[Online survey on the reasons for vaccine hesitancy against COVID-19 in children and adolescents in Brazil]. / Inquérito online sobre os motivos para hesitação vacinal contra a COVID-19 em crianças e adolescentes do Brasil.

The objective is to unveil the reasons for vaccine hesitancy among parents and/or guardians of children and adolescents toward the prevention of COVID-19. This is a descriptive study, with a qualitative approach that seeks to analyze the answers to the open question "Why will you not vaccinate or have not vaccinated or are in doubt about vaccinating the children and adolescents under your responsibility, for the prevention of COVID-19?". The research included adult individuals, Brazilians, living in the country, responsible for children and adolescents under 18 years of age. Data collection took place electronically in November and December 2021. The answers were organized and processed with the support of the software Iramuteq. The textual corpus of this research was composed of the response of 1,896 participants, consisting of 87% who were hesitant (1,650) and 13% (246) of parents who intend to vaccinate but who outlined some doubts and considerations about the vaccination of children and adolescents. These are reasons why parents and/or guardians have not vaccinated or are in doubt about vaccinating the children and adolescents under their responsibility for the prevention of COVID-19: fears about vaccination regarding the conception that the vaccine is in the experimental phase, fear of adverse reactions and long-term effects. The reasons for the lack of intention to vaccinate stem from the understanding of the participants that COVID-19 in children is not serious, the risks of vaccination are greater than the benefits, and the right of choice not to vaccinate.

Objetiva-se desvelar os motivos para hesitação vacinal de pais e/ou responsáveis de crianças e adolescentes para prevenção da COVID-19. Trata-se de um estudo descritivo, de abordagem qualitativa, que busca analisar as respostas da pergunta aberta "por que você não vai vacinar, não vacinou ou está na dúvida em vacinar as crianças e os adolescentes sob sua responsabilidade para prevenção da COVID-19?". A pesquisa incluiu indivíduos adultos, brasileiros, residentes no país, responsáveis por crianças e adolescentes menores de 18 anos. A coleta de dados aconteceu de forma eletrônica entre os meses de novembro e dezembro de 2021. As respostas foram organizadas e processadas com suporte do software Iramuteq. O corpus textual desta pesquisa foi composto pela resposta de 1.896 participantes, constituído por 87% de hesitantes (1.650) e 13% (246) de pais que têm intenção de vacinar, mas que esboçaram algumas dúvidas e considerações a respeito da vacinação de crianças e adolescentes. São motivos pelos quais pais e/ou responsáveis não vacinaram ou estão na dúvida em vacinar as crianças e os adolescentes sob sua responsabilidade para prevenção da COVID-19: receio em razão de a vacina estar em fase experimental e medo das reações adversas e dos efeitos a longo prazo. Já os motivos para ausência de intenção de vacinar decorrem dos entendimentos dos participantes de que a COVID-19 em crianças não é grave, os riscos da vacinação são maiores do que os benefícios e o direito de escolha em não vacinar.

El objetivo es revelar los motivos de la indecisión a las vacunas de padres y/o responsables de niños y adolescentes para la prevención de COVID-19. Se trata de un estudio descriptivo con enfoque cualitativo, que busca analizar las respuestas a la pregunta abierta "¿Por qué no va a vacunar o no vacunó o tiene dudas en vacunar a los niños y los adolescentes bajo su responsabilidad para la prevención del COVID-19?". La investigación incluyó individuos adultos, brasileños, residentes en el país, responsables de niños y adolescentes menores de 18 años. La recolección de datos se realizó de forma electrónica entre los meses de noviembre y diciembre de 2021. Las respuestas se organizaron y procesaron con ayuda del software Iramuteq. El corpus textual de esta investigación fue compuesto por la respuesta de 1.896 participantes, siendo constituido por el 87% de indecisos (1.650) y el 13% (246) de padres que tienen la intención de vacunar, pero que esbozaron algunas dudas y consideraciones respecto a la vacunación de niños y adolescentes. Son motivos por los cuales los padres y/o responsables no vacunaron o están en duda en vacunar a los niños y adolescentes bajo su responsabilidad para prevención del COVID-19: temores con la vacunación en cuanto a la concepción de que la vacuna está en fase experimental, miedo a las reacciones adversas y los efectos a largo plazo. Los motivos de la ausencia de intención en vacunar se deben a que los participantes entienden que el COVID-19 en niños no es grave, que los riesgos de la vacunación son mayores que los beneficios y que tienen derecho a decidir no vacunarse.

Social Representations of Hesitant Brazilians about Vaccination against COVID-19.

BACKGROUND: The control of the COVID-19 pandemic has been a great challenge. Understanding the thoughts and beliefs underlying vaccine hesitancy can help in the formulation of public policies. The present study aimed to analyze the social representations of hesitant Brazilians about vaccination against COVID-19. METHODS: Qualitative research guided by the Theory of Social Representations, carried out through an online survey among Brazilian adults living in Brazil. The data were analyzed using the IRaMuTeQ software. RESULTS: Of the 173,178 respondents, 10,928 were hesitant and declared reasons for vaccination hesitation. The analysis generated three classes: mistrust of the vaccine and underestimation of the severity of the pandemic; (dis)information and distrust of political involvement; and fear of adverse reactions to COVID-19 vaccines. CONCLUSIONS: Social knowledge, presented by the representations apprehended in this study, demonstrates difficulty in discerning the reliability of information and a social imagination full of doubts and uncertainties. Understanding the internal dynamics of these groups, with their representations of the world, is important to propose policies and actions that echo and cause changes in the understanding of the role of immunization. It is essential to shed light on the sociological imagination so that gaps filled with false information can be dismantled and confronted with scientific knowledge accessible to the population.

Trustworthiness of information sources on vaccines for COVID-19 prevention among Brazilians.

OBJECTIVE: This study aims to assess the trustworthiness of information sources, perception of clear information about the vaccine, and strategies to increase adherence to vaccination to provide managers with information that helps establish effective communication with the population about vaccination. METHOD: This is an online survey conducted between January 22 and 29, 2021, preceded by an Informed Consent, that aims to assess vaccine hesitancy, which corresponded to the first week of vaccination initiation to prevent COVID-19 in Brazil. Data were obtained from a questionnaire made available through a free platform and stored in Google Forms and later exported to the SPSS statistical package for analysis. The sample consisted of all questionnaires from participants who self-declared as age 18 or older, Brazilian, and residing in Brazil at the time of the survey. Incomplete records with more than 50% of blank items and duplicates were excluded. All categorical variables were analyzed from their absolute and relative frequencies. Multivariate logistic regression was performed to verify the relationship between dependent variables and independent variables. RESULTS: The results show that trust in information sources diverges between hesitant and non-hesitant. They also showed that some participants show an overall distrust that seems to have deeper foundations than issues related only to the source of information. The high rejection of television and the WHO as sources of information among hesitant suggests that integrated actions with research institutes, public figures vaccinating, and religious leaders can help to combat vaccine hesitation. Two actors become particularly important in this dynamic, both for good and bad, and their anti-vaxxer behavior must be observed: the doctor and the Ministry of Health. CONCLUSION: This study contributes to gathering valuable information to help understand the behavior and thinking relevant to the adherence to vaccination recommendations.

Willingness of Brazilian caregivers in having their children and adolescents vaccinated against Covid-19.

BACKGROUND: The vaccination of children and adolescents for the prevention of Covid-19 is important to:decrease in deaths and hospitalizations, prevent multisystem inflammatory syndrome, avoid long-term complications and decrease the suspension of on-site classes. Despite of these benefits, some studies have shown that some caregivers are still hesitancy. METHODS: This is a voluntary and anonymous online survey conducted from November 17 to December 14, 2021, in Brazil, through a free-of-charge platform with a link provided on social networks. A bivariate analysis was conducted with the independent variables, with vaccine hesitancy as the outcome variable, and a multivariate logistic model was used to calculated adjusted odds ratios. RESULTS: The sample included 15,297 respondents. Approximately 13.3 % (2,028) of the caregivers were hesitant to vaccinate their children and adolescents against Covid-19 in at least one age group. The vaccination hesitanty rate of caregivers of children aged 0-4 years, 5-11 years and adolescents were 16 %, 13 %, 15 %, respectively. The principal factors associated with vaccine hesitancy were the following: belief that they need to wait longer, belief that children that had natural infection doesn't need to vaccinate and belief that vaccine has long term adverse effects. INTERPRETATION: The present study showed that the willingness of caregivers to have their children and adolescents vaccinated in Brazil is high compared to data from adult and pediatric international studies. This study provides a profile of the hesitant caregivers considering their perspectives and beliefs regarding vaccines that can help the elaboration of strategies to increase vaccine adherence.

Incompletude da variável profissão/ocupação nos bancos de síndrome gripal, síndrome respiratória aguda grave e mortalidade, Brasil, 2020-2021 / Incompleteness of the profession/occupation variable in the flu-like syndrome, severe acute respiratory syndrome and mortality databases, Brazil, 2020-2021

Resumo Objetivo: descrever a incompletude da informação sobre profissão/ocupação nas bases de dados de síndrome respiratória aguda grave (SRAG), síndrome gripal (SG) e no Sistema de Informações sobre Mortalidade (SIM) no Brasil. Métodos: estudo descritivo utilizando os bancos de dados de SRAG, SG e SIM. Calcularam-se percentuais de incompletude na variável profissão/ocupação segundo sexo, macrorregiões e unidades da federação, em 2020-2021. Resultados: o percentual de incompletude foi de 94,7% no banco de SG; 97,7% no de SRAG; e 17,0% no SIM. Em todas as macrorregiões a incompletude foi superior a 91,0% nos bancos de SG e SRAG; e superior a 13,0% no SIM. Todas as unidades da federação apresentaram percentuais de incompletude acima de 90,0% para SG; de 74,0% para SRAG; e de 6,8% para óbitos. Amapá apresentou maior percentual de incompletude na base de dados de SG (98,1%); Rio Grande do Sul (99,4%) na de SRAG; e Alagoas (45,0%) no SIM. Conclusões: observaram-se elevados percentuais de incompletude da variável profissão/ocupação nos sistemas de informação estudados. Recomenda-se uma articulação intersetorial, envolvendo representantes dos governos e dos trabalhadores, para formulação de estratégias que contornem a falta de informação sobre ocupação/profissão nas bases de dados relevantes para a vigilância em saúde.

Abstract Objective: to describe the incomplete filling out of the profession/occupation variable in the flu-like syndrome, severe acute respiratory syndrome and mortality databases in Brazil. Methods: descriptive study with secondary data from flu-like syndrome (FLS), severe acute respiratory syndrome (SARS) and mortality databases (SIM). We calculeted the absolute and relative filling frequencies of the profession/occupation variable according to State, gender, regions, and federative units, for 2020 and 2021. Results: we found a 94.7% incompleteness on the FLS database, 97.7% of missing profession/occupation data on the SARS, and 17.0% on the SIM database. Incompleteness frequency was above 91.0% in all Brazilian regions for FLS and SARS. Incompleteness on the mortality database was over 13.0%. All federative units presented incompleteness above 90.0% for FLS, 74.0% for SARS, and 6.8% for mortality in all genders. Higher levels of missing data were found in the states of Amapá for FLS (98.1%), Rio Grande do Sul for SARS and Alagoas (45.0%) for mortality (99.4%). Conclusions: all databases showed a high incompleteness of the profession/occupation variable. We recommend an articulation between the Ministry of Health, Ministry of Labor and workers' representations to solve this lack of data on occupation/profession in public databases.

Inquérito online sobre os motivos para hesitação vacinal contra a COVID-19 em crianças e adolescentes do Brasil / Online survey on the reasons for vaccine hesitancy against COVID-19 in children and adolescents in Brazil / Encuesta en línea sobre los motivos de la indecisión a las vacunas contra COVID-19 en niños y adolescentes de Brasil

Resumo: Objetiva-se desvelar os motivos para hesitação vacinal de pais e/ou responsáveis de crianças e adolescentes para prevenção da COVID-19. Trata-se de um estudo descritivo, de abordagem qualitativa, que busca analisar as respostas da pergunta aberta "por que você não vai vacinar, não vacinou ou está na dúvida em vacinar as crianças e os adolescentes sob sua responsabilidade para prevenção da COVID-19?". A pesquisa incluiu indivíduos adultos, brasileiros, residentes no país, responsáveis por crianças e adolescentes menores de 18 anos. A coleta de dados aconteceu de forma eletrônica entre os meses de novembro e dezembro de 2021. As respostas foram organizadas e processadas com suporte do software Iramuteq. O corpus textual desta pesquisa foi composto pela resposta de 1.896 participantes, constituído por 87% de hesitantes (1.650) e 13% (246) de pais que têm intenção de vacinar, mas que esboçaram algumas dúvidas e considerações a respeito da vacinação de crianças e adolescentes. São motivos pelos quais pais e/ou responsáveis não vacinaram ou estão na dúvida em vacinar as crianças e os adolescentes sob sua responsabilidade para prevenção da COVID-19: receio em razão de a vacina estar em fase experimental e medo das reações adversas e dos efeitos a longo prazo. Já os motivos para ausência de intenção de vacinar decorrem dos entendimentos dos participantes de que a COVID-19 em crianças não é grave, os riscos da vacinação são maiores do que os benefícios e o direito de escolha em não vacinar.

Abstract: The objective is to unveil the reasons for vaccine hesitancy among parents and/or guardians of children and adolescents toward the prevention of COVID-19. This is a descriptive study, with a qualitative approach that seeks to analyze the answers to the open question "Why will you not vaccinate or have not vaccinated or are in doubt about vaccinating the children and adolescents under your responsibility, for the prevention of COVID-19?". The research included adult individuals, Brazilians, living in the country, responsible for children and adolescents under 18 years of age. Data collection took place electronically in November and December 2021. The answers were organized and processed with the support of the software Iramuteq. The textual corpus of this research was composed of the response of 1,896 participants, consisting of 87% who were hesitant (1,650) and 13% (246) of parents who intend to vaccinate but who outlined some doubts and considerations about the vaccination of children and adolescents. These are reasons why parents and/or guardians have not vaccinated or are in doubt about vaccinating the children and adolescents under their responsibility for the prevention of COVID-19: fears about vaccination regarding the conception that the vaccine is in the experimental phase, fear of adverse reactions and long-term effects. The reasons for the lack of intention to vaccinate stem from the understanding of the participants that COVID-19 in children is not serious, the risks of vaccination are greater than the benefits, and the right of choice not to vaccinate.

Resumen: El objetivo es revelar los motivos de la indecisión a las vacunas de padres y/o responsables de niños y adolescentes para la prevención de COVID-19. Se trata de un estudio descriptivo con enfoque cualitativo, que busca analizar las respuestas a la pregunta abierta "¿Por qué no va a vacunar o no vacunó o tiene dudas en vacunar a los niños y los adolescentes bajo su responsabilidad para la prevención del COVID-19?". La investigación incluyó individuos adultos, brasileños, residentes en el país, responsables de niños y adolescentes menores de 18 años. La recolección de datos se realizó de forma electrónica entre los meses de noviembre y diciembre de 2021. Las respuestas se organizaron y procesaron con ayuda del software Iramuteq. El corpus textual de esta investigación fue compuesto por la respuesta de 1.896 participantes, siendo constituido por el 87% de indecisos (1.650) y el 13% (246) de padres que tienen la intención de vacunar, pero que esbozaron algunas dudas y consideraciones respecto a la vacunación de niños y adolescentes. Son motivos por los cuales los padres y/o responsables no vacunaron o están en duda en vacunar a los niños y adolescentes bajo su responsabilidad para prevención del COVID-19: temores con la vacunación en cuanto a la concepción de que la vacuna está en fase experimental, miedo a las reacciones adversas y los efectos a largo plazo. Los motivos de la ausencia de intención en vacunar se deben a que los participantes entienden que el COVID-19 en niños no es grave, que los riesgos de la vacunación son mayores que los beneficios y que tienen derecho a decidir no vacunarse.

What can we learn with the data we didn't have? The case of the variable profession/ occupation on flu-like syndrome, severe acute respiratory syndrome and mortality databases in Brazil / ¿Qué podemos aprender con los datos que no tenemos? El caso de la variable profesión /ocupación sobre base de datos de la síndrome gripal, síndrome respiratorio agudo severo y de mortalidad en Brasil / O que aprendemos diante dos dados que não temos? O caso da variável profissão/ocupação nos bancos de síndrome gripal, síndrome respiratória aguda grave e mortalidade no Brasil

Objective: To describe the completeness of the profession/ occupation on flu-like syndrome, severe acute respiratory syndrome and mortality databases in Brazil between 2020 and 2021 Methods:  the absolute and relative frequencies of the completeness of the variable occupation were calculated for each state for the between 2020 and 2021. Results: For the study period, there was 94.83% incompleteness for notifications of Flu-like syndrome, 97.73% for notified cases of SARS and 17.06% for deaths from all causes. Conclusions: We recommend an articulation between the Ministry of Health, Ministry of Labor and Welfare and workers' representations, such as councils and unions, to solve the problem of lack of data on occupation/profession in public databases.

Objetivo: descrever o preenchimento da variável profissão/ocupação nos bancos de dados do Sistema de Informação de Mortalidade (SIM), de Síndrome Respiratória Aguda Grave (SRAG) e Síndrome Gripal (SG) entre 2020 e 2021 no Brasil. Métodos: foram calculadas as frequências absolutas e relativas do preenchimento da variável profissão/ocupação por Unidade da Federação para cada base de dados durante o período de estudo. Resultados: Para o período de estudo, verificou-se 94,83% de incompletude para as notificações de SG, 97,73% para casos notificados de SRAG e 17,06% para óbitos por todas as causas. Conclusões: Recomendamos uma articulação entre o Ministério da Saúde, Ministério do Trabalho e Previdência e representações de trabalhadores, como conselhos e sindicatos para formulação de estratégias para contornar o problema da falta de dados de ocupação/profissão nos bancos de dados públicos.

Low COVID-19 vaccine hesitancy in Brazil.

BACKGROUND: The COVID-19 pandemic has affected the entire world, and the vaccine has emerged as a source of hope for return to normal life. Still, various countries have reported high vaccine hesitancy rates. It is important to know the vaccine hesitancy profile in Brazil to help design adequate communication strategies. METHODS: A voluntary, anonymous online survey was conducted from January 22 to 29, 2021, including resident Brazilian adults to assess factors related to vaccine hesitancy. Sociodemographic and epidemiological data were analyzed. A bivariate analysis was conducted with the independent variables, with vaccine hesitancy as the outcome variable, and a multivariate logistic model was used to calculated adjusted odds ratios. RESULTS: The sample included 173,178 respondents, and vaccine hesitancy was found in 10.5%. The principal factors associated with vaccine hesitancy were the following: assigning importance to the vaccinés efficacy (AOR = 16.39), fear of adverse reactions (AOR = 11.23), and assigning importance to the vaccinés country of origin (AOR = 3.72). Other risk factors were the following: male gender (AOR = 1.62), having children (AOR = 1.29), 9 years of schooling or less (AOR = 1.31), living in the Central-West region (AOR = 1.19), age ≥ 40 years (AOR = 1.17), and monthly income < U$788.68 (AOR = 1.13). The two vaccines available in Brazil, Covishield and CoronaVac, showed similar confidence, 80.13% and 76.36%, respectively, despite the higher rejection of the latter vaccinés Chinese origin. INTERPRETATION: This online survey confirms the low vaccine hesitancy rate among Brazilians and allowed the identification of a profile that can assist the elaboration of communication strategies to increase vaccine adherence. FUNDING: National Institute of Women, Children and Adolescents Health Fernandes Figueira, FIOCRUZ, Rio de Janeiro, Brazil.

Children's Multisystem inflammatory syndrome with myopathy.

This report describes a case of multisystem inflammatory syndrome in a child that evolved with a pattern of toxic shock syndrome with coronary artery ectasia and neurological involvement, documented by magnetic resonance imaging, with changes in the corpus callosum and myopathy in the pelvic girdle and paravertebral musculature.

Children's Multisystem inflammatory syndrome with myopathy

Abstract This report describes a case of multisystem inflammatory syndrome in a child that evolved with a pattern of toxic shock syndrome with coronary artery ectasia and neurological involvement, documented by magnetic resonance imaging, with changes in the corpus callosum and myopathy in the pelvic girdle and paravertebral musculature.

Invasive Haemophilus influenzae disease in the vaccine era in Rio de Janeiro, Brazil

BACKGROUND Haemophilus influenzae (Hi) serotype b (Hib) conjugate vaccine was incorporated into the infant immunisation schedule in Brazil in 1999, where Hib was one of the major etiologic sources of community-acquired bacterial meningitis. OBJECTIVES The purpose of this study is to describe the molecular epidemiology of invasive Hi disease in Rio de Janeiro state, Brazil, before and after vaccine introduction. METHODS Surveillance data from 1986 to 2014 were analysed. Hi isolates recovered from cerebrospinal fluid (CSF) or blood from 1993 to 2014 were serotyped by slide agglutination, genotyped by multilocus sequence typing (MLST), and the capsule type evaluation, differentiation of serologically non-typeable isolates, and characterisation of the capsule (cap) locus was done by polymerase chain reaction. Antimicrobial susceptibility testing was performed using E-test. FINDINGS From 1986 to 1999 and from 2000 to 2014, 2580 and 197 (42% without serotype information) confirmed cases were reported, respectively. The case fatality rate was 17% and did not correlate with the strain. Hib and b- variant isolates belonged to ST-6, whereas serotype a isolates belonged to the ST-23 clonal complex. Serotype a appeared to emerge during the 2000s. Non-encapsulated isolates were non-clonal and distinct from the encapsulated isolates. Ampicillin-resistant isolates were either of serotype b or were non-encapsulated, and all of them were β-lactamase-positive but amoxicillin-clavulanic acid susceptible. MAIN CONCLUSIONS Although Hi meningitis became a relatively rare disease in Rio de Janeiro after the introduction of the Hib conjugate vaccine, the isolates recovered from patients have become more diverse. These results indicate the need to implement an enhanced surveillance system to continue monitoring the impact of the Hib conjugate vaccine.

Invasive Haemophilus influenzae disease in the vaccine era in Rio de Janeiro, Brazil.

BACKGROUND: Haemophilus influenzae (Hi) serotype b (Hib) conjugate vaccine was incorporated into the infant immunisation schedule in Brazil in 1999, where Hib was one of the major etiologic sources of community-acquired bacterial meningitis. OBJECTIVES: The purpose of this study is to describe the molecular epidemiology of invasive Hi disease in Rio de Janeiro state, Brazil, before and after vaccine introduction. METHODS: Surveillance data from 1986 to 2014 were analysed. Hi isolates recovered from cerebrospinal fluid (CSF) or blood from 1993 to 2014 were serotyped by slide agglutination, genotyped by multilocus sequence typing (MLST), and the capsule type evaluation, differentiation of serologically non-typeable isolates, and characterisation of the capsule (cap) locus was done by polymerase chain reaction. Antimicrobial susceptibility testing was performed using E-test. FINDINGS: From 1986 to 1999 and from 2000 to 2014, 2580 and 197 (42% without serotype information) confirmed cases were reported, respectively. The case fatality rate was 17% and did not correlate with the strain. Hib and b- variant isolates belonged to ST-6, whereas serotype a isolates belonged to the ST-23 clonal complex. Serotype a appeared to emerge during the 2000s. Non-encapsulated isolates were non-clonal and distinct from the encapsulated isolates. Ampicillin-resistant isolates were either of serotype b or were non-encapsulated, and all of them were ß-lactamase-positive but amoxicillin-clavulanic acid susceptible. MAIN CONCLUSIONS: Although Hi meningitis became a relatively rare disease in Rio de Janeiro after the introduction of the Hib conjugate vaccine, the isolates recovered from patients have become more diverse. These results indicate the need to implement an enhanced surveillance system to continue monitoring the impact of the Hib conjugate vaccine.