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.

Timeliness for vaccination according to the expanded immunization program in children under 6 years of age in Colombia between 2014 and 2019.

The aim was to estimate the vaccination timeliness defined as the proportion of children under 6 years of age who received their immunization in the time range established by the Colombian Expanded Immunization Program (EIP). A retrospective cohort study that collected reports of vaccination opportunities between 2014 and 2019 provided by the Ministry of Health. Age, sex, city, ethnicity, health system affiliation regimen, vaccine applied, and timing of vaccination were considered for the time range under study. A total of 3,370,853 immunized children were included from all regions of the country. More than 80% of children had a timeliness to get most vaccines. The exceptions were yellow fever (17%) and seasonal influenza (42%). No differences in timeliness were found according to geographic region or by health system affiliation regime, but the average timeliness for all vaccines of children of the indigenous population (65.8% ±18.4%) was lower than that of the rest of the population (78·6% ± 19·3%) (p = 0·021). The timeliness for vaccination under the EIP of Colombia is high, with proportions of 72-96%, but intergroup differences were identified, mainly lower timeliness among indigenous people. These findings warrant improvement strategies that would guarantee the immunization of the entire child population.

The vaccination companion: A quick guide for healthcare workers

In February 2023, a collaboration was formed between the Pan American Health Organization (PAHO/WHO), the Caribbean Development Bank (CDB), and Global Affairs Canada to initiate a social and behavior change project in St. Vincent and the Grenadines. The project's initial phase aimed to understand barriers to vaccine uptake by raising public awareness, holding focus groups, and interviewing healthcare workers and the public. The Caribbean has seen significant reductions in vaccine-preventable diseases over the last twenty years, thanks to efforts such as PAHO's Expanded Program on Immunization. However, with the onset of the COVID-19 vaccine rollout, misinformation has led to public skepticism and concerns regarding vaccine safety. Despite receiving the first COVAX Facility doses in March 2021 and making robust distribution plans, uptake remains low, especially among healthcare workers. This hesitancy threatens global health initiatives.

The vaccination companion: A quick guide for healthcare workers

In February 2023, a collaboration was formed between the Pan American Health Organization (PAHO/WHO), the Caribbean Development Bank (CDB), and Global Affairs Canada to initiate a social and behavior change project in St. Vincent and the Grenadines. The project's initial phase aimed to understand barriers to vaccine uptake by raising public awareness, holding focus groups, and interviewing healthcare workers and the public. The Caribbean has seen significant reductions in vaccine-preventable diseases over the last twenty years, thanks to efforts such as PAHO's Expanded Program on Immunization. However, with the onset of the COVID-19 vaccine rollout, misinformation has led to public skepticism and concerns regarding vaccine safety. Despite receiving the first COVAX Facility doses in March 2021 and making robust distribution plans, uptake remains low, especially among healthcare workers. This hesitancy threatens global health initiatives.

Determinants of undervaccination of routine childhood immunization in Argentina: A cross-sectional study.

Routine childhood immunization is one of the most effective methods of preventing infectious diseases in children. In Argentina, there has been a decline in routine immunization coverage since 2015, with very little evidence to date on underlying drivers of this steady decline. We administered an online nationwide behavioral insights survey in Argentina between July 1-25, 2022, targeting parents with at least one child under the age of 12 years. Our survey included 1504 parents, 7% (n = 111) of whom did not or only partially vaccinated their children. We found that, compared to the youngest parents (aged 18-24), older parents were less likely to under-vaccinate their children (e.g., 30-34 year-old parents: adjusted Odds Ratio (aOR): 0.31, 95% Confidence Interval (CI) 0.16-0.57). Parents who undervaccinated their children were more likely to take vaccination advice from parent and wellness social media influencers (parent influencers: aOR 2.51, 95% CI 1.46-4.31), and were less likely to trust the social media accounts of official health organizations (aOR 0.82, 95% CI 0.70-0.96). Furthermore, these parents had heightened concerns about routine immunizations, including the number of vaccines given to children and potential for adverse side effects. When asked whether they knew enough to make a vaccine decision for their children, parents who undervaccinated their children were more likely to report that they did not know enough about vaccines or the vaccination schedule to make a decision. These results offer important insights into parental concerns surrounding routine childhood immunization and suggest potential drivers of - and solutions to - the decline in routine immunization seen in Argentina since 2015.

Bulletin d'immunisation, v.46, n.2, Jun. 2024 

L'Organisation panaméricaine de la santé (OPS) publie quatre fois par an le Bulletin d'Immunisation en anglais, français, portugais et espagnol. Son objectif est de faciliter l'échange d'idées et d'informations sur les programmes de vaccination dans la région des Amériques et au-delà. Il est publié depuis 1979 en anglais et en espagnol, les versions française et portugaise ayant débuté en 2001 et 2019, respectivement. Le numéro de juin 2024 du bulletin trimestriel Bulletin d'Immunisation traite des sujets suivants: Semaine de la vaccination dans les Amériques 2024 : « Agis maintenant pour protéger ton avenir #Vaccine-toi »; Décès du Dr Cuauhtémoc Ruiz Matus, chef de l'Unité d’immunisation de l’OPS de 2007 à 2022 ; L'OPS lance de nouvelles pages web pour aider les pays à accroître la demande de vaccins ; Lancement du tableau de bord de la vaccination tout au long de la vie dans les Amériques; Considérations importantes pour l'introduction du vaccin hexavalent (DTwP-HepB-Hib-VPI) (avec vaccin anticoquelucheux à germes entiers) ; Dix ans après la disparition de Ciro de Quadros, nous présentons ici des extraits d'une conversation entre Donald Henderson, Ciro de Quadros et Jon Andrus datant de 2013; Application de l’approche du parcours de vie aux programmes nationaux de vaccination ; Prix des vaccins achetés par l’intermédiaire du Fonds renouvelable de l’OPS, 2024 (prix en US$) ; et Prix des seringues achetées par l'intermédiaire du Fonds renouvelable de l'OPS, 2024 (prix en dollars US).

Boletim de Imunização, v.46, n.2, Jun. 2024 

A Organização Pan-Americana da Saúde (OPAS) publica o Boletim de Imunização quatro vezes por ano em inglês, francês, português e espanhol. Seu objetivo é facilitar o intercâmbio de ideias e informações sobre programas de imunização na Região das Américas e fora dela. Ele é publicado desde 1979 em inglês e espanhol, com versões em francês e português iniciadas em 2001 e 2019, respectivamente. A edição de marzo de 2024 do Boletim de Imunização aborda os seguintes tópicos: Semana de Vacinação nas Américas 2024: “Proteja o futuro: vacine-se”; Nota de falecimento do Dr. Cuauhtémoc Ruiz Matus, chefe da Unidade de Imunização de 2007 a 2022 ; OPAS lança novas páginas em seu site para ajudar os países a aumentar a demanda por vacinas; Lançamento do painel de controle de imunização ao longo do curso de vida na Região das Américas; Considerações importantes sobre a introdução da vacina hexavalente (DTPw-HepB-Hib-VIP) (com o componente pertússis de células inteiras); Dez anos após o falecimento de Ciro de Quadros, apresentamos trechos de uma conversa entre ele, Donald Henderson e Jon Andrus, em 2013; Explorando o uso da abordagem de curso de vida nos programas nacionais de imunização; Preços de vacinas compradas por meio do Fundo Rotativo da OPAS, 2024 (preços em dólares dos Estados Unidos); Preços de seringas compradas por meio do Fundo Rotativo da OPAS, 2024 (preços em dólares dos Estados Unidos).

Boletín de Inmunización, v.46, n.2, Jun. 2024 

La Organización Panamericana de la Salud (OPS) publica cuatro veces al año el Boletín de Inmunización en español, francés, inglés y portugués. Su propósito es facilitar el intercambio de ideas e información sobre los programas de inmunización en la Región de las Américas y más allá. Se publica desde 1979 en inglés y español, con versiones en francés y portugués a partir de 2001 y 2019, respectivamente.

Immunization Newsletter, v.46, n.2, Jun. 2024

The Pan American Health Organization (PAHO) publishes the Immunization Newsletter four times a year in English, French, Portuguese, and Spanish. Its purpose is to facilitate the exchange of ideas and information on immunization programs in the Region of the Americas and beyond. It has been published since 1979 in English and Spanish, with French and Portuguese versions beginning in 2001 and 2019, respectively.

Immunization in the Americas: 2023 Summary

The countries of the Americas, with support from PAHO, have made remarkable progress in providing children with an umbrella of protection against basic vaccine-preventable diseases. Sustained high national immunization coverage levels, the eradication of polio, the interruption of endemic measles virus transmission, and efforts towards rubella and congenital rubella syndrome elimination are hemispheric benchmarks of this progress. Since 2020, the Region has also been facing the COVID-19 pandemic and major efforts have been taken to ensure administration of COVID-19 vaccines across all countries. Countries are now vaccinating age groups outside those usually targeted in the traditional childhood immunization program. Introducing seasonal influenza vaccine in adult populations at risk, vaccinating adolescents and adults, men, and women for rubella elimination, and defining the disease burden of cervical cancer are activities that support the critical need for national immunization programs to transition from child to family immunization. In support to countries, one of PAHO's roles is to disseminate information that can highlight progress and challenges faced in the Region. To that end, PAHO regularly publishes several technical documents related to immunization. The annually published "Immunization in the Americas" brochure summarizes immunization coverage in the Region of the Americas, in addition to illustrating the work done by the Region’s immunization programs for that year. Immunization in the Americas: 2023 Summary includes tables with the Region's demographic, morbidity, program management, financing, and socioeconomic data, as well as reported immunization coverage and surveillance indicators, among other items.

Frequently asked questions (FAQs) on behavioral sciences and vaccination

As national immunization programs grapple with how to increase vaccine uptake for both vaccines against COVID and those that form part of the routine immunization schedule, they should consider the role of behavioral and social drivers of vaccination (BeSD), which help us understand the beliefs and experiences that influence vaccine uptake. The present document includes answers to questions submitted to PAHO about behavioral and social drivers of vaccination with the goal of helping immunization programs understand these factors; what the BeSD framework is and what its four domains – thinking and feeling, social processes, motivation, and practical issues – are; how social and behavioral data can be collected, analyzed, and used to implement and evaluate interventions to increase uptake; what tools are available to do this; the special considerations needed when considering health workers´ role in promoting vaccination; the relationship between BeSD and risk communication and community engagement (RCCE) for vaccination; and the definition and relationship between key social and behavioral terms like vaccine confidence and vaccine hesitancy. Additionally, the document presents the new spectrum on intentions toward vaccination and answers questions about how to handle anti-vaccine advocates (“anti-vaxxers”) and vaccine refusers; managing misinformation and disinformation related to vaccination and engaging in social listening; and using the BeSD framework to change risk perceptions about vaccine-preventable diseases and vaccination. Resources developed by WHO and PAHO that are related to behavioral and social drivers of vaccination are also listed and linked for easy access by the user of the FAQ document.

[Analysis of the operational conditions to preserve immunobiological products in vaccination rooms in Brazil: a mixed study]. / Análise das condições operacionais para conservação de imunobiológicos nas salas de vacinação do Brasil: estudo misto.

This study aimed to analyze the operational conditions to preserve immunobiological products in Brazil. This mixed-method study with a sequential explanatory design was developed in vaccination rooms in several Brazilian regions from 2021 to 2022. Its quantitative stage developed a descriptive cross-sectional study by applying the Immunobiological Conservation Assessment Scale to nursing professionals. Data were analyzed by descriptive statistics. Its qualitative stage developed a descriptive-exploratory study in cold chain instances with the respective technical managers and nursing professionals. The interviews were evaluated by thematic content analysis. The data were combined by connection, and joint-displays and meta-inferences were elaborated. Overall, 280 rooms were analyzed. Most were for exclusive use (79.6%), had polyurethane boxes (77.8%), and kept their equipment away from sunlight/heat (73.5%). Only 27.5% had batteries/generators and 26.5% had other temperature measuring instruments. In total, 60% had refrigerated rooms and 67.6%, air-conditioned rooms. This study found weaknesses associated with geographical conditions, infrastructure, material inputs, human and financial resources, work organization and management, turnover, and training. These findings showed the plurality of the Brazilian cold chain and identified the potentialities and weaknesses related to the structures and work processes in preserving immunobiological products, which require improvement.

Este estudo objetivou analisar as condições operacionais para conservação de imunobiológicos no Brasil. Trata-se de um estudo de método misto com delineamento explanatório sequencial, desenvolvido nas salas de vacinação de distintas regiões brasileiras entre 2021 e 2022. Na etapa quantitativa, desenvolveu-se um estudo transversal descritivo, com a aplicação da Escala de Avaliação da Conservação de Imunobiológicos aos profissionais de enfermagem. Os dados foram analisados por meio de estatística descritiva. Já na etapa qualitativa, desenvolveu-se um estudo descritivo-exploratório nas instâncias da cadeia de frio, com os respectivos responsáveis técnicos e profissionais de enfermagem. Analisou-se as entrevistas por meio da Análise de Conteúdo na Modalidade Temática. Os dados foram combinados mediante conexão, com elaboração de joint-displays e metainferências. Foram analisadas 280 salas, em que grande parte: era de uso exclusivo (79,6%); utilizava caixas de poliuretano (77,8%); e mantinha seus equipamentos distantes da incidência de luz solar/fontes de calor (73,5%). Apenas 27,5% dispunham de baterias/geradores e 26,5% de outros instrumentos de medição de temperatura. Sessenta por cento detinham câmaras refrigeradas e 67,6% ambientes climatizados. Revelaram-se fragilidades associadas a condições geográficas, infraestrutura, insumos materiais, recursos humanos e financeiros, organização e gestão do trabalho, rotatividade e capacitação. Os achados possibilitaram conhecer a pluralidade da cadeia de frio brasileira e permitiram a identificação de potencialidades e fragilidades na conservação de imunobiológicos relacionadas às estruturas e aos processos de trabalho que requerem aprimoramento.

Este estudio tuvo como objetivo analizar las condiciones operativas para la conservación de inmunobiológicos en Brasil. Estudio de método mixto con diseño explicativo secuencial, desarrollado en las salas de vacunación de las distintas regiones brasileñas, entre 2021 y 2022. En la etapa cuantitativa se desarrolló un estudio transversal descriptivo, con la aplicación de la Escala de Evaluación de la Conservación de Inmunobiológicos a los profesionales de enfermería. Los datos fueron analizados mediante estadística descriptiva. En la etapa cualitativa se desarrolló un estudio descriptivo-exploratorio en las instancias de la cadena de frío, con los respectivos responsables técnicos y profesionales de enfermería. Las entrevistas se analizaron por medio del Análisis de Contenido en la Modalidad Temática. Los datos fueron combinados mediante conexión, con elaboración de joint-displays y metainferencias. Se analizaron 280 salas. Gran parte era de uso exclusivo (79,6%); utilizaba cajas de poliuretano (77,8%) y mantenía sus equipos alejados de la incidencia de la luz solar/fuentes de calor (73,5%). Solo el 27,5% disponía de baterías/generadores y el 26,5% de otros instrumentos de medición de temperatura. El 60% tenía cámaras refrigeradas y el 67,6% ambientes climatizados. Se revelaron debilidades asociadas a las condiciones geográficas, la infraestructura, los insumos de materiales, los recursos humanos y financieros, la organización y gestión del trabajo, la rotación y la capacitación. Los hallazgos posibilitaron conocer la pluralidad de la cadena de frío brasileña y permitieron la identificación de potencialidades y debilidades de la conservación de inmunobiológicos relacionadas con las estructuras y los procesos de trabajo que requieren mejoras.

The impact of conspiracy theories and vaccine knowledge on vaccination intention: a longitudinal study.

In this study, we analyzed associations between vaccination knowledge, vaccination intention, political ideology, and belief in conspiracy theories before and during the 2020 Sars-Cov-2 pandemic in the Brazilian population. It was conducted a longitudinal study into three data collections. Participants responded to the Flexible Inventory of Conspiracy Suspicions (FICS), questionnaires measuring their knowledge, and opinion about vaccines, and sociodemographic data. The results were: the greater the belief in conspiracy theories about vaccines, the lesser the intention to get vaccinated, the vaccine knowledge, and the attitudes towards vaccine investment. Religious, prone to right-wing politics, parents, and older people scored more for FICS than atheists/agnostics, and younger people. From 2019 to 2020 the vaccination intention and vaccination investment did not differ, showing that people did not change their opinion about vaccines regardless of personal experience or the pandemic scenario. The research strengthened the relevance of health education as a milestone for public health and protection from dangerous conspiracy theories.

Preguntas frecuentes sobre las ciencias del comportamiento y la vacunación

A medida que los programas nacionales de inmunización intentan aumentar la aceptación de las vacunas contra el COVID-19 y las que forman parte del esquema de vacunación de rutina, deben considerar el papel de los factores conductuales y sociales de la vacunación (BeSD), que nos ayudan a comprender las creencias y experiencias que influyen en la aceptación de las vacunas. El presente documento incluye respuestas a preguntas presentadas a la OPS sobre los impulsores conductuales y sociales de la vacunación con el objetivo de ayudar a los programas de inmunización a comprender estos factores; qué es el marco BeSD y cuáles son sus cuatro dominios: pensamiento y sentimiento, procesos sociales, motivación y cuestiones prácticas; cómo se pueden recopilar, analizar y utilizar los datos sociales y conductuales para implementar y evaluar las intervenciones destinadas a aumentar la aceptación; de qué herramientas se dispone para ello; las consideraciones especiales necesarias a la hora de considerar el papel de los trabajadores sanitarios en la promoción de la vacunación; la relación entre el DSBE y la comunicación de riesgos y el compromiso de la comunidad (RCCE) para la vacunación; y la definición y relación entre términos sociales y conductuales clave como confianza en la vacuna y vacilación ante la vacuna. Además, el documento presenta el nuevo espectro de intenciones hacia la vacunación y responde a preguntas sobre cómo tratar a los defensores antivacunas ("anti-vaxxers") y a los que se niegan a vacunarse; cómo gestionar la desinformación y la desinformación relacionadas con la vacunación y cómo participar en la escucha social; y cómo utilizar el marco BeSD para cambiar la percepción del riesgo.

PAHO's Regional Revolving Funds: A health cooperation success story

The Pan American Health Organization (PAHO)’s Regional Revolving Funds (RRFs) are technical cooperation mechanisms that enable the Americas to equitably and timely access quality vaccines, essential medicines, and public health supplies. When countries work together, they achieve benefits for all: through pooled procurement and planning their demand together, Member States obtain affordable prices, securing around 50% in savings for vaccines and public health supplies; benefitting around 180 million people in the past two years alone. PAHO’s RRFs comprise the Revolving Fund for Access to Vaccines and the Strategic Fund for Public Health Supplies. The RRFs are key to the Americas’ impressive record of addressing public health demands by responding rapidly, implementing critical interventions for access to health technologies, and supporting disease elimination. The Funds’ product portfolio includes medicines for communicable and noncommunicable diseases as well as neglected diseases; diagnostic kits and medical equipment such as rapid tests for HIV, malaria, leishmaniasis and more; vector control supplies such as insecticides and long-lasting insecticidal nets; and vaccines and related supplies such as safety boxes, immunoglobulins, and cold chain equipment. The RRFs have also contributed to the introduction of new health supplies in countries, as well as the response to recent health emergencies such as COVID-19 and mpox. Moreover, the Funds are central to achieving the renewed Disease Elimination Initiative’s targets.

As vacinas contra a covid-19 em plataformas de vídeos curtos no Brasil: o caso do Kwai / Covid-19 vaccines on short video platforms in Brazil: the case of Kwai / Las vacunas contra la covid-19 en plataformas de videos cortos en Brasil: el caso del Kwai

Neste artigo, analisamos as temáticas, os posicionamentos, as formas expressivas, os atores legitimados e os recursos visuais e sonoros empregados na produção de 482 vídeos sobre vacinas, publicados de 2020 a 2022 na plataforma de vídeos curtos Kwai. A partir de análise temática e de análise de conteúdo, identificamos que os vídeos apresentaram, em sua maioria, posicionamento favorável ou neutro em relação às vacinas e que ressaltaram as experiências pessoais com a vacinação. Não obstante, utilizaram sobretudo um tom hu-morístico no tratamento do assunto, com potencial desinformativo quanto aos efeitos colaterais das vacinas. Concluímos assim que, por um lado, o Kwai tem sido utilizado para expressão de experiências positivas com a vacinação, que podem estimular a adesão aos imunizantes, mas, por outro, tem sido também espaço para a circulação de percepções negativas e temores que podem suscitar dúvidas quanto à segurança das vacinas.

In this article, we analyze the themes, positions, expressive forms, legitimized actors, and both visual and sound resources used in the production of 482 videos about vaccines, published from 2020 to 2022 on the short video platform Kwai. Based on thematic analysis and content analysis, we identified that the videos predominantly presented a favorable or neutral stance toward vaccines and that they highlighted personal experiences with immunization. However, they mainly used a humorous tone when dealing with the subject, thereby potentially disseminating misinformation regarding the adverse effects of vaccines. We thus conclude that, on the one hand, Kwai has been used to express positive experiences with vaccination, which can stimulate adherence to vaccinations, but, on the other hand, it has also been a space for the circulation of negative perceptions and fears that can raise doubts regarding the safety of vaccines.

En este artículo, analizamos los temas, posiciones, formas expresivas, actores legitimados y recursos visuales y sonoros utilizados en la producción de 482 videos sobre vacunas publicados de 2020 a 2022 en la plataforma de videos cortos Kwai. A partir del análisis temático y de contenido, identificamos que los videos presentaban, en su mayoría, una posición favorable o neutral con relación a las vacunas y que destacaban experiencias per-sonales con la vacunación. Sin embargo, al abordar el tema, utilizaron, principalmente, un tono humorístico, con potencial desinformativo sobre los efectos secundarios de las vacunas. De ese modo, concluimos que, por un lado, el Kwai tiene sido utilizado para expresar experiencias positivas con la vacunación que pueden estimular la adhesión a las vacunas, pero, por otro lado, también tiene sido un espacio para la circulación de percepciones negativas y miedos que pueden plantear dudas sobre la seguridad de las vacunas.

First vaccine confidence and access index in Argentina: Comparison of results from 2019 to 2022.

In this article, we present and empirically illustrate two concepts about vaccines and the way they are perceived by the Argentinean population and the easiness in accessing vaccination in developing countries. First, we focus on the perceptions of people about vaccines in general and develop a confidence index, and second, we analyze barriers to vaccination, measuring the burden citizens have when they intend to receive immunization (or as caretakers, trying to comply with the vaccination calendar of children and adolescents): for this second concept, we develop an access index. The data comes from representative annual surveys from Argentina from 2019 until 2022 (each one with approximately 7000 responders), which allows us to describe trends and check for changes in the confidence in vaccines and barriers towards vaccination. We find high confidence in vaccines in Argentina, although there is a "structural break" in the confidence for all years after 2020. Because we changed the questionnaire and methodology regarding the access to vaccines index in 2022, the discussion focuses on the cross-section of 2022, observing that barriers to vaccination tend to affect less educated caretakers.

Estimated quantification of residual volume in vaccines supplies and its impact on the Brazilian health system.

Between 2017 and 2021, the Brazilian Unified Health System (BUHS) administered a total of 527,903,302 doses of immunizations. Each immunization results in the presence of a residual volume (RV) due to syringe dead space (DS). The International Organization for Standardization 7886-1 allows a DS of up to 0.07mL in sterile single-use hypodermic syringes with volumes less than 5mL. This study aims to quantify the DS of immunization devices used in Brazil, study the best combinations of needles and syringes to minimize RV, estimate the number of wasted doses from 2017 to 2021, and evaluate the impact on the BUHS. Pneumococcal 10 vaccine with a 25x6mm needle and a regular 1mL syringe exhibited a significantly higher average RV (0.0826mL) and waste rate (14.42%). It was observed that for some intramuscular vaccines, there is less waste when using a 20x5.5mm needle compared to a 25x6mm needle. The use of syringes with plunger stoppers that penetrate the syringe barrel, denoted as low dead space syringes, results in less RV and an estimated difference in the waste rate of approximately 10% compared to the regular syringe. The estimated number of wasted doses from 2017 to 2021 by BUHS is approximately 32 million doses.

Public engagement for the conduct of a controlled human infection study testing vaccines against Necator americanus (hookworm) in areas of active hookworm transmission in Brazil.

Controlled Human Infection Models (CHIS) involve administering human pathogens to healthy participants in controlled medical settings, which can elicit complex bioethical issues. Understanding how the community perceives such studies can significantly increase the participant's sense of cooperation and increases the researcher's and the participant's transparency. The current study describes the development of an educational intervention to achieve these ends as it aims to (1) analyze perceptions of the Controlled Human Infection Studies (CHIS), and (2) evaluate the participants' comprehension of the CHIS. METHODS: This is a qualitative action research that includes the development of an educational intervention with residents of a rural area in Minas Gerais, Brazil, where there is continuous natural transmission of the human pathogen Necator americanus ("hookworm"). In this area, it is intended to carry out a proposed phase 3 vaccine clinical trial in the future to test the efficacy of hookworm vaccines using controlled human infection. Two data collection strategies were used: an educational intervention and a focus group. RESULTS: The participants' perceptions showed distinct perspectives on CHIS. On one side, they recognized that the investigation is essential for the community, but on the other side, they thought that there would be resistance to its conduct by fear of infection. The idea that the study would generate a benefit for the greater good, contributing to the prevention of hookworm infection, was clearly stated. The participants perceived that the study offered concrete risks that could be reduced by constant monitoring by the researchers. They also mentioned the importance of access to information and the positive influence those who express interest in participating in the study can exert in the community. In relation to comprehension the participants memorized the information, mobilized it to explain everyday situations and created strategies to disseminate the study and engage the community in its development. By repeating and making sense of the information, the participant not only assimilates the knowledge transmitted, but also creates new knowledge. CONCLUSION: We concluded that an educational process of discussion and dialogue around participants' perceptions about the CHIS, promotes understanding and allows ways to disseminate information about the research to be collectively created.