Description of vaccination coverage and hesitancy obtained by epidemiological survey of children born in 2017-2018, in Belo Horizonte and Sete Lagoas, Minas Gerais, Brazil.

OBJECTIVE: To describe vaccination coverage and hesitation for the basic children's schedule in Belo Horizonte and Sete Lagoas, Minas Gerais state, Brazil. METHODS: Population-based epidemiological surveys performed from 2020 to 2022, which estimated vaccine coverage by type of immunobiological product and full schedule (valid and ministered doses), according to socioeconomic strata; and reasons for vaccination hesitancy. RESULTS: Overall coverage with valid doses and vaccination hesitancy for at least one vaccine were, respectively, 50.2% (95%CI 44.1;56.2) and 1.6% (95%CI 0.9;2.7), in Belo Horizonte (n = 1,866), and 64.9% (95%CI 56.9;72.1) and 1.0% (95%CI 0.3;2.8), in Sete Lagoas (n = 451), with differences between socioeconomic strata. Fear of severe reactions was the main reason for vaccination hesitancy. CONCLUSION: Coverage was identified as being below recommended levels for most vaccines. Disinformation should be combated in order to avoid vaccination hesitancy. There is a pressing need to recover coverages, considering public health service access and socioeconomic disparities. MAIN RESULTS: Vaccination coverage of children up to 4 years old was 50.2% in Belo Horizonte, and 64.9% in Sete Lagoas. Fear of severe reactions and believing that vaccination against eradicated diseases is unnecessary were the main reasons for vaccination hesitancy. IMPLICATIONS FOR SERVICES: Recovery of high vaccination coverage among children, considering public health service access conditions and socioeconomic inequities. Acting on reasons for hesitancy that can assist in targeting actions. PERSPECTIVES: The multifactorial context of vaccination hesitancy demands the development of health education strategies to raise awareness about child immunization.

Racial inequalities in child vaccination and barriers to vaccination in Brazil among live births in 2017 and 2018: an analysis of a retrospective cohort of the first two years of life.

OBJECTIVE: To describe timely vaccination completion and obstacles in the first 24 months of life in Brazil, examining associations with maternal race/skin color. METHODS: Study participants were 37,801 children born in 2017 and 2018 included in the National Immunization Coverage Survey. We calculated prevalence and 95% confidence intervals for timely vaccine completeness and obstacles at 5, 12 and 24 months of life, according to maternal race/skin color. Associations were analyzed using logistic regression. RESULTS: 7.2% (95%CI 6.3;8.2) of mothers faced difficulties in taking their children to be vaccinated, and 23.4% (95%CI 21.7;25.1) were not vaccinated when taken. These proportions were 75% (95%CI 1.25;2.45) and 97% (95%CI 1.57;2.48) higher, respectively, among Black mothers. At least one vaccination was delayed among 49.9% (95%CI 47.8;51.9) and 61.1% (95%CI 59.2;63.0) of children by 5 and 12 months, respectively. These rates were higher among Black/mixed race mothers. CONCLUSION: There are racial inequalities in both the obstacles faced and in vaccination rates in Brazil. MAIN RESULTS: Marked racial inequalities were found in the obstacles to vaccination of children under 24 months in Brazil and to timely vaccination at 5 months and in the first year of life. IMPLICATIONS FOR SERVICES: Racial inequalities in the occurrence of vaccination shortcomings in health services, in the objective restrictions faced by families in taking their children to vaccination centers and in incomplete vaccination in a timely manner need to be addressed by the Brazilian National Health System. PERSPECTIVES: Equal public policies to address barriers to vaccination and qualification of health services need to be implemented. Studies need to deepen understanding of the structural determinants that lead to racial disparities.

Adherence to Short-Duration Treatment (3HP) for Latent Tuberculosis among International Migrants in Manaus, Amazonas: Evaluation of the Efficacy of Different Treatment Modalities.

Migration, a multifaceted phenomenon, has a significant impact on health. Migrants perform similar movement patterns within their country of origin, in transit, and in the country of destination, thus making it difficult to monitor TB treatment throughout the journey. The objective was to compare the effectiveness of different treatment modalities in adherence to the short-term regimen for LTBI (3HP) among international migrants and refugees. This is a quasi-experimental study conducted in Manaus-AM. The study population was made up of international migrants. The certification and monitoring of medication intake employed three strategies: self-administration (SA), directly observed conventional therapy (DOT), and Video Telemonitoring System for Tuberculosis Treatment (VDOT). The VDOT group and SA group exhibited the lowest rate of treatment dropout or interruption at 16.1%, followed by the DOT group at 23.1%. The results suggest that the most effective strategy for ensuring adherence among migrants and refugees was VDOT (OR_adj 0.26; CI 0.7-0.94), suggesting that migrants may be more likely to adhere to and complete their treatment. The results show that relying on different treatment strategies, adapted to the individuals' needs and risk factors, is a viable and effective way of providing person-centered TB care.

Social protection in areas vulnerable to tuberculosis: a mixed methods study in São Luís, Maranhão.

OBJECTIVES: to analyze the risk areas for tuberculosis and the influences of social protection on the development of treatment for the disease in the municipality of São Luís, Maranhão. METHODS: this is explanatory sequential mixed method research. In the quantitative phase, the data were obtained from the Notifiable Diseases Information System from 2010 to 2019, with georeferencing being carried out to identify areas vulnerable to tuberculosis. In the qualitative phase, semi-structured interviews were carried out with individuals who received social benefits. RESULTS: 7,381 cases were geocoded, and, from the purely spatial scanning analysis, it was possible to identify 13 spatial clusters of risk. As for the interviews, there was a positive relationship between patient improvement and receiving benefits. CONCLUSIONS: geographic space and social determinants are relevant for reorienting monitoring actions for the conditions that generate the health-disease process.

International Migration, Refugees, and Spread of Tuberculosis in Brazil: Analysis of Clusters, Trends, and Associated Factors (2010-2021).

BACKGROUND: International migration is a global phenomenon with significant implications on the health-disease process due to exposures along transit routes and local/destination epidemiological indicators. We aimed to analyze the transmission and spread of tuberculosis among international migrants and refugees from a spatiotemporal perspective and the associated factors. METHOD: This was an ecological study of cases of tuberculosis in international migrants in Brazil, between 2010 and 2021. Annual incidence rates were calculated and spatiotemporal scan techniques were used to identify municipalities at risk. Multiple logistic regression was used to identify factors associated with tuberculosis in international migrants. RESULTS: A total of 4037 cases of tuberculosis were reported in Brazil in international migrants. Municipalities at risk for this event were identified using the spatiotemporal scan technique, and a cluster was identified with ITT: +52.01% and ETT: +25.60%. A higher probability of TB infection was identified in municipalities with a TB incidence rate >14.40 cases/100 inhabitants, population >11,042 inhabitants, Gini index >0.49, and illiteracy rate >13.12%. A lower probability was found in municipalities with average per capita household income >BRL 456.43. CONCLUSIONS: It is recommended that health authorities implement monitoring and rigorous follow-up in affected areas to ensure proper diagnosis and treatment completion for international migrants, preventing disease spread to other communities.

Government Efforts Leverage Effective Combating Against Dengue in Brazil / Esforços Governamentais Alavancam Combate Efetivo à Dengue no Brasil

Dengue has evolved from a disease restricted to a few countries into a serious global public health issue, affecting over 120 countries in recent years. In Brazil, after its reintroduction in 1981, the country has faced several epidemics, with over 16 million cases registered to date. In 2023, under the influence of the El Niño climatic phenomenon, one of the largest epidemics occurred in the country, with over 1.6 million cases reported. High temperatures and precipitation in line with the simultaneous circulation of all four serotypes of the dengue virus increased the risk of disease spread in 2024, especially in populations without immunity to some of the serotypes. In such a scenario, the Ministry of Health undertook various actions to address the situation, including the establishment of a National Arbovirus Situation Room and an Emergency Operations Commitee, financial support to assist states and municipalities in contingency actions for disease surveillance and prevention, with an emphasis on combating arboviruses, and investments in innovations for dengue control, such as vaccination and the Wolbachia method. However, the number of notified dengue cases in the first trimester of 2024 supplanted the whole year of 2023, highlighting the need for a more effective monitoring of the epidemiological situation for early outbreak detection and the preparation of health services for the care of cases with signs of severity. After more than 40 years of recurrent dengue epidemics, the effective control of dengue requires sustained preventive actions using innovative strategies, with coordinated efforts at all levels of health management, along with active participation of the population. Structural actions to improve basic sanitation coverage and to mitigate the effects of climate change are critical conditions for reducing the burden of dengue in the population.

A dengue evoluiu de uma doença restrita a alguns países para um grave problema global de saúde pública, atingindo mais de 120 países nos últimos anos. No Brasil, após sua reintrodução em 1981, o país enfrentou diversas epidemias, com mais de 16 milhões de casos registrados até o momento. Em 2023, sob a vigência do fenômeno climático El Niño registrou-se uma das maiores epidemias de dengue no país, com mais de 1,6 milhões de casos notificados. Temperaturas e pluviosidade mais elevadas em conjunto com a circulação simultânea dos quatro sorotipos do vírus da dengue aumentaram ainda mais o risco de disseminação da doença em 2024, especialmente em populações sem imunidade para alguns dos sorotipos. Diante deste quadro, o Ministério da Saúde promoveu várias ações para enfrentar a situação, incluindo a instalação de uma Sala Nacional de Arboviroses e um Comitê de Operações de Emergência, repasses financeiros para apoiar estados e municípios em ações contingenciais de vigilância e prevenção de doenças, com ênfase no enfrentamento das arboviroses e investimentos em inovações para o controle da dengue, como vacinação e o método Wolbachia. Ainda assim, o primeiro trimestre de 2024 registrou um número de casos suspeitos de dengue superior ao de 2023, destacando a necessidade de aprimoramentos no monitoramento da situação epidemiológica para detecção precoce de epidemias e da preparação dos serviços de saúde para o cuidado dos casos com sinais de gravidade. Após mais de 40 anos de epidemias recorrentes, o controle efetivo da dengue no país requer ações sustentadas de prevenção por meio de estratégias inovadoras, envolvendo esforços coordenados de todas as esferas da gestão em saúde, juntamente com a participação ativa da população. Ações estruturais para a melhoria na cobertura de saneamento básico e para mitigação dos efeitos das mudanças climá

Fatores associados aos desfechos desfavoráveis de tratamento da tuberculose em idosos no Brasil: uma análise multinomial / Factors associated with unfavorable treatment outcomes of tuberculosis in older adults in Brazil: a multinomial analysis

Resumo Objetivo identificar, dentro dos três eixos de vulnerabilidades (individuais, sociais e programáticas), os fatores associados aos desfechos desfavoráveis do tratamento de tuberculose (TB) entre os idosos no Brasil entre 2015 e 2019. Método trata-se de um estudo transversal com dados secundários provenientes do Sistema de Informação de Agravos de Notificação dos casos de TB notificados no Brasil, em pessoas com idade igual ou maior que 60 anos. As co-variáveis associadas com o desfecho de interesse (p≤0,20) foram incluídas em um modelo de regressão logística multinomial utilizando a categoria cura como referência. Resultados idosos autodeclarados pretos e pardos, em situação de rua, com transtorno de saúde mental, que vivem com o vírus da imunodeficiência humana (HIV), que utilizam drogas lícitas e ilícitas tiveram maiores chances de perda de seguimento. Enquanto idosos em situação de rua, com transtorno de saúde mental, que utilizam drogas lícitas e ilícitas, e que não realizaram baciloscopia, apresentaram maiores chances para ocorrência de óbito por TB. Para o desfecho óbito por outras causas, pessoas que vivem com diabetes mellitus e com HIV, que utilizam drogas lícitas e ilícitas, tiveram maiores chances para ocorrência desse desfecho. Conclusão os resultados destacam a influência de fatores nos desfechos do tratamento da TB em idosos, abrangendo os eixos individual, social e programático. Aspectos como idade avançada, raça, sexo feminino, comorbidades e situação de rua foram identificados como determinantes relevantes, ressaltando a necessidade de abordagens integradas para melhorar os resultados e promover um desfecho favorável no tratamento da TB em idosos.

Abstract Objective To identify, within the three axes of vulnerabilities (individual, social, and programmatic), the factors associated with unfavorable treatment outcomes of tuberculosis (TB) among older adults in Brazil between 2015 and 2019. Method This is a cross-sectional study utilizing secondary data from the Notifiable Diseases Information System (SINAN) regarding reported TB cases in Brazil, among individuals aged 60 years or older. The covariates associated with the outcome of interest (p≤0.20) were included in a multinomial logistic regression model using the cure category as the reference. Results Older adults self-identified as black or mixed-race, experiencing homelessness, with mental health disorders, living with the human immunodeficiency virus (HIV), and engaging in the use of licit and illicit drugs had higher odds of loss to follow-up. Furthermore, older adults experiencing homelessness, with mental health disorders, engaging in the use of licit and illicit drugs, and who did not undergo bacilloscopy, presented higher odds of death due to TB. For the outcome of death due to other causes, individuals living with diabetes mellitus and HIV, engaging in the use of licit and illicit drugs, also had higher odds of experiencing this outcome Conclusion The results highlighted the influence of factors on TB treatment outcomes in older adults, encompassing the individual, social, and programmatic axes. Aspects such as advanced age, race, female sex, comorbidities, and homelessness were identified as relevant determinants, emphasizing the need for integrated approaches to improve outcomes and promote a favorable treatment outcome for TB in older adults.

Social protection in areas vulnerable to tuberculosis: a mixed methods study in São Luís, Maranhão / Protección social en zonas vulnerables a la tuberculosis: un estudio mixto en São Luís, Maranhão / Proteção social em áreas vulneráveis à tuberculose: um estudo misto em São Luís, Maranhão

ABSTRACT Objectives: to analyze the risk areas for tuberculosis and the influences of social protection on the development of treatment for the disease in the municipality of São Luís, Maranhão. Methods: this is explanatory sequential mixed method research. In the quantitative phase, the data were obtained from the Notifiable Diseases Information System from 2010 to 2019, with georeferencing being carried out to identify areas vulnerable to tuberculosis. In the qualitative phase, semi-structured interviews were carried out with individuals who received social benefits. Results: 7,381 cases were geocoded, and, from the purely spatial scanning analysis, it was possible to identify 13 spatial clusters of risk. As for the interviews, there was a positive relationship between patient improvement and receiving benefits. Conclusions: geographic space and social determinants are relevant for reorienting monitoring actions for the conditions that generate the health-disease process.

RESUMEN Objetivos: analizar las áreas de riesgo para la tuberculosis y las influencias de la protección social en el desarrollo del tratamiento de la enfermedad en el municipio de São Luís, Maranhão. Métodos: se trata de una investigación explicativa de método mixto secuencial. En la fase cuantitativa, los datos se obtuvieron del Sistema de Información de Enfermedades de Declaración Obligatoria del 2010 al 2019, realizándose georreferenciación para identificar áreas vulnerables a la tuberculosis. En la fase cualitativa se realizaron entrevistas semiestructuradas a personas que recibían beneficios sociales. Resultados: se geocodificaron 7.381 casos y, a partir del análisis de escaneo puramente espacial, fue posible identificar 13 grupos espaciales de riesgo. En cuanto a las entrevistas, hubo una relación positiva entre la mejora del paciente y la recepción de beneficios. Conclusiones: el espacio geográfico y los determinantes sociales son relevantes para reorientar las acciones de seguimiento de las condiciones que generan el proceso salud-enfermedad.

RESUMO Objetivos: analisar as áreas de risco para a tuberculose e as influências da proteção social no desenvolvimento do tratamento para a doença no município de São Luís, Maranhão. Métodos: trata-se de pesquisa de método misto sequencial explanatório. Na fase quantitativa, os dados foram obtidos do Sistema de Informação de Agravos de Notificação de 2010 a 2019, sendo realizado georreferenciamento para identificação das áreas vulneráveis à tuberculose. Na fase qualitativa, realizaram-se entrevistas semiestruturadas com indivíduos que recebiam benefício social. Resultados: foram geocodificados 7.381 casos, e, a partir da análise de varredura puramente espacial, foi possível identificar 13 aglomerados espaciais de risco. Quanto às entrevistas, verificou-se uma relação positiva entre a melhora dos pacientes e o recebimento de benefícios. Conclusões: o espaço geográfico e os determinantes sociais são relevantes para reorientação das ações de monitoramento das condições geradoras do processo saúde-doença.

Description of vaccination coverage and hesitancy obtained by epidemiological survey of children born in 2017-2018, in Belo Horizonte and Sete Lagoas, Minas Gerais, Brazil / Descripción de la cobertura de vacuna y de las vacunaciones obtenidas por la encuesta epidemiológica de niños nacidos en 2017-2018, en Belo Horizonte y Sete Lagoas, Minas Gerais / Descrição da cobertura e da hesitação vacinal obtida por inquérito epidemiológico de crianças nascidas em 2017-2018, em Belo Horizonte e Sete Lagoas, Minas Gerais

ABSTRACT Objective To describe vaccination coverage and hesitation for the basic children's schedule in Belo Horizonte and Sete Lagoas, Minas Gerais state, Brazil. Methods Population-based epidemiological surveys performed from 2020 to 2022, which estimated vaccine coverage by type of immunobiological product and full schedule (valid and ministered doses), according to socioeconomic strata; and reasons for vaccination hesitancy. Results Overall coverage with valid doses and vaccination hesitancy for at least one vaccine were, respectively, 50.2% (95%CI 44.1;56.2) and 1.6% (95%CI 0.9;2.7), in Belo Horizonte (n = 1,866), and 64.9% (95%CI 56.9;72.1) and 1.0% (95%CI 0.3;2.8), in Sete Lagoas (n = 451), with differences between socioeconomic strata. Fear of severe reactions was the main reason for vaccination hesitancy. Conclusion Coverage was identified as being below recommended levels for most vaccines. Disinformation should be combated in order to avoid vaccination hesitancy. There is a pressing need to recover coverages, considering public health service access and socioeconomic disparities.

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RESUMO Objetivo Descrever as coberturas e hesitação das vacinas do calendário básico infantil em Belo Horizonte e Sete Lagoas, Minas Gerais. Métodos Inquéritos epidemiológicos de base populacional realizados de 2020 a 2022, para estimar coberturas vacinais por tipo de imunobiológico e esquema completo (doses válidas e aplicadas) segundo estratos socioeconômicos, e os motivos de hesitação vacinal. Resultados A cobertura global com doses válidas e a hesitação vacinal de pelo menos uma vacina foram, respectivamente, de 50,2% (IC95% 44,1;56,2) e 1,6% (IC95% 0,9;2,7), em Belo Horizonte (n = 1.866), e de 64,9% (IC95% 56,9;72,1) e 1,0% (IC95% 0,3;2,8), em Sete Lagoas (n = 451), com diferenças entre os estratos. O receio de reações graves foi o principal motivo de hesitação vacinal. Conclusão Identificou-se coberturas abaixo do preconizado para a maioria das vacinas. A desinformação deve ser combatida, evitando-se a hesitação vacinal. Há necessidade premente de recuperar as coberturas, considerando acesso ao SUS e disparidades socioeconômicas.

Racial inequalities in child vaccination and barriers to vaccination in Brazil among live births in 2017 and 2018: an analysis of a retrospective cohort of the first two years of life / Desigualdades raciales en la vacunación infantil y obstáculos para la vacunación en Brazil entre nacidos vivos en 2017 y 2018: análisis de uma cohorte retrospectiva de los dos primeros años de vida / Desigualdades raciais na vacinação infantil e nos obstáculos à vacinação no Brasil entre nascidos vivos em 2017 e 2018: análise de uma coorte retrospectiva dos dois primeiros anos de vida

ABSTRACT Objective To describe timely vaccination completion and obstacles in the first 24 months of life in Brazil, examining associations with maternal race/skin color. Methods Study participants were 37,801 children born in 2017 and 2018 included in the National Immunization Coverage Survey. We calculated prevalence and 95% confidence intervals for timely vaccine completeness and obstacles at 5, 12 and 24 months of life, according to maternal race/skin color. Associations were analyzed using logistic regression. Results 7.2% (95%CI 6.3;8.2) of mothers faced difficulties in taking their children to be vaccinated, and 23.4% (95%CI 21.7;25.1) were not vaccinated when taken. These proportions were 75% (95%CI 1.25;2.45) and 97% (95%CI 1.57;2.48) higher, respectively, among Black mothers. At least one vaccination was delayed among 49.9% (95%CI 47.8;51.9) and 61.1% (95%CI 59.2;63.0) of children by 5 and 12 months, respectively. These rates were higher among Black/mixed race mothers. Conclusion There are racial inequalities in both the obstacles faced and in vaccination rates in Brazil.

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RESUMO Objetivo Descrever a completude vacinal em tempo oportuno nos primeiros 24 meses de vida no Brasil e os obstáculos para vacinação, testando-se associações com raça/cor da pele materna. Métodos Fez-se coleta de informações sobre os nascidos em 2017 e 2018, constantes no Inquérito Nacional de Cobertura Vacinal. Foram calculados prevalência e intervalos de confiança de 95% de obstáculos à vacinação e completude vacinal em tempo oportuno aos 5 meses, primeiro e segundo ano, segundo raça/cor da pele materna. Empregou-se regressão logística para análise de associações. Resultados Analisaram-se dados de 37.801 crianças. Do total, 7,2% (IC95% 6,3;8,2) dos responsáveis enfrentaram dificuldades para levar seus filhos para vacinação e 23,4% (IC95% 21,7;25,1) das crianças não foram vacinadas, mesmo sendo levadas. Essas proporções foram 75% (IC95% 1,25;2,45) e 97% (IC95% 1,57;2,48) mais elevadas, respectivamente, entre pretas; e 49,9% (IC95% 47,8;51,9) e 61,1% (IC95% 59,2;63,0) das crianças tiveram atraso em alguma vacina até os 5 meses e o primeiro ano, respectivamente. Tais valores foram maiores entre pardas/pretas. Conclusão Há desigualdades raciais nos obstáculos enfrentados e na vacinação no Brasil.

The economic burden of households affected by tuberculosis in Brazil: First national survey results, 2019-2021.

BACKGROUND: One of the three main targets of the World Health Organization (WHO) End TB Strategy (2015-2035) is that no tuberculosis (TB) patients or their households face catastrophic costs (defined as exceeding 20% of the annual household income) because of the disease. Our study seeks to determine, as a baseline, the magnitude and main drivers of the costs associated with TB disease for patients and their households and to monitor the proportion of households experiencing catastrophic costs in Brazil. METHODS: A national cross-sectional cluster-based survey was conducted in Brazil in 2019-2021 following WHO methodology. TB patients of all ages and types of TB were eligible for the survey. Adult TB patients and guardians of minors (<18 years old) were interviewed once about costs, time loss, coping measures, income, household expenses, and asset ownership. Total costs, including indirect costs measured as reported household income change, were expressed as a percentage of annual household income. We used descriptive statistics to analyze the cost drivers and multivariate logistic regression to determine factors associated with catastrophic costs. RESULTS: We interviewed 603 patients, including 538 (89%) with drug-sensitive (DS) and 65 (11%) with drug-resistant (DR) TB. Of 603 affected households, 48.1% (95%CI: 43-53.2) experienced costs above 20% of their annual household income during their TB episode. The proportion was 44.4% and 78.5% among patients with DS- and DR-TB, respectively. On average, patients incurred costs of US$1573 (95%CI: 1361.8-1785.0) per TB episode, including pre-diagnosis and post-diagnosis expenses. Key cost drivers were post-diagnosis nutritional supplements (US$317.6, 95%CI: 232.7-402.6) followed by medical costs (US$85.5, 95%CI: 54.3-116.5) and costs of travel for clinic visits during treatment (US$79.2, 95%CI: 61.9-96.5). In multivariate analysis, predictors of catastrophic costs included positive HIV status (aOR = 3.0, 95%CI:1.1-8.6) and self-employment (aOR = 2.7, 95%CI:1.1-6.5); high education was a protective factor (aOR = 0.1, 95%CI:0.0-0.9). CONCLUSIONS: Although the services offered to patients with TB are free of charge in the Brazilian public health sector, the availability of free diagnosis and treatment services does not alleviate patients' financial burden related to accessing TB care. The study allowed us to identify the costs incurred by patients and suggest actions to mitigate their suffering. In addition, this study established a baseline for monitoring catastrophic costs and fostering a national policy to reduce the costs to patients for TB care in Brazil.