Introduction of sequential inactivated polio vaccine-oral polio vaccine schedule for routine infant immunization in Brazil's National Immunization Program.

In August 2012, the Brazilian Ministry of Health introduced inactivated polio vaccine (IPV) as part of sequential polio vaccination schedule for all infants beginning their primary vaccination series. The revised childhood immunization schedule included 2 doses of IPV at 2 and 4 months of age followed by 2 doses of oral polio vaccine (OPV) at 6 and 15 months of age. One annual national polio immunization day was maintained to provide OPV to all children aged 6 to 59 months. The decision to introduce IPV was based on preventing rare cases of vaccine-associated paralytic polio, financially sustaining IPV introduction, ensuring equitable access to IPV, and preparing for future OPV cessation following global eradication. Introducing IPV during a national multivaccination campaign led to rapid uptake, despite challenges with local vaccine supply due to high wastage rates. Continuous monitoring is required to achieve high coverage with the sequential polio vaccine schedule.

Vaccination coverage in children in the period before and during the COVID-19 pandemic in Brazil: a time series analysis and literature review.

OBJECTIVE: To evaluate the behavior of VCR and VCH, per municipality and per vaccines offered at the NVC, to identify priority areas for intervention. METHODS: Descriptive study of a time series, using secondary data and accompanied by a narrative review of the literature evaluating VCR and VCH. Vaccines offered to children under one year and to those aged one year in the pre-pandemic period of COVID-19 (2015 to 2019) were selected and compared to those offered during the pandemic period (2020 and 2021). RESULTS AND DISCUSSIONS: The decrease in VCR and VCH is a process that precedes the COVID-19 pandemic but was intensified during this period. In 2021, the VCR was around 70% for most vaccines. This phenomenon encompasses the entire country; however, it is more intense in the states/municipalities located in the north and northeast regions, suggesting greater difficulty in accessing health services. CONCLUSIONS: Low and heterogeneous VCR requires the adoption of practices that were previously implemented, establishing partnerships with governmental and non-governmental institutions, with adequate communication, active search for non-compliance and non-adherence to the regular vaccination program, adopting intra- and extramural vaccination strategies, to reverse the current situation and reduce the risk of recurrence of diseases that have been already controlled and eliminated.

Prevalence of human papillomavirus (HPV) in Brazil: A systematic review and meta-analysis.

OBJECTIVES: This study aimed to estimate the prevalence of genital, anal and oral HPV infection in Brazil through systematic review and meta-analysis. METHODS: We searched EMBASE, LILACS, MEDLINE, Web of Science and SciELO from inception to December 2018. Original research articles that assessed the prevalence of genital (i.e., cervical, penile), anal and oral HPV infection in Brazil were selected in pairs by independent authors. No sex, age, HPV vaccination, language or date restrictions were applied. HPV prevalence was estimated and stratified according to risk factors population and by geographic area throughout the country. The study prevalence was pooled using a random effects model. Analysis was performed using R (version 3.5.2), packages meta version 4.9-4 and metaphor 2.0-0. This review is registered on PROSPERO under protocol number CRD42016032751. RESULTS: We identified 3,351 references. After the screening process, 139 of them were eligible for this systematic review (57,513 total participants). Prevalence of cervical HPV was 25.41% (95% CI 22.71-28.32). Additionally, prevalence was 36.21% (95% CI 23.40, 51.33) in the penile region, 25.68% (95%CI 14.64, 41.04) in the anal region, and 11.89% (95%CI 6.26, 21.43) in the oral region. Subgroup analysis showed prevalence in each anatomic site was higher in high-risk populations. CONCLUSION: The prevalence of HPV is high in the Brazilian population and varies by population risk and anatomic body site, with lower rates in the oral cavity compared to that in the cervical, penile and anal region. Studies on HPV have primarily been developed to evaluate infection and cancer in the cervical region. There is a profound lack of HPV data in many geographic regions of Brazil and for different anatomic sites.

Trends and spatial distribution of MMR vaccine coverage in Brazil during 2007-2017.

We analyzed the time trends and spatial distribution of MMR vaccine coverage in Brazil during 2007-2017. In early 2018, a measles outbreak started in the North region of Brazil, reaching 11 of the 27 federal units by January 24, 2019. In this period, 10,302 cases were confirmed. Although the reintroduction of measles in Brazil is likely due to migration from Venezuela, the spread of the virus was made possible by the low levels of MMR coverage, as a result of significant decreases during the study period. Areas with high concentration of municipalities with low coverage are more susceptible to the spread of the virus, especially in the North and Northeast regions. Increasing vaccination coverage is essential to block the ongoing outbreak in Brazil. Vaccination strategies might target priority areas, especially those with a marked decrease in coverage. Moreover, it is essential to extend actions to travelers, migrants and refugees.

Vaccination coverage in children in the period before and during the COVID-19 pandemic in Brazil: a time series analysis and literature review

Abstract Objective: To evaluate the behavior of VCR and VCH, per municipality and per vaccines offered at the NVC, to identify priority areas for intervention. Methods: Descriptive study of a time series, using secondary data and accompanied by a narrative review of the literature evaluating VCR and VCH. Vaccines offered to children under one year and to those aged one year in the pre-pandemic period of COVID-19 (2015 to 2019) were selected and compared to those offered during the pandemic period (2020 and 2021 ). Results and discussions: The decrease in VCR and VCH is a process that precedes the COVID-19 pandemic but was intensified during this period. In 2021, the VCR was around 70% for most vaccines. This phenomenon encompasses the entire country; however, it is more intense in the states/municipalities located in the north and northeast regions, suggesting greater difficulty in accessing health services. Conclusion: Low and heterogeneous VCR requires the adoption of practices that were previously implemented, establishing partnerships with governmental and non-governmental institutions, with adequate communication, active search for non-compliance and non-adherence to the regular vaccination program, adopting intra- and extramural vaccination strategies, to reverse the current situation and reduce the risk of recurrence of diseases that have been already controlled and eliminated.

Classification of transmission risk of vaccine-preventable diseases based on vaccination indicators in Brazilian municipalities. / Classificação de risco de transmissão de doenças imunopreveníveis a partir de indicadores de coberturas vacinais nos municípios brasileiros.

OBJECTIVE: to describe the transmission risk classification of vaccine-preventable diseases in Brazilian municipalities. METHODS: this was a descriptive epidemiologic study using 2014 data of the Brazilian National Immunization Program Information System; the vaccine coverage indicators were used to classify the transmission risk of vaccine-preventable diseases in the municipalities. RESULTS: of the 5,570 Brazilian municipalities, 12.0% were classified as very low risk, 29.6% as low risk, 2.2% as medium risk, 54.3% as high risk and 1.8% as very high risk. CONCLUSION: the vaccination coverage surveillance allowed to identify most of the municipalities in high risk situation and the minority of children living in municipalities with appropriate coverage; the vaccination coverage surveillance using indicators of the Brazilian National Health System (SUS) is a new tool for identifying priority areas where the actions can be more successful for health managers and improve the quality and the success of the immunizations program.

Effectiveness of ten-valent pneumococcal conjugate vaccine against invasive pneumococcal disease in Brazil: a matched case-control study.

BACKGROUND: In March 2010, Brazil introduced the ten-valent pneumococcal conjugate vaccine (PCV10), which was licensed based on non-inferiority of immunological correlates of protection compared with the seven-valent vaccine. The schedule comprised three primary doses at ages 2 months, 4 months, and 6 months, and a booster dose at age 12 months. A single catch-up dose was offered for children aged 12-23 months at the time of introduction. We assessed PCV10 effectiveness against invasive pneumococcal disease in Brazilian children. METHODS: Invasive pneumococcal disease, defined as isolation of Streptococcus pneumoniae from blood, cerebrospinal fluid, or another normally sterile site, was identified in children age-eligible for at least one PCV10 dose through laboratory-based and hospital-based surveillance in ten states in Brazil from March 1, 2010, until Dec 31, 2012. We aimed to identify four age-matched and neighbourhood-matched controls for each case. We used conditional logistic regression and calculated PCV10 effectiveness as (1-adjusted matched odds ratio) × 100% for vaccine-type and vaccine-related serotypes (ie, in the same serogroup as a vaccine serotype). FINDINGS: In 316 cases (median age 13·2 months, range 2·6-53·1) and 1219 controls (13·3 months, 2·6-53·1), the adjusted effectiveness of an age-appropriate PCV10 schedule was 83·8% (95% CI 65·9-92·3) against vaccine serotypes, and 77·9% (41·0-91·7) against vaccine-related serotypes. Serotype-specific effectiveness was shown for the two most common vaccine serotypes-14 (87·7%, 60·8-96·1) and 6B (82·8%, 23·8-96·1)-and serotype 19A (82·2%, 10·7-96·4), a serotype related to vaccine serotype 19F. A single catch-up dose in children aged 12-23 months was effective against vaccine-type disease (68·0%, 17·6-87·6). No significant effectiveness was shown against non-vaccine serotypes for age-appropriate or catch-up schedules. INTERPRETATION: In the routine immunisation programme in Brazil, PCV10 prevents invasive disease caused by vaccine serotypes. PCV10 might provide cross-protection against some vaccine-related serotypes. FUNDING: Brazilian Ministry of Health, Pan-American Health Organization, and US Centers for Disease Control and Prevention.

Uptake of pandemic influenza (H1N1)-2009 vaccines in Brazil, 2010.

In 2010, the Brazilian Ministry of Health organized a mass vaccination campaign of selected priority groups in response to the 2009 H1N1 influenza pandemic. The campaign was conducted in six phases from March to July, 2010. Priority groups included healthcare professionals, indigenous persons, pregnant women, young children, persons with chronic illnesses and otherwise healthy adults 20-39 years of age. Over 89 million doses of pandemic influenza vaccines were administered, surpassing immunization targets among several priority groups, including healthcare professionals. We reviewed strategies used in Brazil to promote vaccination against pandemic influenza as well as factors external to the campaign that may have contributed to vaccine uptake among priority groups.

Classificação de risco de transmissão de doenças imunopreveníveis a partir de indicadores de coberturas vacinais nos municípios brasileiros / Clasificación de riesgo de transmisión de enfermedades prevenibles a partir de indicadores de cobertura de vacunación en municipios / Classification of transmission risk of vaccine-preventable diseases based on vaccination indicators in Brazilian municipalities

OBJETIVO: descrever a classificação de risco de doenças imunopreveníveis nos municípios brasileiros. MÉTODOS: estudo epidemiológico descritivo com dados do Sistema de Informações do Programa Nacional de Imunizações (SI-PNI) para 2014; os indicadores de coberturas vacinais foram utilizados para classificar o risco de transmissão de doenças imunopreveníveis nos municípios. RESULTADOS: dos 5.570 municípios brasileiros, 12,0% foram classificados como de risco muito baixo, 29,6% de risco baixo, 2,2% de risco médio, 54,3% de risco alto e 1,8% de risco muito alto. CONCLUSÃO: a vigilância das coberturas vacinais permitiu identificar a maioria dos municípios em situação de alto risco e a minoria das crianças vivendo em municípios com cobertura adequada; a vigilância das coberturas utilizando indicadores pactuados no Sistema Único de Saúde (SUS) oferece nova ferramenta para identificação de áreas prioritárias, onde as ações poderão ter maiores chances de acerto pelos gestores e melhorar a qualidade e o sucesso do PNI.

OBJETIVO: describir la clasificación de riesgo de enfermedades prevenibles en municipios brasileños. MÉTODOS: estudio epidemiológico descriptivo con datos del Sistema de informaciones del programa nacional de inmunizaciones (PNI) de 2014; los indicadores de cobertura fueron utilizados para clasificar el riesgo de transmisión de enfermedades prevenibles en los municipios. RESULTADOS: de los 5.570 municipios brasileños, 12,0% fueron clasificados de muy bajo riesgo, 29,6% de bajo riesgo, 2,2% de riesgo medio, 54,3% de alto riesgo y 1,8% de riesgo muy alto. CONCLUSIÓN: la vigilancia de la cobertura de vacunación permitió identificar la mayoría de los municipios en situaciones de alto riesgo y la minoría de niños que viven en municipios con una cobertura adecuada; la vigilancia de la cobertura de vacunación según indicadores acordados en el sistema de salud pública ofrece una nueva herramienta para la identificación de áreas prioritarias en las que la acción pueda tener mayores posibilidades de éxito por los administradores de salud para mejorar la calidad y el éxito del programa de inmunización.

OBJECTIVE: to describe the transmission risk classification of vaccine-preventable diseases in Brazilian municipalities. METHODS: this was a descriptive epidemiologic study using 2014 data of the Brazilian National Immunization Program Information System; the vaccine coverage indicators were used to classify the transmission risk of vaccine-preventable diseases in the municipalities. RESULTS: of the 5,570 Brazilian municipalities, 12.0% were classified as very low risk, 29.6% as low risk, 2.2% as medium risk, 54.3% as high risk and 1.8% as very high risk. CONCLUSION: the vaccination coverage surveillance allowed to identify most of the municipalities in high risk situation and the minority of children living in municipalities with appropriate coverage; the vaccination coverage surveillance using indicators of the Brazilian National Health System (SUS) is a new tool for identifying priority areas where the actions can be more successful for health managers and improve the quality and the success of the immunizations program.

Coberturas vacinais e doenças imunopreveníveis no Brasil no período 1982-2012: avanços e desafios do Programa Nacional de Imunizações / Vaccination coverage and impact on vaccine-preventable diseases in Brazil between 1982 and 2012: National Immunization Program progress and challenges

Objetivo: descrever as coberturas vacinais (CV), proporção de abandono (PA) e homogeneidade de CV, bem como a ocorrência de doenças imunopreveníveis no Brasil. Métodos: foi realizado estudo descritivo, com base em dados dos Sistemas de Informações do Programa Nacional de Imunizações (SI-PNI) referentes ao período 2002-2012, para calcular os indicadores de CV, PA e homogeneidade de CV, e em dados cedidos pela Coordenação-Geral de Doenças Transmissíveis (CGDT/SVS/MS) e referentes ao período 1982-2011, para calcular a incidência de doenças. Resultados: as CV mostraram-se elevadas na vacinação de rotina e em campanhas, resultando na eliminação ou drástica redução da incidência de doenças imunopreveníveis, apesar da heterogeneidade de CV. Conclusão: as estratégias adotadas ampliaram a oferta de vacinas sob o ponto de vista territorial e, sobretudo, populacional; o estabelecimento do PNI como uma prioridade nas políticas públicas de saúde contribuiu para a redução da incidência de doenças imunopreveníveis.

Objective: to describe vaccination coverage (VC) and its homogeneity, dropout rates (DR) and the occurrence of vaccine-preventable diseases in Brazil. Methods: a descriptive cross-sectional study was conducted based on National Immunization Program (PNI) information systems data for the period 2002-2012 in order to calculate VC, its homogeneity and DR indicators, and also based on data provided by the Ministry of Health’s Communicable Diseases Coordination sector for the period 1982-2011 in order to calculate disease incidence. Results: VC was high in both routine vaccination and campaigns, resulting in the elimination or drastic reduction in preventable disease incidence, despite VC heterogeneity. Conclusion: the vaccination strategies adopted have increased vaccine availability in terms of territorial extension and, above all, in terms of population coverage. The establishment of the PNI as a public health policy priority has contributed to the reduction in vaccine-preventable disease incidence.

Monitoramento rápido de coberturas vacinais pós-campanhas de vacinação no Brasil: 2008, 2011 e 2012 / Rapid monitoring of vaccination coverage following vaccination campaigns in Brazil: 2008, 2011 and 2012

Objetivo: descrever os resultados do monitoramento rápido de coberturas (MRC) pós-campanha de vacinação com tríplice viral (SRC) (2008 e 2011) e multivacinação com vacinas do calendário da criança (2012). Métodos: estudo descritivo, com dados do Programa Nacional de Imunizações sobre coberturas vacinais (CV) administrativas, MRC e motivos para não vacinação (2011-2012). Resultados: a CV da SRC superou 95 por cento nas campanhas; pelo MRC, a CV com uma dose da SRC foi 92 por cento, em 2008, e 96 por cento, em 2011; em 2011, pelo MRC, foram administradas 41,7 mil doses da SRC, elevando a CV para 99,5 por cento; em 2012, a CV pelo MRC variou entre 97 por cento para poliomielite e hepatite B e 82 por cento para reforço 2 da vacina difteriatétano-coqueluche (DTP); falta de tempo representou o principal motivo para não vacinação (43,6 por cento em 2011 e 32,7 por cento em 2012). Conclusão: o MRC é ferramenta útil para avaliar CV e resgatar não vacinados, fornecendo subsídios para intervenções.

Objective: describe rapid monitoring of vaccination coverage (RMC) following Measles Mumps Rubella (MMR) (2008-2011) and Multivaccination (2012) vaccination campaigns. Methods: descriptive study using National Immunization Program administrative data on vaccine coverage as well as RMC data, in addition to data on the grounds for non-vaccination (2011-2012). Result: MMR vaccine coverage exceeded 95 per cent in the campaigns. RMC data on a single dose of MMR found 92 per cent post-campaign coverage in 2008 and 96 per cent in 2011. In 2011, 41,700 MMR doses were administered post-campaign, raising vaccination coverage to 99.5 per cent in that year. In 2012 post-campaign coverage ranged between 97 per cent (polio and hepatitis B) and 82 per cent (second diphtheria-tetanus-pertussis booster). "Lack of time" was the main motive for non-vaccination (43.6 per cent in 2011 and 32.7 per cent in 2012). Conclusion: RMC is a useful tool for evaluating vaccination coverage and reaching those not vaccinated, in addition to informing interventions.