A rat model of rheumatoid arthritis: TDZD-8 is associated with the protection against the induction of the synovium knee joint IL-17A/GSK3beta/ROS/alpha-SMA axis of fibrosis / Un modelo de rata de artritis reumatoide: TDZD-8 está asociado con la protección contra la inducción del eje de fibrosis de la articulación sinovial de la rodilla IL-17A/GSK3ß/ROS/α-SMA

SUMMARY: Rheumatoid arthritis (RA) that affects the synovial knee joint causes swelling of the synovial membrane and tissue damage. Interleukin-17A (IL-17A) and the enzyme glycogen synthase kinase-3β (GSK3β) are involved in the pathogenesis of RA. The link between IL-17A, GSK3β, the oxidative stress, and the profibrogenic marker alpha-smooth muscle actin (α-SMA) with and without TDZD-8, GSK3β inhibitor has not been studied before. Consequently, active immunization of rats was performed to induce RA after three weeks using collagen type II (COII) injections. The treated group received daily injection of 1 mg/kg TDZD-8 for 21 days following the immunization protocol (COII+TDZD-8). Blood and synovium tissue samples were harvested at the end of the experiment. RA development was confirmed as corroborated by a substantial increase in blood levels of the highly specific autoantibody for RA, anti-citrullinated protein antibody as well as augmentation of reactive oxidative species (ROS) levels measured as lipid peroxidation. RA induction also increased synovium tissue levels of IL-17A and the profibrogenic marker, α-SMA. All these parameters seemed to be significantly (p<0.0001) ameliorated by TDZD-8. Additionally, a significant correlation between IL-17A, ROS, and α-SMA and biomarkers of RA was observed. Thus, knee joint synovium RA induction augmented IL-17A/GSK3β/ROS/α-SMA axis mediated arthritis in a rat model of RA, which was inhibited by TDZD-8.

La artritis reumatoide (AR) que afecta la articulación sinovial de la rodilla provoca inflamación de la membrana sinovial y daño tisular. La interleucina-17A (IL-17A) y la enzima glucógeno sintasa quinasa-3β (GSK3β) están involucradas en la patogenia de la AR. No se ha estudiadol vínculo entre IL-17A, GSK3β, el estrés oxidativo y el marcador profibrogénico actina de músculo liso alfa (α-SMA) con y sin inhibidor de TDZD-8, GSK3β. En consecuencia, se realizó una inmunización activa de ratas para inducir la AR después de tres semanas usando inyecciones de colágeno tipo II (COII). El grupo tratado recibió una inyección diaria de 1 µg/ kg de TDZD-8 durante 21 días siguiendo el protocolo de inmunización (COII+TDZD-8). Se recogieron muestras de sangre y tejido sinovial al final del experimento. El desarrollo de AR se confirmó como lo corroboró el aumento sustancial en los niveles sanguíneos del autoanticuerpo altamente específico para AR, el anticuerpo antiproteína citrulinada, así como el aumento de los niveles de especies oxidativas reactivas (ROS) medidos como peroxidación lipídica. La inducción de AR también aumentó los niveles de tejido sinovial de IL-17A y el marcador profibrogénico, α-SMA. Todos estos parámetros parecían mejorar significativamente (p<0,0001) con TDZD-8. Además, se observó una correlación significativa entre IL- 17A, ROS y α-SMA y biomarcadores de AR. Por lo tanto, la inducción de AR en la sinovial de la articulación de la rodilla aumentó la artritis mediada por el eje IL-17A/GSK3β/ROS/α-SMA en un modelo de rata de AR, que fue inhibida por TDZD-8.

Vacunación contra el SARS-CoV-2 en el personal de salud / Vaccination against SARS-CoV-2 in health personnel

Introducción: El virus Sars-cov2 es el causante de una enfermedad respiratoria, cuyo grado de severidad es variable, de formas sintomáticas leves a graves. Debido a que no se ha encontrado un tratamiento eficaz para hacerle frente a esta patología, se ha puesto el foco en la prevención mediante vacunas. Una población objetivo de la primera y segunda fase de vacunación a nivel país, fue el personal de salud, por lo que se realiza una encuesta para determinar qué tipo de patologías de base presentan, rango etario predominante, si presentaron algún efecto adverso, y cuántas dosis de inmunización recibieron. Objetivos: Describir el porcentaje de vacunación contra Sars-cov2 en el personal de salud, las enfermedades de base, efectos adversos presentados y describir los motivos por el que se evita la vacunación. Materiales y métodos: Se realizó un estudio descriptivo, observacional y transversal mediante una encuesta en línea (Google Forms). En el cuestionario se registraron las siguientes variables: sexo, edad, profesión dentro del área de salud, departamento de residencia, enfermedad de base, dosis principales y de refuerzo recibidas, efectos adversos presentados, necesidad de atención médica posterior y razones por las que no se han aplicado todas las dosis. Resultados: La mayoría de los encuestados fueron parte del personal médico (85.4%), en su mayoría se encontraban entre los 20-29 años y los 40-49 años. El 48.6% no presenta patologías de base. El 96.3% de la población recibió 2 dosis de la vacuna para Sars-cov2. El 46.3% recibió 2 dosis de refuerzo. Discusión: La predisposición a completar el esquema fue más baja de lo esperado, siendo menor de la mitad. La predisposición para recibir la vacuna contra el COVID-19, en la población general fue de 52,02%. Cabe recalcar que el éxito de un programa de vacunación depende de la proporción de la población que desee vacunarse. Conclusión: La vacunación es un medio de prevención por lo que su promoción es un paso importante para evitar la enfermedad grave. Es necesario realizar una buena educación a toda la población sobre la eficacia, las dosis necesarias para obtener inmunidad, los efectos adversos y los motivos que deben retrasar la colocación de las dosis, porque, como se menciona anteriormente, el éxito de un programa de vacunación depende de la proporción de la población que desee vacunarse.

Introduction: The Sars-cov2 virus is the cause of a respiratory disease, whose degree of severity is variable, from mild to severe symptomatic forms. Since no effective treatment has been found to deal with this pathology, the focus has been on prevention through vaccination. A target population for the first and second phase of vaccination at the country level was health personnel. So a online survey is performed to determine what type of underlying pathologies they present, the age range predominance, the side effects displayed and how many doses they received. Objectives: Describe the percentage of vaccination against Sars-cov2 in health personnel, the underlying diseases, adverse effects and, to describe the reasons why vaccination is avoided. Materials and methods: A descriptive, observational and cross-sectional study is carried out using an online survey (Google Forms). The following variables were recorded in the questionnaire: sex, age, profession within the health area, department of residence, underlying disease, main and booster doses received, adverse effects presented, need for subsequent medical attention and reasons why they did not have been applied all the doses. Results: Most of the respondents were part of the medical staff (85.4%), the majority were between 20-29 years and 40-49 years. The 48.6% do not present basic pathologies. The 96.3% of the population received 2 doses of the Sars-cov2 vaccine. 46.3% received 2 booster doses. Discussion: The predisposition to complete the scheme was lower than expected, being less than a half. The predisposition to receive the COVID-19 vaccine in the general population was 52.02%. It should be emphasized that the success of a vaccination program depends on the proportion of the population that wishes to be vaccinated. Conclusion: Vaccination is a way of prevention, so its promotion is an important step to avoid a serious disease. It is necessary to give a good education to the entire population about the efficacy, the necessary doses to obtain immunity, the adverse effects and the reasons that should delay the doses, because, as mentioned above, the success of a vaccination program depends on the proportion of the population that wants to be vaccinated.

Manual de organización y funciones de la Dirección de Inmunizaciones / Manual of organization and functions of the Directorate of Immunizations

La Dirección de Inmunizaciones, es una dirección especializada del Ministerio de Salud de El Salvador, que tiene asignada la rectoría de todos los aspectos relacionados a la vacunación e inmunización de la población salvadoreña. Esta Dirección es el resultado de una acción conjunta entre los países de la Región de las Américas y de organismos internacionales como la Organización Mundial de la Salud (OMS), su interés es contribuir con acciones tendientes a lograr coberturas universales de vacunación, con el fin de disminuir las tasas de mortalidad y morbilidad causadas por las enfermedades inmunoprevenibles y está sujeta conforme a la Ley de Vacunas. En este sentido y para documentar la organización y funcionamiento de dicha Dirección, se ha elaborado el presente manual como un instrumento técnico normativo de gestión institucional, en el cual se integra la organización y funcionamiento de las diferentes dependencias que lo componen, se describen y establecen los objetivos generales y específicos, las relaciones de autoridad y dependencia de cada ambiente, así como las relaciones de trabajo internas y externas. Tiene el propósito de identificar con claridad las funciones de cada una de las áreas administrativas que la integran, evitar la duplicidad de funciones, conocer las líneas de comunicación y de mando; permitiendo así contar con un instrumento técnico administrativo integrado, que sirva de referencia y consulta a todo el personal laborando en la institución

The Immunization Directorate is a specialized department of the Ministry of Health of El Salvador, who is assigned the rectory of all aspects related to vaccination and immunization of the Salvadoran population. This Address is the result of an action collaboration between the countries of the Region of the Americas and international organizations such as the World Health Organization (WHO), its interest is to contribute with actions aimed at achieving universal vaccination coverage, in order to reduce the rates of mortality and morbidity caused by vaccine preventable diseases and is subject to according to the Vaccination Law. In this sense and to document the organization and operation of said Directorate, has prepared this manual as a regulatory technical management instrument institution, which integrates the organization and operation of the different dependencies that compose it, describe and establish the general objectives and specific, the relationships of authority and dependency of each environment, as well as the internal and external working relationships. Its purpose is to clearly identify the functions of each of the areas that integrate it, avoid duplication of functions, know the lines of communication and command; thus allowing to have a technical administrative instrument integrated, that serves as a reference and consults all the personnel working in the institution

Embarque na residência integrada em saúde: relato de experiências com ênfase em saúde coletiva / Boarding on the integrated health residence: report of experiences with emphasis on public health / Abordaje de la residencia sanitaria integrada: relato de experiencias con énfasis en salud pública

Este trabalho tem o objetivo de relatar a experiência de imersão na especialização com caráter de residência integrada com ênfase em Saúde Coletiva. Trata- se de um estudo descritivo, qualitativo, utilizando-se como referencial teórico para descrição a observação participante, memória afetiva, diário de bordo e da textualização. Foi desenvolvido na Residência Integrada em Saúde, da Escola de Saúde Pública do Estado do Ceará, ênfase em Saúde Coletiva, no período de dois anos, em Fortaleza, Ceará. Os cenários de prática foram setores relacionados à Atenção Primária à Saúde, Vigilância Epidemiológica, Sanitária e Ambiental, Controle de Endemias e Zoonoses, Imunização, além dos espaços de gestão, assistência e controle social. A imersão na especialização em caráter de residência viabilizou ferramentas para a vivência, por meio da interprofissionalidade e integração contínuas, e da realização das atividades, circulação de informações, compreensão das experiências, entendimento de macroprocessos, políticas e indicadores. Rodas de Campo e de Equipe viabilizaram o aprofundamento das temáticas administrativa, formativa, teórica e terapêutica. Percebeu-se resistência e desejo de remodelações, mediante inovação e diálogo intersetorial. A relação entre as categorias profissionais e ser sanitarista foi desafiadora. Oportunizou-se, também, habilidades de gestão, autonomia e governança, com pluralidade formativa e riqueza de atuação. A vivência favoreceu a percepção do programa de residência como processo formativo plural e significativo. O elemento político se destacou como base para a formação dos residentes e fortalecimento do sistema de saúde, e a residência integrada em saúde, como modalidade diferenciada de formação, com desafios e potencialidades.

The object of this study was to report the experience of immersion in the specialization as an integrated residency with emphasis on Public Health. A descriptive, qualitative study, of the experience report type, using participant observation, affective memory, logbook and textualization as theoretical references for description. It was developed in the Integrated Residency in Health, of the School of Public Health. emphasis on Public Health, during two years, in Fortaleza, Ceará, Brazil. The practice scenarios were sectors related to Primary Health Care, Epidemiological, Sanitary and Environmental Surveillance, Endemic and Zoonosis Control, Immunization, in addition to management, assistance and social control spaces. The immersion in the specialization in a residency character has enabled tools for the experience, through continuous interprofessionalism and integration, and the realization of activities, circulation of information, understanding of experiences, understanding of macro processes, policies and indicators. Field and team meetings made it possible to deepen the administrative, formative, theoretical, and therapeutic themes. Resistance and a desire for remodeling was perceived, through innovation and intersectoral dialogue. The relationship between the professional categories and being a sanitarian was challenging. It also provided opportunities for management skills, autonomy, and governance, with formative plurality and richness of action. The experience favored the perception of the residency program as a plural and significant formative process. The political element stood out as the basis for training residents and strengthening the health system, and the integrated health residency as a differentiated training modality, with challenges and potentialities.

El objeto de este estudio fue relatar la experiencia de inmersión en la especialización como residencia integrada con énfasis en Salud Pública. Estudio descriptivo, cualitativo, del tipo relato de experiencias, utilizando la observación participante, la memoria afectiva, la bitácora y la textualización como referentes teóricos para la descripción. Se desarrolló en la Residencia Integrada en Salud, de la Escuela de Salud Pública. énfasis en Salud Pública, durante dos años, en Fortaleza, Ceará, Brasil. Los escenarios de la práctica fueron sectores relacionados con la Atención Primaria de Salud, Vigilancia Epidemiológica, Sanitaria y Ambiental, Control de Endemias y Zoonosis, Inmunización, además de espacios de gestión, asistencia y control social. La inmersión en la especialización en carácter de residencia ha posibilitado herramientas para la experiencia, a través de la continua interprofesionalidad e integración, y la realización de actividades, circulación de información, comprensión de experiencias, entendimiento de macro procesos, políticas e indicadores. Reuniones de campo y de equipo posibilitaron la profundización de los temas administrativos, formativos, teóricos y terapéuticos. Se percibieron resistencias y deseos de remodelación, a través de la innovación y el diálogo intersectorial. La relación entre las categorías profesionales y el ser sanitario fue desafiante. También proporcionó oportunidades para la capacidad de gestión, autonomía y gobernanza, con pluralidad formativa y riqueza de acción. La experiencia favoreció la percepción del programa de residencia como un proceso formativo plural y significativo. Se destacó el elemento político como base para la formación de residentes y fortalecimiento del sistema de salud, y la residencia integrada en salud como modalidad formativa diferenciada, con desafíos y potencialidades.

Modelling COVID-19 vaccination status and adherence to public health and social measures, Eastern Mediterranean Region and Algeria

Objective: To study the link between coronavirus disease 2019 (COVID-19) vaccination status and adherence to public health and social measures in Members of the Eastern Mediterranean Region and Algeria. Methods: We analysed two rounds of a large, cross-country, repeated cross-sectional mobile phone survey in June­July 2021 and October­November 2021. The rounds included 14 287 and 14 131 respondents, respectively, from 23 countries and territories. Questions covered knowledge, attitudes and practices around COVID-19, and demographic, employment, health and vaccination status. We used logit modelling to analyse the link between self-reported vaccination status and individuals' practice of mask wearing, physical distancing and handwashing. We used propensity score matching as a robustness check. Findings: Overall, vaccinated respondents (8766 respondents in round 2) were significantly more likely to adhere to preventive measures than those who were unvaccinated (5297 respondents in round 2). Odds ratios were 1.5 (95% confidence interval, CI: 1.3­1.8) for mask wearing; 1.5 (95% CI: 1.3­1.7) for physical distancing; and 1.2 (95% CI: 1.0­1.4) for handwashing. Similar results were found on analysing subsamples of low- and middle-income countries. However, in high-income countries, where vaccination coverage is high, there was no significant link between vaccination and preventive practices. The association between vaccination status and adherence to public health advice was sustained over time, even though self-reported vaccination coverage tripled over 5 months (19.4% to 62.3%; weighted percentages). Conclusion Individuals vaccinated against COVID-19 maintained their adherence to preventive health measures. Nevertheless, reinforcement of public health messages is important for the public's continued compliance with preventive measures.

Prévision de la séroprévalence de l'hépatite A dans la Wilaya de Setif en 2024 / Forecast of hepatitis a seroprevalence in the Wilaya of Setif in 2024

La séroprévalence des anticorps anti hépatite A (correspondant au taux d'immunisation) était de 100% à Sétif (Algérie), chez les personnes âgées entre 10 et 14 ans en 1986. Elle est passée à 70,4% en 2011. Partant de ce fait, les auteurs se proposent de prévoir cette séroprévalence, dans la même wilaya en 2024, à travers le modèle 'Logit binaire multiple', sur la base des données d'une enquête réalisée en 2011. La séroprévalence globale chez les sujets âgés entre 5 et 19 ans serait, selon les résultats de ce modèle, de 67% en 2024; les principaux facteurs associés à cette séroprévalence seraient l'âge, l'habitat, la taille des ménageset l'antécédent d'ictère. En conséquence, un programme de vaccination pourrait s'imposer comme une nouvelle stratégie de lutte contre la maladie dans la wilaya de Sétif.

The seroprevalence of anti-hepatitis A antibodies (corresponding to the immunization rate) was 100% in Sétif, in people aged between 10 and 14 years in 1986. It has declined to 70.4% in 2011. Starting from this fact, the authors propose to predict this seroprevalence, in the same wilaya (district) in 2024, through the 'multiple binary logit' model, based on data from a survey carried out in 2011. The overall seroprevalence in subjects aged between 5 and 19 years would be, according to the results of this model, 67% in 2024; the main factors associated with this seroprevalence would be age, habitat, household size and a history of jaundice. As a result, a vaccination program could establish itself as a new disease control strategy in Sétif.

Tends of "Zero-dose" children aged 12-23 months in Togo from 2000 to 2017 and predictions for 2030

Guided by the principle of leaving no one behind by improving equitable access and use of new and existing vaccines, the Immunization Agenda 2030 aims, among other things, to halve the incidence of "zero-dose" at the national level. This study aimed at studying the tends of the prevalence of "zerodose" children from 2000 to 2017 and making predictions for 2030. The study consisted of secondary data analyses from the Multiple Indicator Cluster Surveys (MICS) conducted in Togo. The study population consisted of children aged 12-23 months surveyed during MICS2 in 2000, MICS3 in 2006, MICS4 in 2010 and MICS6 in 2017. The dependent variable was the "zero-dose" vaccination status (1=Yes vs 0=No). The explanatory variables were related to the child, mother, household and environment. The study generated the overall annual percentage changes (APC) and by the independent variables. As a result, the prevalence of children with "zero-dose" expected for 2030 was estimated using Excel 2013 and Stata 16.0 software. In total, 636, 864, 916 and 952 children aged 12-23 months were included for MICS2, MICS3, MICS4 and MICS7, respectively. The prevalence of "zerodose" children decreased from 37.15% in 2000 to 31.72% in 2006, then 30.10% in 2010 and 26.86% in 2017, with an overall APC= - 1.89%. The highest relative annual decrease was from 2000 to 2006. If the historical rate of decrease remains unchanged, we predict that percentage of "zero-dose" children aged 12-23 months will be 20.96% in 2030, with a decrease of 22% compared to 2017, against a target of 50%. We suggest that strengthening strategies to increase full immunization coverage of children will contribute to reducing the percentage of zero dose children. A prerequisite will be a better understanding of the predictors of the "zero-dose" phenomenon in children

Knowledge, attitude and perception of mothers of under-five towards vaccination during supplementary immunization activities in Ibadan North-West Local Government Area, Ibadan, Oyo State, Nigeria

Supplementary immunization activities campaigns provide children with an additional dose of vaccine and deliver other interventions. However, there is dearth of information on knowledge, attitude and perception of mothers of under-five towards vaccination during supplementary immunization activities. A descriptive cross-sectional study which employed multistage sampling technique was designed to fill this gap. Four wards were randomly selected from eleven wards in Ibadan North-West Local Government Area and houses were enumerated from the selected wards, systematic random sampling was used to select houses and then respondents. A semi-structured interviewer administered questionnaire was used to elicit information on three hundred and five respondents. Knowledge scores of ≤4, 5-8, and ≥ 9 were rated poor, fair and good, respectively. Attitude scores of ≤5 and >5 was rated negative and positive attitude, respectively while perception scores ≤4 and >4 were rated negative and positive perception, respectively. Data was analyzed with SPSS version 25 using descriptive statistics and Chi-square test at 5% level of significance. The mean age of respondents was 30.6±6.1years, the highest level of education for most (68.5%) was secondary school. Their mean parity and number of under-five were 2.5±1.4 and 1.2±0.4, respectively. Knowledge was generally poor, more than half (53.1%) had poor knowledge, majority (88.2%) have positive attitude while 84.6% have a positive perception. One-fourth (24.6%) and one-fifth are of the opinion that frequent vaccination will make the vaccine ineffective and overload immune system, respectively. There was generally poor knowledge of supplementary immunizations and mothers need to be educated on the importance.

Impact of COVID-19 on the antenatal care services utilization in the region of Guelmim Oued Noun, Morocco

Background: Globally, the covid-19 pandemic has seriously impacted access to healthcare facilities across the world, although there is little evidence on how the pandemic affects the use of essential healthcare in the world. Objective: This study sought to evaluate the impact of the covid-19 pandemic on antenatal indicators in the region of Guelmim Oued Noun, Morocco. Methods: The aggregated data was delivered by regional health authorities covering the period from January 2017 to December 2020. The interrupted time series was mobilized to conduct statistical analysis. Results: The descriptive results revealed a steady decline after the Covid-19 pandemic in Antenatal indicators. The results of the regression model showed a negative impact of the pandemic on the antenatal recruitment rate (ß2 = - 16.14; p < 0.01), recruitment rate of women in antenatal visits the 1st quarter of pregnancy (ß2 = -2.09; p < 0.01), antenatal visit completion rate (ß2 = -18.10, p>0.05), average number of visits/pregnancies (ß2 = -15.65, p<0,05). Conclusion: The effect of the covid-19 pandemic on antenatal rates was significant for almost the indicators studied. Future studies should be focused on the impact of the pandemic on postnatal and immunization services on the national scale.

Mechanical properties and immunotherapeutic effects of dissolving microneedles with different drug loadings based on hyaluronic acid

Abstract Improving vaccine immunity and reducing antigen usage are major challenges in the clinical application of vaccines. Microneedles have been proven to be painless, minimally invasive, highly efficient, and have good patient compliance. Compared with traditional transdermal drug delivery, it can effectively deliver a large-molecular-weight drug into the skin, resulting in a corresponding immune response. However, few studies have examined the relationship between microneedle loading dose and immune effects. In this study, the hyaluronic acid (HA) conical and pyramidal dissolving microneedles were prepared by the two-step vacuum drying method, respectively. The model drug ovalbumin (OVA) was added to HA to prepare dissolving microneedles with different loading amounts. The mass ratios of HA to OVA were 5:1, 5:3, and 5:5. The mechanical properties of the dissolving microneedles were characterized using nanoindentation and in vitro puncture studies. The immune effects of the matrix and drug content were studied in Sprague-Dawley (SD) rats. Finally, the diffusion behavior of OVA and the binding mode of HA and OVA in the microneedles were simulated using Materials Studio and Autodocking software. The experimental results showed that the conical microneedles exhibited better mechanical properties. When the mass ratio of HA to OVA was 5:3, the immune effect can be improved by 37.01% compared to subcutaneous injection, and achieved a better immune effect with relatively fewer drugs. This conclusion is consistent with molecular simulations. This study provides theoretical and experimental support for the drug loading and efficacy of microneedles with different drug loadings

Os efeitos da pandemia de covid-19 no discurso antivacinação infantil no Facebook / The effects of covid-19 pandemic on children's antivaccination discourse in Facebook / Los efectos de la pandemia de covid-19 sobre el discurso antivacunación infantil en Facebook

Este trabalho pretende analisar como o discurso antivacina sobre a covid-19 impactou o discurso sobre vacinação infantil no contexto da mídia social, a partir das estratégias e narrativas de legitimação construídas. Para isso, realizamos uma análise de mais de 260 mil publicações sobre vacinação infantil no Facebook (Meta) entre os anos de 2019 e 2022, com o objetivo de compreender: quais foram as estratégias discursivas utilizadas para legitimar o discurso antivacina e pró-vacina nesses anos; quais as principais narrativas construídas; e como a pandemia de covid-19 impactou nessa discussão. Os resultados indicam um crescimento e uma polarização do debate sobre vacinação infantil na mídia social, com a circulação de discursos desinformativos e conspiratórios. No contexto da pandemia, observamos que o discurso antivacina saiu da vacinação infantil contra a covid-19 e se espalhou para o debate sobre a vacinação infantil para outras doenças. Essas mudanças têm um impacto no discurso pró-vacina que se modifica para tentar responder ao movimento antivacinação.

This work intends to analyze how the anti-vaccination discourse on covid-19 impacted the discourse on childhood vaccination in the context of social media, based on the strategies and narratives of legitimation constructed. In order to do this, we carried out an analysis of more than 260 thousand publications about childhood vaccination on Facebook (Meta) between 2019 and 2022, focusing on understanding: what dis-cursive strategies were used to legitimize the anti-vaccine and pro-vaccine discourse during this period; what are the main narratives constructed; and how the covid-19 pandemic impacted this discussion. The results indicate a growth and polarization of the debate about childhood vaccination on social media, with the circulation of misinformative and conspiratorial discourses. In the context of the pandemic, we noted that the anti-vaccine discourse spread from childhood vaccination against covid-19 and started a debate on childhood vaccination for other diseases. These changes have an impact on the pro-vaccine discourse, that changes itself to try to respond to the anti-vaccination movement.

Este trabajo pretende analizar cómo el discurso antivacunas sobre la covid-19 impactó en el discurso sobre la vacunación infantil en el contexto de las redes sociales, a partir de las estrategias y narrativas de legiti-mación construidas. Para ello, realizamos un análisis de más de 260 mil publicaciones sobre vacunación infantil en Facebook (Meta) entre 2019 y 2022, con los objetivos de comprender qué estrategias discursivas se utilizaron para legitimar el discurso antivacunas y provacunas sobre los años; cuáles fueron las prin-cipales narrativas construidas; y cómo la pandemia de covid-19 impactó esta discusión. Los resultados indican un crecimiento y una polarización del debate sobre la vacunación infantil en las redes sociales, con la circulación de discursos desinformativos y conspirativos. En el contexto de la pandemia, observamos que el discurso antivacunas dejó la vacunación infantil contra el covid-19 y se extendió al debate sobre la vacunación infantil para otras enfermedades. Estos cambios tienen un impacto en el discurso provacunas, que cambia para responder al movimiento antivacunación.

Covid-19: Vacina boa é a aplicada de forma adequada / Covid-19: Vacina boa é a aplicada de forma adequada

Na atualidade, fotografar ou gravar o instante da imunização contra a Covid-19 se tornou rotina compartilhada nas redes sociais. Essa exposição instigou a observação de uma questão relevante: a técnica de aplicação está correta? Com a veiculação de imagens, é possível visualizar as vacinas sendo administradas em diferentes áreas do músculo deltoide, o que pode acarretar efeitos adversos. A otimização da qualificação técnica e pedagógica dos profissionais que elaboram e ministram as capacitações, bem como o envolvimento efetivo dos vacinadores nos treinamentos para injeção intramuscular é uma necessidade constante para evitar mais danos à saúde da população

Currently, photographing or recording the instant of immunization against Covid-19 has become a shared routine on social networks. This exposition prompted the observation of a relevant question: is the application technique correct? With the transmission of images, it is possible to visualize the vaccines being administered in different areas of the deltoid muscle, which can cause adverse effects. The optimization of the technical and pedagogical qualification of the professionals who design and deliver the training, as well as the effective involvement of vaccinators in training for intramuscular injection, is a constant need to avoid further damage to the health of the population

Avaliação da cobertura vacinal da poliomielite nos estados da região sul, com foco no município de Pato Branco, entre os anos de 2009-2019 / Assessment of polio vaccination coverage in the southern states, focusing on the municipality of Pato Branco, from 2009-2019 / Evaluación de la cobertura de vacunación contra la poliomielitis en los estados de la región sur, con enfoque en el municipio de Pato Branco, entre los años 2009-2019

Objetivo: Analisar a taxa de cobertura vacinal da poliomielite em relação às metas de vacinação de 95% da população-alvo, estabelecidas pelo Ministério da Saúde, com base nos registros de imunização do DATASUS nos estados do Paraná, Santa Catarina e Rio Grande do Sul, que compõem a região sul do Brasil, e na cidade de Pato Branco, PR. Métodos: Estudo descritivo de abordagem quantitativa referente à cobertura vacinal da Poliomielite nos estados da região sul e no município de Pato Branco, PR com resultados da cobertura avaliados quanto ao alcance das metas estabelecidas pelo Ministério da Saúde e comparado o desempenho entre os estados e o município no período de 2009 a 2019. Os dados foram recolhidos da seção de Imunizações do DATASUS, o departamento de informática do Sistema Único de Saúde do Brasil. Resultados: No período analisado, o município de Pato Branco se manteve com uma taxa satisfatória em relação à meta estabelecida pelo Ministério da Saúde, exceto nos anos de 2017 e 2018, onde ficou abaixo da meta em cerca de 3% e 11%, respectivamente. Em relação aos estados do sul, o estado do Paraná mostrou-se abaixo da meta de cobertura vacinal recomendada na maioria dos anos estudados, com a menor cobertura ocorrendo em 2017, ficando 15% abaixo do esperado; o estado de Santa Catarina, apesar de apresentar queda desde o ano de 2014, apresentou os melhores índices de cobertura vacinal, com a maior taxa de queda de cobertura no ano de 2018 com cerca de 7%; e o estado do Rio Grande do Sul se apresentou como o estado com o pior desempenho na região, demonstrando quedas significativas da cobertura desde 2010, com menor taxa de vacinação em 2017, ficando 18% abaixo do esperado. Conclusões: Pode-se observar uma queda nos valores da cobertura vacinal entre os anos de 2009 a 2019, tanto no município de Pato Branco, PR, quanto nos estados do Paraná, Santa Catarina e Rio Grande do Sul, algo que é motivo de crescente preocupação pelos serviços de saúde do país devido à possibilidade de reintrodução da doença no território nacional. Ressalta-se, então, a necessidade de criação de estratégias eficazes para o combate das quedas das taxas de cobertura vacinal no país.

Objective: To analyze the rate of polio vaccination coverage in relation to the vaccination goals of 95% of the target population, set by the Ministry of Health, based on DATASUS immunization records in the states of Paraná, Santa Catarina, and Rio Grande do Sul, which make up the southern region of Brazil, and in the city of Pato Branco, PR. Methods: A descriptive study of quantitative approach regarding the vaccination coverage of Poliomyelitis in the states of the southern region and in the municipality of Pato Branco, PR with coverage results evaluated as to the achievement of the goals set by the Ministry of Health and compared performance between the states and the municipality in the period from 2009 to 2019. The data were collected from the Immunizations section of DATASUS, the computer department of the Brazilian Unified Health System. Results: In the period analyzed, the municipality of Pato Branco remained with a satisfactory rate in relation to the target set by the Ministry of Health, except in the years 2017 and 2018, where it was below the target by about 3% and 11%, respectively. Regarding the southern states, the state of Paraná showed below the recommended vaccine coverage target in most of the years studied, with the lowest coverage occurring in 2017, being 15% below expected; the state of Santa Catarina, despite showing a drop since the year 2014, showed the best rates of vaccine coverage, with the highest rate of drop in coverage in the year 2018 with about 7%; and the state of Rio Grande do Sul presented itself as the state with the worst performance in the region, showing significant drops in coverage since 2010, with the lowest rate of vaccination in 2017, being 18% below expectations. Conclusions: A drop in vaccination coverage values can be observed between the years 2009 and 2019, both in the municipality of Pato Branco, PR, and in the states of Paraná, Santa Catarina, and Rio Grande do Sul, something that is a cause of growing concern for the country's health services due to the possibility of reintroduction of the disease in the national territory. Therefore, the need to create effective strategies to combat the declines in vaccination coverage rates in the country is highlighted.

Objetivo: Analizar la tasa de cobertura de vacunación antipoliomielítica en relación con las metas de vacunación del 95% de la población objetivo, establecidas por el Ministerio de Salud, a partir de los registros de inmunización DATASUS en los estados de Paraná, Santa Catarina y Rio Grande do Sul, que conforman la región sur de Brasil, y en la ciudad de Pato Branco, PR. Métodos: Estudio descriptivo de abordaje cuantitativo referente a la cobertura vacunal de la Poliomielitis en los estados de la región sur y en el municipio de Pato Branco, PR con resultados de la cobertura evaluados en cuanto al alcance de las metas establecidas por el Ministerio de Salud y comparado el rendimiento entre los estados y el municipio en el período de 2009 a 2019. Los datos se recogieron de la sección de Inmunizaciones de DATASUS, el departamento de informática del Sistema Único de Salud de Brasil. Resultados: En el período analizado, el municipio de Pato Branco se mantuvo con una tasa satisfactoria en relación a la meta establecida por el Ministerio de Salud, excepto en los años 2017 y 2018, donde estuvo por debajo de la meta en cerca de 3% y 11%, respectivamente. En lo que respecta a los estados del sur, el estado de Paraná se mostró por debajo de la meta de cobertura vacunal recomendada en la mayoría de los años estudiados, siendo la cobertura más baja la que se produjo en el año 2017, estando un 15% por debajo de lo esperado; el estado de Santa Catarina, a pesar de mostrar una caída desde el año 2014, mostró los mejores índices de cobertura vacunal, siendo la mayor tasa de caída de la cobertura en el año 2018 con cerca de un 7%; y el estado de Río Grande do Sul se presentó como el estado con peor desempeño en la región, demostrando caídas significativas en la cobertura desde 2010, con la tasa de vacunación más baja en 2017, siendo un 18% por debajo de lo esperado. Conclusiones: Se observa una caída en los valores de las coberturas de vacunación entre los años 2009 y 2019, tanto en el municipio de Pato Branco, PR, como en los estados de Paraná, Santa Catarina y Rio Grande do Sul, algo que es motivo de creciente preocupación para los servicios de salud del país debido a la posibilidad de reintroducción de la enfermedad en el territorio nacional. Por lo tanto, se destaca la necesidad de crear estrategias eficaces para combatir el descenso de las tasas de cobertura de vacunación en el país.

Construção e validação de cenário de simulação médica no ensino de imunização / Construction and validation of medical simulation scenario in teaching immunization

Introdução: No ensino médico, o uso da simulação clínica enquanto estratégia pedagógica tem sido cada vez mais presente nos currículos. Entretanto, ainda há uma lacuna sobre o uso da estratégia no ensino de tópicos de Atenção Primária à Saúde. Ao reconhecer as atribuições do profissional médico nesse contexto, torna-se necessário, cada vez mais, a oferta de experiências clínicas simuladas. Objetivo: O estudo teve por objetivo construir e validar três cenários de simulação clínica em imunização para o ensino médico. Material e métodos: Trata-se de um estudo descritivo, de construção e validação. Foram construídos e validados três cenários voltados à imunização na Atenção Primária à Saúde, a saber: imunização do adulto, da criança e da gestante. Todos os cenários foram elaborados com base em sete critérios: conhecimento prévio do aprendiz, objetivos de aprendizagem, fundamentação teórica, preparo do cenário, desenvolvimento do cenário, debriefing e avaliação. Participaram do estudo dezesseis profissionais de saúde. O Índice de Validação de Conteúdo (IVC) adotado foi de 0,80. Resultados: Os cenários obtiveram, em todos os itens, IVC entre 87,50% a 100%, julgados por médicos ou enfermeiros com experiência em simulação e titulação mínima de mestre na área da saúde. Conclusão: Os cenários poderão ser replicados tanto em pesquisas quanto no desenvolvimento de habilidades médicas em estudantes e profissionais. Desde que adaptados, esses cenários poderão, também, ser utilizados para o ensino em outros cursos e profissionais da área da saúde (AU)

Introduction: In medical education, the use of clinical simulation as a pedagogical strategy has been increasingly present in curricula. However, there is still a gap in the use of the strategy in teaching Primary Health Care topics. By recognizing the attributions of the medical professional in this context, it becomes increasingly necessary to offer simulated clinical experiences. Objective: The study aimed to construct and validate three clinical simulation scenarios in immunization for medical education. Material and methods: This is a descriptive, construction, and validation study. Three scenarios focused on immunization in Primary Health Care were built and validated, namely: immunization of adults, children, and pregnant women. All scenarios were developed based on seven criteria: prior knowledge of the learner, learning objectives, theoretical background, scenario preparation, scenario development, debriefing, and evaluation. Sixteen health professionals participated in the study. The adopted Content Validation Index (CVI) was 0.80. Results: The scenarios obtained, in all items, CVI between 87.50% to 100%, judged by physicians or nurses with experience in simulation and a minimum master's degree in health care. Conclusion: The scenarios may be replicated both in research and in the development of medical skills in students and professionals. Provided they are adapted, these scenarios may also be used for teaching other healthcare courses and professionals.Keywords: Immunization, Simulation training, Primary health care, Validation study (AU)

Correspondencia vacunación-inmunización como necesidad social y reto para la ciencia y la educación médica / Vaccination-immunization correspondence as a social need and challenge for science and medical education

Introducción: La vacunación constituye el arma preventiva más efectiva para las enfermedades trasmisibles que conoce la humanidad. Hacer que las vacunas aplicadas sean realmente inmunizantes resulta la responsabilidad de los profesionales de la atención primaria. Del mismo modo, es importante que se acepte, sin recelo, la vacunación, sobre todo en la situación epidemiológica actual. Objetivo: Describir las implicaciones sociales, económicas y éticas relacionadas con la existencia de vacunas teóricamente no inmunizantes. Métodos: Se emplearon los resultados de un programa de intervención educativa en edades pediátricas en el Policlínico 13 de marzo. Se utilizó la prueba de rangos con signo de Wilcoxon, con índice de confianza del 95 por ciento. Resultados: Inicialmente, predominó el nivel inadecuado de conocimiento, que luego mejoró significativamente. Se recuperaron 48 niños no vacunados y 29 vacunaciones no inmunizados. Conclusiones: No existe correspondencia entre las coberturas vacunales y la inmunización. Están instauradas, como correctas, falsas contraindicaciones para la vacunación. La intervención educativa fue efectiva, y se hizo patente la pertinencia de programas de pregrado y posgrado que perfeccionen la formación de los profesionales y la calidad en el desempeño profesional(AU)

Introduction: Vaccination is the most effective preventive weapon for communicable diseases known to humanity. It is the responsibility of primary health care professionals to ensure that the administered vaccines are truly immunizing. Likewise, it is important that vaccination be accepted without hesitations, especially in the current epidemiological situation. Objective: To describe the social, economic and ethical implications related to the existence of theoretically nonimmunizing vaccines. Methods: The results of an educational intervention program in pediatric ages at 13 de Marzo Policlinic were used. The Wilcoxon signed-rank test was used, with a confidence index of 95 percent. Results: Initially, an inadequate level of knowledge predominated, which later improved significantly. Forty-eight unvaccinated children and 29 unimmunized children recovered. Conclusions: There is no correspondence between vaccination coverage and immunization. False contraindications for vaccination are established as correct. The educational intervention was effective, while the relevance became evident for undergraduate and postgraduate programs to improve the training of professionals and the quality of professional performance(AU)

Eficacia y seguridad de las vacunas contra la Viruela Símica / Efficacy and safety of monkeypox vaccines

El objetivo de la revisión fue actualizar la revisión que sintetizó la evidencia científica publicada respecto a la eficacia y seguridad de tres vacunas contra la viruela símica. Se identificaron tres vacunas recomendadas para uso frente a viruela símica: ACAM200, JYNNEOS y LC16. ACAM2000 es una vacuna de virus vivo, competente para la replicación, aprobada contra la viruela. JYNNEOS (Imvamune, Imvanex, MVA-BN ó Modified Vaccinia Ankara (MVA)) es una vacuna de virus vivo atenuado no replicante y está aprobada para viruela y viruela símica. LC16 es una vacuna de tercera generación, mínimamente replicante que contiene la cepa Lister del virus vaccinia atenuado, mínimamente replicante, aprobada para la viruela en Japón. El informe del grupo asesor de inmunizaciones del CDC identificó siete ensayos clínicos y treinta y tres estudios observacionales. Los ensayos clínicos incluyeron a participantes sanos sin comorbilidades. La mayoría de ensayos incluyeron participantes que no habían recibido una vacunación previa para la viruela.

Prevalencia de vacunación completa para la hepatitis B en el personal de salud de tres grandes hospitales generales del Paraguay / Prevalence of complete vaccination for hepatitis B in health personnel of three large general hospitals in Paraguay

Introducción: El personal de salud constituye un grupo de riesgo para la infección por el virus de las hepatitis B. Objetivos: Evaluar la frecuencia de vacunación contra Hepatitis B en profesionales médicos y de enfermería de tres grandes centros hospitalarios del Departamento Central de Paraguay. Materiales y métodos: Estudio cuantitativo, observacional, descriptivo, de corte transversal. Se aplicó un cuestionario al personal médico y de enfermería en estudio, elaborado según trabajos afines. Resultados: Fueron encuestadas 1097 personas, siendo médicos 412 (37.6%) yersonal de enfermería 685 (62.4%). Se encontró un nivel de vacunación completa del 48.2% sobre el total de encuestados, 49.5% de los varones presentaron esquema completo y 47.7% de las mujeres. Según la profesión, el personal de enfermería tiene mejor acatamiento con 51% de vacunación completa contra 47% del personal médico. En el Hospital Central del Instituto de Previsión Social, casi un 62% tenía esquema completo, el Hospital de Clínicas alcanzó 40.9% y solamente 36.6% de los encuestados del Hospital Nacional de Itauguá tenían todas las dosis de vacuna anti-Hepatitis B. Para riesgo biológico bajo, el nivel de vacunación completa fue del 36.0%, alcanzó el 36.8% para riesgo moderado y 57.3% para los de alto riesgo de exposición. Conclusión: Ante la baja prevalencia de vacunación completa contra Hepatitis B en el personal de salud, esta debe mejorarse considerando el riesgo biológico de exposición. El equipo de control de infecciones y el Departamento de salud laboral deben llevar un registro de vacunación del personal y tener un plan de inmunizaciones obligatorio.

Introduction: Health care personnel constitute a risk group for hepatitis B virus infection. Objectives: To evaluate the frequency of vaccination against Hepatitis B in medical and nursing professionals of three large hospital centers in the Central Department of Paraguay. Materials and methods: Quantitative, observational, descriptive, cross-sectional, cross-sectional study. A questionnaire was administered to medical and nursing personnel included in the study, based on related studies. Results: A total of 1097 people were surveyed, 412 (37.6%) were physicians and 685 (62.4%) were nurses. In general, a complete vaccination level of 48.2% of the total respondents was reached, 49.5% of men had a complete vaccination schedule and 47.7% of women. According to profession, the nursing staff had a better compliance with complete vaccination with 51% versus 47% of the medical staff. In the Hospital Central del Instituto de Previsión Social almost 62% had a complete schedule, the Hospital de Clínicas reached 40.9% and only 36.6% of the respondents of the Hospital Nacional de Itauguá had all the doses of anti-Hepatitis B vaccine. For low biological risk, the level of complete vaccination was 36.0%, reaching 36.8% for moderate risk and 57.3% for those at high risk of exposure. Conclusion: The level of complete vaccination against Hepatitis B in health personnel was low and should be improved, taking into account the biological risk of exposure. The infection control team and the occupational health department should keep a record of staff vaccination and have a mandatory immunization plan for it.

Infección por SARS - CoV-2 posterior a la inmunización artificial e híbrida en el personal de salud / SARS-CoV-2 breakthrough infection after artificial and hybrid immunization in healthcare workers

Reportes actuales sugieren que el antecedente de infección por SARS - CoV-2 y completar un esquema de vacunación otorga mayor protección contra la presentación sintomática de COVID -19. Se comparó el riesgo de enfermar de COVID -19 entre el personal de salud con esquema completo de vacuna contra SARS - CoV-2 BNT162b2 y el antecedente de infección por SARS - CoV-2. Estudio de cohorte histórica en 1874 trabajadores de la salud del Nuevo Hospital Civil de Guadalajara inmunizados con la vacuna BNT162b2 entre enero y marzo de 2021. Después de seis meses de seguimiento, el grupo de no expuestos (sin antecedente de infección) fue de 1397 y el grupo expuesto (con antecedente de infección), de 477 sujetos. La incidencia de infección por SARS - CoV-2 fue de 39 casos. El riesgo de infección en la cohorte posterior a la inmunización fue de 0,021. El grupo de inmunización híbrida presentó un riesgo menor de infección comparado con el grupo de inmunización artificial (0,015 y 0,243). La inmunización híbrida contribuyó a una reducción del riesgo atribuible a la población de 0,003 (R0 0,024; Rp 0,020). La hospitalización se presentó en el 7,69 % de los casos confirmados con SARS - CoV-2. El riesgo de hospitalización en inmunización híbrida es de 0,210 y de 0,143 en el grupo de inmunización artificial (RR 1,46 IC95 % 0,13 -16,11). Se llegó a la conclusión que la inmunización híbrida podría contribuir a reducir el riesgo de infección por SARS - CoV-2, potenciando la inmunidad generada por la vacuna contra COVID -19

Current reports suggest that a history of SARS - CoV-2 infection and completing a vaccination schedule provides greater protection against the symptomatic presentation of COVID -19. The risk of becoming ill with COVID -19 was compared between health personnel with a complete SARS - CoV-2 BNT162b2 vaccine schedule and a history of SARS - CoV-2 infection. Historical cohort study in 1874 health workers of the New Civil Hospital of Guadalajara immunized with the BNT162b2 vaccine between January and March 2021. After six months of follow-up, the non-exposed group (without a history of infection) was 1397 and the exposed group (with a history of infection), of 477 subjects. The incidence of SARS - CoV-2 infection was 39 cases. The risk of infection in the post-immunization cohort was 0.021. The hybrid immunization group had a lower risk of infection compared to the artificial immunization group (0.015 and 0.243). Hybrid immunization contributed to a population-attributable risk reduction of 0.003 (R0 0.024, Rp 0.020). Hospitalization occurred in 7.69% of confirmed cases with SARS - CoV-2. The risk of hospitalization in hybrid immunization is 0.210 and 0.143 in the artificial immunization group (RR 1.46 CI95% 0.13 -16.11). It was concluded that hybrid immunization could help reduce the risk of SARS - CoV-2 infection, enhancing the immunity generated by the vaccine against COVID -19

Experiencias de los estudiantes de enfermería en el proceso de vacunación para el sars-cov-2 / Experiences of nursing students in the vaccination process for sars-cov-2

El rol de enfermería en el proceso de vacunación contra el SARS-CoV-2 ha sido fundamental para el registro, control y gestión de estas inmunizaciones en los tiempos propuestos por los gobiernos locales. Objetivo: analizar las experiencias de los estudiantes de Enfermería en el proceso de vacunación para el SARS-CoV-2. Materiales y métodos: fue una investigación cuantitativa, descriptiva, transversal que incluyó a un total de 36 estudiantes de la carrera de enfermería de la Universidad Técnica de Ambato a quienes previa firma de un consentimiento informado se les aplicó una encuesta de 15 preguntas cerradas a través de Google Forms para conocer las expectativas, conocimientos, destrezas y experiencias en el proceso de vacunación así como para detectar las principales necesidades de aprendizaje y desempeño práctico. Resultados: el 94% de los estudiantes estuvo de acuerdo con participar en el plan de vacunación, la principal motivación (64,7%) fue adquirir mayores destrezas y conocimientos sobre esta nueva inmunización lo que se logró en el 92% de los estudiantes quienes catalogaron a la experiencia como positiva en su formación profesional, sin embrago, el manejo del sistema de salud pública fue un inconveniente en este proceso y representó la principal necesidad de formación. Conclusión: La mayoría de estudiantes de enfermería tuvieron los suficientes conocimientos, destrezas y experiencias para participar del proceso de vacunación para el SARS-CoV-2 porque dentro de su malla curricular se contempla ampliamente el uso de inmunizaciones en todo tipo de edad, pero en virtud de que el COVID-19 es relativamente nuevo implicó recibir una capacitación sobre preparación, efectos adversos y monitorización con lo cual los estudiantes estuvieron preparados para participar activamente del plan de vacunación(AU)

The role of nursing in the vaccination process against SARS-CoV-2 has been essential for the registration, control and management of these immunizations in the times proposed by local governments. Objective: to analyze the experiences of Nursing students in the vaccination process for SARS-CoV-2. Materials and methods: it was a quantitative, descriptive, cross-sectional research that included a total of 36 nursing students at the Technical University of Ambato, to whom, after signing an informed consent, a survey of 15 closed questions was applied through of Google Forms to know the expectations, knowledge, skills and experiences in the vaccination process as well as to detect the main learning needs and practical performance. Results: 94% of the students agreed to participate in the vaccination plan, the main motivation (64.7%) was to acquire greater skills and knowledge about this new immunization, which was achieved in 92% of the students who They classified the experience as positive in their professional training, however, the management of the public health system was an inconvenience in this process and represented the main need for training. Conclusion: The majority of nursing students had sufficient knowledge, skills and experiences to participate in the vaccination process for SARS-CoV-2 because the use of immunizations at all ages is widely contemplated within their curriculum, but in Due to the fact that COVID-19 is relatively new, it involved receiving training on preparation, adverse effects, and monitoring, with which the students were prepared to actively participate in the vaccination plan(AU)

Vaccine hesitation and the 'pandemic' of the unvaccined: What to do to face the new "Vaccine Revolt"? / Hesitação vacinal e a 'pandemia' dos não vacinados: o que fazer para enfrentar a nova "Revolta da Vacina"?

The frequency of people hesitating to get vaccinated is increasing worldwide and regarding the covid-19 pandemic, this phenomenon has been increasingly noticed at a national level. This article exposes a brief presentation of the historical factors of this phenomenon, approaches its main determinants and conceptual model, in addition to presenting a set of communication strategies in vaccine health that can be implemented to face this problem to raise the credibility and adherence to immunizations (AU)

A frequência da hesitação vacinal está aumentando em todo o mundo e, no contexto da pandemia da Covid-19, esse fenômeno vem sendo cada vez mais percebido no âmbito nacional. No presente trabalho, realizamos uma breve apresentação de fatores históricos desse fenômeno, abordamos seus principais determinantes e modelo conceitual, além de apresentar um conjunto de estratégias de (edu)comunicação em saúde vacinal que podem ser implementadas para enfrentamento dessa problemática com vista a elevar a credibilidade e a adesão às imunizações (AU)