, half (51.1%) of the professionals reported working from home. Regular handwashing was practiced by 98.7% of participants; 92.6% reported adhering to the 1.5-2 m physical distancing rule, but only 45.5% wore a face mask when going outside. While 29.3% of respondents found it relatively easy to stay at home, indoor confinement was extremely difficult for 7.9% of participants. Moreover, 11% of participants were extremely worried about their health during the COVID-19 epidemic. Younger people, male, persons living in a rural area/village or popular neighbourhoods, students and workers reported less preventive behaviour. CONCLUSION: Restrictive measures markedly affected the daily and professional routines of Brazilians. Participants showed a satisfactory level of adherence to national COVID-19 prevention guidelines. Qualitative and follow-up studies are needed to monitor the impact of COVID-19 in the Brazilian society.

Factors Associated with the Completeness of the Vaccination Schedule of Children at 12 and 24 Months of Age in a Brazilian Medium-Size Municipality.

PURPOSE: To analyse the factors associated with the completeness of the vaccination schedule of children at 12 and 24 months of age, in a Brazilian municipality. DESIGN AND METHODS: Cross-sectional study conducted in Araraquara-São Paulo with a probabilistic sample of 388 children born in 2015. The completeness of the vaccination schedule at 12 and 24 months of age was considered a dependent variable. Socioeconomic and demographic characteristics, use of health services and vaccination were the independent variables. For analysis, descriptive statistics and Poisson regression with robust variance were used. RESULTS: The completeness of the vaccination schedule at 12 and 24 months of age was identified in 77.1% and 68.8% of children, respectively. Coverage at 12 months was greater among children of mothers who received guidance from health professionals on vaccination or had health problems during childbirth or in the first seven days. Those who reported a previous episode of adverse reaction to the vaccine, coverage was lower. Coverage at 24 months was greater among those who received guidance from health professionals on vaccination or had health problems during childbirth or in the first seven days. Those who reported a previous episode of adverse reaction to the vaccine, coverage was lower. CONCLUSIONS: This study points to the importance of guiding health professionals, particulary nurses, on the vaccination and vaccine safety. CLINICAL IMPLICATIONS: It is necessary the competent act of the health professionals in of immunization programs, as they are able to provide clear and accurate information of the vaccination.

Fertility rates among very young adolescent women: temporal and spatial trends in Brazil.

BACKGROUND: We assessed whether the reported decrease in fertility rates among 15 to 19 years old Brazilian adolescents has met with a parallel decrease in very young adolescent (10 to 14 years old) fertility rates. So we explored temporal trends for fertility rates among very young adolescents between 2000 and 2012 for Brazil as a whole, its regions and states; and also analyzed the spatial distribution of fertility rates among Brazilian municipalities in the years 2000 and 2012. METHODS: We used data from the Information System on Live Births to calculate the rates. To examine the temporal trends, we used linear regression for time series with Prais-Winsten estimation, including the annual percentage change, for the country, regions, and states. To analyze the spatial distribution among Brazilian municipalities, we calculated the Global Moran Index and created a local Moran significance and cluster map through Local Indicators of Spatial Association (LISA). We also elaborated a thematic map with the rates using empirical Bayesian estimation. RESULTS: Brazilian very young adolescent fertility rates remained high and stable throughout the 2000 to 2012 period, and significantly decreased in three out of 26 states, and in the federal district. On the other hand, an increase was observed in two Northern and Northeastern states. The rates were spatially dependent in Brazilian municipalities (Moran Index = 0.22 in 2012; p = 0.05). The maps indicated a heterogeneous distribution of the rates, with high-rate clusters predominant in the North and low-rate clusters predominant in the South, Southeast, and Midwest. CONCLUSIONS: Our findings indicate that Brazilian very young adolescent fertility rates have not decreased in parallel with adolescent fertility rates as they remain high and did not decrease from 2000 and 2012, even though a few states presented a decrease. Thus, these phenomena probably have distinct underlying causes that warrant further elucidation. Progress in this field is crucial for the development of specific policies and programs focused on very young adolescents.

[Hemoglobin curves during pregnancy before and after fortification of flours with iron]. / Curvas de hemoglobina ao longo da gestação antes e após a fortificação de farinhas com ferro.

OBJECTIVE: To assess the level of hemoglobin-Hb during pregnancy before and after fortification of flours with iron. METHOD: A cross-sectional study with data from 12,119 pregnant women attended at a public prenatal from five macro regions of Brazil. The sample was divided into two groups: Before-fortification (birth before June/2004) and After-fortification (last menstruation after June/2005). Hb curves were compared with national and international references. Polynomial regression models were built, with a significance level of 5%. RESULTS: Although the higher levels of Hb in all gestational months after-fortification, the polynomial regression did not show the fortification effect (p=0.3). Curves in the two groups were above the references in the first trimester, with following decrease and stabilization at the end of pregnancy. CONCLUSION: Although the fortification effect was not confirmed, the study presents variation of Hb levels during pregnancy, which is important for assistencial practice and evaluation of public policies.

[Neonatal mortality in infants with low birth weight]. / Mortalidade neonatal em crianças com baixo peso ao nascer.

OBJECTIVE: To evaluate the factors associated with neonatal mortality in infant born with low birth weight. METHOD: Cross-sectional study that analyzed data from 771 live births with low birth weight (<2500 g) in the city of Cuiabá, MT, in 2010, of whom 54 died in the neonatal period. We obtained data from the Information System on Live Births and Mortality, by integrated linkage. RESULTS: In multiple logistic regression, neonatal mortality was associated with: number of prenatal visits less than 7 (OR=3.80;CI:1,66-8,70); gestational age less than 37 weeks (OR=4.77;CI:1.48-15.38), Apgar score less than 7 at the 1st minute (OR=4.25;CI:1.84-9.81) and the 5th minute (OR=5.72,CI:2.24-14.60) and presence of congenital anomaly (OR=14.39;IC:2.72-76.09). CONCLUSION: Neonatal mortality in infants with low birth weight is associated with avoidable factors through adequate attention to prenatal care, childbirth and infants.

Molecular detection of Toxoplasma gondii and Neospora caninum in seabirds collected along the coast of Santa Catarina, Brazil.

Toxoplasma gondii and Neospora caninum are two closely related protozoans that infect a wide range of animals, including birds. However, the occurrence of N. caninum and T. gondii in seabirds is unknown. Therefore, this study aimed to determine the presence of T. gondii and N. caninum DNA in tissue samples of seabirds. Tissue samples of the pectoral muscles, heart, and brain were collected from 47 birds along the coastline of Santa Catarina State, SC, Brazil. The DNA was extracted from the tissues and screened using nested-PCR (nPCR) targeting internal transcribed spacer 1 (ITS1). T. gondii DNA was detected in tissues from seven seabirds (7/47, 14.8%), kelp gull (Larus dominicanus) (5/21), and Manx shearwater (Puffinus puffinus) (2/8). N. caninum DNA was detected in tissues of nine seabirds (9/47, 19.1%), the kelp gull (L. dominicanus) (4/21), Manx shearwater (P. puffinus) (2/8), neotropic cormorant (Phalacrocorax brasilianus) (1/4), brown booby (Sula leucogaster) (1/5), and white-chinned petrel (Procellaria aequinoctialis) (1/1); however, no co-infection was observed. In conclusion, this study showed the circulation of N. caninum and T. gondii in seabirds along the coastline of Santa Catarina State. Further studies are required to clarify the role of these birds in the epidemiology of neosporosis and toxoplasmosis.

Vaccination coverage of triple viral and poliomyelitis in Brazil, 2011-2021: temporal trend and spatial dependency.

OBJECTIVE: To analyze the coverage of MMR and polio vaccines, the temporal trend and spatial dependence, in children up to one year of age in Brazil, between 2011 and 2021. METHODS: Ecological study with secondary data on vaccination coverage rates, made available by the National Immunization Program Information System. Trend analysis was carried out using the joinpoint method, according to geographic regions, estimating the annual percentage change (APC) and its respective confidence interval (95%CI). Choropleth maps of distribution by health region were constructed and, subsequently, the spatial dependence was verified using Moran's statistics. RESULTS: Between 2011 and 2021, vaccination coverage declined in Brazil, both for MMR (APC: -6.4%; 95%CI -9.0; -3.8) and for poliomyelitis (APC: -4. 5%; 95%CI -5.5; -3.6). There was a decline in coverage of both vaccines in all geographic regions over the years of the study, except in the South and Midwest for the MMR vaccine. Since 2015, few health regions in the country have achieved adequate vaccination coverage (≥95.0% to <120.0%). The North and Northeast health regions showed low-low clusters in the univariate analysis for both immunobiological. CONCLUSIONS: It is urgent to consider studies like this one for the planning of more effective strategies for immunizing children, especially in areas with higher falls. In this way, barriers to access to immunization can be broken, given Brazil's heterogeneity, and access to reliable information that increases confidence in vaccine efficacy can be expanded.

Associated factors with vaccine hesitancy in mothers of children up to two years old in a Brazilian city.

This study aims to evaluate maternal vaccine hesitancy and its associated factors. This is a cross-sectional study of a probabilistic sample of 450 mothers of children born in 2015, living in a Brazilian city, and who was, at the time of data collection, more than two years old. We used the tool proposed by the World Health Organization (10-item Vaccine Hesitancy Scale). To assess its structure, we performed, exploratory and confirmatory factor analyses. We performed linear regression models to evaluate the factors associated with vaccine hesitancy. The factor analysis showed two components for the vaccine hesitancy scale: lack of confidence in vaccines and risk perception of vaccines. High family income was associated with lower vaccine hesitancy (greater confidence in vaccines and lower risk perception of vaccines), while the presence of other children, regardless of birth order, in the family was associated with lower confidence in vaccines. A good rapport with health professionals, willingness to wait for the vaccination and the getting vaccinated through campaigns were associated with greater confidence in vaccines. The deliberate delay or decision not to vaccinate their children and previous experience with adverse reactions to the vaccine were associated with lower confidence in vaccines and greater risk perception of vaccines. Health care providers, especially nurses, play a relevant role to address vaccine hesitancy, guiding vaccination through a trustworthy rapport.

Beyond access to medication: the role of SUS and the characteristics of HIV care in Brazil.

OBJECTIVE: To estimate the public-private composition of HIV care in Brazil and the organizational profile of the extensive network of public healthcare facilities. METHODS: Data from the Qualiaids-BR Cohort were used, which gathers data from national systems of clinical and laboratory information on people aged 15 years or older with the first dispensation of antiretroviral therapy between 2015-2018, and information from SUS healthcare facilities for clinical-laboratory follow-up of HIV, produced by the Qualiaids survey. The follow-up system was defined by the number of viral load tests requested by any SUS healthcare facility: follow-up in the private system - no record; follow-up at SUS - two or more records; undefined follow-up - one record. SUS healthcare facilities were characterized as outpatient clinics, primary care and prison system, according to the respondents' self-classification in the Qualiaids survey (72.9%); for non-respondents (27.1%) the classification was based on the terms present in the names of the healthcare facilities. RESULTS: During the period, 238,599 people aged 15 years or older started antiretroviral therapy in Brazil, of which 69% were followed-up at SUS, 21.7% in the private system and 9.3% had an undefined system. Among those followed-up at SUS, 93.4% received care in outpatient clinics, 5% in primary care facilities and 1% in the prison system. CONCLUSION: In Brazil, antiretroviral treatment is provided exclusively by SUS, which is also responsible for clinical and laboratory follow-up for most people in outpatient clinics. The study was only possible because SUS maintains records and public information about HIV care. There is no data available for the private system.

Epidemiology of monkeypox notifications in the state of Minas Gerais, Brazil.

OBJECTIVES: to describe the epidemiological profile of suspected, confirmed, and probable cases of monkeypox in the state of Minas Gerais, Brazil. METHODS: a descriptive, retrospective study of reported suspected, confirmed, and probable cases of monkeypox infection in the state of Minas Gerais, Brazil. The study period was from the first notification, on June 11, to September 7, 2022. RESULTS: a total of 759 suspected, confirmed, and probable cases of monkeypox infection were reported, with 35.44% suspected, 53.75% confirmed, and 10.81% probable cases, respectively. As for the coexisting diseases within confirmed cases, 38.79% were related to people living with human immunodeficiency virus, and 13.74% had some active sexually transmitted infection. Regarding the evolution of confirmed cases, 47.43% were cured. CONCLUSIONS: the results contribute to greater knowledge and control of the infection by allowing better disease management and care offered in health services.

Profile of the cohort of people being treated for HIV infection in the SUS, Brazil, 2015-2018.

OBJECTIVE: To build an integrated database of individual and service data from the cohort of people who started antiretroviral therapy (ART), from 2015 to 2018, in Brazil. METHODS: Open cohort study that includes people aged 15 years or older who started ART from 2015 to 2018, with follow-up in services of the Brazilian Unified Health System (SUS), and who responded to the 2016/2017 Qualiaids national survey. The source of individual data was the related HIV database, derived from the probabilistic linkage between data from the SUS systems of diagnostic information, medication, tests, and deaths. The data source for the services was the services' response database to the Qualiaids survey. After analysis of consistency and exclusions, the database of individuals was deterministically related to the database of services. RESULTS: The cohort comprised 132,540 people monitored in 941 SUS services. Of these services, 59% are located in the Southeast region and 49% followed 51 to 500 cohort participants. The average performance of organization and management of patient care ranged from 29% to 75%. Most of the cohort participants are male, black and mixed, aged between 20 and 39 years old, and have between 4 and 11 years of schooling. Median baseline T-CD4 was 419 cells/mm3, 6% had an episode of tuberculosis, and 2% died of HIV disease. CONCLUSION: For the first time in Brazil, this cohort provides the opportunity for a joint analysis of individual factors and services in the production of positive and negative clinical outcomes of HIV treatment.

Vaccination against poliomyelitis in Brazil from 2011 to 2021: successes, setbacks, and challenges ahead. / Vacinação contra poliomielite no Brasil de 2011 a 2021: sucessos, reveses e desafios futuros.

The drop in childhood vaccination coverage (VC), including poliomyelitis, has become a health concern. The objective was to analyze the temporal trend of coverage of the three doses of the polio vaccine in the first 12 months of life between 2011 and 2021, in addition to mapping vaccination coverage in Brazil, including the COVID-19 pandemic period. An ecological study was carried out using interrupted time series (STI) techniques and spatial analysis, with data from the National Immunization Program Information System. The VC trend was adjusted by the Newey-West variance estimator according to the federated units and the Brazilian Deprivation Index. The VC distribution was estimated by Bayesian models and the spatial clusters by the global and local Moran index, identifying areas of lower coverage in the health regions. There was a reduction in the VC over the period in all regions, being more pronounced in the North and Northeast regions and during the Covid-19 pandemic. The biggest drops were identified in states and health regions with greater social vulnerability after 2019. The drop in VC shows that the risk of reintroduction of the wild virus is imminent and the challenges need to be faced with the strengthening of the Brazilian Health System (SUS).

A queda de coberturas vacinais (CV) na infância, entre elas a da poliomielite, vem se tornando uma preocupação sanitária. O objetivo foi analisar a tendência temporal das coberturas das três doses da vacina contra a poliomielite nos primeiros 12 meses de vida entre 2011 e 2021, com destaque na pandemia de COVID-19, além de mapear as CV no Brasil. Foi realizado um estudo ecológico com técnicas de série temporal interrompida (STI) e análise espacial, a partir dos dados do Sistema de Informação do Programa Nacional de Imunização. A tendência da CV foi ajustada pelo estimador de variância de Newey-West, segundo as unidades federadas e o Índice de Privação Brasileiro. A distribuição da CV foi estimada por modelos bayesianos e os aglomerados espaciais pelos índices de Moran global e local, identificando áreas de menor cobertura nas Regiões de Saúde. Observa-se perda da CV ao longo do período em todas as regiões do país, sendo maiores no Norte e no Nordeste e se acentuando durante a pandemia. As maiores quedas foram identificadas em estados e regiões de saúde com maior vulnerabilidade social. A queda na CV mostra que o risco de reintrodução do vírus selvagem é iminente e os desafios precisam ser enfrentados com o fortalecimento do Sistema Único de Saúde.

Measles vaccination in Brazil: where have we been and where are we headed? / Vacinação do sarampo no Brasil: onde estivemos e para onde vamos?

The re-emergence of vaccine-preventable diseases due to the decline in vaccine coverage (VC) has been documented in several countries. The objective was to analyze the VC, the homogeneity of VC, and measles cases in Brazil from 2011 to 2021, focusing on the period of the COVID-19 pandemic, its temporal trend, space-time distribution, and factors associated with clusters of lower VC. This is an ecological study on measles VC (dose 1), with methods of interrupted time series and evaluation of spatio-temporal disposition, through the sweep test to identify clusters of VC. Starting in 2015, we observe a progressive decline in VC and homogeneity, with an accentuation after 2020, in all regions, particularly in the North and Northeast. Low VC clusters were associated with worse human development indicators, social inequality, and less access to the Family Health Strategy. In Brazil, the pandemic intensified health inequalities with low VC of measles in socially more vulnerable and unequal municipalities. There is a risk of virus circulation, however, the challenge of strengthening primary care, improving health communication and guaranteeing access to the vaccine, reducing missed opportunities for vaccination and vaccine hesitancy, is highlighted.

A reemergência de doenças imunopreveníveis devido à queda das coberturas vacinais (CV) tem sido documentada em vários países. O objetivo foi analisar a CV, a homogeneidade das CV e os casos de sarampo no Brasil de 2011 a 2021, com enfoque no período da pandemia de COVID-19, sua tendência temporal, distribuição espaço-temporal e fatores associados aos aglomerados de menor CV. Trata-se de um estudo ecológico sobre a CV de sarampo (dose 1), com métodos de série temporal interrompida e de avaliação da disposição espaço-temporal, por meio do teste de varredura na identificação de aglomerados de CV. A partir de 2015, observa-se queda progressiva das CV e da homogeneidade, acentuando-se após 2020 em todas as regiões, particularmente Norte e Nordeste. Aglomerados de baixa CV foram associados a piores indicadores de desenvolvimento humano, desigualdade social e menor acesso à Estratégia de Saúde da Família. No Brasil, a pandemia intensificou as iniquidades em saúde, com baixas CV de sarampo em municípios socialmente mais vulneráveis e desiguais. Há risco de circulação do vírus, reafirmando o desafio de fortalecer a atenção básica, aprimorar a comunicação em saúde e garantir acesso à vacina, diminuindo oportunidades perdidas de vacinação e a hesitação vacinal.

Detection of Toxoplasma gondii DNA in milk of dairy cows from southern Brazil.

Consumption of unpasteurized cow's milk may be a transmission route for some pathogenic microorganisms, but there is little information about the risk of Toxoplasma gondii infection. Blood and milk samples were collected in a paired and random fashion from 106 dairy cows and bulk-tank milk samples were also collected from each of the six farms, in southern Brazil. Serum anti-T.gondii antibodies (IgG) were detected by an indirect fluorescent antibody test (IFAT) with a cutoff point of 1:64. Nested PCR targeting the ITS1 was performed on milk samples to detect the Sarcocystidae family, confirmed to be T.gondii by Sanger sequencing. The occurrence of anti-T.gondii antibodies in the herds was 14.1%, (15/106) with seropositive cows in all herds. Antibody titers in positive samples ranged from 64 to 128. T.gondii DNA was detected in 2.8% (03/106) of the milk samples. The ITS1 sequences generated in this study were ON809793 - ON809794 and the sequencing revealed 98-100% identity with T. gondii DNA sequences deposited in GenBank. All cows PCR positive for T.gondii in milk were negative for IgG antibodies in serum, suggesting that naturally infected cows may shed T. gondii in milk in the acute phase of infection. The results of this study demonstrate that T. gondii DNA may be detected in raw cow's milk, so the potential risks of lactogenic infection should be considered. The presence of T. gondii DNA in milk does not confirm that the protozoa are viable and infective, and further investigations into the role of cow's milk in the epidemiology of toxoplasmosis are needed.

Municipality-level measles, mumps, and rubella (MMR) vaccine coverage and deprivation in Brazil: A nationwide ecological study, 2006 to 2020.

To better understand the declining rates of routine childhood vaccination in Brazil, we investigated the association between measles, mumps, and rubella (MMR) first dose vaccine coverage and deprivation at the municipality level. Using routinely collected data from 5565 Brazilian municipalities from 2006 to 2020, we investigated the association between municipality-level MMR vaccine first dose coverage (i.e., as a continuous variable and as a percentage of municipalities attaining the 95% target coverage) in relation to quintiles of municipality-level deprivation, measured by the Brazilian Deprivation Index (Índice Brasileiro de Privação, IBP), and geographic regions. From 2006 to 2020, the mean municipality-level MMR vaccine coverage declined across all deprivation quintiles and regions of Brazil, by an average of 1.2% per year. The most deprived quintile of municipalities had higher coverage on average, but also the steepest declines in coverage (i.e., an annual decline of 1.64% versus 0.61% in the least deprived quintile) in the period of 2006-2020, and the largest drop in coverage at the beginning of the COVID-19 pandemic (2019-2020). Across all deprivation quintiles and regions (except for the Southeast region), less than 50% of municipalities in Brazil met the 95% MMR coverage target in 2020.The decrease in MMR first dose vaccine coverage in Brazil is widespread, but steeper declines have been observed in the most deprived municipalities. To promote vaccine equity and prevent future outbreaks, further research is urgently needed to understand the causal mechanisms underlying the observed associations between municipality-level MMR vaccine coverage and deprivation.

Seroprevalence of SARS-CoV-2 antibodies in schoolchildren in the city of São Paulo, 2020.

OBJECTIVE: To estimate seroprevalence of SARS-CoV-2 antibodies in schoolchildren aged 4 to 14 years living in the city of São Paulo, according to clinical, demographic, epidemiological, and social variables, during the school closure period as a measure against covid-19 spread. METHODS: A serological survey was made in September 2020 with a random sample stratified by school system (municipal public, state public and private) type. A venous blood sample was collected using the Wondfo SARS-CoV-2 Antibody Test (lateral flow method) for detection of total SARS-CoV-2 virus antibodies. Semi-structured questionnaires were applied to collect clinical, demographic, social, and epidemiological data. RESULTS: Seroprevalence of SARS-CoV-2 antibodies in schoolchildren was of 16.6% (95%CI 15.4-17.8). The study found higher seroprevalence in the municipal (18.5%; 95%CI 16.6-20.6) and state (16.2%; 95%CI 14.4-18.2) public school systems compared to the private school system (11.7; 95%CI 10.0-13.7), among black and brown students (18.4%; 95%CI 16.8-20.2) and in the most vulnerable social stratum (18.5 %;95%CI 16.9-20.2). Lower seroprevalence was identified in schoolchildren who reported following the recommended protective measures against covid-19. CONCLUSION: Seroprevalence of SARS-CoV-2 antibodies is found mainly in the most socially vulnerable schoolchildren. This study can contribute to support public policies that reinforce the importance of suspending face-to-face classes and developing strategies aimed at protective measures and monitoring of the serological status of those who have not yet been included in the vaccination schedule.

Effect of a conditional cash transfer programme on infant up-to-date and timely vaccination.

BACKGROUND: Conditional cash transfer (CCT) programmes are one of the strategies to increase vaccination coverage among underprivileged families by conditioning cash transfer to the up-to-date immunisation of children. However, there are gaps in knowledge of its impact on vaccination at the recommended age (timely). METHODS: We performed two cross-sectional analyses of secondary data from a retrospective cohort, at the landmark ages of 12 and 24 months, to assess the effect of the Brazilian CCT on the up-to-date and timely vaccination in children born between 2014 and 2016 and resident in the city of Araraquara, São Paulo (Southeast Brazil). The Propensity Score Matching (PSM) was used to balance two pre-defined groups (beneficiaries and non-beneficiaries) according to the profile of socioeconomic and demographic characteristics. RESULTS: From a total of 7386 children within the cohort, 22.2% (1636) were from beneficiary families of the CCT. After the pairing by PSM, the final sample size included in the analyses was 1440 for each group. We found higher up-to-date vaccination coverage, at 12 (92.1%, 95% CI=90.6% to 93.5%) and 24 months (83.8%, 95% CI=81.8% to 85.7%), among the CCT beneficiaries compared with the non-beneficiaries (85.1%, 95% CI=83.2% to 86.9% at 12 months and 73.6%, 95% CI=71.2% to 75.8% at 24 months). The coverage of timely vaccination did not statistically differ between beneficiaries (41.5%, 95% CI=38.9% to 44.1% and 17.4%, 95% CI=15.4% to 19.4%) and non-beneficiaries (40.7%, 95% CI=38.1% to 43.3% and 17.1%, 95% CI=15.2% to 19.1%) at 12 and 24 months, respectively. CONCLUSION: The study highlights a positive effect of the CCT on vaccination coverage of the up-to-date infant vaccination schedule. However, there was no difference in timely vaccination.

Correction: Reasons for nonadherence to vaccination for influenza among older people in Brazil.

[This corrects the article DOI: 10.1371/journal.pone.0259640.].

Molecular characterization of Sarcocystis spp. in seabirds from southern Brazil.

Sarcocystis spp. are cyst forming apicomplexan parasites that infect many vertebrates including birds. Sarcocystis spp. infection was investigated in tissue samples (pectoral muscles, heart, and brain) of 47 dead seabirds collected from the coastline of Santa Catarina State SC - Brazil, between August 2019 and March 2020. A portion of each tissue was fixed in 10% buffered formalin for histopathologic analysis while DNA was extracted from another portion and screened using nested-PCR targeting ITS1. Based on molecular analysis, Sarcocystis spp. were identified in 15/47 (31.9%) seabirds of five species, kelp gull (Larus dominicanus), manx shearwater (Puffinus puffinus), neotropic cormorant (Phalacrocorax brasilianus), brown booby (Sula leucogaster) and great skua (Stercorarius skua). Microscopically visible sarcocysts were observed only in the pectoral muscle of four seabirds 8.5% (4/47), while in one brown booby, sarcocysts were seen in both pectoral and cardiac muscles. Two types of sarcocysts, thin walled (≤1 µm) and thick-walled (≥ 2 µm) were identified. Based on ITS1 sequence comparison, S. halieti, S. falcatula and three not yet described Sarcocystis spp. were detected. Phylogenetically, S. falcatula isolates were classified as two distinct clusters. This is the first confirmation of S. halieti in seabird's species in South America and S. falcatula in birds of the order Charadriiformes. Further molecular studies are needed to understand the epidemiology of the Sarcocystis spp. infection and its impact on the health of seabirds.