Phylogenetics, Epidemiology and Temporal Patterns of Dengue Virus in Araraquara, São Paulo State.

Dengue virus (DENV) is a prominent arbovirus with global spread, causing approximately 390 million infections each year. In Brazil, yearly epidemics follow a well-documented pattern of serotype replacement every three to four years on average. Araraquara, located in the state of São Paulo, has faced significant impacts from DENV epidemics since the emergence of DENV-1 in 2010. The municipality then transitioned from low to moderate endemicity in less than 10 years. Yet, there remains an insufficient understanding of virus circulation dynamics, particularly concerning DENV-1, in the region, as well as the genetic characteristics of the virus. To address this, we sequenced 37 complete or partial DENV-1 genomes sampled from 2015 to 2022 in Araraquara. Then, using also Brazilian and worldwide DENV-1 sequences we reconstructed the evolutionary history of DENV-1 in Araraquara and estimated the time to the most recent common ancestor (tMRCA) for serotype 1, for genotype V and its main lineages. Within the last ten years, there have been at least three introductions of genotype V in Araraquara, distributed in two main lineages (L Ia and L Ib, and L II). The tMRCA for the first sampled lineage (2015/2016 epidemics) was approximately 15 years ago (in 2008). Crucially, our analysis challenges existing assumptions regarding the emergence time of the DENV-1 genotypes, suggesting that genotype V might have diverged more recently than previously described. The presence of the two lineages of genotype V in the municipality might have contributed to the extended persistence of DENV-1 in the region.

Computerized immunization record agreement in Araraquara, São Paulo, Brazil, 2018. / Concordância do registro informatizado de imunização de Araraquara, São Paulo, 2018.

OBJECTIVE: To describe agreement between the Juarez System immunization data and information in vaccination record booklets and vaccination coverage in children aged 12 to 24 months. METHODS: This was a descriptive study to assess the vaccination status at 12 and 24 months of age of children born in 2015 and recorded on the Juarez System. The levels of agreement between the Juarez System data and the information in vaccination record booklets were verified. RESULTS: 429 children were included. It was found that agreement ranged between 84.1% and 99.1%. The vaccine survey found that coverage for each vaccine ranged from 86.01% to 100% and for the full schedule, from 77.1% (12 months) to 68.8% (24 months). The spatial distributions of vaccine coverage ranged from 28% to 100%. CONCLUSION: There was excellent agreement between the data, with high vaccination coverage, but heterogeneity in their spatial distributions.

Agreement of the computerized immunization record of Araraquara, São Paulo, Brazil, 2018 / Concordancia del registro de vacunación computarizado de Araraquara, São Paulo, Brasil, 2018 / Concordância do registro informatizado de imunização de Araraquara, São Paulo, 2018

Objective: To describe the agreement between the immunization data of the Juarez System and the information in the vaccination booklet and vaccination coverage in children aged 12 to 24 months. Methods: Descriptive study to assess the vaccination status at 12 and 24 months of age of children born in 2015 and registered in the Juarez System. The levels of agreement between the Juarez System data and the information in the vaccination booklet were verified. Results: 429 children were included. it was found that the agreement varied between 84.06 and 99.06%. The coverage (vaccine survey) for each vaccine ranged from 86% to 100% and for the complete schedule, 77.1% (12 months) and 68.8% (24 months). The spatial distributions of vaccine coverage ranged from 28% to 100%. Conclusion: excellent agreement between the data, high vaccination coverage, but heterogeneity in their spatial distributions.

Objetivo: Descrever a concordância entre os dados de imunização do Sistema Juarez e as informações da caderneta de vacinação e as coberturas vacinais em crianças de 12 a 24 meses. Métodos: Estudo descritivo, para avaliar a situação vacinal aos 12 e 24 meses de idade de crianças nascidas em 2015 e registradas no Sistema Juarez. Foram verificados os níveis de concordância entre os dados do Sistema Juarez e as informações da caderneta de vacinação. Resultados: Foram incluídas 429 crianças. Verificou-se que a concordância variou entre 84,06 e 99,06%. As coberturas no inquérito vacinal para cada vacina variaram de 86 a 100%; e para o esquema completo, de 77,1 (12 meses) a 68,8% (24 meses). As distribuições espaciais da cobertura vacinal foram de 28 a 100%. Conclusão: Observou-se ótima concordância entre os dados, com altas coberturas vacinais, muito embora heterogeneidade em suas distribuições espaciais.

Concordância do registro informatizado de imunização de Araraquara, São Paulo, 2018 / Concordancia del registro de vacunación computarizado de Araraquara, São Paulo, Brasil, 2018 / Computerized immunization record agreement in Araraquara, São Paulo, Brazil, 2018

Objetivo: Descrever a concordância entre os dados de imunização do Sistema Juarez e as informações da caderneta de vacinação e as coberturas vacinais em crianças de 12 a 24 meses. Métodos: Estudo descritivo, para avaliar a situação vacinal aos 12 e 24 meses de idade de crianças nascidas em 2015 e registradas no Sistema Juarez. Foram verificados os níveis de concordância entre os dados do Sistema Juarez e as informações da caderneta de vacinação. Resultados: Foram incluídas 429 crianças. Verificou-se que a concordância variou entre 84,1 e 99,1%. As coberturas no inquérito vacinal para cada vacina variaram de 86,1 a 100%; e para o esquema completo, de 77,1 (12 meses) a 68,8% (24 meses). As distribuições espaciais da cobertura vacinal foram de 28 a 100%. Conclusão: Observou-se ótima concordância entre os dados, com altas coberturas vacinais, muito embora heterogeneidade em suas distribuições espaciais.

Objetivo: Describir la concordancia entre los datos de vacunación del Sistema Juárez y la información de la cartilla de vacunación y cobertura vacunal en niños de 12 a 24 meses. Métodos: Estudio descriptivo para evaluar el estado de vacunación a los 12 y 24 meses de edad de los niños nacidos en 2015 e inscritos en el Sistema Juárez. Se verificaron los niveles de concordancia entre los datos del Sistema Juárez y la información del carné de vacunación. Resultados: Se incluyeron 429 niños. Se encontró que la concordancia varió entre 84,1 y 99,1%. La cobertura (encuesta de vacunas) para cada vacuna varió de 86% a 100% y para el esquema completo, 77,1% (12 meses) y 68,8% (24 meses). Las distribuciones espaciales de la cobertura vacunal oscilaron entre el 28% y el 100%. Conclusión: excelente concordancia entre los datos, alta cobertura de vacunación, pero heterogeneidad en sus distribuciones espaciales.

Objective: To describe agreement between the Juarez System immunization data and information in vaccination record booklets and vaccination coverage in children aged 12 to 24 months. Methods: This was a descriptive study to assess the vaccination status at 12 and 24 months of age of children born in 2015 and recorded on the Juarez System. The levels of agreement between the Juarez System data and the information in vaccination record booklets were verified. Results: 429 children were included. It was found that agreement ranged between 84.1% and 99.1%. The vaccine survey found that coverage for each vaccine ranged from 86.01% to 100% and for the full schedule, from 77.1% (12 months) to 68.8% (24 months). The spatial distributions of vaccine coverage ranged from 28% to 100%. Conclusion: There was excellent agreement between the data, with high vaccination coverage, but heterogeneity in their spatial distributions.

Zika virus infection among symptomatic patients from two healthcare centers in Sao Paulo State, Brazil: prevalence, clinical characteristics, viral detection in body fluids and serodynamics.

Zika virus (ZIKV) clinical presentation and frequency/duration of shedding need further clarification. Symptomatic ZIKV-infected individuals identified in two hospitals in Sao Paulo State, Brazil, were investigated regarding clinical characteristics, shedding in body fluids, and serodynamics. Ninety-four of 235 symptomatic patients (Site A: 58%; Site B: 16%) had Real-Time PCR-confirmed ZIKV infection; fever, headache and gastrointestinal symptoms were less frequent, and rash was more frequent compared to ZIKV-negative patients. Real-Time PCR in serum had worse performance compared to plasma, while urine had the highest sensitivity. Shedding in genital fluids and saliva was rare. IgM positivity was the highest <14 days after the symptoms onset (86%), decreasing >28 days (24%); IgG positivity increased >14 days (96%) remaining positive in 94% of patients >28 days. ZIKV prevalence varied importantly in two neighboring cities during the same transmission season. Urine Real-Time PCR can improve diagnostic sensitivity; serum testing is less useful. Accurate serological tests are needed to improve diagnosis and surveillance.

[Assessment of vaccination coverage of children in a medium-sized Brazilian city using electronic immunization registry]. / Avaliação de coberturas vacinais de crianças em uma cidade de médio porte (Brasil) utilizando registro informatizado de imunização.

Administrative data show high vaccination coverage rates in Brazil, but there is no assessment of the validity and timeliness of dose administration, or whether the vaccination schedule is complete. This study assessed timely and updated coverage rates in children 12 to 24 months of age. This was a longitudinal population-based study in Araraquara, São Paulo State, a predominantly urban medium-sized municipality, using the Juarez System, an electronic immunization registry (EIR). Coverage rates were assessed in 49,741 children born from 1998 to 2013, a period in which five different vaccination schedules were used. Trends were estimated with the Prais-Winsten linear regression method. Updated coverage of the complete schedule varied from 79.5% to 91.3% at 12 months and from 75.8% to 86.9%, at 24 months. Timely coverage (all doses applied at the recommended ages, with no delays) ranged from 53.3% to 74% at 12 months and from 36.7% to 53.8% at 24 months. There was an upward trend in updated coverage at 24 months. The delays in relation to recommended age increased starting at six months and appeared to relate more to age than to the number of doses in the schedule. The proportion of invalid and late doses was lower than in other studies. Despite the increase in the number of doses in the vaccination schedule, the study showed high updated coverage rates and higher timely coverage than reported in the national and international literature; however, more effort is needed to increase timeliness. EIR proved relevant for assessing and monitoring vaccination coverage with more accurate analyses.

Dados administrativos mostram altas coberturas vacinais no Brasil, porém não há avaliação da validade e oportunidade de aplicação das doses, nem se o esquema vacinal está completo. Este estudo avaliou as coberturas oportunas e atualizadas de crianças de 12 a 24 meses de idade. Estudo longitudinal de base populacional em Araraquara, São Paulo, uma cidade de médio porte predominantemente urbana, utilizando dados do Sistema Juarez, um registro informatizado de imunização (RII). As coberturas foram avaliadas para 49.741 crianças nascidas entre 1998 e 2013, período com cinco calendários de vacinação diferentes. As tendências foram estimadas pelo método de regressão linear Prais-Winsten. A cobertura atualizada do esquema completo variou entre 79,5% e 91,3%, aos 12 meses, e entre 75,8% e 86,9%, aos 24 meses. A cobertura oportuna (todas as doses aplicadas na idade recomendada, sem atraso) variou entre 53,3% e 74%, aos 12 meses, e entre 36,7% e 53,8%, aos 24 meses. Houve tendência crescente para a cobertura atualizada aos 24 meses. Os atrasos em relação à idade recomendada se acentuam em doses a partir dos seis meses e parecem estar mais relacionados à idade do que ao número de doses do esquema. A proporção de doses inválidas e atrasadas foi menor do que em outros estudos. Apesar do aumento do número de doses no calendário vacinal, foram alcançadas altas coberturas atualizadas e coberturas oportunas maiores do que as encontradas na literatura nacional e internacional, porém são necessários mais esforços para o aumento da oportunidade. O RII mostrou-se relevante para avaliação e monitoramento de coberturas vacinais, com análises mais acuradas.

Los datos administrativos muestran altas coberturas de vacunación en Brasil, sin embargo, no existe una evaluación de la validez y oportunidad de aplicación de las dosis, ni si la cartilla de vacunación ha sido completada. Este estudio evalúo las coberturas necesarias y actualizadas en niños de 12 a 24 meses de edad. Se trata de un estudio longitudinal con base poblacional en Araraquara, São Paulo, una ciudad media, predominantemente urbana, utilizando datos del Sistema Juarez, un registro informatizado de inmunización (RII). Las coberturas se evaluaron en 49.741 niños, nacidos entre 1998 y 2013, durante un período con cinco calendarios de vacunación diferentes. Las tendencias se estimaron mediante el método de regresión lineal Prais-Winsten. La cobertura actualizada del esquema completo varió entre 79,5% y 91,3%, a los 12 meses, y entre 75,8% y 86,9%, a los 24 meses. La cobertura necesaria (todas las dosis aplicadas a la edad recomendada, sin atrasos) varió entre 53,3% y 74%, a los 12 meses, y entre 36,7% y 53,8% a los 24 meses. Hubo una tendencia creciente en la cobertura actualizada a los 24 meses. Los atrasos, en relación con la edad recomendada, se acentúan en dosis a partir de los seis meses y parecen estar más relacionados con la edad que con el número de dosis del esquema. La proporción de dosis inválidas y atrasadas fue menor que en otros estudios. A pesar del aumento del número de dosis en el calendario de vacunas, se alcanzaron altas coberturas actualizadas y coberturas oportunas mayores que las encontradas en la literatura nacional e internacional, sin embargo, se necesitan más esfuerzos para el aumento de la oportunidad. El RII se mostró relevante en la evaluación y supervisión de coberturas de vacunación con análisis más exactos.

The role of inter-regional flows in the spread of epidemics in a city of regional influence with a tropical climate. / El papel de los flujos interregionales en la diseminación de epidemias de dengue en una ciudad de clima tropical.

The aim of this research was to investigate the origin of imported cases of dengue in the city of Araraquara, Brazil and to describe the disease's main epidemiological characteristics. The study encompassed all confirmed cases of dengue recorded in the Information System for Notifiable Diseases (SINAN) [Sistema de Informação de Agravos de Notificação] from 1998 to 2013. Cases whose origin of infection was likely located outside Araraquara were considered imported. The epidemiological study entailed a descriptive analysis of the data, regarding the distribution of cases by sex, age, and classification of imported and autochthonous cases. A geographic information system was used to map flows and estimate distances. There were 6,913 confirmed cases, 419 of which were imported. In most cases, the origin of infection was located in the state of São Paulo as well as other Brazilian regions. The results indicate the relevance of imported cases and differences in the epidemiological profile with respect to age and sex. Conclusions indicate the need to increase epidemiological and environmental health surveillance at ports, airports, truck stops, and bus and train terminals.

El objetivo de este trabajo fue investigar el origen de los casos importados de dengue en la ciudad de Araraquara, Brasil y describir las principales características epidemiológicas. El estudio abarcó todos los casos confirmados de dengue registrados en el Sistema de Información de Enfermedades de Notificación (SINAN) [Sistema de Informação de Agravos de Notificação] de 1998-2013. Se consideraron como casos importados aquellos cuyo lugar de origen de infección se ubicara fuera de Araraquara. Se realizó un análisis descriptivo de la distribución de los casos por género, edad y clasificación de casos importados y autóctonos. Se utilizó un sistema de información geográfica para mapear los flujos y estimar las distancias de los puntos de contagio. Se incluyeron 6.913 casos confirmados, de los cuales 419 fueron importados. En la mayoría de estos casos, el origen de infección se ubicó en el estado de San Pablo, además de otras regiones brasileñas. Los resultados indican la relevancia de los casos importados y diferencias en el perfil epidemiológico por edad y sexo. Las conclusiones indican la necesidad de aumentar la vigilancia epidemiológica y de salud ambiental en los puertos, aeropuertos, paradas de camiones y terminales de buses y trenes.

El papel de los flujos interregionales en la diseminación de epidemias de dengue en una ciudad de clima tropical / The role of inter-regional flows in the spread of epidemics in a city of regional influence with a tropical climate

RESUMEN El objetivo de este trabajo fue investigar el origen de los casos importados de dengue en la ciudad de Araraquara, Brasil y describir las principales características epidemiológicas. El estudio abarcó todos los casos confirmados de dengue registrados en el Sistema de Información de Enfermedades de Notificación (SINAN) [Sistema de Informação de Agravos de Notificação] de 1998-2013. Se consideraron como casos importados aquellos cuyo lugar de origen de infección se ubicara fuera de Araraquara. Se realizó un análisis descriptivo de la distribución de los casos por género, edad y clasificación de casos importados y autóctonos. Se utilizó un sistema de información geográfica para mapear los flujos y estimar las distancias de los puntos de contagio. Se incluyeron 6.913 casos confirmados, de los cuales 419 fueron importados. En la mayoría de estos casos, el origen de infección se ubicó en el estado de San Pablo, además de otras regiones brasileñas. Los resultados indican la relevancia de los casos importados y diferencias en el perfil epidemiológico por edad y sexo. Las conclusiones indican la necesidad de aumentar la vigilancia epidemiológica y de salud ambiental en los puertos, aeropuertos, paradas de camiones y terminales de buses y trenes.

ABSTRACT The aim of this research was to investigate the origin of imported cases of dengue in the city of Araraquara, Brazil and to describe the disease's main epidemiological characteristics. The study encompassed all confirmed cases of dengue recorded in the Information System for Notifiable Diseases (SINAN) [Sistema de Informação de Agravos de Notificação] from 1998 to 2013. Cases whose origin of infection was likely located outside Araraquara were considered imported. The epidemiological study entailed a descriptive analysis of the data, regarding the distribution of cases by sex, age, and classification of imported and autochthonous cases. A geographic information system was used to map flows and estimate distances. There were 6,913 confirmed cases, 419 of which were imported. In most cases, the origin of infection was located in the state of São Paulo as well as other Brazilian regions. The results indicate the relevance of imported cases and differences in the epidemiological profile with respect to age and sex. Conclusions indicate the need to increase epidemiological and environmental health surveillance at ports, airports, truck stops, and bus and train terminals.

Use of electronic immunization registry in the surveillance of adverse events following immunization.

OBJECTIVE: To describe adverse events following vaccination (AEFV) of children under two years old and analyze trend of this events from 2000 to 2013, in the city of Araraquara (SP), Brazil. METHODS: This is a descriptive study conducted with data of the passive surveillance system of AEFV that is available in the electronic immunization registry (EIR) of the computerized medical record of the municipal health service (Juarez System). The study variables were: age, gender, vaccine, dose, clinical manifestations and hospitalization. We estimated rates using AEFV as numerator and administered doses of vaccines as denominator. The surveillance sensitivity was estimated by applying the method proposed by the Centers for Disease Control and Prevention. We used Prais-Winsten regression with a significance level of 5.0%. RESULTS: The average annual rate of AEFV was 11.3/10,000 administered doses, however without a trend in the study period (p=0.491). Most cases occurred after the first dose (41.7%) and among children under one year of age (72.6%). Vaccines with pertussis component, yellow fever and measles-mumps-rubella were the most reactogenic. We highlighted the rates of hypotonic-hyporesponsive episodes and convulsion that were 4.1/10,000 and 1.5/10,000 doses of vaccines with pertussis component, respectively, most frequently in the first dose; 60,0% of cases presented symptoms in the first 24 hours after vaccination, however, 18.6% showed after 96 hours. The sensitivity of surveillance was 71.9% and 78.9% for hypotonic-hyporesponsive episodes and convulsion, respectively. CONCLUSIONS: The EIR-based AEFV surveillance system proved to be useful and highly sensitive to describe the safety profile of vaccines in a medium-sized city. It was also shown that the significant increase of the vaccines included in the basic vaccination schedule in childhood in the last decade did not alter the high safety standard of the National Immunization Program.

Use of electronic immunization registry in the surveillance of adverse events following immunization / Uso de registro informatizado de imunização na vigilância de eventos adversos pós-vacina

ABSTRACT OBJECTIVE To describe adverse events following vaccination (AEFV) of children under two years old and analyze trend of this events from 2000 to 2013, in the city of Araraquara (SP), Brazil. METHODS This is a descriptive study conducted with data of the passive surveillance system of AEFV that is available in the electronic immunization registry (EIR) of the computerized medical record of the municipal health service (Juarez System). The study variables were: age, gender, vaccine, dose, clinical manifestations and hospitalization. We estimated rates using AEFV as numerator and administered doses of vaccines as denominator. The surveillance sensitivity was estimated by applying the method proposed by the Centers for Disease Control and Prevention. We used Prais-Winsten regression with a significance level of 5.0%. RESULTS The average annual rate of AEFV was 11.3/10,000 administered doses, however without a trend in the study period (p=0.491). Most cases occurred after the first dose (41.7%) and among children under one year of age (72.6%). Vaccines with pertussis component, yellow fever and measles-mumps-rubella were the most reactogenic. We highlighted the rates of hypotonic-hyporesponsive episodes and convulsion that were 4.1/10,000 and 1.5/10,000 doses of vaccines with pertussis component, respectively, most frequently in the first dose; 60,0% of cases presented symptoms in the first 24 hours after vaccination, however, 18.6% showed after 96 hours. The sensitivity of surveillance was 71.9% and 78.9% for hypotonic-hyporesponsive episodes and convulsion, respectively. CONCLUSIONS The EIR-based AEFV surveillance system proved to be useful and highly sensitive to describe the safety profile of vaccines in a medium-sized city. It was also shown that the significant increase of the vaccines included in the basic vaccination schedule in childhood in the last decade did not alter the high safety standard of the National Immunization Program.

RESUMO OBJETIVO Descrever os eventos adversos pós-vacina ocorridos em crianças com até dois anos de idade e analisar a tendência desses eventos, entre 2000 e 2013, em Araraquara, SP, Brasil. MÉTODOS Estudo descritivo com dados da vigilância passiva de eventos adversos pós-vacina, disponíveis no registro informatizado de imunização do prontuário eletrônico do serviço municipal de saúde (Sistema Juarez). As variáveis de estudo foram: idade, sexo, vacina, dose, manifestações clínicas e hospitalização. As taxas foram estimadas tomando-se os casos de eventos adversos pós-vacina como numerador e as doses aplicadas, como denominador. Estimou-se a sensibilidade da vigilância de eventos adversos pós-vacina aplicando-se o método proposto pelo Centers for Disease Control and Prevention. Para análise de tendência utilizou-se a regressão de Prais-Winsten, considerando o nível de significância de 5,0%. RESULTADOS A taxa anual média de eventos adversos pós-vacina foi de 11,3/10.000 doses aplicadas, porém, sem tendência no período estudado (p = 0,491). Houve predomínio de casos após a primeira dose (41,7%) e entre menores de um ano de idade (72,6%). As vacinas com componente pertussis, de febre amarela e de sarampo-caxumba-rubéola foram as mais reatogênicas. Destacou-se a frequência de episódio hipotônico hiporresponsivo e convulsão, com taxas de 4,1/10.000 e 1,5/10.000 doses de vacinas com componente pertussis, respectivamente, mais elevadas na primeira dose; 60,0% dos casos apresentaram sintomas nas primeiras 24 horas após a vacinação e 18,6% apresentaram-se após 96 horas. A sensibilidade da vigilância foi estimada em 71,9% e 78,9% para episódio hipotônico hiporresponsivo e convulsão, respectivamente. CONCLUSÕES O sistema de vigilância de eventos adversos pós-vacina com base no registro informatizado de imunização mostrou-se útil e dotado de elevada sensibilidade para descrever o perfil de segurança das vacinas em um município de médio porte. Adicionalmente, a expressiva ampliação, na última década, das vacinas incluídas no esquema básico de vacinação na infância não alterou o elevado padrão de segurança do Programa Nacional de Imunizações.

Avaliação de coberturas vacinais de crianças em uma cidade de médio porte (Brasil) utilizando registro informatizado de imunização / Assessment of vaccination coverage of children in a medium-sized Brazilian city using electronic immunization registry / Evaluación de las coberturas de vacunación en niños de una ciudad media (Brasil), utilizando el registro informatizado de inmunización

Dados administrativos mostram altas coberturas vacinais no Brasil, porém não há avaliação da validade e oportunidade de aplicação das doses, nem se o esquema vacinal está completo. Este estudo avaliou as coberturas oportunas e atualizadas de crianças de 12 a 24 meses de idade. Estudo longitudinal de base populacional em Araraquara, São Paulo, uma cidade de médio porte predominantemente urbana, utilizando dados do Sistema Juarez, um registro informatizado de imunização (RII). As coberturas foram avaliadas para 49.741 crianças nascidas entre 1998 e 2013, período com cinco calendários de vacinação diferentes. As tendências foram estimadas pelo método de regressão linear Prais-Winsten. A cobertura atualizada do esquema completo variou entre 79,5% e 91,3%, aos 12 meses, e entre 75,8% e 86,9%, aos 24 meses. A cobertura oportuna (todas as doses aplicadas na idade recomendada, sem atraso) variou entre 53,3% e 74%, aos 12 meses, e entre 36,7% e 53,8%, aos 24 meses. Houve tendência crescente para a cobertura atualizada aos 24 meses. Os atrasos em relação à idade recomendada se acentuam em doses a partir dos seis meses e parecem estar mais relacionados à idade do que ao número de doses do esquema. A proporção de doses inválidas e atrasadas foi menor do que em outros estudos. Apesar do aumento do número de doses no calendário vacinal, foram alcançadas altas coberturas atualizadas e coberturas oportunas maiores do que as encontradas na literatura nacional e internacional, porém são necessários mais esforços para o aumento da oportunidade. O RII mostrou-se relevante para avaliação e monitoramento de coberturas vacinais, com análises mais acuradas.

Administrative data show high vaccination coverage rates in Brazil, but there is no assessment of the validity and timeliness of dose administration, or whether the vaccination schedule is complete. This study assessed timely and updated coverage rates in children 12 to 24 months of age. This was a longitudinal population-based study in Araraquara, São Paulo State, a predominantly urban medium-sized municipality, using the Juarez System, an electronic immunization registry (EIR). Coverage rates were assessed in 49,741 children born from 1998 to 2013, a period in which five different vaccination schedules were used. Trends were estimated with the Prais-Winsten linear regression method. Updated coverage of the complete schedule varied from 79.5% to 91.3% at 12 months and from 75.8% to 86.9%, at 24 months. Timely coverage (all doses applied at the recommended ages, with no delays) ranged from 53.3% to 74% at 12 months and from 36.7% to 53.8% at 24 months. There was an upward trend in updated coverage at 24 months. The delays in relation to recommended age increased starting at six months and appeared to relate more to age than to the number of doses in the schedule. The proportion of invalid and late doses was lower than in other studies. Despite the increase in the number of doses in the vaccination schedule, the study showed high updated coverage rates and higher timely coverage than reported in the national and international literature; however, more effort is needed to increase timeliness. EIR proved relevant for assessing and monitoring vaccination coverage with more accurate analyses.

Los datos administrativos muestran altas coberturas de vacunación en Brasil, sin embargo, no existe una evaluación de la validez y oportunidad de aplicación de las dosis, ni si la cartilla de vacunación ha sido completada. Este estudio evalúo las coberturas necesarias y actualizadas en niños de 12 a 24 meses de edad. Se trata de un estudio longitudinal con base poblacional en Araraquara, São Paulo, una ciudad media, predominantemente urbana, utilizando datos del Sistema Juarez, un registro informatizado de inmunización (RII). Las coberturas se evaluaron en 49.741 niños, nacidos entre 1998 y 2013, durante un período con cinco calendarios de vacunación diferentes. Las tendencias se estimaron mediante el método de regresión lineal Prais-Winsten. La cobertura actualizada del esquema completo varió entre 79,5% y 91,3%, a los 12 meses, y entre 75,8% y 86,9%, a los 24 meses. La cobertura necesaria (todas las dosis aplicadas a la edad recomendada, sin atrasos) varió entre 53,3% y 74%, a los 12 meses, y entre 36,7% y 53,8% a los 24 meses. Hubo una tendencia creciente en la cobertura actualizada a los 24 meses. Los atrasos, en relación con la edad recomendada, se acentúan en dosis a partir de los seis meses y parecen estar más relacionados con la edad que con el número de dosis del esquema. La proporción de dosis inválidas y atrasadas fue menor que en otros estudios. A pesar del aumento del número de dosis en el calendario de vacunas, se alcanzaron altas coberturas actualizadas y coberturas oportunas mayores que las encontradas en la literatura nacional e internacional, sin embargo, se necesitan más esfuerzos para el aumento de la oportunidad. El RII se mostró relevante en la evaluación y supervisión de coberturas de vacunación con análisis más exactos.

Vaccination coverage according to doses received and timely administered based on an electronic immunization registry, Araraquara-SP, Brazil, 2012-2014. / Coberturas vacinais por doses recebidas e oportunas com base em um registro informatizado de imunização, Araraquara-SP, Brasil, 2012-2014.

OBJECTIVE: to describe vaccine coverage by type of vaccine at 12 and 24 months of age. METHODS: descriptive cohort study with children born in 2012, living in Araraquara-SP, Brazil, recorded in the Information System on Live Births (Sinasc); a manual linkage of Sinasc data with an electronic immunization registry (EIR) was performed; the assessment was based on vaccination status according to São Paulo State recommendations, and on doses received and timely administered. RESULTS: 2,740 children were registered on Sinasc and 99.6% of them were included into EIR; among the 2,612 (95.3%) children studied, the triple viral vaccine (measles, mumps and rubella) had the lowest coverage at 12 months for received dose (74.8%) and at 24 months for timely vaccination (53.5%) and received doses (88.0%). CONCLUSION: coverage was higher than 90% for most vaccines; however, delayed vaccination was observed, which indicates the need to intensify actions aimed at timely vaccination.

Coberturas vacinais por doses recebidas e oportunas com base em um registro informatizado de imunização, Araraquara-SP, Brasil, 2012-2014 / Coberturas de vacunación según las dosis recibidas y oportunas basada en un registro computarizado de inmunización, Araraquara-SP, Brasil, 2012-2014 / Vaccination coverage according to doses received and timely administered based on an electronic immunization registry, Araraquara-SP, Brazil, 2012-2014

OBJETIVO: descrever as coberturas vacinais por tipo de vacina aos 12 e aos 24 meses de idade. Métodos: estudo de coorte descritivo com crianças nascidas em 2012, residentes em Araraquara-SP, Brasil, registradas no Sistema de Informações sobre Nascidos Vivos (Sinasc); realizou-se relacionamento manual dos dados do Sinasc com um registro informatizado de imunização (RII); avaliou-se a situação vacinal pelas recomendações do estado de São Paulo, por doses recebidas e oportunas. Resultados: 2.740 crianças estavam registradas no Sinasc; dessas, 99,6% constavam no RII; entre as 2.612 (95,3%) crianças estudadas, a vacina tríplice viral (sarampo, caxumba e rubéola) apresentou as menores coberturas aos 12 meses por doses recebidas (74,8%) e aos 24 meses por doses oportunas (53,5%) e recebidas (88,0%). Conclusão: as coberturas foram superiores a 90% para a maioria das vacinas; entretanto, observou-se atraso vacinal, o que aponta a necessidade de intensificar ações que visem à vacinação oportuna.

OBJETIVO: describir las coberturas de vacunación, por tipo de vacuna, a los 12 y 24 meses de edad. MÉTODOS: estudio de cohorte descriptivo de nacidos en 2012, viviendo en Araraquara-SP, Brasil, registrados en el Sistema de Información de Nacidos Vivos (Sinasc); se realizó vinculación manual de Sinasc con un registro computarizado de inmunización (RCI); se evaluó el estado de vacunación siguiendo recomendaciones del estado de São Paulo, según dosis recibidas y oportunas. RESULTADOS: 2.740 niños fueron registrados en el Sinasc y 99,6% estaban en el RCI; entre los 2.612 (95,3%) niños estudiados, la vacuna triple viral (sarampión, paperas y rubéola) tuvo menor cobertura a los 12 meses según dosis recibidas (74,8%) y a los 24 meses según dosis oportunas (53,5%,) y recibidas (88,0%). CONCLUSIÓN: las coberturas fueron superiores al 90% para la mayoría de vacunas; no obstante, se observó un retraso de vacunaciones, que indica necesidad de intensificar acciones destinadas a la vacunación oportuna.

OBJECTIVE: to describe vaccine coverage by type of vaccine at 12 and 24 months of age. METHODS: descriptive cohort study with children born in 2012, living in Araraquara-SP, Brazil, recorded in the Information System on Live Births (Sinasc); a manual linkage of Sinasc data with an electronic immunization registry (EIR) was performed; the assessment was based on vaccination status according to São Paulo State recommendations, and on doses received and timely administered. RESULTS: 2,740 children were registered on Sinasc and 99.6% of them were included into EIR; among the 2,612 (95.3%) children studied, the triple viral vaccine (measles, mumps and rubella) had the lowest coverage at 12 months for received dose (74.8%) and at 24 months for timely vaccination (53.5%) and received doses (88.0%). CONCLUSION: coverage was higher than 90% for most vaccines; however, delayed vaccination was observed, which indicates the need to intensify actions aimed at timely vaccination.

Cross reactivity of commercial anti-dengue immunoassays in patients with acute Zika virus infection.

Several countries have local transmission of multiple arboviruses, in particular, dengue and Zika viruses, which have recently spread through many American countries. Cross reactivity among Flaviviruses is high and present a challenge for accurate identification of the infecting agent. Thus, we evaluated the level of cross reactivity of anti-dengue IgM/G Enzyme-Linked Immunosorbent Assays (ELISA) from three manufacturers against 122 serum samples obtained at two time-points from 61 patients with non-dengue confirmed Zika virus infection. All anti-dengue ELISAs cross reacted with serum from patients with acute Zika infection at some level and a worrisome number of seroconversion for dengue IgG and IgM was observed. These findings may impact the interpretation of currently standard criteria for dengue diagnosis in endemic regions.

Preliminary report of the use on adults of a recombinant yeast-derived hepatitis B vaccine manufactured by Instituto Butantan

Tres doses de 10 ug da vacina recombinante contra hepatite B, produzida pelo Instituto Butantan, atrave de tecnologia propria, foram administradas numa populacao de adultos (idade media 30 anos), seguindo o esquema de imunizacao 0,1 e 6 meses apos a primeira dose. A avaliacao clinica da vacina foi considerada satisfatoria em termos de imumogenicidade (titulos dos anticorpos anti-HBs entre 17,5-29500 UI/1, soroconversao 95,3 por cento) e reatividade (sem efeitos colaterais e sintomas clinicos relevantes)